UE Orthopedics Flashcards
Hand Evaluation (purpose)
To identify:
1) physical limitations (ie: loss of ROM);
2) functional limitations (ie: inability to perform ADLs);
3) substitution patterns to compensate for loss of sensibility or motor function; and
4) abnormalities (ie: joint contracture).
Most Important Small Joint of Hand
Proximal Interphalangeal Joint (PIP): Critical for grasp and is considered the most important small joint. Limitations in flexion or extension result in significant functional impairment (ie: boutonniere deformity, etc.).
Thoracic and Cervical Curvature of Spine in relation to UE Use
Cervical or thoracic curvature abnormalities may reduce potential for shoulder movement. Muscle imbalances in the area are also important to note (if imbalanced strength or length, may appear asymmetric and might indicate weakness or torn rotator cuff).
Adhesive Capsulitis
Also called: Frozen Shoulder.
Pattern: Loss of active & passive shoulder motion w/most pronounced loss in EXTERNAL ROTATION and, lesser, abd and int rotation
Characteristics/Tests: Capsular end feel to passive motions in restricted planes of movement
Subacromial Impingement
Shoulder Condition. Pattern: Painful arc of motion betw ~80 & 100˚ of ELEVATION or at end range of active elevation
Characteristics/Tests: In early stages, muscle tests may be strong & painless despite positive impingement test
Rotator Cuff Tendinitis
Shoulder Condition. Pattern: Painful active or resistive use of rotator cuff muscle, especially in ABDUCTION or EXT ROTATION
Characteristics/Tests:
• Painful MMT of scapular plane abd or ext rotation
• Pain-free passive motion end ranges
• Tenderness at tendons of supraspinatus/infraspinatus
Rotator Cuff Tear
Shoulder Condition. Pattern: Significant substitution of scapula w/attempted arm elevation, especially in ABDUCTION or EXT ROTATION
Characteristics/Tests:
• Positive drop arm test
• Very weak, less than three-fifths abd or ext rotation
Soft Tissue Tightness in Shoulder
After trauma, immobilization or disuse, joints may develop dysfunction. May be restored through joint mobilization techniques before attempting P/AROM.
Joint Mobilization
Use of passive muscle movement applied to resolve when there is soft tissue tightness; when there is abnormal joint play or accessory motions (ie: joint rotation/distraction—passive movements), and when the movements can only be performed with assistance. Usually when there is restriction of accessory motions, when pain is present bc of tightness of joint capsule, meniscus displacement, muscle guarding, ligamentous tightness, or adherence. Limitations in motion can also be caused by tightness of extrinsic/intrinsic muscles and tendons.
Contraindications to joint mobilization: infection, recent fracture, neoplasm (abnormal growth of cells; a tumor), joint inflammation, RA, OA, degenerative joint disease, and many chronic diseases.
Cubital Tunnel Syndrome
Tingling/numbness in hand/ring/pinky, esp. with bent elbow. Weak grip. Pain on inside of elbow. CAUSED by injury/bending often of elbow or leaning on. Ulnar nerve compression.
TESTS:
• Elbow Flexion Test
• Wartenberg’s Sign
Carpal Tunnel Syndrome
Tingling/numbness in fingers or hand, usually thumb/index/mid/ring. Worse at night/during activity. CAUSED by pressure on median nerve (wrist); repetitive motion like typing/wrist movement.
TESTS: • Tinel’s Sign at wrist • Phalen’s Test • Reverse Phalen’s Test • Carpal Compression Test
Ulnar Nerve Paralysis
Paralysis of adductor pollicis muscle. Lost sensation/coordination in ring/pinky. Tingling/burning/pain in hand. Weakness increases with activity. Loss of grip. CAUSED by long-term pressure on elbow or base of palm; elbow fracture/dislocation; repeated elbow bending.
TESTS:
• Froment’s/Jeanne’s/Wartenberg’s Sign
Gamekeeper’s Thumb / Skier’s Thumb
Ulnar collateral ligament (UCL) is injured (strained or torn). Weakened grasp/pinching ability in thumb. CAUSES: Acute injury or chronic overuse. FOOSH when thumb pulled violently away from index finger. RA and smoking can also weaken ligaments, making them prone to injury. Instability in thumb MP joint.
TEST: Movement >35˚ when valgus instability stress is applied to thumb MP joint.
De’Quervains Syndrome / Tenosynovitis
Painful condition affecting tendons on thumb side of wrist. Hurts to turn wrist, grasp or make fist. Pain/swelling near base of thumb (tendon sheath is irritated). CAUSE is unknown, but can be repetitive hand/wrist movement can worsen; direct injury to wrist/tendon; RA.
TESTS:
• Pain with pressure on thumb side of wrist.
• Finkelstein Test
Tx of Fractures of the Hand/Wrist
Surgeon attempts to achieve good anatomic position through a closed (non-operative) or open (operative) reduction. Internal fixation with Kirshner wires, metallic plates, or screws may be used. External fixation may also be used. Hand usually immobilized in wrist ext and MP joint flex, with ext of distal joints whenever injury allows. Also consider any trauma to tendons or nerves. Recovery of all injured structures influence tx of fx. OT may begin at period of immobilization, ~3-5 wks. Uninvolved fingers kept mobile through active motion. Edema monitored (use elevation). Mobilization of injured part allowed once bone stabile. Surgeon guides on amt of resistance. Activities to correct poor motor patterns and encourage use of affected hand as soon as pain free (avoids adherence of tendons and reduces edema). When cast removed, hand/edema are assessed and orthosis may be used to correct abnormal joint changes or protect finger from addtl trauma.
Orthoses Used for Hand/Wrist Fractures
Dorsal block orthosis: to limit full ext of finger, and avoid overstretching flexor tendon.
Dynamic orthosis: to achieve full ROM or prevent dev of further abnormal joint changes (6-8 wk post fracture)
Velcro “buddy” orthosis: to correct abnormal joint changes or to protect a finger from addtl trauma, or to encourage movement of a stiff finger.
Intraarticular Fractures
Assessed for joint surface damage if pain/stiffness. X-ray exam used, and thermal modalities, restoration of joint play, or joint mobilization/corrective or dynamic orthoses used, followed by active use. Resistive exercises after bony healing has been achieved.
Scaphoid Fractures
Fracture of bone in wrist, most proximal below thumb. 2nd most common bone to fx, ie when hand dorsiflexed at time of injury. May require longer healing time due to lack of vascularity. When the proximal pole is fractured it may result in a nonunion because of poor blood supply to this area.
Lunate Fractures
Bone in wrist, most proximal below pinky; trauma may result in avascular necrosis (Kienbock’s Disease), from one-time trauma or repetitive. Kienbock’s treated with bone graft, removal of proximal carpal row, or partial wrist fusion.
Kienbock’s Disease
Avascular necrosis, often seen in lunate bone fractures. Treated with bone graft, removal of proximal carpal row, or partial wrist fusion.
