Upper Extremity Flashcards
Most common carpal fractures is…
Scaphoid fracture
With scaphoid fractures, you need to be concerned about…
Blood supply/necrosis
Blood from distal to proximal
Colle’s vs Smith’s fracture
Both are distal radius fracture (fall on an outstretched hand)
Colle’s: dorsal displacement
Smith’s: volar displacement
Metacarpal fractures, common complication is…
Rotational deformities
Boxer’s fracture
Fifth metacarpal
Splint with an ulnar gutter splint
When middle phalanax is fractured, we are worried about mobility of the..
Flexor digitorum superficilias
When first assessing fractures, you should NOT…
Assess PROM until ordered by physician
OT intervention for…
Immobilization phase of fractures
Stabilizing and healing are the goals
- AROM of joints above and below the stabilized part
- Edema control: elevation, manual edema mobilization and compression garments
- Light ADLs and role activities with no resistance, progress as tolerated (if sling, shoulder immobilizer, LAC, fracture brace or ORIF…instruct on one-handed techniques)
OT intervention for…
Mobilization phase for fractures
Consolidation is the goal
- Edema control: elevation, manual edema mobilization, gentle retrograde massage, contrast baths, compression garments
- Splint for protection possibly
- AROM (progress to PROM when physician approved)
- Light purposeful occupation based activities
- Pain management: positioning and PAMs
- Strengthening when approved by physician
With elbow fractures, we are concerned with…
Involvement of radial head may result in limited rotation of the forearm
Wrist fracture injuring median nerve produces…
Carpal tunnel like symptoms
- Palmar numbness
- Numbness of the first digit to half of the fourth digit
- Generalized weakness
- Pain
Wrist fractures injuring the ulnar nerve results in…
Ulnar claw deformity
Numbness on ulnar side of hand (half of 4th and 5th digit)
Generalized weakness and pain on ulnar side
Avulsion injuries are…
Tendons separate from bone/insertion and removes bony material (swan necks, boutonniere, mallet)
Mallet finger injury…
Avulsion of terminal tendon
Splinted in full extension for 6 weeks
Boutonniere deformity…
Disruption of the central slip of the extensor tendon
Characterized by PIP flexion and DIP hyperextension
PIP splinted in extension
Isolated DIP extension exercises are performed
Swan neck deformity…
Injury to the MCP, PIP or DIP joints
Characterized by PIP hyperextension and DIP flexion
PIP splinted in slight flexion
Cumulative Trauma Disorder
Trauma to soft tissue caused by repeated force
This is a mechanism of injury, not a diagnosis
Could be diagnosed as anything from rotator cuff tear to osteoarthritis to deQuervain syndrome
OT intervention for Cumulative Trauma Disorder
- Acute phase: reduce inflammation and pain
- Subacute phase: Stretching, progressive resistive exercise, education, splinting
- Return to work: therapy as work simulator
- Functional capacity evaluation
- Work hardening
What kind of splint do you need for flexor tendon injuries?
Dorsal Block Splint
Wrist: 20-30 (flexion?)
MCP: 50-70
IP: full extension
Early mobilization for flexor tendon injuries should look like…
Duran: do it yourself, passively flex and extend your fingers
Kleinhart: rubberband passively flex, actively extend
Discharge splint around week 6
Strengthening does NOT occur until week 8
Immobilization protocols for flexor tendon injuries should really only be used for…
Children
Patients without cognitive capacity
Those who will not be able to maintain safety and/or care for themselves safely
Which zone of flexor tendons is considered “no man’s land” and why
Zone II: center portion of middle phalanx to distal palmar crease
Because of the difficulty of tendon gliding without scarring to surrounding tissues
What are the tests for Carpal Tunnel Syndrome?
Tinel’s sign: tap on the median nerve at wrist to elicit symptoms
Phalen’s test: holding the wrist in full flexion for 1 minute to elicit changes in sensation
Moberg pick up test: timed test manipulating small objects to test function (typically for children and cognitively impaired adults)
What type of splint would you use for Carpal Tunnel Syndrome?
Wrist cock up splint at 0-10 degrees extension
Dupuytren’s Disease
Thickened and contracted fascia of the palms with developing cords/bands that extend into the digits
Results in flexion deformities of the involved digits
Remember that is fixes with the Z-plasty
Then splint in extension as advised by surgeon
With Complex Regional Pain Syndrome, you should typically avoid/proceed with caution for…
- PROM
- Passive stretching
- Joint mobilization
- Dynamic splinting
- Casting
Testing for DeQuervain’s Tenosynovitis
Finklestein’s Test
Place thumb in closed fist
Tilt hand down
Pain is felt in this position
Splinting for DeQuevain’s
Thumb spica splint
