Upper Extremity Flashcards
1
Q
Carpi
Digitorum
Policis
Indices
Minimi
Longus
Brevis
A
Wrist
Digits
Thumb
Index finger
Little Finger
Long
Short
2
Q
Flexor Digitorum Profundus VS Flexor Digitorum Superficialis
A
FDP passes through (DIP)
FDS splits and stops (PIP)
3
Q
Intrinsic VS Extrinsic
A
Intrinsic = muscles that are apart of the hand
Extrinsic = muscles that are in the forearm with tendons leading into the hand
4
Q
Flexor Carpi Radialis
A
Flex wrist, radial deviation
5
Q
Flexor Carpi Ulnaris
A
Flex wrist, ulnar deviation
6
Q
Flexor Digitorum Superficialis
A
Flex fingers up to PIP
7
Q
Flexor Digitorum Profundus
A
Flex fingers to DIP
8
Q
Extensor Carpi Radialis Longus
A
Extend wrist, radial deviation
9
Q
Extensor Carpi Radialis Brevis
A
Extend Wrist, radial deviation
10
Q
Extensor Digitorum
A
Extend fingers
11
Q
Extensor Digiti Minimi
A
Extend little finger
12
Q
Extensor Carpi Ulnaris
A
Extend wrist, ulnar deviation
13
Q
Extensor Indices
A
Extend index finger
14
Q
Lumbricals
A
IP extension, MP flexion
15
Q
Interossei
A
finger abduction/adduction
16
Q
Glenohumeral Rhythm
A
during adduction, humerus does the movement until 90 degrees, then the scapula rotates past 90 degrees
17
Q
Collateral Ligaments
A
Common cause of IP flex contractures post surgery or edema/trauma.
18
Q
Natural Tension (tendons)
A
many muscle spread over multiple jts and stretch; position affects ROM, strength, impt for tendon repair and useful for tenodesis
19
Q
Functional Position of the Hand
A
Slight extension of the wrist
zero position = resting position
20
Q
DR CUMA
A
Drop Wrist = Radial Nerve
Claw Hand = Ulnar Nerve
Ape Hand = Median Nerve
21
Q
Purpose of Orthoses
A
Immobilize early to protect, mobilize later to correct
22
Q
The 5 P’s of Splints (purpose)
A
Pain = Arthritis
Paresthesia = Nerve compression, CTS
Protection = fx or s/p surgery
Positioning = Weakness, drop wrist
Prevention = Contractures
23
Q
Stages of Healing
A
Inflammation = avoid infection (a few days)
Proliferation = forming scar tissue (2-8 weeks)
Maturation = remodeling (months to a year)
24
Q
Splints purpose during the 3 stages of healing
A
inflammation = stabilize
proliferation = stabilize and cautiously grading movement/activity
maturation = getting back to typical fx
25
Static Splint
generic splint, immobilizes and protects
- constant pressure
- immobilize, protect, position (prevent but functional
i.e., wrist cock up
26
Serial Static Splint (serial casting)
series of static splints, or splint that is reheated and adjusted to the clients new available ROM to improve it
-constant pressure
-adjusted over time
-purpose = mobilize and improve PROM
27
Static Progressive Splint
Static, adjustable, non-elastic, 90 degrees, purpose = mobilization, improve PROM, good on stiff jts, follow wear with active use.
28
Dynamic splint
dynamic, elastc, 90 degrees, purpose = mobilization, improve PROM, resistance exercise, assist with movement (i.e., readial nerve palsy)
29
Purpose of mobilization splints
Remodel scar tissue
contractures
increase ROM
movement
resistance exercise
jt fx reduce
30
Resting hand splint
general comfort
slight wrist extension
common after stroke
31
Anti-deformity Splint (intrinsic Plus)
Alligator Splint
Slight wrist extension
MCP flex
IP, DIP, PIP in extension
for trauma or edema
32
Long/Short Thumb Spica
Unicorn splint
Long spica = de quervain
short spica = arthritis of CMC/MP of thumb
Thumb is slightly flexed and abducted, wrist slightly extended
unrestricted movment of digits 2-4
33
Dorsal Block Splint
Back side of hand
flexor tendon repair to limit flexion to decrease risk of rupture
slight wrist flex (20 degrees), MP at 50 degrees
34
Wrist Cock Up splint
Radial nerve
Radial nerve palsy
Radial tunnel syndrome
carpal tunnel syndrome
35
Posterior Elbow Splint
MCL/LCL injury, elbow recovery at 90 degrees
36
Anterior Elbow splint
can be used for burn or to promote extension
37
Mallet Splint
injury to extensor tendon of DIP
MUST USE SPLINT for 6-8 weeks or you have to start all over. Finger must stay in extension when client changes splint
38
Boutonniere Splint
Oval 8
arthritis
39
Swan Neck Deformity Splint
oval 8
arthritis
40
PAMs
Chill out, relax in the sun, distract yourself with electric gadget. get PAMs from CVS
41
Purpose of PAMs
address pain, inflammation, muscle tone and encourage healing and muscle function
42
When using PAMs, consider CVS
Cognition/Communication
Vascular Fx
Sensation
if these are areas of concern then monitor closely or avoid PAMs
43
Heat
relax muscles, increase circulation, superficial or deep
results in improved healing, stretch, pain relief
Gentle PROM after heat, AROM preferred
44
Hot Packs
Standard heat PAM
Superficial heat pentetration
45
Paraffin Wax
Superficial
Arthritis, stiffness, and healed burns
46
Fluidotherapy
Superficial
sensory re-ed
can affect deeper structures
47
Ultrasound
deep penetrating heat, useful for deep heat and healing
48
Cold
decreases circulation, inflammation, and pain following intial discomfort
extra cushion with vascular conditions (Raynaud's syndrome)
use cold for acute injury
for pain = redness, burning, aching, and numbness (stop here)
49
E-stim
penetrating depth depends on electrode placement, further the deeper
50
NMES and FES
exercise and functional use
51
E stim types of wavelengths
Symmetrical biphasic = emphasis on large muscles
Asymmetrical Biphasic = small muscle (black lead where you want to focus)
Russian = rare, very strong, large muscles only!
52
E-stim High Volt Pulsed Current (HVPC)
Edema
Pain
Healing
small muscle re-ed
53
TENS
Pain management
Gate control theory
best for acute pain (fx, tendon/ligament repairs, sprains)
different settings can be used to decrease trigger points
54
Purpose of heat vs cold vs e stim
Heat = relax muscle, increase circulation
Cold = constrict circulation, numb pain
E-stim = stimulate muscles, contraction, and senstation
55
Closely Associated PAM's
Arthritis (OA) = Paraffin Wax
Trigger points = TENS
Edema and Acute injury = Cold
CRPS = Fluidotherapy
56
EDEMA
has a cause, MASTECCTomy, causes deformity
57
MASTECCTomy
Manual Edema Mobilization
AROM
Splint
Tapping
Elevation
Compression
Cold
Think
58
Edema Deformity
Swelling reults in skin tension
MCP extension
IP flex
thumb adduction/extension
loss of MC arch
results in collateral ligament and volar plate shortening
59
Resistive Exercise
Isometric, eccentric, concentric
compromised stability = caution
compromised mobility = motion
60
Essentric
Maintaining one position and then lengthening muscle
61
Isometric
maintaining one position with resistance (holding a weight still)
62
Concentric
shortening of the muscle
63
Standard ROM progression
Immobilization
AROM
PROM
Isometric
Eccentric
Concentric
64
Evaluation
Evaluation physcial and funcitonal with your NEW SPORC (to C whats wrong) Nerve, Edema, Wounds, Strength, Pain, Occuaption, ROM, Coodination
65
Wounds
Black and Yellow are bad (keep bees away from wounds)
no inflammation (not to the touch)
66
DASH
common functional assessment of UE
Disabilities of the Arm, Shoulder and Hand
67
NEW SPORC
Nerve
Edema
Wounds
Strength
Pain
Occupation
ROM
Coordination
68
Eval, Nerves
Sensation= Semmes Weinstein Monofilament & 2 point discrimination
Nerves are responsible for bodily fx's = vascular, sweating, goosebumps & wrinkling when wet, skin texture, hair, and nail growth
69
Evaluation = Edema
Circumfrential vs Volmetry
Classification = pitting vs non-pitting
70
Eval, Strength
grip and pinch testing (dynamometer)
MMT
71
Eval, Pain
numerical scale
consider with or without movement
72
Eval, Occupation
functional assessments
DASH/QuickDASH
73
Eval, ROM
*PHYSICALLY ACT OUT WHAT YOU READ*
Complete AROM & PROM of ALL jts
Finger AROM < PROM = weakness/adhesion
Finger AROM = PROM, wrist position doesnt affect it = joint stiffness
Finger AROM = PROM, wrist does change ROM = extrinsic issues
Finger AROM = PROM, MCP changes ROM = intrinsic issues
74
Eval, Coordination
9 hole peg test
Moberg's pick up test
75
Shoulder Principle
Proximal stability leads to distal mobility
High mobility, low stability
Relies on musculature for stability more than other joints (prone to greater dysfunction from muscular problems than other joints)
scapulohumeral rhythm
76
Brachial Plexus
Nerve injury or impingement at the BP, give it space and keep it mobile
a limp or paralyzed arm
lack of muscle control in the arm/wrist/hand
lack of feeling or sensation in the arm/hand
sudden pain in the shoulder or arm that may be stinging or burning
77
Erb's Palsy
that Nerd Erb is always raising his hand in class
Upper BP injury
affects the upper arm: shoulder on down
adduction and internal rotation at shoulder, extension at elbow, and pronation at wrist
78
Klumpke's Palsy
trouble with your keys with Klumpke's
Lower BP injury
affects lower arm (hand on up)
paralysis of intrinsic hand muscles (flexors of the wrist), can appear like the claw hand deformity,
79
Brachial Plexopathy/Thoracic Outlet Syndrome
Injury to the Brachial plexus
consider TOS as the same thing (might have vascular problems as well)
Usually comes from trauma to the shoulder
affects the shoulder/arm
wont be like other nerve issues (DR CUMA, dermatomes, myotomes)
symptoms worsen with overhead movement and poor posture
80
Tx options for BP/TOS
Address the problem
MEND vs MOVE = Give it space but keep it mobile
Improve posture, strengthen scapular elevators (avoid most any other exercise)
Nerve glides and stretching (avoid scapular depression with stretch, i.e., doorway stretch with shoulder shrug)
Sleeping positin (avoid compression of TOS)
Diaphragmatic breathing
81
Proximal Humeral Fx
Stabilize until clear, then PROM, AROM and beyond. Watch your scapula! Wait (tick tock pendulum) for the surgeon to clear. No substitute for a grandfather clock
82
Frozen Shoulder (adhesive Capsulitis)
pain free AROM and compensation until it thaws naturally.
If there's an iceberg in your way, keep moving to stay warm until it thaws naturally
83
Cause of Frozen Shoulder
Loss of shoulder ROM d/t adhesion of the GH jt capsule and coracohumeral ligament
idiopathic/secondary to surgery/trauma
3 phases = freezing, frozen and thawing, it can last up to 4 years
84
Tx for Frozen shoulder
try not to cause inflammation with overstretching especially during freezing phase
encourage regular movement through comfortable range
primary treatment is compensatory strategy training and environmental mod
basically encourage pain free AROM and to work around it until it thaws
85
Glenohumeral Instability
freq impingement or dislocations, strengthen RC muscles to compensate
86
AMBRI/TUBS
always been loose vs torn loose
87
RC tests
Checking for impingement for the shoulder
shoulder is the Neerest jt to your arm, flap your arms like a hawk
88
AMBRI
Atraumatic, multi-directional instability, bilateral rehab, inferior shift
No hx of dislocation
impingement present especially with overhead motions like throwing
RC muscles do not properly counteract upward pull of deltoid, impinges, from RC weakness or poor proprio.
Typically non surgical
89
TUBS
traumatic, unidirectional instability, bankart lesion, surgery required
Hx of dislocation (usually anterior)
Bankart lesion is damage to anterior and inferior portion of GH capsule, allows for repeated dislocations
SLAP lesion = superior labrum anterior to posterior
typcially surgical tx (after non surgical attempted)
90
GH Instability Tx
Strengthen and improve proprio for RC and scapular muscles
start with isometrics in neutral position
Anterior instability (focus on internal rotators and adductors)
global instability (all of the muscles of the scapular and shoulder
91
Arthritis
JAPO, Really Anything
92
RA
Right Angle, wRist Also, Really Anything
93
Splint for Arthritis
Thumb spica to protect CMC
94
OA
wearing down of cartilage of jts
95
RA
autoimmune condition that attacks the jts
96
Goal for tx of arthritis
manage and prevent worsening of symptoms and maximize function
