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NBCOT > Upper Extremity > Flashcards

Upper Extremity Flashcards

1
Q

Carpi
Digitorum
Policis
Indices
Minimi
Longus
Brevis

A

Wrist
Digits
Thumb
Index finger
Little Finger
Long
Short

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2
Q

Flexor Digitorum Profundus VS Flexor Digitorum Superficialis

A

FDP passes through (DIP)
FDS splits and stops (PIP)

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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

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4
Q

Flexor Carpi Radialis

A

Flex wrist, radial deviation

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5
Q

Flexor Carpi Ulnaris

A

Flex wrist, ulnar deviation

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6
Q

Flexor Digitorum Superficialis

A

Flex fingers up to PIP

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7
Q

Flexor Digitorum Profundus

A

Flex fingers to DIP

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8
Q

Extensor Carpi Radialis Longus

A

Extend wrist, radial deviation

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9
Q

Extensor Carpi Radialis Brevis

A

Extend Wrist, radial deviation

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10
Q

Extensor Digitorum

A

Extend fingers

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11
Q

Extensor Digiti Minimi

A

Extend little finger

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12
Q

Extensor Carpi Ulnaris

A

Extend wrist, ulnar deviation

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13
Q

Extensor Indices

A

Extend index finger

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14
Q

Lumbricals

A

IP extension, MP flexion

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15
Q

Interossei

A

finger abduction/adduction

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16
Q

Glenohumeral Rhythm

A

during adduction, humerus does the movement until 90 degrees, then the scapula rotates past 90 degrees

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17
Q

Collateral Ligaments

A

Common cause of IP flex contractures post surgery or edema/trauma.

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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

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19
Q

Functional Position of the Hand

A

Slight extension of the wrist
zero position = resting position

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20
Q

DR CUMA

A

Drop Wrist = Radial Nerve
Claw Hand = Ulnar Nerve
Ape Hand = Median Nerve

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21
Q

Purpose of Orthoses

A

Immobilize early to protect, mobilize later to correct

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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

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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)

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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

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25
Q

Static Splint

A

generic splint, immobilizes and protects
- constant pressure
- immobilize, protect, position (prevent but functional
i.e., wrist cock up

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26
Q

Serial Static Splint (serial casting)

A

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

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27
Q

Static Progressive Splint

A

Static, adjustable, non-elastic, 90 degrees, purpose = mobilization, improve PROM, good on stiff jts, follow wear with active use.

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28
Q

Dynamic splint

A

dynamic, elastc, 90 degrees, purpose = mobilization, improve PROM, resistance exercise, assist with movement (i.e., readial nerve palsy)

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29
Q

Purpose of mobilization splints

A

Remodel scar tissue
contractures
increase ROM
movement
resistance exercise
jt fx reduce

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30
Q

Resting hand splint

A

general comfort
slight wrist extension
common after stroke

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31
Q

Anti-deformity Splint (intrinsic Plus)
Alligator Splint

A

Slight wrist extension
MCP flex
IP, DIP, PIP in extension
for trauma or edema

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32
Q

Long/Short Thumb Spica
Unicorn splint

A

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

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33
Q

Dorsal Block Splint

A

Back side of hand
flexor tendon repair to limit flexion to decrease risk of rupture
slight wrist flex (20 degrees), MP at 50 degrees

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34
Q

Wrist Cock Up splint

A

Radial nerve
Radial nerve palsy
Radial tunnel syndrome
carpal tunnel syndrome

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35
Q

Posterior Elbow Splint

A

MCL/LCL injury, elbow recovery at 90 degrees

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36
Q

Anterior Elbow splint

A

can be used for burn or to promote extension

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37
Q

Mallet Splint

A

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

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38
Q

Boutonniere Splint

A

Oval 8
arthritis

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39
Q

Swan Neck Deformity Splint

A

oval 8
arthritis

40
Q

PAMs

A

Chill out, relax in the sun, distract yourself with electric gadget. get PAMs from CVS

41
Q

Purpose of PAMs

A

address pain, inflammation, muscle tone and encourage healing and muscle function

42
Q

When using PAMs, consider CVS

A

Cognition/Communication
Vascular Fx
Sensation

if these are areas of concern then monitor closely or avoid PAMs

43
Q

Heat

A

relax muscles, increase circulation, superficial or deep
results in improved healing, stretch, pain relief
Gentle PROM after heat, AROM preferred

44
Q

Hot Packs

A

Standard heat PAM
Superficial heat pentetration

45
Q

Paraffin Wax

A

Superficial
Arthritis, stiffness, and healed burns

46
Q

Fluidotherapy

A

Superficial
sensory re-ed
can affect deeper structures

47
Q

Ultrasound

A

deep penetrating heat, useful for deep heat and healing

48
Q

Cold

A

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
Q

E-stim

A

penetrating depth depends on electrode placement, further the deeper

50
Q

NMES and FES

A

exercise and functional use

51
Q

E stim types of wavelengths

A

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
Q

E-stim High Volt Pulsed Current (HVPC)

A

Edema
Pain
Healing
small muscle re-ed

53
Q

TENS

A

Pain management
Gate control theory
best for acute pain (fx, tendon/ligament repairs, sprains)
different settings can be used to decrease trigger points

54
Q

Purpose of heat vs cold vs e stim

A

Heat = relax muscle, increase circulation
Cold = constrict circulation, numb pain
E-stim = stimulate muscles, contraction, and senstation

55
Q

Closely Associated PAM’s

A

Arthritis (OA) = Paraffin Wax
Trigger points = TENS
Edema and Acute injury = Cold
CRPS = Fluidotherapy

56
Q

EDEMA

A

has a cause, MASTECCTomy, causes deformity

57
Q

MASTECCTomy

A

Manual Edema Mobilization
AROM
Splint
Tapping
Elevation
Compression
Cold
Think

58
Q

Edema Deformity

A

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
Q

Resistive Exercise

A

Isometric, eccentric, concentric
compromised stability = caution
compromised mobility = motion

60
Q

Essentric

A

Maintaining one position and then lengthening muscle

61
Q

Isometric

A

maintaining one position with resistance (holding a weight still)

62
Q

Concentric

A

shortening of the muscle

63
Q

Standard ROM progression

A

Immobilization
AROM
PROM
Isometric
Eccentric
Concentric

64
Q

Evaluation

A

Evaluation physcial and funcitonal with your NEW SPORC (to C whats wrong) Nerve, Edema, Wounds, Strength, Pain, Occuaption, ROM, Coodination

65
Q

Wounds

A

Black and Yellow are bad (keep bees away from wounds)
no inflammation (not to the touch)

66
Q

DASH

A

common functional assessment of UE

Disabilities of the Arm, Shoulder and Hand

67
Q

NEW SPORC

A

Nerve
Edema
Wounds
Strength
Pain
Occupation
ROM
Coordination

68
Q

Eval, Nerves

A

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
Q

Evaluation = Edema

A

Circumfrential vs Volmetry

Classification = pitting vs non-pitting

70
Q

Eval, Strength

A

grip and pinch testing (dynamometer)
MMT

71
Q

Eval, Pain

A

numerical scale
consider with or without movement

72
Q

Eval, Occupation

A

functional assessments
DASH/QuickDASH

73
Q

Eval, ROM

A

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
Q

Eval, Coordination

A

9 hole peg test
Moberg’s pick up test

75
Q

Shoulder Principle

A

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
Q

Brachial Plexus

A

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
Q

Erb’s Palsy

A

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
Q

Klumpke’s Palsy

A

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
Q

Brachial Plexopathy/Thoracic Outlet Syndrome

A

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
Q

Tx options for BP/TOS

A

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
Q

Proximal Humeral Fx

A

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
Q

Frozen Shoulder (adhesive Capsulitis)

A

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
Q

Cause of Frozen Shoulder

A

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
Q

Tx for Frozen shoulder

A

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
Q

Glenohumeral Instability

A

freq impingement or dislocations, strengthen RC muscles to compensate

86
Q

AMBRI/TUBS

A

always been loose vs torn loose

87
Q

RC tests

A

Checking for impingement for the shoulder
shoulder is the Neerest jt to your arm, flap your arms like a hawk

88
Q

AMBRI

A

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
Q

TUBS

A

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
Q

GH Instability Tx

A

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
Q

Arthritis

A

JAPO, Really Anything

92
Q

RA

A

Right Angle, wRist Also, Really Anything

93
Q

Splint for Arthritis

A

Thumb spica to protect CMC

94
Q

OA

A

wearing down of cartilage of jts

95
Q

RA

A

autoimmune condition that attacks the jts

96
Q

Goal for tx of arthritis

A

manage and prevent worsening of symptoms and maximize function

NBCOT (26 decks)

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