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Orthotic Study > Upper extremity > Flashcards

Upper extremity Flashcards

1
Q

Nerve roots of the axillary nerve

A

C5, C6

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2
Q

Nerve roots of the radial nerve

A

C5, C6, C7, C8, T1

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3
Q

Nerve roots of the median nerve

A

C5, C6, C7, C8, T1

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4
Q

Nerve roots of the ulnar nerve

A

C8, T1

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5
Q

Cords of the brachial plexus innervating the axillary nerve

A

Posterior

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6
Q

Cords of the brachial plexus innervating the radial nerve

A

Posterior

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7
Q

Cords of the brachial plexus innervating the median nerve

A

Medial and Lateral

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8
Q

Cords of the brachial plexus innervating the ulnar nerve

A

Medial

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9
Q

Sensory Distribution of Axillary Nerve

A

Skin over distal portion of deltoid muscle

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10
Q

Sensory Distribution of Radial Nerve

A

Dorsal surface of forearm

Dorsal aspect of the radial half of the hand

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11
Q

Sensory Distribution for the Median Nerve

A

Skin on palmar aspect of the thumb

Palmar aspect lateral 2.5 fingers

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12
Q

Sensory Distribution of the Ulnar Nerve

A

Skin of 5th finger, 4th finger (1/2 palmar, full dorsal), Medial half of the hand (palmar and dorsal)

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13
Q

Motor Distribution for the Axillary Nerve

A

Deltoid

Teres Minor

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14
Q

Motor Distribution for the Radial Nerve

A

Triceps Brachii
Anconeus
Brachioradialis
Ext Carp Rad Long

All other Extensor-Supinator muscles of the forearm

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15
Q

Motor Distribution for the Median Nerve

A

Flexor-Pronator Muscles of the Forearm

1st and 2nd Lumbricals

All Thenar (Thumb) Muscles EXCEPT ADDuctor Pollicus

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16
Q

Motor Distribution of the Ulnar Nerve

A

Flex Carp ULNARIS

Flex Carp Digitorum Profundus (ulnar head)

Adductor Pollicis

3rd and 4th Lumbricals

Plamar and Dorsal Interossei

Hypothenar Muscles (Everything Minimi!!!)

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17
Q

Mallet Finger

A

Hyperflexion of DIP joint

Avulsion of the Extensor Digitorum Tendon

Orthotic Treatment
Hold DIPJ in extension/prevent flexion
Hyperextend and immobilize DIP to allow reinsertion

Mallet Finger Cap

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18
Q

Boutonniere Deformity (Secondary to RA, or from trauma)

A

DIPJ hyperextended, PIPIJ flexed, MCPJ extended

Orthotic Treatment
3PPS to aid extension at PIPJ and allow flexion at DIPJ

Dynamic
(with spring wire) or
Static
Boutenniere splint (ex. Digisplint)

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19
Q

Swan Neck Deformity (contracture of intrinsic hand muscles)

A

PIPJ hyperextended, DIPJ flexed, MCPJ flexed

3PPS to prevent hyperextension at PIPJ and also allow flexion at the PIPJ

Swan Neck Splint
Static (ex. Digisplint)

20
Q

RA deformities of the MCPJ, Metacarpal Ulnar Deviation (MUD)

A

Volar subluxation and ulnar deviation of the proximal phalanges

Align wrist in excessive ulnar deviation to provide optimal alignment of long finger extesnor tendons (reduces the lateral pull)

Static WHO (plastic or leather)

21
Q

Game Keeper’s Thumb / Skier’s thumb

A

AKA skier’s thumb, UCL (Ulnar collateral ligament) tear

UCL is torn at its insertion site into prox phalanx

Common cause - falling on outstretched hand

Instability of the MCP joint

Pain
Swelling
Weakness of pinch grasp, poor ability to grasp objects (tying shoes, tearing paper etc.)

22
Q

Thumb OA

A

Most common form of osteoarthritis affecting the hand

Cushioning cartilage wears away from adjoining ends of bones making up thumb CMC joint

Severe hand pain
Swelling
Decreased strength/ROM
Difficultly performing ADLs (turning doorknobs, opening jars)

Orthotic Treatment

Hold thumb in opposition to index and middle finger for stabilization with functional pinch/grasp ability

Static Short opponens orthotic (Thumb Post Splint)

23
Q

De Quervain’s Tenosynovitis

A

Inflammation of the Ext Pol Brevis and Abd Pol Long tendons

Prevent excursion of EPB and AbPL tendons

Stabilize and thumb and wrist in neutral position as these long tendons cross the wrist joint

Static Long Opponens Orthosis

24
Q

Ulnar Nerve Palsy

A

4th an 5th MCPJ hyperextension, PIPJ hyperflexion

Need MCPJ flexion and PIPJ extension assist

Prevent hyperextension at 4th and 5th MCPJs, and allow weak extension of PIPJs

Dynamic Orthosis
Ulnar Nerve Palsy Orthoses (i.e spring wire) encourage joint mobility and augment hand function

Static Orthosis
for positioning and prevention of contracture

25
Q

Median Nerve Palsy

A

Loss of opposition of the thumb

Need MPJ flexion, CMCJ Abduction, CMCJ pronation

Static or Dynamic positioning of thumb for function

Static thumb post or Dynamic thumb positioning with elastic component

26
Q

Radial Nerve Palsy

A

Loss of wrist and MCPJ extension

Need to assist wrist and MCPJ extension, allow MCPJ flex-ext

Stabilize wrist in functional position while fingers and thumb extend at MCPJs

Static WHO (dorsal shell) with Dynamic MCPJ extension assist (spring wires), stabilize 1st CMCJ, Dynamic wrist extension component

27
Q

Medial and Ulnar Nerve Palsy (intrinsic minus hand)

A

Loss of wrist and finger flexion, thumb opposition

Need to pinch or grasp of fingers in release

Stabilize thumb for pinch, prevent hyperextension of MCPJs, allow weak IPJ extension by extensor communis

Dynamic Positioning of the thumb and 4 MCPJs to encourage joint mobility and augment hand function

Static Positioning of thumb and fingers to prevent contracture

28
Q

Carpal Tunnel Syndrome

A

Compression of the median nerve within the carpal tunnel

Resulting muscle weakness and sensory disturbances (tingling and numbness)

Stabilization of wrist required to prevent tension or compression of the median nerve, wrist positioned in neutral position for rest and functional use

Static WHO - plastic or leather design

29
Q

OA/RA of the wrist

A

Destruction of joint space = painful ROM

Need functional position of wrist, prevention of pain

Stabilize the wrist in 25 degrees of extension and 5 degrees of ulnar deviation

Functional WHO, gauntlet, leather or plastic design

30
Q

Zig Zag Deformity

A

Radial deviation of wrist with Ulnar deviation of fingers

Usually caused by rheumatoid arthritis

Correction of deformity

Excessive (>5 degrees) ulnar deviation to counteract the ulnar deviation of the fingers

Function WHO, gauntlet, leather or plastic design

31
Q

Dupuytren’s contracture

A

Fixed flexion contraction of the hand due to palmar fibromatosis

Inherited proliferative connective tissue disorder affecting palmar fascia

Fingers bent towards palm, cannot fully extend

Ring and little finger most commonly affected

Index and thumb usually spared

Contractures progress slowly, usually painless

Orthotic treatment to prevent further contracture

32
Q

Lesions Affecting the Axillary Nerve

A

Rarely affected alone

May be involved in

Spinal cord and brachial plexus lesions
Fractures and dislocations of the head of the humerus
Violent blows on the shoulder
Bullet, stab, and other wounds
Pressure or stretching of the shoulder during sleep

Deltoid paralysis
- inability to protract/retract arm, abduct it to horizontal position

Teres MInor paralysis

  • weakness of external rotation
  • atrophy of affected muscles
  • sensation lost over deltoid prominence
  • pain is present in neuritis
33
Q

Lesions affecting radial nerve

A

Most commonly injured peripheral nerve

Involved in cervical and brachial lesions

Peripheral injuries may affect the trunk or some of the branches of the nerve as in

Dislocations of the shoulder
Fractures of the humerus
Callus formation around the fracture
Pressure from crutch
Violent blows on the arm
Tuberculosis of the bone
Fractures of the neck of the radius
Toxic or infectious neuritis (inflammation of nerve)
34
Q

Lesions affecting Median Nerve

A

Cervical cord and brachial plexus lesions

Lacerations of the arm, forearm, wrist, hand due to auto accidents, stab wounds, bullets, etc.

Prolonged compression in sleep/anesthesia

Dislocations of ulna, fractures to elbow and distal radius

Toxic or infectious neuritis

35
Q

Lesions affecting Ulnar Nerve

A

Cervical cord and brachial plexus lesions

Fractures/Dislocations of the head of the humerus
Direct lacerating trauma in lacerating wounds (eg. knife, auto accident etc.)
Pressure on nerve during sleep
Drunkenness, general anesthesia
Callus formaiton
Neurinoma (tumor)
Toxicity (lead)

36
Q

Median/Ulnar Nerve Lesion

A

Frequently injured together

If lesion complete, functional disturbances are constant

If one or both nerves are only partially involved, symptoms differ widely

Classified according to varied appearance and functions of the hand

37
Q

SCI with C8 Escape

A

Loss of Opposition of intrinsic hand and muscle function

Stabilize thumb for weak opposition

Static thumb post

38
Q

SCI with C7 Escape

A

Loss of

Pronation
Wrist Flexion
Finger flexion and extension (but maintains ext car rad l & b, and ext car ulnaris)

FInger flexion and extension for pinch and grasp

Stabilize thumb for pinch against fingers

Harness action of Extensor Carpi Radialis for Tenodesis splint

Wrist driven flexor hinge hand orthosis (Tendodesis splint)

Ideal for this level of injury

39
Q

SCI with C6 Escape

A

Loss of

Pronation
Wrist flexion
FInger flexion and extension (Only Ex car radialis l&b left)

Stabilize thumb for pinch against fingers

Harness action of Extensor Carpi Radialis for Tenodesis splint

Wrist driven flexor hinge hand orthosis (Tendodesis splint)

40
Q

SCI with C5 escape

A

Loss of all hand and finger function

No longer wirst flexion and finger flex/ext for grasp and pinch

External power need to flex wrist and hand

41
Q

SCI C4 and above

A

Loss of all upper extremity function

No longer shoulder, elbow, wrist and finger motion

External power mobile arm support with power drive flexor hinge hand

42
Q

Brachial plexus injury C8-T1

A

Loss of intrinsic hand muscles and long finger flexors

Grasp and pinch

Stabilize the wrist

Tenodesis splint

43
Q

Brachial plexus injury C5-C6

A

Loss of

shoulder and elbow function
weakness of wrist and finger extensors

Stabilize shoulder in slight abduction

Elbow supported in adjustable flexion/extension

Wrist and hand supported in neutral or functional position if some hand function remains

SEWHO- Shoulder Elbow Wrist Hand Orthosis (“Airplane”)

Elbow orthosis

WHFO to augment hand function

44
Q

Brachial plexus injury- complete flail arm

A

Loss of upper extremity function

Support weight of flail arm by stabilizing shoulder joint

Flex elbow for functional positioning of hand in front of the body

Stabilize the wrist and hand

SEWHO- Shoulder elbow wrist hand orthosis (“gun slinger”)

Shoulder stabilizer or positioner
Elbow joint, possibly adjustable
Static WHFO
WHO with MCPJ flexion by external cable or power

45
Q

Elbow Trauma (burns/dislocation), surgery, self abusive patients

A

Contracture of skin and soft tissues

Joint instability

Dynamic Elbow Orthosis - apply extension assist or stretch

Static Elbow Orthosis- maintain position, support protect

Hinged Elbow Orthosis- M/L and hyper extension support

46
Q

CVA (Stroke) involvement

A

Hemiplegia and Spasticity

Harris Hemi-sling for GH subluxation

Spasticity leads to pronation, wrist flexion, thumb flexion and adduction

Static WHFO or resting hand splint

Maintains wrist/hands in neutral position
Prevent development of contractures
Keep palm open and dry (hygiene)

Orthotic Study (45 decks)

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