Upper Extremity Diagnoses

Question 1

What tasks are made difficult by Dupuytren’s Disease?

Answer 1

Shaking hands, grasping large objects, typing

Question 2

Best splint for a typical Dupuytren’s patient

Answer 2

Volar-based extension wrist and hand splint with wrist and MCPs in neutral position. Initially worn at all times except exercise and bathing

Question 3

OT intervention for Dupuytren’s Disease

Answer 3

Wound care: dressing changes, whirlpool if ordered Edema control: Elevation, gentle controlled motion Extension splint A/PROM within limits of the splint Scar management: massage, scar pad, compression garment, heat (once healed) Purposeful activities requiring flexion and extension

Question 4

Skier’s (Gamekeeper’s) Thumb definition

Answer 4

Rupture of the ulnar collateral ligament of the MCP joint of the thumb

Question 5

Skier’s Thumb OT intervention

Answer 5

• Thumb splint for 4-6 weeks with ROM in IP joint
• AROM at 4 weeks with medical clearance
• Key pinch exercises early on, no tip pinch until 8 weeks or later
• Focus on ADLs that require opposition and pinch strength

Question 6

Complex Regional Pain Syndrome (CPRS) definition

Answer 6

Vasomotor dysfunction, following a noxious event or nerve injury, resulting in severe pain, edema, discoloration, stiffness, sudomotor changes, temperature changes, abnormal hair/nail growth, and hyperhydrosis. If suspected, treat immediately becuase the sooner, the better.

Question 7

OT interventions for CPRS

Answer 7

• Modalities to decrease pain including Fluidotherapy with AROM, ultrasoud, TENS
• Edema management: elevation, manual edema mobilization (massage), compression glove/stocking
• AROM to invloved joints
• ADL to encourage active use
• Progressive desensitization
• Stress loading* - weight bearing/joint distraction activities including scrubbing and carrying activities
• Splinting to prevent contractures if needed
• Encourage self management

Question 8

OT interventions to avoid with CRPS

Answer 8

• PROM
• Passive stretching
• Joint mobilization
• Dynamic splinting
• Casting

Question 9

Colles’ Fracture

Answer 9

Fracture of the distal radius with dorsal displacement.

Most common distal radius fracture. Usually caused by FOOSH

Question 10

Smith’s Fracture

Answer 10

Fracture of the distal radius with volar displacement. Also called a Reverse Colles’ fracture.

Question 11

Location of carpal bones

Answer 11

Question 12

Scaphoid Fracture

Answer 12

Most common carpal fracture. Caused by hyperextension of wrist combined wiht radial deviation.

The proximal scaphoid has poor blood supply and may become necrotic

Question 13

Boxer’s Fracture

Answer 13

Fracture at the base of the metacarpal. Most commonly 4th or 5th MC.

Requires an ulnar gutter splint.

Question 14

Bennett’s fracture-dislocation

Answer 14

Intraarticular fracture of the thumb metacarpal

Question 15

Humeral Shaft Fracture - common complication

Answer 15

Injury to the radial nerve resulting in wrist drop.

Question 16

OT assessment of UE Fractures

Answer 16

• History and special test results
• Edema
• Pain
• AROM (do not test PROM or strength until ordered by Dr.)
• Sensation
• Roles, occupations, ADLs

Question 17

OT intervention for UE fractures

Answer 17

• Immobilization phase - AROM of other joints, Edema control, Light ADLs with no resistance
• Mobilization phase - Edema control, AROM, PROM with clearance, occupation based activities, pain managment, strengthening with clearance

Question 18

Cumulative Trauma Disorders (CTD) risk factors

Answer 18

Repetition, static position, awkward postures, forceful exertions, and vibration

Question 19

DeQuervain’s Disorder definition

Answer 19

A CTD resulting in stenosing tenosynovitis of the APL and EPB causing pain and swelling over radial styloid

Diagnosed with a positive Finkelstein’s Test

Question 20

OT intervention for DeQuervain’s Disorder

Answer 20

• Thumb spical splint (IP joint free)
• Activity modification
• Ice massage over radial wrist
• Gentle AROM to prevent stiffness

Post-op: thumb spica splint and gentle AROM (0-2 weeks), strengthening and ADLs (2-6 weeks)

Question 21

Lateral Epicondylitis definition and treatment

Answer 21

Overuse of wrist extensors, especially ECRB.

• elbow strap, wrist splint
• ice and deep friction massage
• stretching
• activity modification
• strengthening as pain decreases

Question 22

Medial epicondylitis definition and treatment

Answer 22

Overuse of wrist flexors (golfer’s elbow)

• elbow strap, wrist splint
• ice and deep friction massage
• stretching
• activity modification
• strengthening as pain decreases

Question 23

Trigger Finger definition and treatment

Answer 23

Tenosynovitis of the finger flexors, most commonly in the A1 pulley

• Hand based splint with MCP extended and IP joints free
• Scar massage
• Edema control
• Tendon gliding
• avoid repetitive gripping activities

Question 24

OT intervention for shoulder dislocation

Answer 24

• Regain ROM - if anterior dislocation, avoid combined abduction and external rotation
• Pain free ADL and role activities
• Strengthen rotator cuff

Question 25

Adhesive Casulitis (frozen shoulder) OT intervention

Answer 25

Greatest limitation is ER > abduction > IR > flexion

• PROM (if surgery, immediately after)
• Modalities, pain relief
• Encourage active use in ADLs

Question 26

OT intervention goals following tendon repair

Answer 26

• Increase tendon excursion
• improve strength at repair site
• increase joint ROM
• prevent adhesions
• facilitate resumption of activities

Question 27

Kleinert Protocol

Answer 27

Early flexor tendon repair mobilization program consisting of passive flexion using rubber band traction and active extension to the hood of the dorsal block splint.

Question 28

Duran Protocol

Answer 28

Early flexor tendon release mobilization program consisting of passive flexion and extension of digit withing dorsal block splint