Upper Extremity Diagnoses Flashcards
What tasks are made difficult by Dupuytren’s Disease?
Shaking hands, grasping large objects, typing
Best splint for a typical Dupuytren’s patient
Volar-based extension wrist and hand splint with wrist and MCPs in neutral position. Initially worn at all times except exercise and bathing
OT intervention for Dupuytren’s Disease
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
Skier’s (Gamekeeper’s) Thumb definition
Rupture of the ulnar collateral ligament of the MCP joint of the thumb
Skier’s Thumb OT intervention
- 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
Complex Regional Pain Syndrome (CPRS) definition
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.
OT interventions for CPRS
- 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
OT interventions to avoid with CRPS
- PROM
- Passive stretching
- Joint mobilization
- Dynamic splinting
- Casting
Colles’ Fracture
Fracture of the distal radius with dorsal displacement.
Most common distal radius fracture. Usually caused by FOOSH
Smith’s Fracture
Fracture of the distal radius with volar displacement. Also called a Reverse Colles’ fracture.
Location of carpal bones
Scaphoid Fracture
Most common carpal fracture. Caused by hyperextension of wrist combined wiht radial deviation.
The proximal scaphoid has poor blood supply and may become necrotic
Boxer’s Fracture
Fracture at the base of the metacarpal. Most commonly 4th or 5th MC.
Requires an ulnar gutter splint.
Bennett’s fracture-dislocation
Intraarticular fracture of the thumb metacarpal
Humeral Shaft Fracture - common complication
Injury to the radial nerve resulting in wrist drop.
OT assessment of UE Fractures
- History and special test results
- Edema
- Pain
- AROM (do not test PROM or strength until ordered by Dr.)
- Sensation
- Roles, occupations, ADLs
OT intervention for UE fractures
- 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
Cumulative Trauma Disorders (CTD) risk factors
Repetition, static position, awkward postures, forceful exertions, and vibration
DeQuervain’s Disorder definition
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
OT intervention for DeQuervain’s Disorder
- 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)
Lateral Epicondylitis definition and treatment
Overuse of wrist extensors, especially ECRB.
- elbow strap, wrist splint
- ice and deep friction massage
- stretching
- activity modification
- strengthening as pain decreases
Medial epicondylitis definition and treatment
Overuse of wrist flexors (golfer’s elbow)
- elbow strap, wrist splint
- ice and deep friction massage
- stretching
- activity modification
- strengthening as pain decreases
Trigger Finger definition and treatment
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
OT intervention for shoulder dislocation
- Regain ROM - if anterior dislocation, avoid combined abduction and external rotation
- Pain free ADL and role activities
- Strengthen rotator cuff
Adhesive Casulitis (frozen shoulder) OT intervention
Greatest limitation is ER > abduction > IR > flexion
- PROM (if surgery, immediately after)
- Modalities, pain relief
- Encourage active use in ADLs
OT intervention goals following tendon repair
- Increase tendon excursion
- improve strength at repair site
- increase joint ROM
- prevent adhesions
- facilitate resumption of activities
Kleinert Protocol
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.
Duran Protocol
Early flexor tendon release mobilization program consisting of passive flexion and extension of digit withing dorsal block splint
