Upper extremity Injuries Flashcards
Paresthesia refers to a _______ or prickling sensation that is usually felt in the hands, arms, legs, or feet, but can also occur in other parts of the body. The sensation, which happens without warning, is usually painless and described as tingling or numbness, skin crawling, or itching
burning
__ ________ syndrome is caused by cumulative microtrauma resulting in tenosynovitis of the thumb muscle tendon unit, the abductor pollicis longus and extensor pollicis brevis, and the tendons in the first dorsal compartment of the wrist.
de Quervain
Protective reeducation educates clients to _______ compensate for sensory loss and to avoid working with machinery and temperatures below 60°.
visually
Discriminative reeducation uses motivation and ________ in a vision–tactile matching process in which clients identify objects with and without vision.
repetition
For sensory reeducation after nerve injury, sensory recovery begins with pain perception and progresses to _______ of 30 cycles per second, moving touch, and constant touch.
vibration
Desensitization is a process of applying different _______ and ________ stimulation to reeducate the nervous system so clients can tolerate sensations during functional use of the upper extremity.
textures
tactile
PAMs are considered a ________ method for the therapeutic use of occupations or purposeful activities
preparatory
Cryotherapy
Indications, contraindications, and precautions: Avoid use with clients with impaired circulation, peripheral vascular disease, ____________ to cold, impaired ________, open wounds, or infections.
hypersensitivity
sensation
Thermotherapy
Indications, contraindications, and precautions: Avoid use with clients with _____ inflammation, edema, _______ impairment, cancer, blood clot, infection, cardiac problems, and impaired cognition.
acute
sensory
Phonophoresis is the use of ________ to promote absorption of topically applied medication to accelerate tissue repair and decrease inflammation.
ultrasound
Ultrasound
Indications, contraindications, and precautions: Avoid use with clients who have cancer; are pregnant; or have a ___________, bleeding, or an infection. Avoid use over the eyes, blood clots, and growth plates of bones in _______. Be cautious when using with inflammation, fractures and breast implants and with clients who have cognitive, language, or _______ impairments.
pacemaker
children
sensory
NMES, TENS, and iontophoresis
Indications, contraindications, and precautions: Do not use over _________, carotid sinus, pregnant uterus, and eyes or with clients with epilepsy, cancer, infection, decreased ________, cardiac disease, and stroke. With iontophoresis use, be aware of possible drug allergies.
pacemakers
sensation
Resting hand splints maintain the wrist at 20°–30° ________, thumb at 45° palmar ________, MCPs at 35°–45° _______, and PIPs and DIPs in slight flexion.
extension
abduction
flexion
Antideformity resting hand splints (burn intrinsic plus) maintain the wrist at 30°-__° extension, thumb at 45° palmar abduction, MCPs at 70°- __° flexion, and PIPs and DIPs in full __________.
40
90
extension
Ball or ____ antispasticity splints are ulnar or volar based and provide thumb palmar or radial abduction, a hard surface in contact with finger ______, and serial casting for the wrist, elbow, knee, or ankle to decrease soft tissue contractures.
cone
flexors
Wrist cock-up splints (dorsal or volar wrist immobilization) maintain hand arches, full thumb movement, and full MP ______.
flexion
Thumb spica splints (volar thumb or radial gutter thumb immobilization) are used on the long or short opponens to provide CMC __________.
immobilization
Finger splints include PIP ________ (i.e., Boutonniere, Capener, prefabricated dynamic extension assist, and serial casting) splints, PIP flexion splints, PIP hyper________ block (swan neck) splints, DIP ________ (mallet finger, serial casting) splints, DIP flexion splints, and silver ring splints.
extension
extension
extension
Nerve injury splinting
Carpal tunnel syndrome: Wrist in _______ to 10° _________.
neutral
extension
Nerve injury splinting
Ulnar nerve at wrist: Block fourth and fifth MCPs to 30°–45° ______ to prevent ____________.
flexion
hyperextension
Nerve injury splinting
Radial nerve injury: _____-__ splint, with dynamic finger extension assist optional
Cock-up
Nerve injury splinting
Radial tunnel syndrome: Wrist in 30° ________, forearm ________, elbow in 90° _______.
extension
supinated
flexion
Nerve injury splinting
Anterior interosseous: Forearm ______, elbow in 90° _______
neutral
flexion
Nerve injury splinting
Pronator syndrome: Forearm and wrist ______, elbow in 90° ______
neutral
flexion
Dynamic splints are designed to correct contractures, increase _______ motion, protect recent surgery, or substitute for lost _______ motion.
passive
active
A soft, _____________ orthosis improves client compliance with wearing it.
Carpal tunnel wrist support
Anti-vibration gloves
Neoprene wrap thumb support for CMC osteoarthritis and de Quervain syndrome
Forearm bands for medial and lateral epicondylitis
MCP anti–ulnar deviation splints for rheumatoid arthritis
Buddy taping
Neoprene tube digit extension splint
Pediatric neoprene thumb abductor and supinator TheraTogs (TheraTogs, Inc., Telluride, CO; Gabriel et al., 2015)
circumferential
Wound Closure
Primary—Wound is closed with _______.
sutures
Wound Closure
__________—Wound is left open and allowed to close on its own.
Secondary
Wound Closure
_______ primary—Wound is cleaned, debrided, and observed 4 to 5 days before suturing it closed.
Delayed
Wound Healing Phases
The acute phase lasts 24–48 hours to __ days, and the subacute phase lasts 7 to __ days.
Local signs include redness, swelling, heat, and pain; systemic signs are fever and leukocytosis.
7
14
Wound Healing Phases
The inflammation phase includes the _____acute phase which lasts 24–48 hours to __ days, and the subacute phase lasts 7 to __ days.
Local signs include redness, swelling, heat, and pain; systemic signs are fever and leukocytosis.
acute
7
14
The three phases of wound healing are?
Inflammation
Proliferative
Remodeling
___________ resurfaces the wound, tissue granulation forms new collagen and blood vessels, and myofibroblasts connect to the wound margins.
Epithelization
In the _________ phase of wound healing, wound contraction lasts 5 days to 2–__ weeks.
Linear wounds heal quickly, rectangular wounds moderately quickly, and circular wounds the most slowly.
proliferative
3
In would healing, the _________ phase lasts __ weeks to 1–2 years.
If collagen synthesis exceeds collagen lysis, hypertrophic and keloid scars can form.
remodeling
2
Dynamic splinting, serial casting, continuous passive motion, positional stretching, NMES, and silastic gel pads can help decrease __________ scarring.
hypertrophic
Finger metacarpal fractures: Base shaft, neck, head, such as a _______ (4th and 5th finger)
fracture.
Thumb fractures: Base fracture is Bennett’s fracture; shaft and neck fractures; _____ ligament is
skier’s thumb.
boxer’s
torn
Avulsion injuries occur when the ______ separates from the bone and insertion and removes
bone material with the tendon.
a. Mallet finger is avulsion of the terminal tendon and is splinted in full ________ for 6 weeks.
tendon
extension
b. Boutonniere deformity is disruption of the central slip of the extensor tendon characterized
by proximal interphalangeal (PIP) flexion and distal interphalangeal (DIP) hyperextension;
the PIP is splinted in ________, and isolated DIP flexion exercises are performed.
c. Swan neck deformity is injury to the metacarpophalangeal (MCP), PIP, or DIP joints
characterized by PIP hyperextension and DIP flexion; the PIP is splinted in slight _______.
extension
flexion
The three common phases of healing are __________, repair, and remodeling. ___________
provides the cellular activity needed for healing, repair forms the callus for stabilization, and
remodeling deposits _____bone.
inflammation
Inflammation
bone
Interventions for fractures of the hand.
Early _________ mobilization. Therapeutic exercises provide motion to further enhance
performance and function to ultimately improve ADL performance.
Controlled active range of
motion (AROM) begins __–6 weeks after fracture if fixation is stable. Consider intrinsic
tightness versus extrinsic tightness versus joint capsule tightness
controlled
3
Interventions for fractures of the wrist.
ROM is allowed in the early phases of healing and repair. True or false?
True
Interventions for fractures of the wrist.
Orthotics are used to protect the extremity from ______ or allow for protected _______; later,
dynamic or static-progressive orthotics can be used after the fracture is healed to increase
ROM.
motion
motion
Interventions for fractures of the wrist.
Exercises are used to facilitate movement and improve performance of the upper extremity;
examples include AROM with wrist ________ and fingers ________; blocking exercises; tendon and
nerve gliding exercises; stretching exercises and later strengthening exercises (e.g., use of
therapy putty, hand exercises)
extended
flexed
Radial head fractures are the most common of elbow fractures. These fractures are
usually caused by a fall on an __________ hand (FOOSH).
outstretched
Interventions for fractures of the forearm
a. Orthotics are used for _________ as needed.
b. ROM is begun early, within the 1st week if medically cleared.
c. A sling is used for Type I fractures or comfort if the client has pain and is nervous in public
places.
d. Be watchful of stiff elbow.
immobilization
Intervention for CRPS
- Gentle, pain-free ______ for short periods; no passive range of motion (PROM) or painful
treatment - Stress loading: for example, scrubbing the floor, carrying a weighted handbag
- Pain control techniques: Transcutaneous electrical nerve stimulation, splinting (static, then
dynamic as tolerated), continuous passive motion - Edema control techniques: Elevation, massage, AROM, contrast baths, compression
- Desensitization techniques, fluidotherapy
- Blocked exercises, tendon gliding
- Joint protection, energy conservation
AROM
\_\_\_\_\_\_\_\_\_ trauma disorder Five grades (I–V) according to severity
- Grade I: Pain after activity, resolves quickly
- Grade II: Pain during activity, resolves when activity stopped
- Grade III: Pain persists after activity and affects work productivity; objective weakness and
sensory loss - Grade IV: Use of extremity results in pain up to 75% of time, work is limited
- Grade V: Unrelenting pain, unable to work
Cumulative
Intervention for Cumulative Trauma Disorder
- Acute phase: Reduction of inflammation and pain through ______ splinting, ice, contrast baths,
ultrasound phonophoresis, iontophoresis, and high-voltage electric and interferential
stimulation - Subacute phase: Slow stretching, myofascial release, progressive resistive exercise as tolerated,
proper body mechanics, education on identifying triggers and returning to acute phase
treatment with flareups; static splint during activities that cause pain - Return to work
a. Assessment of job site, tools used, and body positioning
b. Therapy using a work simulator, weight well, elastic bands, putty, functional activities, and
strengthening activities - Functional capacity evaluation
- Work hardening
static
Extensor tendons post surgery
Strengthening usually is not initiated until the late phase of the repair, around 8–12 weeks
after surgery. True or false?
True
An individual with a short below-elbow amputation will require a _____ elbow socket to provide stability because natural forearm rotation is not possible.
fixed
