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Upper Extremity Orthoses Flashcards

1
Q

Muscles innervated by musculocutaneous nerve

Primary motions affected by injury

A

Biceps brachii
Brachialis
Coracobrachialis

Elbow flexion, forearm supination

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2
Q

Muscles innervated by axillary nerve

Primary motions affected by injury

A

Deltoid
Teres minor

Shoulder abduction (15-90°)
Shoulder flexion and extension
Shoulder ER

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3
Q

Muscles innervated by radial nerve

Primary motions affected by injury

A

Triceps brachii
Wrist and finger extensors
Brachioradialis
Supinator

Elbow and wrist extension
MCP extension

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4
Q

Muscles innervated by median nerve

Primary motions affected by injury

A

Wrist and finger flexors
Pronator teres and quadratus
Lateral 2 lumbricals
Pollicis: opponens, abductor brevis, flexor brevis

Forearm pronation
Wrist and finger flexion (2&3)
Radial deviation
Weak grip strength and opposition

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5
Q

Muscles innervated by ulnar nerve

Primary motions affected by injury

A

Flexor carpi ulnaris
Medial flexor digitorum profundus
Hypothenar eminence
Interossei
Medial 2 lumbricals
Adductor pollicis

Wrist and finger flexion (3&4)
Ulnar deviation
Weak finger abduction, adduction, and opposition

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6
Q

Clinical presentation radial PNI

A

Wrist drop (lack of wrist/finger extension)

Weak thumb abduction and extension

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7
Q

Clinical presentation median PNI

A

Hand of benediction when trying to flex fingers (lack of movement digits 1,2,3)

Only digits 3&4 will close

Loss of thumb opposition

‘Ape hand’

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8
Q

Clinical presentation ulnar PNI

A

Claw hand when trying to extend fingers (lack of movement digits 3&4)

Only digits 1,2,3 will open

Hyperextension MCP and flexion IP 4&5

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9
Q

Wrist driven WHFO: termination of finger extension and thumb post

A

Mid nail bed

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10
Q

Wrist driven WHFO: location of wrist axis

A

2mm distal to radial styloid

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11
Q

Wrist driven WHFO: location of MCP axis

A

Lateral to 2nd MCPJ

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12
Q

C6,7 SCI recommendation

A

Wrist driven (eg Rancho, RIC)

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13
Q

C5 SCI recommendation

A

Ratchet driven
Mobile arm support

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14
Q

C8, T1 SCI recommendation

A

Natural tenodesis w/lateral prehension
Static HO

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15
Q

General pattern of deficit C6 SCI

A

Can control shoulder, biceps

No control at hand

*may have wrist control - ECRL, ECRB from radial nerve

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16
Q

General pattern of deficit C8 T1 SCI

A

Problems w/hands - opposition

Mild claw hand (similar to median and ulnar n. Lesion at wrist)

Atrophy of thenar and hypothenar eminences

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17
Q

Pattern of deficit C5 SCI

A

Loss of wrist and elbow extension

Can flex elbow and shoulder

Elbow flexion contracture risk
Gravity extends elbow

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18
Q

C4 SCI recommendation

A

Static positioning orthoses to prevent contracture

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19
Q

Incomplete vs complete SCI

A

Complete = no function below level of injury, symmetrical

Incomplete = some function (variable) below level of injury, asymmetric

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20
Q

Common prehension patterns

A

3 Jaw chuck
Spherical
Cylindrical
Hook/snap
Lateral/key
Tip

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21
Q

Intrinsic plus vs intrinsic minus hand positions

A

Intrinsic plus = 30 wrist ext, 70 MCP flex, IP ext

Intrinsic minus = MCP hyperextension, IP flex

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22
Q

Muscle imbalance in intrinsic plus vs intrinsic minus

A

Intrinsic plus = spastic intrinsic (interossei and lumbricals); weak extrinsics

Intrinsic minus = strong extrinsics and weak intrinsics

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23
Q

Safe position of the hand

A

Intrinsic plus position

Wrist ext 30
MCP flex 70-90
PIP and DIP ext

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24
Q

Resting / Functional position of the hand

A

Wrist ext 30
MCP flex 35-40
PIP flex 30
DIP flex 5-10
Thumb opposed w/webspace and IP ext

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25
Describe Rancho orthosis
‘Rancho los amigos’ Aluminum line w/plastazote w/attachment sites for components
26
Describe TIRR orthosis
Prefab laminated hand shells, palmar piece primary component Can be difficult to don w/tight webspace
27
Describe IRM orthosis
Custom thermoplastic HO, self suspending from tight AP
28
Goals of a hand orthosis
Maintain: palmar arch, thumb position, web space Provide attachment site for components
29
Parts of hand orthosis
Palmar and dorsal bars Opponens bar C-bar
30
Function of palmar and dorsal bars
Maintain palmar arch
31
Function of opponens bar
Maintain thumb in opposition (encapsulates shaft of 1st metacarpal)
32
Function of C-bar
Maintains webspace Thumb adduction stop
33
Thumb control options for WHFO
Thumb post Adduction stop (C-bar) Abduction assist Extension assist
34
Thumb post indications
Flail thumb (complete SCI at all cervical levels) Intrinsic minus hand M, R, and U nerve injuries
35
Thumb adduction stop indications
Median nerve (abd pollicis brevis) Radial nerve (abd pollicis longus) Spasticity (UMN)
36
Thumb abduction assist indications
Radial nerve (abd pollicis longus) Similar to c-bar
37
Thumb extension assist indications
Radial nerve (thumb extensors)
38
MCP joint control options for WHFO
MP stop/IP assist MCP flexion assist
39
MP stop/IP assist indications
Median and ulnar nerve (lumbricals, Interossei, finger flexors)
40
MCP flexion assist indications
Median and ulnar nerve ‘Knuckle bender’ and ‘reverse knuckle bender’ for ext. assist
41
Finger control options for WHFO
1st dorsal interosseus assist Finger driven WHO
42
1st dorsal interosseus assist indications
Ulnar nerve (interossei and MP abductors)
43
Finger driven WHO indications
Weak MP extension, must have active flexion or at least 1 finger Provides MP ext assist Atypical PNI
44
WHFO design for radial nerve injury @ elbow
WHO Wrist and MCP extension assist C-bar &/or thumb abduction assist Thumb extension assist
45
WHFO design for median nerve injury @ wrist
Opponens bar MP extension stop & IP extension assist 2&3
46
WHFO design for ulnar nerve injury
MP ext stop / IP ext assist for digits 4&5 1st dorsal interosseus assist
47
Clinical presentation of combined median and ulnar PNI
Claw hand - loss of MCP flexion Loss of thumb opposition
48
WHFO design for combined median and ulnar nerve injury
MCP extension stop / IP ext assist (2-5) Opponens bar
49
Mallet finger presentation and recommendation
Flexion of DIP, inability to extend ‘extensor lag’ Stack splint 6wk to maintain extension
50
Boutonnière deformity presentation and recommendation
PIP flexion and DIP hyperextension Silver ring splint 6-8 wk to maintain PIP extension
51
Swan neck deformity presentation and recommendation
PIP hyperextension and DIP flexion Silver ring/fig 8 splint to maintain PIP flexion 20°
52
Number of spinal nerve roots in cervical region
8 pairs of spinal nerve roots
53
Rotator cuff muscles
‘SITS’ Supraspinatus Infraspinatus There’s minor Subscapularis
54
Rotator cuff - external rotators
Supra and infra spinatus Teres minor
55
Rotator cuff - internal rotator
Subscapularis
56
Rotator cuff - abductor
Supraspinatus
57
Function of labrum at shoulder
Deepens glenoid fossa, fibrocartilage
58
Shoulder is made up of which joints
Glenohumeral Acromioclavicular Sternoclavicular Scapulothoracic
59
Scapulohumeral rhythm
During shoulder abduction to 180° GH joint responsible for 120° Scapulothoracic responsible for 60° Ratio = 2:1
60
Shoulder slings hold the shoulder in this position Why is it detrimental
Adduction and IR with elbow flexion Unstable for shoulder subluxation
61
Indications for Givmohr sling
Flaccid paralysis
62
Function and indication for Sully orthosis
Prevents shoulder abduction, flexion, and extension beyond a certain range Subacromial impingement, rotator cuff instability Can be used during sports and to prevent overhead arm
63
Arm positioning after arthroplasty
Shoulder 0-15° flexed, 30° abducted, neutral or slight ER Elbow 90° flex and neutral forearm
64
Common extensor origin (forearm) Inflammation pathology
Lateral epicondyle Tennis elbow
65
Common flexor origin Inflammation pathology
Medial epicondyle Golfer’s elbow
66
Pronation and supination occur at which joint
Proximal radioulnar joint
67
Biceps origin, insertion, primary action
Coracoid process and supraglenoid tubercle (scapula) Radial tuberosity Forearm supination (also elbow flexor)
68
Triceps origin, insertion, primary action
Infraglenoid tubercle and posterior humerus Olecranon process Elbow extension (also shoulder ext/add)
69
Triceps agonist muscle
Anconeus
70
Functional elbow ROM
30-130°
71
Recommendation for lateral epicondylitis
Counterforce band 2cm distal to muscle origin WHO decreases wrist extension EWHO in severe cases
72
Common MOI for BPI
Tension or penetrating trauma
73
Weakness in C5-7 BPI
Weak shoulder If C7-T1 preserved, maintains wrist and hand
74
Elbow joint recommendation for BPI
Step locks
75
Treatment of fixed vs flexible contractures
Fixed - accommodate, prevent worsening Flexible - low load, long duration stretch
76
Consequence of high magnitude stretch
Antagonist response
77
Joint axis at elbow aligns with
Lateral epicondyle
78
Effect of Botox and timeline
Reduce spasticity Takes effect in 3-10 days, max effect at 1mo, lasts 2-3mo
79
Commonly sprained elbow ligament MOI, common population
Medial collateral ligament from repetitive stress or trauma Baseball players or throwing athletes
80
Olecranon fracture recommendation
Splint and sling Post-op - 4 wk EO with progressive motion, start at 60° flexed
81
Elbow arthroplasty recommendation
EO 60° flexion 1 week
82
Biceps tendon repair recommendation
Splint elbow 90°, forearm supination 2 wk Hinged EO limited range 30-135° w/forearm supination 5wk
83
Function of volar plate (fingers)
Prevent hyperextension, fibricartilage
84
What anatomy is affected in Boutonniere deformity
Central extensor tendon and lateral bands
85
What anatomy is affected in swan neck deformity
Lateral bands
86
Difference between grade 1,2, and 3 sprains
1=partial tear, no instability 2=partial tear w/PROM instability 3=complete tear
87
Healing phases for fractures
Hematoma, inflammation, bruising Soft callus Hard callus Remodeling
88
Sarmiento’s principles
Physiologic motion at fx site is conducive to osteogenesis Soft tissue compression maintains alignment and stabilizes fragments
89
Minor shortening, angulation, and rotation after fx
Inconsequential deviations
90
UL fracture bracing for these types of fractures
Humeral Isolated ulnar shaft Selected colle’s fx
91
Common cause of humeral fx - adult and ped
Adult - fall, low energy injury w/rotation Ped - high energy injury
92
Common cause of ulnar fx - adult and ped
Adult - direct blow Ped - fall, child abuse <1 y/o
93
Common cause of colles fx
Fall on outstretched hand
94
Common population for colles fx
50+ y/o
95
Describe colles fx
Fx at distal radius Radial head usually dislocates Dorsal displacement Results in wrist extension and radial deviation positioning
96
Fitting of humeral fx orthosis
1” distal to axilla and 1” proximal to humeral epicondyles
97
Does fx orthosis have to completely cover fx site
No
98
What are codmans exercises
Hanging arm circles used in humeral fx rehabilitation (passive alignment, shoulder motion)
99
What ulnar fx are treated orthotically
Isolated, in distal 2/3 of forearm
100
Describe Monteggia fx
Proximal ulnar fx and radial head dislocation
101
Ulnar fix orthosis allows which motions
Allows elbow and wrist ROM Blocks rotation, maintains forearm supination
102
When to discontinue ulnar fx orthosis
When symptoms resolve (regardless of healing phase)
103
When to discontinue humeral fx orthosis
Absence of pain, bony bridge
104
Colles style orthosis
Extends above condyles to limit rotation Used to address high rate of dislocation after sx Best for extraarticular fx
105
Functional pronation/supination ROM
~50° each
106
Functional wrist flexion and extension ROM
54° flexion 60° extension
107
Functional radial and ulnar deviation ROM
10° radial 20° ulnar
108
Which directions is the shoulder most stable? Least stable?
Most stable in inferior direction Least stable in anterior direction
109
Sources of stability at shoulder
Joint capsule and ligaments, labrum, muscle action

Orthotics (7 decks)

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