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Orthotics > Upper Extremity Orthoses > Flashcards

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
Q

Describe Rancho orthosis

A

‘Rancho los amigos’

Aluminum line w/plastazote w/attachment sites for components

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26
Q

Describe TIRR orthosis

A

Prefab laminated hand shells, palmar piece primary component

Can be difficult to don w/tight webspace

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27
Q

Describe IRM orthosis

A

Custom thermoplastic HO, self suspending from tight AP

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28
Q

Goals of a hand orthosis

A

Maintain: palmar arch, thumb position, web space

Provide attachment site for components

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29
Q

Parts of hand orthosis

A

Palmar and dorsal bars
Opponens bar
C-bar

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30
Q

Function of palmar and dorsal bars

A

Maintain palmar arch

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31
Q

Function of opponens bar

A

Maintain thumb in opposition (encapsulates shaft of 1st metacarpal)

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32
Q

Function of C-bar

A

Maintains webspace
Thumb adduction stop

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33
Q

Thumb control options for WHFO

A

Thumb post
Adduction stop (C-bar)
Abduction assist
Extension assist

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34
Q

Thumb post indications

A

Flail thumb (complete SCI at all cervical levels)
Intrinsic minus hand
M, R, and U nerve injuries

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35
Q

Thumb adduction stop indications

A

Median nerve (abd pollicis brevis)

Radial nerve (abd pollicis longus)

Spasticity (UMN)

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36
Q

Thumb abduction assist indications

A

Radial nerve (abd pollicis longus)

Similar to c-bar

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37
Q

Thumb extension assist indications

A

Radial nerve (thumb extensors)

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38
Q

MCP joint control options for WHFO

A

MP stop/IP assist
MCP flexion assist

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39
Q

MP stop/IP assist indications

A

Median and ulnar nerve (lumbricals, Interossei, finger flexors)

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40
Q

MCP flexion assist indications

A

Median and ulnar nerve

‘Knuckle bender’ and ‘reverse knuckle bender’ for ext. assist

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41
Q

Finger control options for WHFO

A

1st dorsal interosseus assist
Finger driven WHO

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42
Q

1st dorsal interosseus assist indications

A

Ulnar nerve (interossei and MP abductors)

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43
Q

Finger driven WHO indications

A

Weak MP extension, must have active flexion or at least 1 finger

Provides MP ext assist

Atypical PNI

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44
Q

WHFO design for radial nerve injury @ elbow

A

WHO

Wrist and MCP extension assist

C-bar &/or thumb abduction assist

Thumb extension assist

45
Q

WHFO design for median nerve injury @ wrist

A

Opponens bar

MP extension stop & IP extension assist 2&3

46
Q

WHFO design for ulnar nerve injury

A

MP ext stop / IP ext assist for digits 4&5

1st dorsal interosseus assist

47
Q

Clinical presentation of combined median and ulnar PNI

A

Claw hand - loss of MCP flexion

Loss of thumb opposition

48
Q

WHFO design for combined median and ulnar nerve injury

A

MCP extension stop / IP ext assist (2-5)

Opponens bar

49
Q

Mallet finger presentation and recommendation

A

Flexion of DIP, inability to extend ‘extensor lag’

Stack splint 6wk to maintain extension

50
Q

Boutonnière deformity presentation and recommendation

A

PIP flexion and DIP hyperextension

Silver ring splint 6-8 wk to maintain PIP extension

51
Q

Swan neck deformity presentation and recommendation

A

PIP hyperextension and DIP flexion

Silver ring/fig 8 splint to maintain PIP flexion 20°

52
Q

Number of spinal nerve roots in cervical region

A

8 pairs of spinal nerve roots

53
Q

Rotator cuff muscles

A

‘SITS’

Supraspinatus
Infraspinatus
There’s minor
Subscapularis

54
Q

Rotator cuff - external rotators

A

Supra and infra spinatus
Teres minor

55
Q

Rotator cuff - internal rotator

A

Subscapularis

56
Q

Rotator cuff - abductor

A

Supraspinatus

57
Q

Function of labrum at shoulder

A

Deepens glenoid fossa, fibrocartilage

58
Q

Shoulder is made up of which joints

A

Glenohumeral
Acromioclavicular
Sternoclavicular
Scapulothoracic

59
Q

Scapulohumeral rhythm

A

During shoulder abduction to 180°
GH joint responsible for 120°
Scapulothoracic responsible for 60°

Ratio = 2:1

60
Q

Shoulder slings hold the shoulder in this position

Why is it detrimental

A

Adduction and IR with elbow flexion

Unstable for shoulder subluxation

61
Q

Indications for Givmohr sling

A

Flaccid paralysis

62
Q

Function and indication for Sully orthosis

A

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
Q

Arm positioning after arthroplasty

A

Shoulder 0-15° flexed, 30° abducted, neutral or slight ER

Elbow 90° flex and neutral forearm

64
Q

Common extensor origin (forearm)

Inflammation pathology

A

Lateral epicondyle

Tennis elbow

65
Q

Common flexor origin

Inflammation pathology

A

Medial epicondyle

Golfer’s elbow

66
Q

Pronation and supination occur at which joint

A

Proximal radioulnar joint

67
Q

Biceps origin, insertion, primary action

A

Coracoid process and supraglenoid tubercle (scapula)

Radial tuberosity

Forearm supination (also elbow flexor)

68
Q

Triceps origin, insertion, primary action

A

Infraglenoid tubercle and posterior humerus

Olecranon process

Elbow extension (also shoulder ext/add)

69
Q

Triceps agonist muscle

A

Anconeus

70
Q

Functional elbow ROM

A

30-130°

71
Q

Recommendation for lateral epicondylitis

A

Counterforce band 2cm distal to muscle origin

WHO decreases wrist extension

EWHO in severe cases

72
Q

Common MOI for BPI

A

Tension or penetrating trauma

73
Q

Weakness in C5-7 BPI

A

Weak shoulder

If C7-T1 preserved, maintains wrist and hand

74
Q

Elbow joint recommendation for BPI

A

Step locks

75
Q

Treatment of fixed vs flexible contractures

A

Fixed - accommodate, prevent worsening

Flexible - low load, long duration stretch

76
Q

Consequence of high magnitude stretch

A

Antagonist response

77
Q

Joint axis at elbow aligns with

A

Lateral epicondyle

78
Q

Effect of Botox and timeline

A

Reduce spasticity

Takes effect in 3-10 days, max effect at 1mo, lasts 2-3mo

79
Q

Commonly sprained elbow ligament

MOI, common population

A

Medial collateral ligament from repetitive stress or trauma

Baseball players or throwing athletes

80
Q

Olecranon fracture recommendation

A

Splint and sling

Post-op - 4 wk EO with progressive motion, start at 60° flexed

81
Q

Elbow arthroplasty recommendation

A

EO 60° flexion 1 week

82
Q

Biceps tendon repair recommendation

A

Splint elbow 90°, forearm supination 2 wk

Hinged EO limited range 30-135° w/forearm supination 5wk

83
Q

Function of volar plate (fingers)

A

Prevent hyperextension, fibricartilage

84
Q

What anatomy is affected in Boutonniere deformity

A

Central extensor tendon and lateral bands

85
Q

What anatomy is affected in swan neck deformity

A

Lateral bands

86
Q

Difference between grade 1,2, and 3 sprains

A

1=partial tear, no instability
2=partial tear w/PROM instability
3=complete tear

87
Q

Healing phases for fractures

A

Hematoma, inflammation, bruising
Soft callus
Hard callus
Remodeling

88
Q

Sarmiento’s principles

A

Physiologic motion at fx site is conducive to osteogenesis

Soft tissue compression maintains alignment and stabilizes fragments

89
Q

Minor shortening, angulation, and rotation after fx

A

Inconsequential deviations

90
Q

UL fracture bracing for these types of fractures

A

Humeral
Isolated ulnar shaft
Selected colle’s fx

91
Q

Common cause of humeral fx - adult and ped

A

Adult - fall, low energy injury w/rotation

Ped - high energy injury

92
Q

Common cause of ulnar fx - adult and ped

A

Adult - direct blow

Ped - fall, child abuse <1 y/o

93
Q

Common cause of colles fx

A

Fall on outstretched hand

94
Q

Common population for colles fx

A

50+ y/o

95
Q

Describe colles fx

A

Fx at distal radius

Radial head usually dislocates

Dorsal displacement

Results in wrist extension and radial deviation positioning

96
Q

Fitting of humeral fx orthosis

A

1” distal to axilla and 1” proximal to humeral epicondyles

97
Q

Does fx orthosis have to completely cover fx site

A

No

98
Q

What are codmans exercises

A

Hanging arm circles used in humeral fx rehabilitation (passive alignment, shoulder motion)

99
Q

What ulnar fx are treated orthotically

A

Isolated, in distal 2/3 of forearm

100
Q

Describe Monteggia fx

A

Proximal ulnar fx and radial head dislocation

101
Q

Ulnar fix orthosis allows which motions

A

Allows elbow and wrist ROM

Blocks rotation, maintains forearm supination

102
Q

When to discontinue ulnar fx orthosis

A

When symptoms resolve (regardless of healing phase)

103
Q

When to discontinue humeral fx orthosis

A

Absence of pain, bony bridge

104
Q

Colles style orthosis

A

Extends above condyles to limit rotation

Used to address high rate of dislocation after sx

Best for extraarticular fx

105
Q

Functional pronation/supination ROM

A

~50° each

106
Q

Functional wrist flexion and extension ROM

A

54° flexion
60° extension

107
Q

Functional radial and ulnar deviation ROM

A

10° radial
20° ulnar

108
Q

Which directions is the shoulder most stable? Least stable?

A

Most stable in inferior direction
Least stable in anterior direction

109
Q

Sources of stability at shoulder

A

Joint capsule and ligaments, labrum, muscle action

Orthotics (7 decks)

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