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PHTY3120 > Upper limb > Flashcards

Upper limb Flashcards

1
Q

Describe kinematics at GHJ and appropriate glides

A

abduction = superior roll and inferior slide = inferior glide
ER - anterior slide and posterior roll - anterior glide
IR - posterior slide and anterior roll - posterior glide
Flexion - posterior spin - distraction
extension - anterior glide - distraction

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2
Q

What structures provide passive anterior stability to shoulder

A
  • coracoacromial ligament
  • coracohumeral ligament
  • transverse humeral ligament
  • anterior GH ligament (superior, middle and inferior)
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3
Q

Which muscular force couple prevents winging?
Which force couple controls elevation?
Which force couple controls end range elevation?

A
  1. Serratus anterior and lower traps
  2. Serratus anterior, lower traps and upper traps
  3. middle traps and serratus anterior
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4
Q

Red flags?

A 
Cancer
Signs of infection 
Trauma 
unexplained neurological signs 
metastatic disease 
fractures and dislocation 
Avascular necrosis 
Neurovascular compromise
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5
Q

Yellow flags?

A 
RTW for older than 50 
Higher pain intensity 
Long pain duration 
Previous injury 
Extensive time off work 
Co-morbidities 
Previous shoulder pain 
Activity avoidance 
High BMI
Job satisfaction 
Poor social support
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6
Q

Imaging options for shoulder conditions

A

X-ray - OA and impingement
US - rotator cuff, LHB, bursa
MRI - rotator cuff
Arthrography- labrum, bony bankart-lesion, Hill-sachs lesion

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7
Q

4 phases of adhesive capsulitis

A
  1. Sharp pain at EOR, achy pain at rest and sleep disturbances
  2. Freezing- severe pain, early loss of ER
  3. Frozen - pain and loss of ROM
  4. Thawing- resolving pain but persistent stiffness
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8
Q

Impingement- primary and secondary causes

A

Primary - structural involvement (AC arthropathy, type 2 or 3 acromion, bone spurs, swelling of soft tissues
Secondary - functional problems (RC weakness, instability, scapular dyskinesias)

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9
Q

Typical presentation of scap dyskinesias

A
  • Lack of upward rotation, external rotation and posterior tilt
  • increased clavicular elevation and retraction
  • scapular asymmetry
  • scapular winging
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10
Q

Management options

A
  • Advice and education
  • Ergonomics
  • Manual therapy
  • taping
  • exercise (strength, motor control, proprioception)
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11
Q

Open and closed packed positions of elbow

A 
Humeral ulnar joint 
- open = 70 flexion 10 supination 
- closed = extension and supination 
Radiohumeral joint 
- open = elbow extension and supination 
-closed = 90 flexion and 5 supination 
Radiohumeral joint 
open - 35 supination and 70 flexion 
closed - 5 supination
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12
Q

Arthrokinematics at elbow + glide

A

flexion - ulna and radius glide anteriorly on humerus (longitudinal and PA)
extension - ulna and radius glide posteriorly on humerus (AP)
pronation - radius medially spins and posterior glides (AP)
supination - radius laterally spins and anteriorly glides (PA)

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13
Q

When are ligaments taut at elbow?

A

Anterior MCL - taut throughout range (first restraint)
Posterior bundle MCL - taut at full flexion
With no MCL - more instability in pronation
Lateral complex is uniform tension throughout range.
With no LCL - more instability in supination

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14
Q

Median nerve pathway and common site of compression at elbow

A

through cubital fossa, compressed at distal humerus under ligament of struthers and in between two heads of pronator teres.

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15
Q

Radial nerve pathway and common site of compression at elbow

A
  • anterior to lateral epicondyle and radiohumeral joint where it divides into superficial branch and PIN. Compression at intramuscular tunnel in supinator (arcade of Frohse)
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16
Q

Ulnar nerve

A

Posterior to medial epicondyle, passing between humeral and ulnar heads of FCU. Compression at cubital tunnel if valgus instability

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17
Q

Acute injuries at elbo

A 
Fracture or dislocation 
MCL rupture 
Tendon strain or rupture 
Joint overload 
Bursitis
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18
Q

Chronic injuries at elbow

A 
Tendinopathy 
Chronic instability 
Neural entrapment 
Joint overload 
Stress fracture 
Referred pain 
Bursitis
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19
Q

TDT for lateral tendinopathy

A
  • PA on radial head

- Lateral glide at radiohumeral joint

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20
Q

Not to miss conditions at elbow

A

Osteochondritis dissecans

referred pain

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21
Q

Causes of upper limb entrapment neuropathies

A 
infection 
immune-related 
metabolic 
ischaemic 
hereditary 
compression
traumatic 
toxic
22
Q

Positive and negative symptoms of nerve entrapment

A

positive - pain, pins and needles, hyperalgesia and allodynia, spontaneous pain
negative- sensory loss, motor weakness, reduce impulse conduction

23
Q

Clinical features of nerve entrapment

A 
painful sensations (burning, deep ache, cramping, parasthesia)
antalgic postures, AROM and PROM impairments, pain with nerve tension and compression, signs of impulse conduction loss, impairments in surrounding neural tissues.
24
Q

Stages of carpal tunnel

A

stage 1:

  • severe pain may be from wrist to shoulder
  • tingling in hands and fingers
  • flick sign relieves symptoms
  • wake up night feeling hand is swollen and then stiff in morning

2

  • symptoms also in day with sustained positions and repeated movements
  • drop things cause they can’t feel fingers

3
sensory symptoms diminish
- aching in thenar eminence
- weakness and atrophy of thenar muscles

25
Q

Classification of wounds

A 
Black = necrotic 
yellow = sloughy tissue 
red = granulation 
pink = epithelium tissue
26
Q

Outcome measures for hand

A

DASH
PRWE
VAS

27
Q

How can you describe a wound

A
  • tidy (clean surgical incision)
  • untidy (loss of tissue +/- soft tissue coverage)
  • type of closure (primary, delayed primary, secondary intention, closure)
28
Q

What is total active motion of fingers?

A

Flexion at MCP + IPs - any loss of extension. Actively. TPM is same but passive

29
Q

Treatment of oedema

A

pressure (coban, glove, tubigrip)

effleurage (pat the cat_

30
Q

What can cause stiffness in hand?

A

Oedema
Immobilisation
Scarring

31
Q

General treatment principles in hand

A
  • Wound management
  • Oedema control
  • therapeutic exercise and manual therapy
  • Splinting
  • Scar management
  • Sensory re-education
  • functional use
32
Q

Strength of repair timeline

A

1-20 days depends on type of surger
1-10 = strength decreases (worst at day 5)
3-6 weeks = strength increases
12 weeks = full strength

33
Q

What will influence post op management of hand?

A
  • type of surgery and what was injured in surgery
  • surgeon’s preference
  • condition of tendon
  • any other injuries
  • rate and quality of scar
  • patient age, general health and social influences
34
Q

Treatment aims in hand management

A
  • restore maximal tendon gliding without adhesions
  • prevent contractures
  • maintain full ROM of uninvolved joints
  • return to previous level of function
35
Q

Tendon gliding exercises

A

Fist (maximum FDP)
Straight fist (maximum FDS)
Hook (maximum differential glide (more FDP than FDS)

36
Q

Management of crush injury

A
  • oedema control
  • pain management
  • manage stiffness (exercise, heat, splintage)
  • gradual strength and endurance
37
Q

Management of amputations

A
  • wound management
  • oedema control
  • stump shaping
  • hand and finger ROM
  • scar management
  • desensitisation
  • functional use
  • psychological aspect
38
Q

Joint protection principles for rheumatoid arthritis

A
  • respect pain
  • use larger joints if possible
  • distribute load
  • avoid deforming positions
  • avoid prolonged positions
  • avoid repeated jarring of joints
  • use adaptive equipment
  • balance work and rest
39
Q

Pinch strength alternatives

A

Lateral pinch
Chuck pinch
Tip pinch

40
Q

Test sensation in hand

A
  • 2 point discrimination

Moberg’s pick up test

41
Q

What are the 4 levels of involvement in AHTA

A
  • accredited hand therapist
  • associate
  • affiliate
  • newsletter subscriber
42
Q

Pre-op considerations in hand

A
  • allergies
  • bleeding disorders
  • recent or long term illness
  • psychological illnesses
  • keyloid scars or poor healing
  • explain risks to patient
  • ask about general health
43
Q

Post op considerations in hand

A
  • minimise swelling
  • relieve pain
  • limit immobilisation
  • consider prior injury and what’s been injured in the surgery
44
Q

Aims of splinting?

A
  • protect healing structures
  • facilitate healing structures
  • maintain optimal anatomical position
  • assist weak structures
  • restrict/control movement
  • improve/promote ROM
  • promote function
45
Q

POSI?

A

25 wrist extension, 60 MCP flexion, 10 PIP flexion, 5 DIP flexion
- facilitates veinous drainage, minimises stiffness of collateral ligaments, maintains balance of long F, E and intrinsics

46
Q

When to use which splints in healing process

A

Inflammatory - static, serial static, static progressive (at end)
proliferative - serial static, static progressive, dynamic
remodelling - serial static, static progressive

47
Q

Classification of splints

A

Immobilisation - static splint
mobilisation - dynamic, serial static, static progressive.
Restrictive- static and dynamic

48
Q

Arch system of hand

A
  • longitudinal (flexion of MCP, IPs)
  • proximal transverse (fulcrum for wrist and long flexors)
  • distal transverse (through MC head)
49
Q

What is dual obliquity?

A

the length of 2nd to 5th MC gradually decrease- need to consider when making splint

50
Q

Considerations when splinting

A
  • leverage
  • fit/comfort
  • strength
  • pressure areas
  • skin
  • bony prominences
  • friction
  • oedema
  • circulation/sensory loss
  • convenience
  • is it only restricting the things that need to be
51
Q

PROCESS of splinting

A
  • pattern
    -refine pattern
    -options for material
    -cut and heat
  • evaluate fit when moulding
  • strapping and components
    -splint finishing touches
    evaluate if it worked and explain to the patient.
52
Q

Go over materials for splinting and pros and cons for them i

A

notes

PHTY3120 (1 decks)

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