Upper Limb Flashcards
Orthotic aims of erbs palsy (2)
- prevent and reduce deformity
- improve functional position of hand
Shoulder girdle (1)
-help to increase mobility at shoulder joint through changing the position of the shoulder girdle
Elbow joint (3)
Hinge joint
- 2 articulations: humeroradial and humeroulnar
- capsule of elbow joint also includes proximal radioulnar joint
Carpal bones (2)
- 8 short bones
- bound by ligaments forming a compact mass called the carpus
Elbow joint articular surfaces (3)
- pulley shaped trochlea medial side and spherical capitulum on lateral side
- distal articular surfaces are cupped shaped superior surface of head of radius and trochlear notch of ulna
- humeroulnar surfaces (trochlea on humerus and trochlear notch on ulna) form a more stable joint than the humeroradial articular surfaces on the shallow cup on the head of the radius provides little grasp for the capitulum
Describe the elbow joint (4)
- between radius ulna and humerus
- humeroradial and humeroulnar joints
- trochlea of humerus articulates with trochlear notch of ulna
- capitulum on lateral surface of humerus articulates with head of radius
What does sternal end of clavicle articulate with? (2)
- axial skeleton
- at sternoclavicular joint
Injuries of erbs palsy (3)
In many cases are self resolving with full recovery
-80-90% spontaneously recover
No significant recovery in 3 months then surgery
Incidence of erbs palsy (5)
- 1/1000 births downs syndrome
- 2-3/1000 births cp
- 1/3500 boys muscular dystrophy
- 1/1000 births spina bifida
- 3/1000 births erbs palsy
What bones are in the arm (4)
- long bonea
- humerus
- radius
- ulna
Orthoses used in erbs palsy (3)
- dynamic elbow joint
- rachet elbow joint
- custom made sleeping orthoses to stretch out
Movement at acromioclavicular joint (6)
- completely passive
- no muscles connecting bones to bring about movement
- movement occurs when scapula moves
- acromion process can glide forwards and backwards on the clavicle: protraction and retraction
- elevation an depression can occur as the scapula moves upwards and downwards
- there is also some rotation here as the scapula rotates medially and laterally
Movements at the shoulder joint (10)
- flexion, extension, adduction, abduction, medial and lateral rotation and circumduction
- flexion is anterior and medial movement of arm
- extension is return of flexion
- 110degrees flexion and 70degrees extension possible
- incorporating pectoral girdle 180degrees flexion and 90degrees extension achieved
- abduction is anterolateral movement of arm away from midline
- adduction is movement back towards the trunk
- first 25degrees abduction purely at shoulder, rotation of scapula accounts for about 1/3 of movement thereafter
- medial (or internal) rotation and lateral (or external) rotation in horizontal plane about vertical axis possible
- 170degees rotation at shoulder, measured with elbow flexed and arm held close to body - arm and forearm then moved out away from the trunk. The degree of rotation is less in other positions of the arm
Cuff (shoulder) for bpi (4)
- good for c5/c6 onjury who still have hand and elbow function
- many off the shelf designs
- prevents shoulder subluxation and pain
- does not control elbow or hand
Phalanges (4)
- 14
- in fingers
- 2 in thumb/pollex and 3 in other digits
- proximal middle and distal or proximal and distal for thumb
Further treatment pf brachial plexus (5)
- glenohumeral arthrodesis
- transhumeral arthrodesis
- amputation
- bpi pts with fused shoulders make poor users of functional prosthesis
- cosmetic benefit of own arm
Dynamic wilmer elbow orthosis (3(
- sping mechanism counteracts gravity and enables flexing of elbow
- limited movement is sufficient to initiate flexion
- no locking mechanism encorporated
Carpal tunnel syndrome (3)
- repetitive stress to flexor muscle tendons which lie just deep to flexor retinaculum (eg due to prolonged typing at a key board) can cause tendons to become inflammed
- resultant swelling puts pressure on median nerve causing pain known ad carpal tunnel syndrome
- median nerve supplies structures on lateral side of hand so there may be weakness in the thumb muscles (the thenar muscles) and there may also be pins and needles over the thumb and lateral fingers
Ul Patient history (5)
- condition
- dominant hand
- other disabilities
- work, hobbies
- pain
Ul skin condition (6)
- dryness
- moisture
- redness
- scar tissue
- grafts
- open wounds
Ul sensation (3)
- tactile
- temperature
- proprioception
Mobility ul (3)
- rom
- instability: subluxation, dislocation
- spasticity
Ul strength (1)
-oxford mrc scale
Ul assessment (5)
- pt history
- skin condition
- sensation
- mobility
- strength
Pathologies in ulo (5)
- trauma: tendon repairs, nerve damage, burns
- dupuytrens disease
- ra
- tenosynovitis
- upper motor neurone conditions - stroke, cp, sci etc
Aims of ul orthoses (6)
- prevent/reduce pain
- prevent/ reduce contracture
- improve functionality of hand
- reduce scar tissue
- promote tissue healing
- provide joint stability
Members of ul clinic team (5)
- hand/ul surgeon
- physio
- ot
- nursing staff
- orthotist
Ul fingers (5)
- thumb
- index
- middle
- ring
- little
Categories of ul orthoses (3)
- static
- dynamic
- functional
Static ul orthoses (2)
- most commonly prescribed
- use to: immobilise, support, protect, position parts in their optimum position
Static orthoses principles (3)
- should only immobilise intended joints
- immobilise joints in appropriate position
- should only be used as long as physiologically intended
Static orthoses: principles (1)
-when correcting a contracture, leave a gap between the joint and orthosis- allowing the strap to correct the joint
Dynamic orthoses (7)
Encourages and/or assists motion usually with elastic bands or springs Used to: -correct muscle imbalance -prevent and/or correct deformity -improve rom -offer resistance for active exercise -assist or substitute for muscle length
Dynamic orthoses principles (5)
- dynamic orthoses work by applying tension to the tissues of a low magnitude over a long period of time to alter the way that tissue is formed
- tension must be low magnitude
- consider adaptation of tissues will alter forces required ie orthosis needs to be easily altered
- mobilising force must be at 90degrees to joint axis of motion
- force must be at 90degrees to segment being immobilised
Functional orthoses (6)
Improves patients ability to actively use upper limb for functional tasks
Combines static and dynamic segments
Examples:
-wrist driven prehension orthosis
-stanmore flail arm orthosis
-hand orthosis which incorporates eating appliances
Functional orthoses principles (2)
- may only be use for specific activities ie not full time wear
- benefits of wearing should outweigh disadvantages eg difficulty donning and doffing
Ul materials (7)
- fabrics
- polypropylene
- polyethylebe
- low temperature thermoplastixs
- carbon fibre
- metals - for finger orthoses
- silicone
Three basic ul who positions (3)
- safe immobilisation to prevent contractures
- function - useful hand positioning
- rest/comfort - relief of pain
Position of safe immobilisation (10)
Wrist at 20-30degrees extension
-to balance the long flexors and extensors
MCP at 80-90degrees flexiob
-to maintain the collateral ligaments at the maximum length
IPs completely straight
-to prevent contracture of the volar plates
Thumb in opposition
-ie abduction and extension preventing web space contracture
Neural ulnar/radial deviation
Neutral pro/supination
Position of function (11)
Wrist at 20-30degrees extension -for stability and provides more powerful grip MCP at 45degrees -balanced stable position where the collateral ligaments are tightened IPs at 5 degrees -muscle balance is achieved Thumb in opposition -to facilitate opposition Web space maintained Neutral ulnar/radial deviation Neutral pro/supination
Position of rest/comfort (8)
Wrist in neutral flexion/extension
-as the wrist extends the carpal bones pack together
Mcps and ips in slight flexiob
Thumb in a comfortable mid position of oppositiob
Neutral of slight ulnar deviation
-to prevent zigzag deformity
Neutral pro/supination
All of these positions will be modified to achieve a pain free hand
Wrist and hand orthoses (3)
Joints rarely used Components for dynamic orthoses: -outriggers -finger loops/slings -pulley system -elastic bands -spring wire Straps- velcro, webbing, bandage, tape
Basic trimlines for who (6)
Distal trimlines -distal palmar crease Proximal trimlines -1/2-2/3 length of forearm Side trimlines -widest part of the arm
Elbow orthoses (3)
Epicondylitis clasps - tennis elbow, golfers elbow
Functional orthosis: often only one joint and side steel is needed
Progressive static/dynamic elbow orthoses for contracture management
Elbow joints (6)
- free motion
- polycentric
- adjustable rom joint
- ratchet joint
- sprung joint
- locking joint
Shoulder orthoses (4)
- slings
- humeral cuff
- aeroplane orthosis
- flail arm orthosis
