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Upper Extremity Orthotics > Week 3 > Flashcards

Week 3 Flashcards

0
Q

Cutaneous inner actions refer to areas innervated by specific peripheral nerves which can contain fibers from ________spinal nerve roots

A

Multiple spinal nerve roots

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1
Q

An area of skin which is innervated by a single spinal nerve?

A

Dermatomes

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2
Q

True or false?
Vast majority of patients with plexus injuries are otherwise healthy unless disabled by pain, generally remain active and are able to carry out ADL’s with the use of one hand?

A

True

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3
Q

What Are the biomechanical principles?

A

To prevent deformity
To correct deformity
Position limb to obtain maximal function
5 degrees of supination

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4
Q

What are some patient considerations?

A

~Most patients Re independent with one hand but bilateral activities should be facilitated
~Device shouldn’t interfere with remains ability
~Device needs to allow independent donning/doffing
~Cost must be considered vs. length of use & potential for benefit

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5
Q

Axillary nerve injury is the loss of active __________________
Sensory loss on lateral side of proximal arm

A

Shoulder abduction and flexion

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6
Q

Orthotic assistance is limited to functional arm support to decrease gravitational pull on the Glenohumeral joint- deltoid and teres minor for what nerve injury?

A

Axillary nerve injury

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7
Q

Due to loss of biceps and brachialis, the patient loses all useful elbow flexor strength and can be compensated if the pronator teres and brachii radialis are well contained is what nerve lesion injury?

A

Musculocutaneous Nerve lesion

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8
Q

Radial nerve lesion is also known as?

A

Wrist drop - loss of extensor muscles

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9
Q

What are the three levels of radial nerve lesion?

A

Below the elbow
Mid-humerus
Axillary level

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10
Q

The finger and thumb Extensors and long thumb abductor loses motor function is what level of radial nerve lesion?

A

Below the elbow

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11
Q

What orthotic treatment is recommended for radial nerve lesion below the elbow?

A

HO or WHO

With IP extension assist (MP extension stop if patient becomes hyper mobile at MP joint)

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12
Q

Wrist extensor paralysis is added to the absence of finger and wrist extensor control which greatly affects grasp and pinch coordination because the finger Flexors cannot contract sufficiently to maintain grasp is what level of radial nerve lesion?

A

Radial nerve lesion mid humerus

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13
Q

What is the orthotic treatment recommendation for radial nerve lesion mid humerus?

A

Static control at the wrist to counteract the effects of gravity and pull of the finger Flexors as they contract
Static WHO

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14
Q

In addition to wrist and hand Extensors, when the lesion occurs at the axillary level, the triceps motor function becomes affected is what level of radial nerve lesion?

A

Radial nerve lesion axillary level

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15
Q

What are the most common mechanisms of injury for radial nerve lesion -axillary level?

A

Poorly fit crutches

Falling asleep with arm over a chair -Saturday night palsy

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16
Q

What are the ulnar nerve lesion levels of involvement?

A

Wrist

Elbow or above

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17
Q

Absent intrinsic muscle action in the ring and little finger and sensory loss of palmar and dorsal aspect of 5th digit and 1/2 of 4th digit is what level of ulnar nerve lesion?

A

Wrist

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18
Q

What is the common mechanism of injury for a ulnar nerve injury -wrist?

A

Is a cut horizontally at the wrist -suicide attempt

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19
Q

Claw hand or ulnar palsy is also referred to as?

A

An intrinsic minus hand

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20
Q

Volkmann’s ischemic contracture occurs when?

A

There is a lack of blood flow (ischemia) to the forearm

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21
Q

For ulnar nerve lesion-wrist the claw hand position of the fingers can be readily corrected with an?

A

Orthotic MP extension stop

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22
Q

The flexor Digitorum profundus muscle (of the 4th and 5th fingers) loses motor function, in addition to the intrinsic hand muscles is what ulnar nerve injury level?

A

Elbow and above

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23
Q

Due to paralysis of the flexor carpi ulnaris, the hand will deviate________ during radiocarpal flexion?

A

Radially

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24
Q

What is the most common mechanism of injury for a ulnar nerve injury of elbow or abov?

A

Fracture of the medial epicondyle of the humerus

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25
Q

What are the two sites of median nerve lesion injury involvement?

A

Wrist

Elbow or above

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26
Q

The __________________ is the absolute pathway for all sensory fibers from critical areas, which also includes the radial side of the index finger

A

Median nerve lesion

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27
Q

The median nerve motor supply include what muscles?

A

The thumb intrinsic muscles and the extrinsic Flexors of the thumb, index and middle finger

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28
Q

Only the thumb intrinsics ( Lumbricals to index and middle finger ) are paralyzed is what median nerve lesion level?

A

Wrist

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29
Q

What is the mechanism of injury for median nerve injury of the wrist?

A

A horizontal cut on the wrist -suicide attempt

Carpal tunnel syndrome

30
Q

For a median nerve injury the patient will present with _________?

A 
Ape hand 
Patient will have sensory loss on the palmAr and dorsal aspects of the: palmar aspect of the thumb 
Index
Middle 
1/2 ring finger
31
Q 
Weakened wrist flexion ( hand will radially deviate) 
Loss of : flexion at digits 1-3 
Pronation 
Thumb abduction 
Thumb opposition
A

Median nerve injury-elbow and above

32
Q

What is the mechanism of injury for median nerve injury of the elbow and above?

A

Due to supra condylar humeral fracture

33
Q

For a median nerve injury of the elbow and above the patient can present with?

A

Ape hand

Hand of benediction - also known as the popes hand

34
Q

Ape hand occurs when the Thenar eminence is __________

A

Flattened

35
Q

Occurs when the patient attempts to make a fist and the index and middle fingers remain extended, while the 4th and 5th fingers flex

A

Hand of benediction

36
Q

What are the 4 types of brachial plexus injuries that occur at birth?

A

Neuroma
Rupture
Avulsion
Neuro praxia

37
Q

What is a neuroma?

A

Nerve root has attempted to heal on its own

The neuroma is the scar tissue that grows around and decreases the signal strength sent to the muscles

38
Q

What is a rupture?

A

Where the nerve is torn but not at the spinal attachment

39
Q

What is an Avulsion?

A

Occurs when the nerve root is torn at the location where it exits (vertebra foramen)

40
Q

What is neuropraxia?

A

Occurs when the nerve is damaged (stretched but not torn)

41
Q

Presents with adducted and internally rotated shoulder, extended elbow and pronated wrist (waiter’s tip” presentation)
Occurs in about 0.7 in1000 births

A

Erb’s palsy

42
Q

What portion of the brachial plexus is affected in Erb’s palsy?

A

Upper portion of the brachial plexus

C5, C6

43
Q

What is the mechanism of injury for Erb’s palsy?

A

In most cases is traction on the plexus during delivery

44
Q

In Erb’s palsy treatment should be deferred for ____ to ______ days, then physical therapy and splinting should be undertaken

A

7 to 10 days

45
Q

Caused by a sudden shoulder abduction motion and loss of ulnar nerve sensory areas

A

Klumpke’s palsy

46
Q

What is the treatment recommendation for klumpke’s palsy?

A

Most patients do well with a WHO

47
Q

What is the portion of the brachial plexus is klumpke’s palsy?

A

Lower segment involvement (loss of hand intrinsic muscles)

C7,8, T1

48
Q

Due to impingement of the ulnar nerve in klumpke’s palsy, patients will present a “__________” and?

A

Claw hand”
Wrist in extreme extension because of the un opposed wrist extensors
Hyperextension of MCP due to loss of hand intrinsic muscles
Flexion of IP joints due to loss of hand intrinsic muscles

49
Q

Patients with C 1-3 Level impairment can perform what ADL’s?

A

Total dependence on caregiver

50
Q

What are some recreational activities can C 1-3 level impairments can do?

A

Discussion groups, spectator sports, reading and painting (by mouth)

51
Q

What is the available movement for C 1-3 Level impairment?

A

Neck control

52
Q

What are some orthotic treatment recommendation for C 1-3 Level Impairment?

A

Positional WHO’s

Resting hand splint

53
Q

Patients with C 4 Level impairment can perform what ADL’s?

A

Total dependence ( may incorporate external power systems

54
Q

What recreational activities can C4 Level impairment can do?

A

Discussion groups, spectator sports, reading and painting (by mouth)

55
Q

What are the available muscles for a C4 Level impairment?

A

Diaphragm and trapezius

56
Q

What are the orthotic treatment recommendations for a C4 Level impairment?

A

Mobile arm support, powered tenodesis WHO and or static WHO

57
Q

Patients with C 5 Level impairment can perform what ADL’s?

A

Can independently feed, groom, and complete light home-keeping duties

58
Q

What recreational activities can C5 level impairment do?

A

Board games, card games, art and crafts

59
Q

What are the available muscles for a C 5 level impairment?

A

Deltoid, biceps, supinator, rotator cuff group, don’t have wrist Extensors

60
Q

What is the orthotic treatment recommendation for a C5 level impairment?

A

Mobile arm support (initially), ratchet WHO or Powered tenodesis WHO

61
Q

Patients with C 6 Level impairment can perform what ADL’s?

A

Can independently feed, grooming, independent transfer and driving (hand control)

62
Q

What recreational activities can C 6 level impairment do?

A

Wheelchair sports, archery, gardening

63
Q

What are the available muscles for C 6 Level impairment?

A

extensor carpi radialis Longus and Brevis
Pronator teres
Pectoralis major

64
Q

What are the orthotic treatment recommendations for C6 level impairment?

A

Wrist driven- WHO

65
Q

Patients with C 7 Level impairment can perform what ADL’s?

A

Total independence and driving car with hand controls

66
Q

What recreational activities can a C7 level impairment do?

A

Wheelchair sports
Archery
Gardening

67
Q

What are the muscles are available for C7 level impairment?

A

Triceps, latissimus dorsi, extensor Digitorum, flexor carpi radialis, flexor Digitorum

68
Q

What are the orthotic treatment recommendations for a C7 level impairment?

A

Wrist driven WHO (initially)

Static WHO

69
Q

Patients with C8-T1 Level impairment can perform what ADL’s?

A

Total independence and driving car with hand controls

70
Q

What recreational activities can C8-T1 impairments do?

A

Wheelchair sports

71
Q

What muscles are available for C8-T1 impairments?

A

Interossei, Lumbricals, Thenar and hypothenar muscles

72
Q

What is the orthotic recommendation for C8-T1 level impairment?

A

HO (initially)

Upper Extremity Orthotics (7 decks)

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