Week 7 Flashcards

Question

OT Treatment of Obesity: Education

Answer 1

▪Occupational therapy doesn’t treat obesity; it deals with the effects of obesity. ▪A major concern is education of the client and caregivers, both at home and in the medical settings. ▪Bed positioning and bed mobility ▪Transfers ▪Body mechanics for caregivers ▪Assistive devices for mobility and transfers ▪Energy conservation and work simplification ▪Activity tolerance and monitoring ▪Skin protection and hygiene

Answer 2

▪Occupational therapy practitioners work closely with clients, family, and caregivers to facilitate engagement in ADLs. ▪How can you modify the task, the tools, and the environment for: ▪Bathing ▪Dressing ▪Toileting and toilet hygiene ▪Functional mobility

Answer 3

How can you modify the task, the tools, and the environment for: ▪Meal preparation ▪Home management ▪Community mobility ▪Driving ▪Public transportation ▪Other modes of transportation

Answer 4

ROM PROM MMT pinch gauge

Answer 5

▪Functional test used to incorporate stereognosis or object identification. ▪With the eyes open, the client is asked to pick up 12 common objects while the examiner times the task. The client is then asked to complete the task with vision occluded. Use of the hand is noticed and documented. ▪Although a lack of standardized functional skills assessments to test sensation exists, it is important for OT practitioners to follow standardized procedures within their own clinic.

Answer 6

Choose a handful of common objects such as a nail, a key, paper clip, coin, pen, ect. ▪Have the client ID the objects with eyes occluded

Answer 7

▪Helps “rule out” certain diagnoses, while palpation assists in determining what anatomical structures may be involved. ▪To perform a provocative test, the clinician manipulates the client’s anatomical structures in order to reproduce pain or elicit a certain response. Phalen’s Tinel’s ▪Finkelstein’s

Answer 8

▪Most common soft-tissue mass in the UE ▪Develop on the synovial lining of a joint or tendon sheath ▪Vary in size and are not usually painful ▪Often located on the volar wrist, dorsal wrist, extrinsic extensors, or over the flexor tendon at the level of the proximal phalanx ▪May be associated with osteoarthritis and are surgically removed if they are causing pain and intruding on nearby structures. ▪Clients with ganglion cysts are not usually seen in therapy for conservative treatment, but instead referred to OT after surgery.

Answer 9

also known as Dupuytren’s disease, is progressive contraction of the fascia in the palm of the hand. ▪Causes nodules in the palm that may lead to fixed flexion of the MCP and the PIP joints, making it difficult to extend the fingers ▪Affects any finger in the hand, however it is usually seen in the ring and small fingers.

Answer 10

is limiting function is either a surgical fasciotomy or closed fasciotomy. ▪Clients with Dupuytren’s contracture are not seen in therapy for conservative treatment, however are referred to OT after an open or closed fasciotomy. ▪Treatment includes a custom extension orthosis, suture care, scar management, ROM exercises, and progression to strengthening exercises to regain functional use of the hand. ▪Collagen injection; highly expensive ▪Steroid for pain; non curative

Answer 11

Tenosynovitis occurs in the first dorsal compartment over the radial side of the wrist and hand where the tendons of the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB) are located. ▪ Occurs from thickening and narrowing of the first compartment tunnel or may occur along with inflammation and degeneration of the APL and EPB tendons ▪Seen most often in women and may be a result of repetitive thumb abduction and wrist ulnar deviation. ▪Pain, Swelling at Radial Styloid

Answer 12

rest of the APL and EPB tendons in an orthosis along with activity modification and client education. ▪Cessation of exacerbating activities ▪ Modalities may be used to decrease pain, and AROM exercises are initiated once pain has subsided. ▪ Some clients will require a surgical release of the first dorsal compartment in order to alleviate symptoms. ▪Helps open things up so the tendon can glide ▪After surgery, therapy includes a custom orthosis for postsurgical positioning, AROM with tendon gliding exercises, scar management within a few days

Answer 13

▪Tenosynovitis of the flexor tendons at the level of the A1 pulley (at the volar plate at the MCP joint) in the palm is called a trigger finger. ▪Tendons can get stuck due to decreased space; often to inflammation and thickening. ▪Consider how a fishing pool operates if there is debris. ▪Characterized as a finger that, once flexed, will lock into position and be difficult to straighten. ▪Can be painful and may be associated with a palpable nodule in the palm. ▪ Risk factors include repetitive gripping, diabetes, arthritis, or an associated injury to the palm. ▪Trigger fingers are seen most often in females.

Answer 14

If a trigger finger is left untreated, it may lead to significant joint stiffness. ▪Conservative measures ▪Rest ▪Tendon Gliding exercises ▪Steroid Injections ▪Positional orthosis to block full flexion of the affected digit(s) ▪Client education and activity modification ▪ Surgery

Answer 15

▪Usually the result of an injury or accident and will always require surgical repair to improve function

Answer 16

▪Tears or rupture ▪Almost always requires surgery and a period of immobilization ▪12 Weeks ▪Regaining finger motion after flexor tendon injury and repair remains one of the biggest challenges in hand surgery. ▪Categorized by zone, with zone I at the level of the fingertip and zone V at wrist level, with the thumb having its own zones. ▪Surgical repair is categorized by zone to assist in identifying what other structures may be involved.

Answer 17

▪Postsurgical treatment of flexor tendon repairs includes protection in a custom dorsal blocking orthosis, suture care, and the initiation of protected motion as prescribed by the surgeon. ▪The goals of therapy are to protect the healing tendon, prevent adhesions, and promote tendon glide. ▪Although recent research advocates for early mobilization protocols after flexor tendon repairs, flexor tendon injuries still may result in stiffness, scarring, and loss of function.

Answer 18

▪Passively flex and Passive Extend for Early Mobilization ▪4-6 Weeks ▪Tendon Gliding Exercises to prevent contractures and adhesions ▪Place and Hold exercises ▪6-8 ▪Continue Program ▪Add occupation tasks ▪Splint discontinued ▪8-12 ▪Strengthening ▪12 and over

Answer 19

▪Passive flexion and Active Extension via a Rubber Band Pulley System during early mobilization ▪4-6 Weeks ▪Tendon Gliding Exercises to prevent contractures and adhesions ▪Place and Hold exercises ▪6-8 ▪Continue Program ▪Add occupation tasks ▪Splint discontinued ▪8-12 ▪Strengthening ▪12 and over

Answer 20

▪Similar to Flexor Tendon Injury Causations ▪Also categorized by zone, with zone I at the fingertip, zone VII at the wrist, and the thumb having its own zones. ▪Treatment protocols vary by Zone ▪See OT Miri Video ▪Surgical repair of extensor tendons may not be as complicated as repair of the flexor tendons ▪ Intricate anatomy and superficial location over the dorsum of the hand makes them susceptible to scarring and stiffness. ▪Boutonniere deformity

Answer 21

to provide protection and positioning to the healing tendon. ▪Protocols for extensor tendon repairs usually include a period of immobilization to ensure integrity of the healing tendon. ▪Postsurgical treatment includes extension positioning in a custom fabricated orthosis. ▪Due to the balance between the flexor and extensor anatomy, the goals of therapy will be to regain extension before flexion. ▪Treating extensor tendon injuries requires a comprehensive knowledge of anatomy and the principles of tissue healing, and progression through protocols should adhere to these principles

Answer 22

Treatment of fractures varies by location and whether fracture was open or closed and whether it was displaced. For fractures or dislocation of the elbow, wrist or fingers, consider the following: ▪Often treatment includes immobilization, which can include a cast, commercial orthosis, custom orthosis, or buddy taping.

Answer 23

▪One of the most common fractures in the UE. Distal radius fractures are typically the result of a fall on an outstretched hand (FOOSH); however they also occur in a younger population that engages in contact sports. ▪ The physician determines how a distal radius fracture is treated, which may be with a reduction, immobilization in a cast, or with surgery ▪Clients with an ORIF to the distal radius fracture usually begin therapy at two to four weeks after surgery and are fitted with a custom fabricated volar wrist orthosis. ▪Gentle AROM is also initiated at two to four weeks, and activity is progressed as tolerated. ▪Several complications have been documented with treatment of a distal radius fracture including carpal tunnel syndrome, ulnar styloid fractures, and CRPS.

Answer 24

▪Most common to be fractured. ▪The symptoms are swelling and pain in the anatomical snuff box on the radial side of the wrist. ▪Difficult to diagnose as the fracture may not be seen initially on x-ray. ▪Fractures to the proximal portion of the scaphoid take a long time to heal because the blood supply to this area is minimal. ▪Often require surgery with an ORIF and bone graft to repair the broken bone. ▪Therapy intervention for a scaphoid fracture involves a custom thermoplastic thumb spica orthosis for protection.

Answer 25

▪Fifth metacarpal fractures are also known as boxer’s fractures as they usually occur with impact to the metacarpal with a closed fist . ▪Typically heal quickly, and if they are nondisplaced, require two to three weeks of immobilization before beginning ROM exercises. ▪Rotation of the fractured metacarpal can produce scissoring of the fingers when attempting to make a fist, therefore these types of fractures will require surgery to correct the rotational deformity. ▪After surgery, the client will benefit from a custom orthosis to provide protection. ▪Metacarpal fractures should be positioned in MCP joint flexion after injury or surgery to prevent MCP collateral ligament tightness. ▪ As the fracture heals, gentle ROM exercises are initiated, with the

Answer 26

▪The most common fractures in the finger are at the level of the distal phalanx, which accounts for 50% of all hand fractures. ▪ Distal phalanx fractures are often associated with nailbed injuries and are also called tuft fractures. ▪Nondisplaced distal phalanx fractures are positioned in extension in a protective orthosis for three to six weeks. Stable fractures can tolerate gentle AROM at one week. ▪A bony mallet is a distal phalanx fracture that disrupts the extensor tendon along with the fracture, resulting in a fingertip that droops. A bony mallet should be positioned in extension within a custom orthosis for at least six weeks to provide adequate time for the tendon to heal. ▪Distal phalanx fractures that require surgery for proper bone alignment, and to promote healing will benefit from a custom positional orthosis after surgery. When indicated by the physician, a referral to OT will assist in improving motion and regaining functional

Answer 27

▪Fractures of the middle phalanx are less common, however, due to the delicate and intricate anatomy at the PIP joint where the middle phalanx and proximal phalanx meet, treatment of these fractures can be challenging.

Answer 28

▪With a stable fracture, the goals of therapy will be to provide a custom positional orthosis for protection, to decrease inflammation, to decrease pain, and to promote tendon glide and joint ROM. ▪With an unstable fracture or one that requires surgery, a positional orthosis will be provided after surgery.

Answer 29

Stable and nondisplaced fractures can be treated with buddy taping or a custom finger orthosis and are encouraged to begin early active motion as tolerated. ▪Displaced proximal phalanx fractures, or those that require surgery will benefit from a custom fabricated positional orthosis and assistance to limit edema and scarring. ▪Unless otherwise instructed by the physician, the position of safety for the PIP joint, within in an orthosis, should be full extension. ▪To avoid joint contractures and stiffness, gentle AROM exercises, including blocking and tendon gliding, should be encouraged as soon as the physician indicates. ▪Complications seen in the treatment of finger fractures include joint contracture, loss of finger extension, infections, stiffness, and CRPS.

Answer 30

▪Many athletes have heard the expression “jammed finger”, but what may appear to be a simple jammed finger is often a dislocation at the PIP joint, and when left untreated, results in stiffness, swelling, pain, and the inability to use the hand. ▪ Dislocations in the PIP joint of the finger are either classified as volar dislocations, dorsal dislocations, or lateral dislocations and refer to the position of the bone in relationship to the joint. ▪Dislocations are treated similar to fractures, as joint stability is the main goal.

Answer 31

the ulnar collateral ligament (UCL) of the thumb is also known as gamekeeper’s thumb or skier’s thumb. ▪Occurs with radial deviation and hyperextension of the thumb MP joint, which is often the result of a ski injury when the pole twists and hyperextends the thumb. ▪AROM exercises are initiated at 4 weeks post-surgery and progression to normal activities between 6 and 10 weeks. ▪Clients may wear a protective orthosis for return to strenuous activities and sports.

Answer 32

▪One of the most common joints in the hand to develop osteoarthritis is the CMC joint between the trapezium and metacarpal, at the base of the thumb. This is also known as basal joint arthritis. ▪Use of an orthosis provides support and stability, which decreases pain by limiting CMC joint motion, and may even provide a tactile reminder to clients to modify the way they perform activities. ▪Home management will

Answer 33

Mildest form, is usually the result of nerve compression or repetitive stress. Sensory changes may occur, however recovery is expected. Most nerve compression syndromes such as carpal tunnel and cubital tunnel are considered a type of neuropraxia.

Answer 34

More severe and may be the result of a crush or traction injury. With axonotmesis motor loss is expected, and whereas there is the potential for recovery, it may take a long time.

Answer 35

▪ Nerve has either been lacerated or transected and will require surgery in order to improve.

Answer 36

Compression of the median nerve at the level of the wrist is called carpal tunnel syndrome. ▪A laceration or injury to the median nerve will cause loss of sensory and motor function.

Answer 37

▪Compression of the ulnar nerve at the elbow is called cubital tunnel syndrome. ▪Characterized by numbness and tingling in the ring and small fingers ▪The ulnar nerve can also be compressed at Guyon’s canal, which is at the level of the wrist. ▪This condition is not as common as carpal tunnel syndrome however is treated in the same manner.

Answer 38

▪Compression of the radial nerve at the forearm is called radial tunnel syndrome and occurs with repetitive pronation and supination with wrist flexion and extension. ▪Characterized by pain medial to the lateral epicondyle over the extensor muscle mass, however is not associated with sensory loss or muscle weakness. ▪A laceration or injury to the radial nerve will result in sensory loss over the dorsum of the hand and loss of motor function to the wrist extensors and the extensors to the fingers and thumb.

Answer 39

▪Usually seen in combination with other injuries to the hand, such as tendon lacerations and trauma. ▪When injured, not only limit function, but also make it unsafe for a person to handle hot, cold, or sharp objects. ▪ Digital nerves are usually repaired end-to-end, however they may require a nerve graft if they have lost length or if too much tension will be placed on the repair. ▪ Therapy after a digital nerve repair includes a protective orthosis to minimize tension on the repair, scar management, ROM exercises, and sensory reeducation.

Answer 40

▪A common, simple dislocation seen in children is called “nurse-maid’s elbow” and is a result of pulling or swinging a child with an extended elbow. ▪Stable fractures and simple dislocations are treated with a period of immobilization, often in a hinged orthosis that allows for early controlled motion. ▪More complex fractures may require surgical intervention.

Answer 41

▪Characterized by pain and tenderness at the lateral epicondyle, which is the point of insertion of the extensor muscles in the forearm. ▪Pain is present with the combined motions of gripping, wrist extension, and elbow extension. ▪Lateral epicondylitis is also known as tennis elbow; however, most clients who present with this condition do not play tennis.

Answer 42

▪Affects the medial side of the elbow at the insertion of the flexor and pronator musculature. ▪Medial epicondylitis, also known as golfer’s elbow, is characterized by pain in the elbow and wrist on the inside of the forearm with the combined movements of gripping and wrist flexion.

Answer 43

▪ Edema and pain management ▪ ADL training, ▪Orthotics ▪Client Education on Activity Modification

Answer 44

CRPS, previously known as reflex sympathetic dystrophy (RSD), is a chronic pain syndrome that develops either in the upper or lower extremity ▪Characterized by swelling; stiffness; burning pain; hypersensitivity to cold; changes in skin color; hair and nail growth; and a loss of functional use of the extremity. ▪ CRPS symptoms may vary in severity, go away on their own, or last for months.

Answer 45

Type I ▪Most common, is a result of an illness or injury that did not involve a nerve. ▪Type II ▪ Also called causalgia, is the result of an injury to a nerve.

Answer 46

▪Minimize the pain and to decrease edema while improving functional ROM. ▪Decreasing the client’s pain, and not contributing to an increase in pain, is very important when treating CRPS. ▪The client with CRPS will also require encouragement to use the affected extremity, and therapy should incorporate bilateral hand use, use of the hand for self-care activities, and weight-bearing for motor relearning. ▪Graded motor imagery, sensory reeducation, and orthotic intervention and modalities are all helpful in managing the symptoms of CRPS. ▪ The client with CRPS will benefit from the support of a multidisciplinary team in order to address the physical and psychosocial components of this frustrating and painful condition.

Answer 47

▪In the second phase of wound healing, inflammation becomes a problem when it does not resolve. ▪ During the maturation phase of wound healing, inflammation that has not resolved is considered a chronic condition, and would then be considered edema.

Answer 48

▪Result of mechanical dysfunction within the lymphatic system and is categorized as either primary or secondary. ▪Lymphedema can be minimal to severe and will affect the skin, mobility within joints, and hand function. ▪ Its treatment includes manual lymph drainage (which is a massage-like technique), compression bandaging and transition to a compressive garment, exercises, and Manual Edema Mobilization and retrograde massage.

Answer 49

▪Treatment may involve similar activities for both hypo- and hypersensation. ▪Sensory reeducation ▪Mirror visual feedback ▪Protection/injury prevention ▪Desensitization ▪Immersion, textures, vibration

Answer 50

▪There are many areas of education important to the client with a hand injury and his/her family, caregiver, and even employers: ▪PAM’s (to be revisited in another lecture) ▪Ergonomics ▪Joint protection ▪Use of adaptive equipment ▪Activity and lifestyle modification