Week 9 Terms: UE Orthopedics, Burns, and Wound Healing Flashcards
Codman’s Pendulum Exercises
Therapeutic exercise for the shoulder joint in which the client bends forward at the waist with the arm perpendicular to the floor, then rocks the body side-to-side allowing the relaxed arm to freely move in a clockwise and counterclockwise direction
Controlled Range of Motion
active or passive movement within a predetermined safe arc. (middle of range gradually upgraded toward the full arc as healing occurs)
Scapular Plane
Midpoint between shoulder flexion and abduction; majority of functional activities occur in this plane
Shoulder Immobilizer
An orthopedic appliance that maintains the arm against the body in a slightly abducted and internally rotated position
Trendeleburg Gait
ambulation pattern that results from weakened gluteus medius; client lurches toward the injured side to place center of gravity over the hip; characterized by dropping of the pelvis on the unaffected side at heel strike of the affected foot.
Volkmann’s Ischemia
deformity of the hand, fingers, and wrist caused by injury to the muscles of the forearm
ORIF
Open Reduction Internal Fixation
Colle’s Fracture
complete fracture of the distal radius at the wrist with dorsal displacement
Cole waves at you
Smith’s Fracture
complete fracture of the distal radius with palmar displacement
Barton’s Fracture
Fracture of the lip of the distal radius
Impingement
compression of soft tissue between the ends of two or more bones
Subluxation
the partial displacement of a bone from its joint
Finkelstein’s Test
If positive, Indicates de Quervain’s tenosynovitis. Grasp the thumb against the palm and then move the wrist toward the midline in the ulnar deviation
Brachial Plexus
network of interlacing nerves found in the upper arm area
Originating from C5-T1
Forearm & Hand Nerves; Median, Ulnar, Radial
Shoulder Distocia
delayed or difficult birth of the fetal shoulders after the head is born
Waiter’s Tip
- lateral rotators of the shoulder, arm flexors & hand extensor muscles
- arm hanging by the side, rotated medially
- forearm extended and pronated
- wrist flexed
Erb’s Palsy
Claw Deformity
Position of MP hyperextension and PIP flexion associated with muscle imbalance in ulnar-innervated structures.
Wartenberg’s Sign
fifth finger held abducted from the fourth finger
Froment’s Sign
flexion of the IP of the thumb when a lateral pinch is attempted
Think Ok sign with fingers
Crutch Palsy
weakening of forearm, wrist, and hand muscles because of nerve impairment in the axilla caused by incorrectly fitted crutches or poor posture
Swan Neck Deformity
hyperextension of PIP joint and flexion of DIP joint
Boutonniere Deformity
flexion of PIP joint and hyperextension of DIP joint
Dupytren’s Contracture
A gradual thickening and tightening of the fibrous tissue layer (palmar fascia) under the skin in the hand
Restricts tendons from gliding through the sheath
Thermal Burns
caused by contact with open flames, hot liquids or surfaces, or other sources of high heat
Chemical Burns
Damage caused to the skin by chemicals
Radiation Burns
redness and blistering on the surface of the skin or other organs caused by intense exposure to ionizing radiation
Electricity Burns
Burns caused by alternating
Light Burns
burns caused by infrared rays, eclipse light, and laser burns
Frictrion Burn
resulting from harsh rubbing of the skin
Superficial Burn
a burn that involves only the epidermis, the outer layer of the skin; also called a first-degree burn.
Superficial Partial Thickness Burn
Involves the epidermis and the upper portion of the dermis
Deep Partial Thickness Burn
extends into the skin dermis; 2nd degree
Full Thickness Burn
a burn in which all the layers of the skin are damaged; also called a third (or fourth) degree burn.
Hypermetabolism
A higher-than-normal metabolic rate
Escharotomy
Escar is removed and skin grafts or artificial skins are placed
Fasciotomy
A surgical incision through the fascia to relieve tension or pressure
Pruitus
Severe itching
Microstomia
Abnormally small mouth
Tendinopathy
Tendons are not well vascularized = easily damaged
Biomechanical Deficits of Tendinopathy
Symptoms
Muscle Weakness
Decreased ROM
Scar Tissue
Pain w/ AROM, Resistance, Passive Stretch
Tendonitis
Inflammation
Microtears in tendon
Sudden or Heavy Force
Less common than tendinosis; Often wrongly identified
About how long does it take to heal tendonitis?
A. 4 weeks
B. 5 weeks
C. 6 weeks
D. 7 weeks
C. 6 weeks
Tendinosis
NO inflammatory response
Degenerative Changes
Overuse
Collagen needs nourished
Pain can be severe
Significant impact on function
About how long does it take to heal tendinosis?
A. 10 weeks to 10 months
B. 8 weeks to 8 months
C. 6 weeks to 6 months
D. 4 weeks to 4 months?
C. 6 weeks to 6 months
Lateral Epicondylitis
Tennis Elbow
involves the extrinsic extensors of the hand at their origin
Extensor Carp Radialis Brevis is most commonly involved
There is pain in wrist BLANK with lateral epicondylitis (tennis elbow).
There is pain in wrist extension with
lateral epicondylitis (tennis elbow).
Medial Epicondylitis
Golfer’s Elbow
involves the extrinsic flexors at their orgin on the volaar aspect of the medial elbow
Flexor Carpi Radialis most commonly involved
There is pain in wrist BLANK & BLANK with medial epicondylitis (golfer’s elbow).
There is pain in wrist Flexion & Supination with medial epicondylitis (golfer’s elbow).
Treatment for Lateral and Medial Epicondylitis
Rest
Ice
Therapy
NSAIDs
Ergonomics
Cortisone Injection
Occasionally Surgery
Symptoms of DeQuervain’s Tenosynovitis
Pain and swelling along radial side of wrist with gross grasping
Causes of Erb’s Palsy
Common Brachial Plexus Injury
Excessive stretching/tear upper trunk of BP
Shoulder dystocia during childbirth
Waiter’s Tip deformity
* lateral rotators of the shoulder, arm flexors & hand extensor muscles
* arm hanging by the side, rotated medially
* forearm extended and pronated
* wrist flexed
Loss of sensation in the lateral aspect of the forearm
Symptoms of Thoracic Outlet Syndrome
Shoulder & neck pain
Neck muscle spasms
Numbness in fingers
Weak grip
Causes of Thoracic Outlet Syndrome
Trauma
Poor posture
Repetitive injuries esp. above shoulder activity
Anatomical defects (extra rib)
Cubital Tunnel Syndrome
Second most common UE nerve entrapment
Ulnar Nerve Compression
Symptoms of Cubital Tunnel Syndrome
Forearm pain
Tingling/pins and needles
Decreased sensation small & ring fingers
Grip & pinch strength decreased
Common Presentations of Cubital Tunnel Syndrome
Claw Hand
Wartenberg Sign
Froment’s Sign
Radial Nerve Palsy can be caused by…
Compression
Ischemia (loss of blood flow)
Fractures
Wounds
Lesion above the elbow results in…
A. Complete Wrist Drop
B. Sensory Loss
C. Infraspinatus Impingement
D. Both A and B
E. Both B and C
D. Both A and B
Lesion above the elbow results in complete wrist drop & sensory loss
Posterior Interosseous Nerve Syndrome (PINS)
Entrapment at supinator muscle
Below Elbow
Purely Motor
Posterior Interosseous Nerve Syndrome (PINS) is caused by…
Tumors
RA
Fractures
Dislocations
Treatment of PINS
Maintaining PROM
Splinting to prevent deformity & promote function
Surgical decompression, if necessary
True/False
The median nerve provides sensation to radial palm.
True
True/False
The carpal tunnel does not protect the median nerve.
False
The carpal tunnel does protect the median nerve.
Carpal Tunnel Syndrome
Compression of the median nerve under the flexor retinaculum
Caused by swollen or thickened tendons
Symptoms of Carpal Tunnel Syndrome
Pain
Numbness
Tingling in median nerve distribution
Weak thumb flexion and abduction
Treatments for Carpal Tunnel Syndrome
Night Splinting
Steroid Injection
Therapy
Surgery if needed
Risk factors for Carpal Tunnel Syndrome
Not Necessarily Causes
Genetics
more common in people with small wrists
Females > males
Diabetes, rheumatoid arthritis, thyroid disorders
Obesity
Fluid retention as in pregnancy
(usually goes away after baby born)
Working with tools that vibrate
Frequent or prolonged wrist flexion
Extensor Hood
Where finger extensors connect
(Extensor digitorum, lumbricals, interossei)
Extensor digitorum can only extend MP joint by itself
Intrinsics extend the PIPs and DIPs but cannot extend MP joint
Both are needed for full extension of the finger
Symptoms of a Scaphoid Fracture
Tender on palpation at anatomical snuff box
Pain may increase with pinch/grip
FOOSH
Symptoms of a Scaphoid Fracture
Tender on palpation at anatomical snuff box
Pain may increase with pinch/grip
Potential Radial Nerve Compression
Treatment of Scaphoid Fracture
Extended immobilization
Surgery
Therapy to restone decreased ROM and oss of ADL function of the hand
Complex Regional Pain Syndrom (CRPS)
Also known as Reflex Sympathetic Dystrophy
Pain is disproportionate to injury
There are three different types
Any upper extremity injury has the potential to result in CRPS
Complex Regional Pain Syndrome (CRPS)
Symptoms
STAMP
Sensory; allodynia, hypo-/hyperalgesia, hypo-/hyperesthesia
Trophic; skin, hair, nail changes
Autonomic; swelling, edema, sweating
Motor; weakness, contractures, atrophy
Pain
Causes of Compartment Syndrome
Bone fracture/crush injury
Serious bruising
Constricting bandages/cast
Return of blood flow following blockage
Treatment of Compartment Syndrome
Anti-Inflammatory
Movement
Surgery
What happens with compartment syndrome?
Swelling and bleeding can occur in a compartment and can cause increased pressure on nerves and blood vessels
Types of Burns
Causes
Thermal
Chemical
Radiation
Electricity
Light
Friction
Classification of Burns
Severity
Level of cellular injury:
Superficial
Superficial Partial-Thickness
Deep Partial-Thickness
Full-Thickness
Superficial Burn
Burn Classification
Only the epidermis affected
Heal in 7 days
No scar
Superficical Partial
Burn Classification
Epidermis and paprt of the dermis affected
Blister Formation
Heal in 7-12 days
Deep Partial-Thickness
Burn Classification
Epidermis & into dermis affected
White blotches – damaged blood vessels
Often grafted to promote healing
Light touch impaired
Full-Thickness
Burn Classification
Destruction of all skin layers
Waxy/white - adipose tissue visible
No sensation – nerve damage
Must be grafted
Assessment of Burn Area
Rule of Nines
Major burn is defined as a burn covering 25% or more of total body surface area
Why would it be important to know total body surface area that is burned?
Calculating nutritional & fluid requirements
Determining level of acuity
Establishing level of medical treatment needed
Classifying patients for use of standardized protocols
What are the secondary effects of burn injury?
Local and Systemic
Dehydration and edema
Respiratory problems
Increased metabolic needs (while body is trying to heal)
Shock
Pain
Infection
What is a major factor in recovery for burns?
A. Edema
B. Pain
C. Shock
D. Infection
B. Pain
What are some some interventions that can exacerbate pain in someone with a burn injury?
Dressing changes
Debridement
ROM
What does an infected burn look like?
Purulent Exudate (pus)
Blue-Green Color
It will be cultured to determine which microbe
Emergent Phase
Burns
- Immediate: Emergency treatment - 72 hours
clean & cover to prevent infection
inhalation injury
edema develops inside airways
may require intubation - Medically induced coma
facilitate healing
spare pain - Surgeries
Escharotomy
scar is removed & skin grafts or artificial skins placed
graft site – now like a burn since skin has been removed
sometimes happens a couple times
Surgery for severe or extensive burns
Fasciotomy
cutting facia to reduce constriction caused by edema
Surgery for severe or extensive burns
Skin Grafts
Burns
- Skin is taken from person’s own body
- Cadaver or pig skin may be used temporarily
- Person’s own skin cultured in lab for later use
- Grafted skin may be meshed to stretched over larger area
- Biosynthetic “skin” products developing
faster healing, fewer surgeries, less scarring, less infection
Rehabilitation Phase
Burns
- Wound closure through scar maturation
- May be 6 months to 2 years
- Medical treatment
pressure garments
reconstructive surgeries - Therapy
Scar management (measure & fit pressure garments)
Contracture prevention
Patient and family education
Potential Complications
Burns
- Pruritus (itching)
- Microstomia (shrinkage of mouth opening)
- Heterotopic ossification (bone formation where bone doesn’t belong)
- Heat intolerance
*Unable to sweat with split-thickness skin grafts
May sweat a lot in unaffected areas
Vulnerable to overheating. *
