Wrist And Hand - Manual Therapy

Question 1

Nerve healing acute injury

Answer 1

12-48 hours wallergian degeneration
48-72 hours axons break into twisted fragments - macrophages and Schwann cells present
2 weeks - all traces of axons are lost

Question 2

Nerve healing atonal degeneration phase 1

Answer 2

6-18 mo
Neuro recovers
Atonal growth commences
Axon reaches injured zone

Question 3

Nerve healing axonal regeneration phase 2

Answer 3

6-18 mo
Scar delay
Axon transverse scar tissue at site of injury

Question 4

Nerve healing axonal regeneration phase 3

Answer 4

6-18 mo

Axons propagate beyond site of injury to reach peripheral target

Question 5

Nerve healing axonal regeneration phase 4

Answer 5

6-18 mo

Restoration of normal patterns of conduction

Question 6

DASH

Answer 6

Disabilities of the Arm, Shoulder, and Hand
Outcome measure
-30 item self report
-minimum 27 items must be answered
Higher score is more disabled

Question 7

DASH MDC

Answer 7

12.7

More for research use

Question 8

DASH MCID

Answer 8

15

Clinical significance

Question 9

Symptom severity scale

Answer 9

Specifically for CTS
Higher score means more severe
Not as commonly used

Question 10

Clearing Cspine for all UQ

Answer 10

Spurlings
Neck distraction
ULTTA
Cervical rotation <60 deg

Question 11

Normal scapholunate angle

Answer 11

30-60 deg

Question 12

Scapholunate dorsiflexion instability

Answer 12

> 70 deg

Scapolunate Lig injured

Question 13

Scapholunate palmarflexion instability

Answer 13

<30 deg

Question 14

CTS exam

Answer 14

Neuroscreen
Cspine - cerv radic
Tinnel 
Rule out TOS
ULND
Phalan’s test
Reverse phalans

Question 15

CTS tax

Answer 15

Splint
Avoid forceful grip
Reduce entrapment
Nerve mobility 
Associated impairments

Question 16

Splinting vs sx for CTS

Answer 16

Splinting better at 1 mo
Sx better long term
—-
Splint while waiting for sx

Question 17

Sliding vs tensioning

Answer 17

Sliding has more longitudinal excursion

Sliding less aggressive - uncoupling learnt expectations of pain

Question 18

Sliding more appropriate for

Answer 18

Acute injuries
Post op management
Situations leading to nerve irritation and entrapment 
\: bleeding and inflammation around nerve
Prevention of chronic pain

Question 19

Tensioning

Answer 19

Reduce intraneural swelling
Reduce circulatory compromise
Milking effect - alternating intraneural pressure

Question 20

Movement based vs immobilization in cubital tunnel

Answer 20

Movement based management may be beneficial

Question 21

CTS and manual therapy vs neuro mobe

Answer 21

Pt can benefit from manual treatment
Carpal mobe no better than nueral mobe
Manual therapy better than no therapy

Question 22

Post immobilization for collies fx

Answer 22

Grade III oscillations earlier in intervention = more range and less pain
Sustained stretches later in intervention = more range