2014 Nbcot Study Cards - Anatomy Of The Hand, Wrist And Arm

Front 1

Intrinsic muscles of the hand innervated by MEDIAN Nerve

Back 1

-Abductor pollicis brevis (palmar Abduction)
-Opponens pollicis (opposition)
-Flexor pollicis brevis (thumb MCP flexion)
-Lumbricals radial side IF & MF (MCP flexion, IP extension)

Front 2

Median nerve damage at the wrist will cause difficulty with:

Back 2

Abduction, opposition & MCP flexion of the thumb
MCP flexion & IP extension of index & middle fingers

*Pinch, 3 jaw chuck

Front 3

Extrinsic flexor hand muscles innervated by the median nerve

Back 3

-(FDS) Flexor digitorum superficialis (PIP flexion)
-(FDP) flexor digitorum profundus (DIP flexion)
-FPL (flexor pollicis longus) (thumb IP flexion)

Front 4

Median Nerve damage at the elbow will cause difficulty with:

Back 4

Finger PIP and DIP flexion, thumb IP flexion

*Hook Grasp

*Fine motor precision

*Gross grasp

Front 5

Intrinsic hand muscles innervated by ulnar nerve

Back 5

* Abductor digiti minimi (little finger ABduction)

* Opponens digiti minimi (Little finger opposition)

* Flexor digiti minimi (Little finger MCP flexion, opposition)

* Adductor (adducts thumb CMC)

* Lumbricals - Ulnar side(LF and RF MCP flexion & IP extension

* Palmar interossei (Digits 2-5 adduction, MCP flexion, IP extension

*Dorsal Interossei (Digits 2-5 ABduction, MCP flexion, IP extension)

Front 6

Extrinsic hand flexors innervated by Ulnar nerve

Back 6

* FDP Flexor digitorum profundus (LF and RF DIP flexion)

Front 7

Extrinsic hand extensors innervated by Radial nerve

Back 7

* EDC Extensor digitorum communis (Extension of MCPs, helps with extension of IPs)

* EDM Extensor digiti minimi (LF MCP extension, helps with IP extension

* EIP Extensor indicis proprius (IF MCP & IP extension)

* EPL Extensor pollicis longus (Thumb IP extension)

* EPB Extensor pollicis brevis (thumb MCP, CMC extension)

* APL ABductor pollicis longus (Thumb CMC abduction & extension)

Front 8

Which wrist extensor crosses two joints?

Back 8

ECRL extensor carpi radialus longus
Radial nerve
*all wrist extensors innervated by radial nerve (ECRB, ECU)

Front 9

If musculocutaneous nerve to UE damaged which muscle could be used for elbow flexion?

Back 9

Brachioradialus is innervated by radial nerve

Biceps & brachialis are elbow flexor innervated by musculocutaneous

Front 10

OT intervention for Dupytren's

Back 10

Post sx wound care & edema control
Extension splint
A/PROM progress to strengthening when wounds are healed
Scar management
Emphasize gripping/flexion & release/extension

Front 11

OT intervention for skiers thumb

Back 11

Conservative: thumb splint 4-6wks, AROM, pinch strengthening 6 wks, ADL requiring opposition & pinch strength

Post op:
Thumb splint 6 wks
AROM
PROM at 8 wks
strengthening at 10 wks

Front 12

What interventions are contraindicated for CRPS?

Back 12

PROM
Passive stretching
Joint mobilization
Dynamic splinting
Casting

Hint 12

Passive and complete immobilization

Front 13

What interventions are contraindicated for CRPS?

Back 13

PROM
Passive stretching
Joint mobilization
Dynamic splinting
Casting

Hint 13

Passive and complete immobilization

Front 14

Indicated interventions for CRPS

Back 14

Modalities to ⬇️ pain
Edema management
AROM to involved joints
ADL to encourage active pain free use
Stress loading (WB & joint distraction)
Splinting to prevent contracture promote engagement
Self management

Hint 14

Pain and Active intervention

Front 15

What splint would you use for a boxers fracture?

Back 15

Ulnar gutter splint

Hint 15

Fracture of the 5th MC

Front 16

Common complication in proximal phalanx fractures

Back 16

A/PROM in PIP
Most common in thumb & index finger

Front 17

Mallet finger

Back 17

Terminal extensor tendon damage associated with Distal phalanx fracture - most common type of finger fracture

Front 18

Elbow fracture with limited FA rotation suggests involvement of the

Back 18

Radial head

Front 19

Wrist drop after humerus fracture suggests

Back 19

Humeral shaft fracture with damage to the radial nerve

Front 20

Elbow fracture with damage to greater tuberosity

Back 20

May result in rotator cuff injury

Front 21

Etiology of humoral fractures

Back 21

Fall on outstretched upper extremity

Front 22

OT evaluation for UE fractures

Back 22

Hx - Mechanism of injury & fracture management
Test results - X-ray, MRI, CT scan
Edema
Pain
AROM
-DO NOT assess PROM & strength until ordered by MD except
-humerus fractures fractures often begin with PROM or AAROM
Sensation
Roles occupations ADL activities related to roles

Front 23

OT evaluation for UE fractures

Back 23

Hx - Mechanism of injury & fracture management
Test results - X-ray, MRI, CT scan
Edema
Pain
AROM
-DO NOT assess PROM & strength until ordered by MD except
-humerus fractures fractures often begin with PROM or AAROM
Sensation
Roles occupations ADL activities related to roles

Front 24

Intervention for UE fractures during immobilization phase

Back 24

Goals are stabilization & healing
-AROM of joints above & below stabilized part
-Edema control
*elevation
*retrograde massage
* compression garments
-light ADL with NO resistance progress as tolerated

Front 25

OT evaluation for UE fractures

Back 25

Hx - Mechanism of injury & fracture management
Test results - X-ray, MRI, CT scan
Edema
Pain
AROM
-DO NOT assess PROM & strength until ordered by MD except
-humerus fractures fractures often begin with PROM or AAROM
Sensation
Roles occupations ADL activities related to roles

Front 26

Intervention for UE fractures during immobilization phase

Back 26

Goals are stabilization & healing
-AROM of joints above & below stabilized part
-Edema control
*elevation
*retrograde massage
* compression garments
-light ADL with NO resistance progress as tolerated

Front 27

Intervention for UE fractures during mobilization phase

Back 27

Consolidation is the goal
-Edema control add contrast baths
-AROM
Progress to PROM with MD approval (4-8 wks) except w/humerus fractures which often begin w/PROM or AAROM
-light purposeful or OB activities
-Pain management: positioning, PAMs
-strengthening
Begin with isometrics w/MD approval

Front 28

Cumulative trauma injury risk factors

Back 28

Repetition
Static position
Awkward postures
Forceful exertions
Vibration

Front 29

Cumulative trauma injury risk factors

Back 29

Repetition
Static position
Awkward postures
Forceful exertions
Vibration

Front 30

Common types of cumulative trauma injuries: De Quervain' s

Back 30

S&S: pain, swelling over radial styloid
Positive finklestein's test

Conservative: Thumb spica splint , activity/work modification, ice massage, gentle AROM of wrist, thumb to prevent stiffness

Post op tx:
*Thumb spica splint
Gentle AROM (0-2 weeks)
*Strengthening, ADL, role activities (2-6 weeks)
*unrestricted activities (6 weeks)

Front 31

Lateral epicondylitis etiology

Back 31

Overuse of wrist extensors especially ECRB
= tennis elbow

Front 32

Lateral epicondylitis etiology

Back 32

Overuse of wrist extensors especially ECRB
= tennis elbow

Front 33

Etiology of medial epicondylitis

Back 33

Overuse of wrist flexors
= golfers elbow

Front 34

Conservative intervention for lateral & medial epicondylitis

Back 34

- Elbow strap, wrist splint
- Ice & deep friction massage
- Stretching
- Activity/ work modification
- add strengthening as pain decreases
*begin with isometric
*progress to isotonic & eccentric

Front 35

Trigger finger conservative treatment

Back 35

-Hand based trigger finger splint (MP extended, IPs free)
-scar massage
-edema control
-tendon gliding
-activity/work modification: avoid repetitive gripping activities & using tools with handles too far apart