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130 Cards in this Set
- Front
- Back
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Flexor digitorum Superficialis (Sublimis) (FDS)
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o:medial epicondyle
I: middle phalanx (2 slips) fxn: flexion of PIP jts N: median nerve |
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Flexor digitorum Profundus (FDP)
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O: proximal 2/3 of ulna & interosseous membrane
I: distal phalanx fxn: flex of DIP jts to digits 2 & 3 n: median |
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Flexor Pollicis Longus (FPL)
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O: radius, middle 1/3
I: distal phalanx of thumb fxn: flex of IP jt of thumb N: median |
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flexor digitorum protundus
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O: proximal 2/3 of ulna & interosseous membrane
I: distal phalanx fxn: flex of DIP jts to digtis 4 & 5 N: ulnar |
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Extensor Digitorum Communis (EDC)
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O: lateral epicondyle
I: medial band to middle phalanx & lateral band to distal phalanx fxn: ext of MCP jts & contribute to ext of IP jts N: radial |
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Extensor digiti mini (EDM)
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O: lat epicondyle
I: inserts into EDC at MCP level of 5th digit fxn: ext of MCP of 5th digit & contributes to ext of IP jts N: radial nerve |
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Abductor Pollicis Brevis
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O: scaphoid, trapexium, flexor retinaculum & tendon of abductor pollis longus
I: base of proximal phalanx, radial side of thumb fxn: palmar abd N: median |
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Opponens Pollicis
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O: trapezium & flexor retinaculum
I: 1st metacarpal Fxn opposition N: median |
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Flexor Pollicis Brevis (superficial head)
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O: trapezium, trapezoid, capitate & flexor retinaculum
I: base of proximal phalanx, radial side of thumb fxn: thumb MCP flex deep head innervated by ulnar head N: median |
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Lumbricals (radial side)
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O: tendons of flexor digitorium profundus, index & middle finges (radial & palmar sides)
I: radial side of digits 2 &3 into extnsor expansion fxn: MCP flex & ext of IP jts N: median |
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Abductor digiti minimi
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O: pisiform & tendon of flexor capi ulnaris
I: proximal phalanx of the 5th digit fxn: abd of 5th digit N: ulnar |
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Opponens digiti Minimi
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O: hook of hamate & flexor retinaculum
I: 5th metacarpal fxn: opposition of 5th digit N: ulnar |
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Flexor Digiti Minimi
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O: hook of hamate & flexor reticulum
I: proximal phalanx of 5th digit fxn: flex of MCP jt & opposition of 5th digit N: ulnar |
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Lumbricals (ulnar side)
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O: tendons of flexor digitorium profundus for digits 4 & 5
I: radial side of digits 4& 5 into extensor expansion Fxn: MCP flex & ext of IP jts of digits 4 & 5 N: ulnar |
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Palmar Interossei
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O: 1st palmar; ulnar surface of 2nd metacarpal
2nd palmar; radial surface of 4th metacapral 3rd palmar; radial survace of 5th metacarpal I: 1st palmar; ulnar surface of 2nd proximal phalanx 2nd palmar; radial surface of 4th proximal phalanx 3rd palmar; radial surface of 5th proximal phalanx fxn: add & assist with MCP flex & ext of IP jts of digits 2-5 N: ulnar |
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Doral Interossei
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O: all 4 muscles arise from adjacent sides of metacarpals
I: proximal phalanx on tthe raqdial aspect of the index, radial & ulnar sides of middle finger & ulnar side of ring finger (into extensor digitorum) fxn: abd & assist with MCP flex & ext of IP jts 2-5 N: ulnar |
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Extensor Indicis Proprius (EIP)
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O: ulna, middle 1/3
I: inserts into EDC at MCP level fxn: ext of MCP jt of 2nd digit & contributes to ext of IP jts N: radial |
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Extensor Pollicis Longus (EPL)
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O: ulna, middle 1/3
I: distal phalanx of thumb fxn: ext of IP jt of thumb N: radial |
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Extensor Pollicis Bravis (EPB)
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O: radius, middle 1/3
I: proximal phalanx of thumb fxn: ext of MCP & CMC jts of thumb N: radial |
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Abductor Pollicis Longus (APL)
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O: middle 1/3 of ulna & radius
I: 1st metacarpal, radial side fxn: abd & ext of CMC jt N: radial |
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Median Nerve wrist flexors
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flexor carpi radialis (FCR): fxn: flex of wrist & radial deviatoin
palmaris longus (PL): fxn: flex of wrist |
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Ulnar Nerve wrist flexors
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flexor carpiulnaris (FCU): fxn: flex of wrist & ulnar deviation
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radial Nerve Wrist Extensors
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extensor carpi radialis brevis (ECRB): fxn: ext of wrist & radial deviation
extensor carpi radials longus (ECRL): fxn: ext of wrist & radial deviation extensor carpi ulnaris (ECU): fxn: ext of wrist & ulnar deviation |
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median nerve volar forearm muscles
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pronator teres : fxn: forearm pronation
pronator quadrates: fxn: forearm pronation |
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Radial Nerve dorsal forearm muscles
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supinator: fxn: forearm supinator
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musculocutaneous elbow muscles
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biceps: fxn- elbow flex with forearm supoination
brachialis: fxn-elbow flex with forearm pronated |
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radial nerve elbow muscles
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brachioradialis: elbow flex with forearm neutral
triceps: elbow ext anconeous: elbow ext |
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subscapular nerve shoulder muscles
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subscapularis: IR
teres major: ext |
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Suprascapular Nerve shoulder muscles
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supraspinatus: abd & flex
infraspinatus: ER |
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musculocutaneous Nerve shoulder muscles
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coracobrachialis: flex
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Axillary Nerve Shoulder muscles
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teres minor: ER
anterior deltoid: flex middle deltoid: abd posterior deltoid: horizonal abd |
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Lateral Pectoral Nerve Shoulder Muscles
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pectoralis major: horizontal add
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Thoracodersal Nerve shoulder muscles
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latissiums dorsi: ext of schoulder, downward roation of scapula
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spinal accessory nerve msucles of scapula (CNXI)
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trapezius: upward rotation
middle also does scapula add upper also does scapula elevation lower also does scapula depression |
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Dorsal Scapular nerve muscles of scapula
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rhomboids: downward rotation
-rhomboid major also does scapula add |
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Long Thoracic Nerve Muscles of Scapula
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serratus anterior: upward rotation, downward roation, abd
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C3-C4 Nerve muscles of Scapula
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levator scapulae: downward rotation, elevation
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Dermatome Distribution
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Dupuytrersis Disease
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fascia of palm & digits becomes thic & contracte, develops cords & bands extending into digits
results in flex deformities of involved digits surgicial release is required OT: wound care, edema control, ext splint, A/PROM, strengthening, scare management, flex & ext act (gripping & releaseing) |
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Skiers thumb (gameskeepers thumb)
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rupture of ulnar collateral ligament of MCP jt of thumb
most common cause is fall with thumb out OT: conservative tx 4-6 wks (ex splinting) AROM & pinch strengthing (6 wks) ADLS requiring opposition & pinch strenght post operative tx: thumb splint for 6 wks, followed by AROM PROM starts at 8 wks strengthening at 10 wks |
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Complex regional pain syndrome (CRPS)
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Type I formeraly called reflex sympathetic dystrophy (RSD)
type II formerly called causalgia vasomotor dysfunction as a result of abnromal relfex can be localied or spread to toher parts of extremity may follow trauma or surgery, but noknow cause symptoms: severe pain, edema, discoloration, osteoporesis, sudomotor changes, tempearature changes, trophic changes & vasomotor instability OT: modalities to decrease pain edema management (elevation, manual edema mobilization, compression glove) AROM ADL to encouage pain-free active use stress loading (wt bearing & jt distractnact (scrubbing & carrying activities)) splinting to prevent contractures encourage self management interventions to avoid or proceed with caution: PROM, passive stretche, jt mobilization, dynamic splinting & casting |
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Colles' fx
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fx of distal radius with dorsal displacement
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Smith's fx
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fx of distal radius with volar displacement
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carpal fx
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most common is scaphoid fx
proximal scaphoid has poor blood supply & may beceome necrotic |
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metacarpal fx
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classified according to location (head, neck, shaft or bone)
common complications is rotational deforminties boxers fx: fx of 5th metacarpal (requires ulnar gutter splint) |
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phalanx fx
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proximal: most common with thumb & index
-common complication is loss of PIP A/PROM middle phalanx: not common distal: most common. May result in mallet finger (involves terminal extensor tendon) |
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Elbow fx
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radial head invovlement may result in limitied rotation of forearm
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humerus fx
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nondisplaced or displaced
humeral shaft fx may cause radial nerve injury resulting wrist drop |
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medical tx of fx
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closed reduction: stabiliation (short arm cast (SAC), long arm cast (LAC), splint sling or fx brace
open reduction internal fixation (ORIF) nails, screws, plaes or wire external fixation arthorodesis: fusion arthroplasty: jt placement OT: during immobiliazation phase: goal of stabilization and healing, AROM just above & below stabilized part, edema control (elevation, retrograde masage, compression garments), light ADL & role activiteis with no resistance, progress as tolerated mobiliation phase: goal of sonsolidation: edema control (elevatin, retrograde massage, contrast baths, compression garments), AROM (PROM upon dr approval pain management 4-8 wks), light purposeful occupation activities, pain management (positioining PAMS) strengthening (begin with isometrics upon dr approval) |
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DeQuervians
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stenosing tenosynovitis of abductor pollicis longus & extensor pollicis brevis
pain & swelling over radial styloid positive Finkelstein's test Tx: thumb spica splint (IP free), act/work modification, ice massage over radial wrist, gentale AROM or wrist & thumb post operative tx: thumb spica splint & gentle AROM (0-2 wks), strengthening, ADL, & role act (2-6 wks), unrestricted act (6wks) |
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lateral & medial epicondylitis
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degeneration of tendon origin as result of repetitive microtrauma
lat epicondylitis: overuse of wrist extensors, esp extensor carpi radialis brevis (tennis elbow) medial: overuse of wrist flexors (golfer's elbow) tx: elbow strap, wrist splint, ice & deep friction massage, stretching, act/work modification, as pain decreases add strengthening (begin with isometric exercises then progress to isotonic & eccentric) |
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Cumulative trauma disorders (CTD) aka: repetitive strain injuries (RSI) overuse syndrome and/or musculoskeleteal disorders
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risk factors: repetition, static position, awkward postures, forceful extenstions & vibration, acute trauma, pregnancy, dm, arthritis & wrist sized shape
most common types: De Quervains, lateral & medial epicondylitis, trigger finger, & nerve compressions |
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Trigger finger
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tenosynotivitis of the finger flexors: most common is the A1 pulley
caused by repetition and the use of tools that are placed too far apart tx: hand based trigger finge splint (MCP extended, IP jts free), scar massage, edema control, tendon gliding, act/work modificaitons (avoid repetitive gripping act, & using tools wtih handles too far apart) |
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Tendon repairs
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OT goals: early mobiliztion (prevents adhesion formation, facilitates wound/tendon healing), increase tendon excuersion, improve strength at repair site, increse jt ROM, prvent adhesions, facilitate resumption of meaningful roles, occupations of act
early mobili\ations programs for flexor tendons= Kleinert & duran protocals most common ealry mobilization programs for extensor tendons= zone 1 & 2, zone 3 & 4, zone 5, 6 & 7 |
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Kleinert
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passive flex using rubber band traction & active ext to hood of the splint
protocol:0-4 wks (early phase): dorsal block splint, wrist is positioned in 20-30 flex, MCP jts in 50-60 flex & IP jts extended. passive flex & active ext w/in limits of splints 4-7 wks (indermediate phase): continue dorsal block splint, but adust the wrist to neurtal place/hold exercises & differential flexor tendon gliding exercises, scare management 6-8 wks: AROM, differntial tendon gliding, light purposeful & occupation-based act. D/C splint 8-12 wks: strenghtening & work & leisure activity |
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Duran
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passive flex & ext of digit
protocol: 0-4 1/2 wks: dorsall blocking splint, exercises splint include passive flexion of PIP jt, DIP jt & to DPC 10 reps every hr 4 1/2-6 wks: active flex & ext w/in limits of splint 6-8 wks: tendon gliding & differential tendon gliding, scar management, & light purposeful & occupation based activity 8-12 wks: strengthening & work activities |
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Zone 1 & 2
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mallet finger deformity
0-6 wks: DIP ext splint |
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Zone 3 & 4
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Boutunniere deformity
0-4 wks: PIP ext splint (DIP free) AROM of DIP while in splint 4-6 wks: begin AROM of DIP & flex of digits to the DPC |
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Zone 5, 6 & 7
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0-2 wks: volar wrist splint with wrist in 20-30 of ext, MCPs in 0.-10 of flex & IP jts in full ext
2-3 wks: shorten splints to allow flex & ext of IP jt 4 wk: remove splin tot begin MCP active flex & ext 5 wks: begin active wrist ROM, wera splint in between exercise session 6 wks: discharge splintq |
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Carpal Tunnel Syndrome (CTS)
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median nerve compression, caused by reptition, awkward postures, vibration, anatmoical anomalities & pregnancy
symptoms: numbness & tingling of the thumb, index, middle & radial 1/2 of ring fingers. Paresthesis usually occurs at NOC, complains of dropping things, positive Tinel's sign at wrist. Positive Phalens sign. Advanced stages result in muscle atrophy of thenar eminence tx: wrist splin in neutral (worn at NOC & during repetitive act of day). Activity modification (avoid extensive wrsit flex, wrist flex with repetitive finger flex & wrist flex with a static grip, median nerve gliding exercises & differential tendon gliding exercises, ergonomics surgical intervention: carpal tunnel release (CTR) post op tx: edema control, AROM, nerve and tendon gliding exdricses, sensory reeducation, strenghting of thenar muscles (usually 6 wks post-op) |
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Pronator Teres Syndrome (proximal volar forearm)
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median nerve compression betwen 2 heads of pronator teres
caused by repetitive pronation & supination & excessive pressure on volar forearm symptoms: aching pain in proximal forearm, numbness & tingling of 1-3 radial 4 digits. Positive Tinel's sign of the forearm, no NOC symptoms tx: elbow splint at 90 with forearm in neutral, avoid act that include repetitive forearm pronation & supination surgical intervention: decompression post-op: AROM, nerve gliding, strenthening (2 wks post-op), sensory reeducaton, work/act modifications |
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Guyans's canal
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ulnar nerve compression at wrist. Caused by repetition, ganglion, pressure & fascia thickening
symptoms: numbness & tingling in ulnar distribution of hand, motor weakness of ulnar nerve-innervated musculature, positive Tinel's sign at Guyans canal. Advanced stages can lead to atrophy of ulnar nerve-innervated musculature in teh hand tx: wrist splint in neurtral, work/act modification surgical intervention: decompression post-op tx: edema control, AROM, nerve gliding, strengthening (2-4 wks) focus on power grip, sensory reeducation |
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Cubital Tunnel Syndrome
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ulnar nerve compression at teh elbow caused by 2nd most common compression; pressure at elbow (leaning on elbow) & extreme elbow flex
symptoms: numbness & tingling, along unlar aspect of forearm & hand. Pain at elbow with extreme position of elbow flex, weakness of power grip, positive Tinel's sign at elbow, Advanced stages lead to atrophy of FCU, FDP to digits 4 m& 5 & ulnar nerve innervated intrinsic muscles of hte hand tx: elbow splint ot prevent positions of extreme flexion (esp NOC), elbow pad to decrease compresson of nerve when leaning on elbows, act/work modifications surgical intervention: decompresson or transposition post-op tx: edema control, scare management, AROM & nerve gliding (2 wks post-op), strengthening (4 wks post-op), MCP flex splint if clawing noted |
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Radial Nerve Palsy
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radial nerve compression, caused by sleeping pattern in position that places stress on raidal nerve, compression as a result of humeral shaft fx
symptoms: weakness or paralysis of extensors to the wrist, MCPs, & thumb; wrist drop tx: dynamic extension splint, work/act modividations, strengthening wirst & finger extensors when motor fxn returns surgical intervetnion: decompression post-op tx: ROM, nerve gliding, strengthening (6-8 wks post-op), ADL & meaningful role act |
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Median Nerve Laceration
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sensory loss: central palm (thumb to radial 1/2 of 3rd digit) palmar surface of 1-3 & radial 1/2 of 4th digit, dorsal surface of 2-3 & radial 1/2 of 4 (middle & distal phalanges)
motor less for low lesion at wrist: lumbricals 1 & 2 MCP flex of digits 2-3), opponens pollicis (opposition), abductor pollicis brevis (abd), flexor pollicis brevis (flex of thumb MCP) motor loss for high lesion at or proximal to the elbow; lumbricals 1 & 2, opponens pollicis, abd pollicis brevis, flexor pollicis brevis, FDP to 2 & 3 digits, FPL (flex of tip of 2,3 & 1 digits), FCR (inabiity to flex to radial aspect of wrist) deformity: flattening of thenar eminance (ape hand, clawing of digist 2-3 for low lesion), benediction sign ofr a high lesion functional loss: loss of tumb opposition, weakness of pinch OT tx: dorsal protection splint with wrist positioniend in 30 flex if low lesion, include elbow 90 flex if high lesion, A/PROM of digits with wrist in flexed (2 wks post-op) scare management, AROM of wrist include edeman if high lesions (4 wks), strengthening at 9 wks splinting: c-bar to preven add contracture sensory reeducation: begin when individual demonstrates diminished protective sensation on semmes's aversion |
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Ulnar nerve laceration
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sensory loss: ulnar aspect of palmar & dorsal surfaces, ulnar 1/2 of ring & little finges on palmar & dorsal surfaces
motor loss: low leison at wrist: palmar & dorsal innterossei (add & abd of MCP jts, blumbricals 3 & 4 (MCP flex of digits 4 & 5), FPB & adductor pollics (flex & add of thumb), ADM, ODM, FDM (abd, opposition & flex of 5th digit) motor loss: high leison wrist or above: plamar & dorsal interossili, lumbricals 3 & 4, FPB & adductor pollicis, ADM, ODM, FDM, FCU (flex towards ulnar wrist) FDP 4&5 digits) deformity: claw hand, flattened metacarpal arch, positive Feramen's sign (assessment of thumb adductor while latreally pinching paper) fxnal loss: loss of pwerfrip, decrease pinch strength OT tx: splinting consideration MCP flex block splint, sensory reeducaiton (begin when individual demonstrates a level of diminished protective sensation on Semme's aversion, dorsal protection splint with wrist positioned in 30 flex, if low lesion, elbow 90 flex if high lesion, A/PROM at digits & wrist flex at 2 wks post-op, scar management, AROM of wrist (4 wks), strengthening (9wks) |
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radial nerve laceration
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sensory loss: high lesion at level of humerus (medial aspect of dorsal forearem, radial aspect of dorsal palm, thumb & index, middle & radial 1/2 of ring phalanges)
motor loss: low lesion, at hte level of the forearm, loss of wrist ext due to absent or impaired innervaton to ECU, EDC, EI, EDM (MCP ext), EPB, EPL, ADL (thumb ex) motor loss: high lesion at level of humerus loss of wrist ext EPB, EPL, ADL, ECRB, ECRL & bracioradialis. If level of axilla, losso of tricep (elbow ext) fxnal loss: inability ot extend digits to release ojects, diferentiaint manipulating objects defomrity: wrist drop OT tx: dynamic extension splint, ROM, sensory reeducation if needed, instruct in home program act modification |
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Rotator Cuff Tendonitis
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impingement at coracocromial arch, Caused by repetitive overuse, curved or hook acomen, weakness of RC, weakness of scapula musculate, ligament & capsule tightness, trauma
OT tx: act modification: avoid above shoulder level act until pain subsides, educate insleepign posture (avoid sleeping with arm over head or combined add & IR), decrease pain (positioning, PAMS, & rest), restore pain free ROM,"", strengthening (below shoulder level), occupaiton & role speciifc training surgery: arthoscope surbery, open repair (small, med, lg & massive tears) OT post-op: PROM (0-6 wks) AROM, decrese pain (begins with ice, progress to heat), strengthening (6 wks post-op) begin with isometrics, progress to isotomic (below shoulder), act modification, light ADL & meaningful roll act, proggress as tolerated, leisure & work act (8-12 wks post-op) |
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Adhesive Capuslities
aka frozen shoulder |
restricted shoulder PROM
glenohumral ligametns & jt capsule caused by inflammation & immobility linked to DM & parkinson's disease OT tx: encourage actie use thorugh ADL & role activities, PROM, PAMs surgery: manipulation, & orthoscopic surgery OT post-op: PROM immediately, pain releive (PAMS) encouarge use of extremity for all ADL & role act |
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Shoulder Dislocation
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anterior dislocation most common
caused by trauma, repetive over use OT tx: regain ROM (avoid combined abd & ER with anterior dislocation), pain free ADL & role act., strengthen RC |
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Boutenniere Deformity
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flex of PIP t, & hyperextsion of DIP jt
-common deformity with arthritis |
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Swan Neck Deformity
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hyperextension of PIP jt & flex of DIP jt
-common with arthritis |
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Heberderis Nodes
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at DIP jts
type of bone spurs with osteoarthritis |
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Bouchord's Nodes
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bone spurs at PIP jt wth osteoarthritis
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osteogenesis imperfecta
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autosomal dominant inherited disorder
signs & symptoms: fx in utero, during birth process in most severe cases, brittle bones that fx easily, multiple fx as child grows, deformities of arms & legs, developmental growth problems, eye abnormalities (ble sclera, cataracts), risk of hearing impairement medical tx: casts & braces, pain management, audiological consultation, act restrictions, secondary to high risk of fx & actual fx occurance OT tx: act interests that can be safely persued, envronmental risk fx activity adpatation & asissitive devices Rx to facilitate safe participation during occupations, envrironmentalmodifications to maintain safety, preventative positioning & protective splinting, padding, act to increase mscule strength, wt bearing act, to facilitate bone growth, family caregier & teacher ed regarding proper hadnling, positioning, safety & environmental modifications |
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Types of hip replacements
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total hip jts implant: replaces acetabulum & femoral head
austin Moore: partical hip replacement, replaces femoral head |
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Forequarter
aka interscapulothoracic |
UE amputation
loss of clavicle, scapula & entire UE 0% of UE left |
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Finger Amputation
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amputation of digit (s) at any level
UE amputation |
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wrist disarticulation
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amputation distal to the wrist jt loss of entire hand
UE amputation |
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Below-elbow (BE) long or short
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amputation belwo the elbow at any level of the forearm
very short has 35% forearm short has 55% forearm long has up to 100% forearm UE amputation |
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Elbow Disarticulation
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amputation of UE distal to the elbow jt
90-100% of upperarm left |
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Above elbow (AE) (long or short)
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amputation avove the elbow of any level on the upperarm
long has 30% of upper arm left short has 50% of upper arm left |
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shoulder disarticulation
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loss of entire UE
0% of limb left |
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hemipelvectomy
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amputation of 1/2 of pelvis & entire LE
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Hip disarticulation
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amputation at teh hip jt loss of entire LE
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above knee amputation (transfemoral)
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amputation above knee at any level on the thigh
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knee disarticulation
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amputation at the knee jt
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below knee amputation (transtibial)
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amputation below knee at any level on the calf (most common)
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Complete Torsal
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amputation at the knee
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Partial torsal
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amputation of metatarsals & phalanges
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Complete phalanges
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amputation of toe(s)
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Voluntary Opening (VO) terminal device
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hood remains closed until tension is placed on cable & then it opens
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Voluntary closing (VC) terminal device
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hook remains opened until tension placed on cable then it closes
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cosmetic device terminal disease
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minimal fxn
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amputation complications
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neuromas (nerve endings adhered to scar tissue)
skin breakdown phantom limb syndrome phantom limb pain infection knee flexion contractures intranstisal amputation pscyhological impairement due to shock/grief |
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amputation OT tx preprosthetic
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if needed change of dominance act
]ROM of uninvolved jts prepare limbs for prostheses desenensilization wrapping to shape & shrink residual limb (wrap distal to proximal tension should decrese with proximal wrapping) ADL training supportive counseling to facilitate adjustment individualizsed tx to enhance physical & phsycholoical adjustment |
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OT amputation prosthetic tx
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fxnal training with prostheses (practice engagement in act of interest & occupational role act)
donning & doffing the prosthesis increase prosthetic wearing tolerance individualize tx to enhance physical & psychological adjustment |
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OT for LE amputation
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wrapping to shape residual limb & decrease swelling
desensilization strengthening (UE) with focus on triceps xfer training; LE dressing most difficult standing tolerance wc mobility |
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hooks VO (body powered)
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cosmetically unfavorable
pinch force: 1 lb rubber band, more rubber bands yield stronger grip but require more effort ot open prehension pattern: presice, exact pinch wt: lighter than hands; Al to stainless stell; 3-8.7 oz durabiity: durable, stainless stell is strongest reliablity: very good, requires min service feedback: some proprioceptive feedback form tension on hands & limbs in socket when operating TD/elbow base of use: effort increase with more rubber bands use in various planes: difficult for high planes visibility of items grasped: very good cost lowest |
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VC TRS Grip body power
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cosmetics: unfavorable
pinch force: controlled strong grip >40# dependenton force exerted on cable pretension pattern: pinch more precise than hand, less than hook wt: Al, polyner stainless teel 4- 16 oz reliability: very good, requires min sevice feedback: bette proprioceptive feedback, as tension on cable must be maintained for sustained grasp ease of use: more effort to sustain grasp, lock avaliable use in various planes: difficult for high planes visiblity of items grasped: good, less than VO cost: higher than hook, less than hand |
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Hands (external power)
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cosmesis: favorable
pinch force: strong grip, 22#, may have propertivial contrest prohension patter: cylindrical gasp, 3 pt pinch; configuration same as BP hand wt: heavy 16 oz durability: not durable, delicate inner electronics & glove reliability: good if not used for rugged act feedback: some feedback through intensity of msucle contraction, particualry for proportional control ease of use: low effort to activitate use in various planes: very good for transrodial amputation visibility of item grasped: poor for small items cost: highest cost |
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hands VO (body power)
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cosmesis: favorable
pinch force: pinch stronger than VO hook but weaker than external powered TD), relies on internal spring, adjustable prehension pattern: cylindrical grasp, 3 point pinch, configeration same as external pwered hand wt: heavy 10.5-14 oz durability: not durable, delicate inner spring mechanism & glove feedback: feedback similar to VO hook ease of use: more effort ot open, an relax for grasp use in various planes: similar to VO hook/hand b/c of harness) visibility of items grasped: poor for smaller items cost: higher than hook, lowered than externally powered hand |
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Greifer (external power)
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cosmesis: unfavorable
pinch force: stgrong pinch 32# prehension patter: precise pinch cylndrical grasp wt: heavy 19 oz durability: durable & rugged reliablity: very good feedback: some feedack through intensity of muscle contraction, particularly for preportional control ease of use: low effort to activate use in various planes: very good for fransadral amputation visibility of items grasped: poor for small items cost: highest cost |
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Terminal device control training
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movement: humeral flex with scapular abd (protraction) on side of amputation, bilateral scapular abd for midline use of TC or when strenth is limited
intervention: manually guide pt through motions, for transhemoral prostheses, keep elbow unit locked in 90 flex, teach TD control first |
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wrist unit for practice controls training
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move; rotate td to supination, midposition or pronation. For unilateral amputation, pt uses sound hand to rotate TD, for bilaeral amputation rotate TD against stationalry object, btwn knees or with contralateral TD
intervention: have pt analyze the task & determine the most efficeint approach for grasp avoiding excessive or awkaward movements. Ex: TD in midposition for carrying a toy in pronation for grasping small box from table |
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Elbow unit practice controls traiing
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movement: depress arm while extending & abducting humerus to lock or unlock elbow mechanism. Practice flexing & locking elbow in several planes
intervention: manually guide pt through motions. Begin with elbow unlocked pt listens for click as lock activation. Hav pt exagerate movemetns initially use a mirror. Use humeral flex to flex elbow go beyond desired ht since the armwill drop with gravity pull as pt is in process of locking the elbow unit |
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Turntable practice controls training
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movement: rotate elbow turntable toward or away form body using sound hand with bilateral amputations, push or pull against stationary object to rotate
intervention: teach pt to analyze task to determine need to use this component more efficiency |
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superficial burn (1st degree)
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epidermis only
minimal pain & edema no blisters healing time: 3-7 days |
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superficial partial thickness burn (2nd degree)
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epidermis & upper dermis (ie sunburn), appears red, blistering, wet, painful, no grafting necessary, heals on its own.
healing time: 7-21 days eval: occupational profile, ROM, 72 hrs post-op, sensation, when wounds are healed, strength, ADL & meaninful role act ASAP Interention: wounds care & debridement, sterile whirl-pool, dressing changes, gentle AROM & PROM to individuals tolerance, edema control; splinting, if needed, ADL & role act |
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deep partial thickness burn
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deep 2nd degree burn (epidermis & dermis), hair follicles, sweat glands, appears red & elastic. Sensation potentila to convert to full thickenss burn due to infection, healing time 21-35 days
eval: occupational profile, ROM (72 hrs post-op), sensation (when wounds are healed), strength (when wounds are healed), AROM & meaninful role act as soon as possible intervention: wound care & debridement, sterile, whirl-pool, & dressing changes, gentle A/PROM as tolerated, edema control, splinting, occupational role act & ADL strenghtening when wounds are healed |
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Full thicknes burn (3rd degree)
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involes epidermis & dermis, hair follicles, sweat glands, & nerve endings, appears while, waxy, leathery & non-elastic. Sensation absent, requires skin graft, hypertrophic scare, healing time can take months
eval: ROM (5-7 days post-op), occupational profile, sensation (when wounds healed), strength (when wounds healed), ADL & meaninful role act ASAP Post-op intervention: 72 hrs (dressing cahnges, splint at all times) 5-7 days: begin AROM, light ADL & meaninful act, sterile whirlpool 7 + days: PROM as tolerated, ADL & meaninful act when wounds healed use masage order compression garmetns provide otoform/ elastoner inserts strengthening |
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Fourth degree burn
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involes fat, muscle & bone
electrical burn: destruction of nerve along pathway |
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fxnal assessments of pain
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McGill Pain Questionnaire
Pain disability Index Fxnal interference estimate |
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Rule of nines
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groin: 1%
arms & head: 9% each legs: 18% each torso: 36% |
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Burns to hand splints
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wrist in 20-30 ext
MCP jt in 50-70 flex IP jts in full ext thumb abd & ext |
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Volar surface Hnad burn splint with flexion contracture
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palmar ext spling
wrist in 0-30 ext MCP jts in neutral to slight ext & abd (monitor collateral ligament) IP jts full ext thumb abd & ext |
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Anterior neck anti-contracture posiitoning
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contracture tendency: neck flex
position/splint: remove pillows, use 1/2 mattress to extend the neck, neck ext splint or collar |
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axilla anti-contracture positioning
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contracture tendency: add
position/splint: 120 abd with slight ER, axilla splint or positioing wedges; watch for signs of brachila plexus strain |
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Anterior elbow anti-contracture positioning
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contracture tendency: flex
position/splint: elbow ext splint in 5-10 flex |
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dorsal wrist anti-contracture positioning
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contracure tendency: wrist ext
position/splint: wrist support in neutral |
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volar wrist anit-contracture positioning
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contracture tendency: wrist flex
position/splint: wrist cockup splint in 5-10 flex |
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hand dorsal anti-contracture positioing
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contracture tendency: claw hadn deformity
posiiton/splint: fxnal hand splint with MP jts 70-90 flex, IP jts fully extended, 1st web open, thumb in opposition |
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hand volar anit-contracture positioning
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contracture tendency: palmar contractur, apping of hand
position/splint: palm exdension splint, MPs in slight hyperextension |
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hip-Anterior anti-contracture positioning
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contracture tendency: hip flex
position/splint: prone posturing, wts on thigh in supine, knee immobilizers |
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knee anti-contracture positioning
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contracture tendency: knee flex
position/splint: knee ext positioning and/or splints prevent ER, which may cause peroxanl nerve compresion |
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foot anit-contracture positioinign
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contracture tendency: foot drop
position/splint: ankle at 90 flex with foot board or splint; watch for signs of heal ulcer |
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web space burn splint
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c-splint
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hypertrophic scar
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most comon with dep 2nd & 3rd degree burns
appears 6-8 wks after wound closure 1-2 yrs to mature compression garments should be worn 24 hrs daily (applied when woudns are healed) recommendation is to wera 24 hrs for 1-2 yrs until scare is matured additional interventsion include ROM, skin care, ADL, role act & pt/family ed |
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myofasial pain
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specific to msucles, tendons or facia
myofasial pain syndrom (MPS) -persistant deep acting pain in muslce nonarticular in origin, characterized by well defined, highly sensitve tender spots (trigger points) |
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Fibromyalgia Syndrome (FMS)
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musculoskeletal pain & fatigue disorder tha can vary in intesity. Widespread pain accompained by tenderness of muscles & adjacent soft tissues. Anonarticular rheuatic disease of uknown origin
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