Nbcot Ch. 6 & 11

Front 1

Dupuytren's Disease

what happens?

Treatment?

OT Intervention:

1.

2.

3.

4.

5.

6.

Back 1

Fascia of palm and digits becomes thick and contracted, flexion deformities of involved digits*

etiology=unknown

fasciotomy required

OT:

wound care

edema ctrl

extension splint* AT ALL TIMES except ROM and bathing

A/PROM --> strengthening once wounds heal

Scar mgmt

Occupation-based tasks (grasp and release)

Front 2

Skier's Thumb/Gamekeeper's Thumb:

what happens?

etiology/cause:

OT Tx:

1. splint? (how many wks)

2. then?

3. what ax? (a, b)

4. If operated? what is post-op tx?

a. splint for how long

b. then..?

c.

d.

Back 2

Rupture of ulnar collateral ligament of thumb MCP joint

Etiology: fall while skiing

OT:

1. thumb splint 4-6 wks

2. 6 wks: AROM and pinch strength

3. adl ax that focus on opposition** and **pinch strength

4. post-op = thumb splint for 6 wk, then AROM.

8 wks = PROM

10 wks = strengthening

Front 3

CRPS

what happens?

etiology?

sx?

OT Tx?

1.

2.

3.

4.

5.

6.

7.

CONTRAS?

Back 3

vasomotor dysf as result of abnormal reflex

ca be 2/2 fx or surgery, etiol. unknown

sx: pain, edema, discoloration, osteoporosis, sudomotor changes, temp changes, vasomotor instability

OT Tx:

modalities to decrease pain

2. edema mgmt

3. AROM

4. ADL w/ pain-free active use

5. Stress loading (wt bearing, joint distraction ax--SCRUB/CARRY)

6. splinting

7. self-mgmt encouragemt

Contraindicated: PROM, joint mobs, dynamic splint, cast

Front 4

Colles' Fracture (what is it)

Back 4

fx of distal radius w/ dorsal displacement

Front 5

Smith's fx: what is it?

Back 5

fx of distal radius with volar displacement

Front 6

Boxer's fx?

Back 6

fx of the 5th metacarpal

Front 7

Humerus fx:

etiology:

may result in _______ injuries

or damage to ________ nerve

this is the only fx for which tx begins with.. ?

Back 7

fall onto outstretched uE

may be rotator cuff injuries

radial nerve -->wrist drop

only fx for which tx begins with PROM/AAROM

Front 8

OT eval of fx:

1.

2.

3.

4.

5.

Back 8

1. hx = mechanism of injury, fx mgmt

2. xrays, MRI, etc.

3. edema

4. pain

5. AROM (NO PROM til doc says OK, exception - humerus fx)

6. Sensation

7. Roles, ADLs

Front 9

OT Tx for fx:

A. Immobilization Phase

1.

2.

3.

B. Mobilization phase

1.

2

3.

4.

5.

Back 9

Immob:

1. AROM of joints above/below stabilized part

2. control edema-massage, compression, elev.

3. light ADL/role ax w/ no resistance

Mob:

1. edema ctrl (contrast baths), elevation, massage

2. AROM

3. 4-8 wks: PROM (*cept humerus)

4. pain mgmt: positioning, PAMS

5. strengthening: begin with isometrics**

Front 10

de Quervain's

1. What happens/where?

2. sx?

3. What test?

4. OT Tx (cons):

-

-

-

-

5. OT Tx (post-op)

1. 0-2 wks:

2. 2-6 wks:

3. 6 wks;

Back 10

1. pain near snuff box 2/2 tendonitis

positive finklestein's test

cons tx:

-thumb spica splint

-ax/work mod

-ice massage

-gentle AROM

Post-op:

1. thumb spica, gentle AROM

2. 2-6 wks: strengthening, ADL

3. unrestricted

Front 11

Lateral/Medial Epicondylitis Tx:

Back 11

Lateral = tennis elbow, overuse of extensors

Medial = golfer's elbow, overuse of flexors

Tx:

elbow strap/wrist splint

ice and deep friction massage

stretching

ax/work mod

isometric -- > isotonic, eccentric ex

Front 12

Trigger Finger

what is it/cause?

conservative Tx?

1

2

3

4

5

Back 12

1. tendonitis of finger flexors 2/2 overuse

2. Tx:

-hand-based trigger finger splint

-scar massage

-edema ctrl

-tendon gliding

-ax/work mod

Front 13

Kleinert Protocol for Flexor Tendons after Tendon Repair:

a. 0-4 weeks

b. 4-7 weeks

c. 6-8 weeks

d. 8-12 weks

Back 13

a. 0-4: dorsal block splint

Wrist 20-30 degr flexion, MCP 50-60 degr flexion, IPs extended

passive flexion, active extension

b. 4-7 wks: dorsal block splint adjust wrist to neutral

place and hold

flexor tendon gliding ex

scar mgmt

c. 6-8 wks: AROM, differential tendon gliding, occ-based light ax, D/C splint

d. 8-12: strengthening, work, leisure ax

Front 14

Duran protocol for flexor tendons after tendon repair

0-4.5 wk:

b. 4.5-6 wk:

c. 6-8 wk

d. 8-12 wk

Back 14

a. dorsal block splint

passive flexion of PIP and DIP

10 reps/hour

b. 4.5-6 wk: active flex/ext w/in splint

c. tendon glides, scar mgmt, light occ-based ax

d. strengthening, work ax

Front 15

Mallet Finger

Back 15

extensor tendon disruption

Tx: 0-6 wks DIP extension splint

Front 16

Boutonniere deformity

0-4 wks:

4-6 wks:

Back 16

0-4: PIP ext splint, AROM of DIP while in splint

4-6 wk: AROM of DIP, flexion of digits to DPC

Front 17

Zone V, VI, and VII Extensor Tendon Injury Protocol

1.

2.

3.

4.

5.

Back 17

1. 0-2 wk: volar wrist splint; wrist in 20-30 *extension*, MCPs: 0-10 flexion, IP:ext

2. 2-3 wks: shorten splint, flex/ext IP joints

3. 4 wks: begin mcp ACTIVE FLEX/EXT

5 WK: ACTIVE WRIST rom, SPLINT B/T SESSIONS

6 WKS: d/c splint

Front 18

Carpal Tunnel Syndrome

what nerve?

sx:

conservative TX:

1.

2.

3.

4.

post-op tx:

1.

2.

3.

4.

5.

6.

Back 18

median nerve

sx: numbness, tingling of thumb, index, middle, and radial half of ring finger

paresthesias at night

-person c/o dropping things

- + Tinel's sign at wrist, Phalen's sign

- muscle atrophy at thenar eminence

Tx:

1. wrist splint in neutral

2. median nerve glides, tendon glides

3. Ax modification (avoid wrist flexion and repeated finger flexion)

4. ergonomics: approp workstation

Post-op Tx:

1. edema trl

2. AROM*

3. Nerve and tendon glides

4. Sensory re-ed

5. strengthen thenar muscles

6. work/ax mod

Front 19

Pronator Teres Syndrome

what nerve?

Sx:

Conservative Tx:

1.

2.

Post-op Tx:

1.

2.

3.

4.

5.

Back 19

sx: same as CTS, aching pain in prox forearm

+ Tinel's sign at forearm

No night sx

Tx:

1. elbow splint at 90 degr w/ forearm neutral

2. avoid ax w/ repeated pron/supin

Post-op:

1. arom

nerve glides

strength (2 wks post op)

sensory reed

work/ax mod

(same as CTS)

Front 20

Guyon's Canal Injury

what nerve?

Sx?

Conservative tx?

Post op?:

Back 20

Ulnar nerve compression at wrist*

Sx: numbness/tingling in ulnar nerve distr of hand

motor weakness in ulnar nerve- musculature

+ Tinel's sign at Guyon's canal

atrophy of ulnar nerve innervated musculature (digiti minimi, lumbricals, thumb, interossei)

Tx:

wrist splint, ax mod

Post-op: same as always

strengthen-focus on power grip

Front 21

Cubital Tunnel syndrome

what nerve:

Sx:

1.

2. what position brings about pain?

3. what is weak?

4. Tinel's sign where?

5.

Conservative Tx:

1.

2.

3.

Post-op:

Back 21

u. nerve compression at elbow

sx:

1. numb/tingles along ulnar aspect of forearm and hand

2. elbow pain in extreme flexion

3. weak power grip**

4. + Tinel's sign @ elbow

5. atrophy of ulnar nerve muscles : FCU, FDP

Cons Tx:

1. elbow splint

2. elbow pad

3. ax/work mod

Post-op:

same as always..

edema, scar mgmt, AROM/nerve glides, strengthen, mCP flexion splint if clawing noted

Front 22

Radial Nerve Palsy

Sx:

Conservative Tx:

Post-op Tx: when OK to start strengthening?

Back 22

Sx: weak/paralyzed extensors, wrist drop

Conservative:

1. dynamic extension splint

2. work/ax mdo

3. strengthening wrist and finger ext

Post-op:

Strengthen 6-8 wks

Front 23

Median Nerve Laceration

Sx:

Sensory Loss:

1.

2.

3.

Motor Loss (what movements, not muscles):

1.

2.

3.

4.

Motor loss if high lesion above elbow?

loss of flexion of what fingers?

wrist?

What test/sign?

Deformity?

**fUNCTIONAL LOSS:

1.

2.

OT Tx:

1.

2.

3.

4.

5.

Sensory re-ed

Back 23

Sensory loss to:

1. central palm

2. palmar surface of thumb, ind, middle, and radial half of ring finger

3. dorsal index, mid, radial 1/2 of ring

Motor loss:

1. MCP flexion digits II and III

2. opposition

3. thumb ABD

4. flexion of thumb MCP

high lesion:

loss of flexion of tip of index, mid, thumb

radial aspect of wrist

Deformity: ape hand

Test/sign: Benediction Sign (high injury)

FXL LOSS:

1. opposition

2. pinch strength

OT Tx:

Dorsal protection splint, wrist: 30 degr flexion

elbow 90 degr flexion splint if high laceration

A/PROM 2 weeks post-op

Scar mgmt

AROM of wrist at 4 wks

9 wks: strengthening

sensory reed

Front 24

Ulnar Nerve Laceration:

1. sensory loss

1.

2.

2. Motor Loss (low lesion)

1.

2.

3.

4.

(High lesion) Motor:

Deformity:

What + sign/test?

Fxl loss:

OT Intervention

Back 24

Sensory: ulnar aspects palmar and dorsal surfaces

Ulnar 1/2 of ring and little fingers on palmar and dorsal surfaces

Motor (low):

1. adduction and abduction of MCP joints

2. MCP flexion of digits 4 & 5

3. flexion adduction of thumb

4. ABD, opp, and flexion of 5th digit

(high):

1. flexion twd ulnar wrist

2. flexion of ring/little fing DIPs

Claw hand deformity*

flattened metacarpal arch

+ Froment's Sign (laterally pinching paper assessing thumb adductor)

FXL loss:

1. power grip

2. pinch strength

OT Tx:

Same as Median Nerve

Splint: MCP flexion block splint

sensory re-ed

Front 25

Radial Nerve Laceration

Sensory Loss:

1.

2.

Motor loss (low):

1.

2.

3.

Motor Loss (high)

1.

2.

Functional Loss:

1.

2.

Deformity:

Ot Tx:

1.

2.

3.

4.

5.

Back 25

Sensory:

1. med aspect dorsal forearm

2, radial aspect dorsal palm, thumb, index, middle, and radial 1/2 of ring

Motor loss:

1. wrist extension

2. MCP extension

3. thumb extension

(high):

1. if @ axilla, loss of triceps

Fxl:

-can't extend digits to release objects

2. manipulating objs difficult

wrist drop

OT:

dynamic ext splint

ROM

sensory re-ed

home program

activity mod

Front 26

OT Conservative Tx for Rotator Cuff Injuries:

1. avoid what movement?

2. sleeping? what to avoid

3.

4.

5.

Post-op Tx

1.2

.

3.

4.

Back 26

1. ax mod: avoid above sh level ax

2. avoid sleeping w/ arm in adduction and IR

3. decrease pain-positioning, modalities, rest

4. restore pain free ROM

5. strengthen below sh level

6. role-specific

Post-op:

1. 0-6 wk: PROM to begin* (think codman's, get blood flow there), then AAROM

2. ice--> heat

3. 6 wks: strengthen: isometric to isotonic below

sh level

4. ax mod

5. roles

4. ax mod: light ADL/mgful role ax

Front 27

Shoulder Dislocation:

OT Tx:

avoid what position?

Back 27

avoid combined ABD and ER

pain free ADL ax

strengthen rotator cuff

Front 28

Rheumatoid Arthritis

Sx

Common deformities?

Back 28

**Systemic

most commonly smal joints of hands affected

Sx:

Pain, stiffness, limited ROM, fatigue, weight loss, limited ADL status, swelling, deformities

Common deformities:

1. ulnar dev, subluxation of wrist and MCP

2. Boutonniere deformity

3. Swan neck deformity

Front 29

Osteoarthritis

Back 29

Not systemic, but degenerative

commonly affects large wt bearing joints, attacks cartilage

Sx: pain, stiffness, limited ROM, bone spurs

spurs=(Heberden's nodes and Bouchard's nodes)

Front 30

Arthritis Eval:

PROM vs AROM?

muscle strength?

use what to test grip?

use what to measure edema?

Back 30

1. avoid PROM< esp inflamm stage, focus on AROM

2. avoid muscle testing unless doc request

use sphygmomanometer

strength related to fxn

3. ADL/role

pain scales

edema: volumeter or tape measure

Front 31

OT Intervention for Arthritis:

1. Splinting

2. ROM?

3. modalities?

4. Strengthening?

Back 31

Splinting:

a. acute stage=resting hand splints

b. wrist if indicated

c. ulnar drift splint

d. silver ring splints

e. dynamic MCP extension

f. hand base thumb splint

joint protection

energy cons

AROM

heat modalities (avoid during inflam stage)

*paraffin rec.

Avoid strengthening during inflam stage

occ-based

AE

Front 32

Osteogenesis Imperfecta:

Etiology:

Sx:

OT Eval:

OT Tx:

Back 32

genetic, lack of collagen

sx:

malformed bones, loose joints, sclera blue/purple, brittle teeth, hearing loss, respiratory probs, insufficient collagen

Tx:

1. activity adapt, assist device

2. environ mods

3. positioning/spilnting/padding

4. ax to increase muscle strgt

5. wt bearing ax

6. healthy lifestyle

7. caregiver ed

Front 33

Hip Fx OT INtervention

1.

2.

3.

4.

5.

Back 33

1. bed mobility

2. UE strengthening

3. Fxl ambulation/transfers w/ device 2/2 wbearing status

4. practice AE use

5. practice occbased ax

Front 34

forequarter amputation

loss of what bones?

Back 34

clavicle, scapula, and entire UE

Front 35

shoulder disarticulation amp

Back 35

loss of entire UE

Front 36

elbow disarticulation amputation

Back 36

amp of UE distal to the elbow joint

Front 37

wrist disarticulation amputation

Back 37

distal to wrist, loss of entire hand

Front 38

hemipelvectomy amp

Back 38

amp of half pelvis and entire LE

Front 39

Complications 2/2 amputation:

1.

2.

3.

4.

5.

6.

7.

Back 39

1. Neuromas: nerve endings adhered to scar tissue (can be painful/hypersens)

2. skin breakdown

3. phantom limb syndrome: sensation of presence of limb

4. phantom limb pain

5. infection

6. knee flexion contractures in transtib amp

7. psych impairments

Front 40

Preprosthetic Tx:

1.

2.

3.

4.

5.

6.

7.

Back 40

1. change of dominance (R vs. L) ax if needed

2. ROM of uninvolved joints

3. prepare limb

4. desensitization

5. wrapping to shape/shrink residual limb

6. ADL training, ed in skin care

7. supportive counseling

Front 41

Prosthetic Tx:

1.

2.

3.

4.

Back 41

1. fxl training w/ prosthesis--ax of interest (teach pt to analyze task, determine most efficient way to use device; and/or guide pt manually thru motions)

2. don/doffing

3. ^ prosthetic wearing tolerance

4. individualize tx for phys/psych adjustment

Front 42

Tx for LE Amps:

1-7

Back 42

1. wrapping to shape resid limb, decrease swelling

2. desensitization

3. strengthen UE (esp triceps)

4. transfer training, stand pivot

5. ADL training, LE dressing

6. standing tolerance

7. w/c mob