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47 Cards in this Set

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What are some "person" interventions for injuries at the wrist and hand?
pain management
ROM, stregth
adaptive coping
what are some "occupation" interventions for injuries at the wrist and hand?
adaptive equipment
joint protection techniques
energy conservation techniques
What was Complex Regional Pain Syndrome (CRPS) formally known as?
Reflex Sympathetic Dystrophy (RSD)
DEFINE Complex Regional Pain Syndrome (CRPS)
post tramatic pain accompanied by inappropriate activity and impaired UE function...but NOT fake
DEFINE Type I CRPS
CRPS w/out an identifiable peripheral nerve injury
DEFINE Type II CRPS
CRPS with an identifiable peripheral nerve injury (typically characterized by severe, unrelenting pain/hypersensitivity, which is atypical for injury)
What are common assessments for a patient that has been diagnosed with CRPS?
*multidisciplinary effort
*pain scale
*AROM, PROM (if tolerated)
*Edema, sensitivity
*Sleep, psych reaction
*functional loss and/or compensations
DEFINE stage I CRPS
Acute stage (1-3 weeks)
characterized by:
*soft, puffy edema
*intractable pain
*jhypersensitive
*limited ROM, mm spasm
*hyperthermia
TREATMENT early stage I CRPS
*STATIC/RESTING SPLINT
*edema/pain control; fluidotherapy
*AROM w/in tolerance
*Adapted ADL
*weightbearing and stress loading/carrying program 6-8x a day for 2-3 min each
DEFINE later stage I CRPS
3-6 weeks
*hair and nail growth changes
*sweating
*cold, clammy, cynotic (3 C's)
*Osteoporosis
TREATMENT later stage I CRPS
*same as early stage I but w/ more heat modalities
*progress to DYNAMIC splint, more stretching
*progressive joint mobilization
*weightbearing and stress loading programs cont.
DEFINE stage II CRPS
Dystrophic stage (2-6 mos)
*decrease in pain
*brawny edema
*taut, shiny skin
*sweating, hypersensitivity, cold
*joint stiffness
*fat pad atrophy
TREATMENT stage II CRPS
*PROGRESSIVE splinting
*exercise
*ADL adaptation
*desensitization and pain control
*psych support
*progressive weightbearing and stress loading
DEFINE stage III CRPS
atrophic stage (6-9 mos)
*rare pain
*muscle/bone atrophy
*thickening of fascia
*joint ankylosis
*atrophic, cool, glossy and taut skin w/ less cyanosis
TREATMENT stage III CRPS
*splint to improve fx/prevent deformity
*home unit of e-stim to prevent mm wasting
*extensive home maintenance programs for stretching and exercise
what are common wrist fractures?
Smith's fracture
Colles' fracture
DEFINE smith's fracture
flexion fracture of the radius
DEFINE colles' fracture
extension fracture of the radius
What are some medical management of Distal radial fractures (DRFs)?
closed reduction (cast)
internal/external fixation
-external fixators yield best results
What are some complications of wrist fractures?
*angulation of radius/ulna
*arthritis
*hand contracture and intrinsic tightness
*complex regional pain syndrome (CRPS)
*carpal tunnel syndrome
What are some therapy techniques used when a patient is in a closed reduction or external fixator of wrist fracture?
edema control
finger AROM and gentle PROM
light functional activity
exercise uninvolved joints
What carpal bone is often fractures with carpal fractures?
scaphoid
What is a common MOI for carpal fracutres?
fall on outstretch hand
what are some symptoms of carpal fractures?
prone to avasculat necrosis
point tenderness in snuff box
What are medical management techniques for carpal fractures?
long arm thumb spica cast, then short arm cast for 4-6wks
What are goals for splinting for a closed reduction of the fracture?
splint IS the closed reduction for fracture
-used for "hairline" fracture of ulna
*maximize hand use while protecting fracture
*minimize pain and edema
what are goals for splinting after fracture has healed?
incr fx use of hand
protect wrist due to muscle weakness
improve wrist ROM
What are common splint options for wrist fracture/post wrist fracture?
fracture: static
post wrist fracture:
*serial static
*static progressive (flex, ext, sup, pro)
*dynamic wrist flex/ext
What splint should you use after the immobilization for
DRF?
first 2 wks: wrist cock up splint
then: progressive dynamic splints may be needed to provide low-load prolonged stress
What therapy techniques should be used after the immobilization period for DRF?
AROM/PROM
modalities
occupational adaptation
What are common sites of injury for wrist sprains?
between carpals, carpals/proximal metacarpals, carpals/radio-ulnar joint
What injuries often occur with wrist sprains?
dislocations, fracture, lig tear, tendonitis
How long does a minor sprain with mild pain or swelling take to heal?
2-3wks
What splint should be used for wrist sprains and why?
immobilization w/ removable wrist cock up splint for edema and pain management
DEFINE rheumatoid arthritis
systemic disease that causes synovial proliferation of joints which thickens and destroys articular surfaces & soft tissue supports
**may affect shoulder, elbow, wrist, and finger joints
When should you splint for RA? Why?
splints used during periods of acute inflammation to reduce pain by decreasing joint and lig stress and mm spasms
*may or may not prevent additional deformity
*splint straps should be easy to remove
What splint should you use for RA flare ups? what should the wearing schedule be?
resting hand splint (may seperate fingers to decrease ulnar deviation of MPs)
wear:
day and night during flare up
*remove for exervise every 1-2 hours
What is the mechanism of ulnar drift in patients with RA?
lig weaken around carpals causing proximal row to move radially and distal row to move ulnarly. Therefore causing MPs to drift ulnarly
How can hand splints decrease ulnar drift?
DO NOT correct deformity, just prevent
*help improve fx pinch
*resting pan splint w/ finger dividers to decrease pain, inflammation and ulnar drift
*does not routinely need splinting
What are some rehab considerations for patients with a risk of ulnar drift?
splinting
avoid strong grip/pinch
angle wrists in ulnar direction and pull MPs in radial dir.
finger walk to radial side
maintain passive MP ext and PIP/DIP flex
How are splints used to help with burn healing?
splint used to help promote healing of tissues and prevent deformity caused by tissue shortening and joint contracture
What splint do you use for burns?
resting hand splint (made wide to fint hand/wrist when bandaged)
**use antideformity position to prevent collateral lig, volar plate and wrist capsule contracture
What are some issues you should be aware of when splinting for a burn?
*allow room for bandages or scar management system in splint
*use material that cen be "re-used" to adjust for changes in edema and serial changes to promote more fx position
*position should NOT cause ischemia
DEFINE dupuytren's disease
thickening of palmer fascia; firm nodule under skin--non-painful but limits fx
**usually Ring and little finger flexed at MP and PIP, DIP ext
How is dupuytren's disease treated?
surgically
how do you splint for post surgical dupuytren's disease?
*do NOT put in full ext during inflammatory healing stage
2 weeks: dorsal blocking splint; 24/7 (gentle flexion w/in splint every 2 hours)
7-10 days post: add volar ext splints MP-DIP within the DBS
2.5-3wks post: D/C the DBS, replace with hand based volar extension splint for MP-DIP at night (Tendon gliding and full fist)
What is Dupuytren's contracture therapy?
acute: instruct on edema ande pain management. splinting 24/7 and remove splint hourly for tendon glide ex. and modalities
Post acute: ROM. once wound healed: grip stregth exercises; modalities to minimize scar formation