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275 Cards in this Set
- Front
- Back
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Which intrinsic muscles are innervated by the median nerve?
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Abductor Pollicis Brevis
Opponens Pollicis Flexor Pollicis Brevis: superficial head Lumbricals (radial side) |
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Abductor Pollicis Brevis
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palmar abduction
O: scaphoid, trapezium, flexor retinaculum, and tendon of the abductor pollicis longus I: base of proximal phalanx, radial side of thumb |
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Opponens Pollicis
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opposition
O: trapezium and flexor retinaculum I: first metacarpal |
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Flexor Pollicis Brevis: superficial head
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thumb MCP flexion, deep head innervated by ulnar nerve
O: trapezium, trapezoid, capitate and flexor retinaculum I: base of proximal phalanx, radial side of thumb |
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Lumbricals (radial side)
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MCP flexion and extension of IP joints
O: tendons of flexor digitorum profundus, index and middle fingers (radial and palmar sides) I: radial side of digits 2 and 3 into extensor expansion |
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What intrinsic muscles are innervated by the ulnar nerve?
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Abductor Digiti Minimi
Opponens Digiti Minimi Flexor Digiti Minimi Lumbricals (ulnar side) Palmar Interossei Dorsal Interossei |
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Abductor Digiti Minimi
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abduction of the 5th digit
O: pisiform and tendon of flexor carpi ulnaris I: proximal phalanx of the 5th digit |
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Opponens Digiti Minimi
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opposition of the 5th digit
O: hook of hamate and flexor retinaculum I: 5th metacarpal |
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Flexor Digiti Minimi
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flexion of MCP joint and opposiiton of the 5th digit
O: hook of hamate and flexor retinaculum I: proximal phalanx of 5th digit |
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Lumbricals (ulnar side)
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MCP flexion and extension of IP joints of digits 4 and 5
O: tendons of flexor digitorum profundus for digits 4 and 5 I: radial side of digits 4 and 5 into extensor expansion |
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Palmar Interossei
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adduction and assitance with MCP flexion and extension of IP joints of digits 2-5
O: first palmar; ulnar surface of 2nd metacarpal. Second palmar; radial surface of 4th metacarpal. Third palmar; radial surface of 5th metacarpal I: first palmar; ulnar surfacec of 2nd proximal phalanx. Second palmar; radial surface of 4th proximal phalanx. Third palmar; radial surface of 5th proximal phalanx |
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Dorsal Interossei
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abduction and assists with MCP flexion and extension of IP joints of digits 2-5
O: all four muscles arise from the adjacent sides of the metacarpals I: proximal phalanx on the radial aspect of the index, radial and ulnar sides of middle finger, and ulnar side of ring finger (all into extensor digitorum) |
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What extrinsic flexor muscles of the hand are innervated by the median nerve?
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Flexor Digitorum Superficialis (FDS)
Flexor Digitorum Profundus (FDP) Flexor Pollicis Longus (FPL) |
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Flexor Digitorum Superficialis (sublimis) (FDS)
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flexion of PIP joints
O: medial epicondyle I: middle phalanx (two slips) |
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Flexor Digitorum Profundus (FDP)
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flexion of DIP joints to digits 2 and 3
O: proximal 2/3rds of the ulna and interosseous membrane I: distal phalanx |
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Flexor Pollicis Longus (FPL)
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flexion of IP joint of thumb
O: radius, middle 1/3rd I: distal phalanx of thumb |
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What extrinsic flexors of the hand are innervated by the ulnar nerve?
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Flexor Digitorum Profundus
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Flexor Digitorum Profundus
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flexion of DIP joints to digits 4 and 5
O: proximal 2/3rds of the ulna and interosseous membrane I: distal phalanx |
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What extrinsic extensor muscles of the hand are innervated by the radial nerve?
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Extensor Digitorum Communis (EDC)
Extensor Digiti Minimi (EDM) Extensor Indicis Proprius (EIP) Extensor Pollicis Longus (EPL) Extensor Pollicis Brevis (EPB) Abductor Pollicis Longus (APL) |
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Extensor Digitorum Communis (EDC)
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extension of MCP joints and contributes to extension of the IP joints
O: lateral epicondyle I: medial band to middle phalanx and lateral band to distal phalanx |
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Extensior Digiti Minimi (EDM)
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extension of MCP joint of the 5th digit and contributes to extension of the IP joints
O: lateral epicondyle I: inserts into EDC at MCP level of the 5th digit |
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Extensor Indicis Proprius (EIP)
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extension of the MCP joint of the 2nd digit and contributes to extension of the IP joints
O: ulna, middle 1/3rd I: inserts into EDC at MCP level |
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Extensor Pollicis Longus (EPL)
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extension of the IP joint of the thumb
O: ulna, middle 1/3rd I: distal phalanx of thumb |
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Extensor Pollicis Brevis (EPB)
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extension of the MCP and CMC joints of the thumb
O: radius, middle 1/3rd I: proximal phalanx of thumb |
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Abductor Pollicis Longus (APL)
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abduction and extension of the CMC joint
O: middle 1/3rd of ulna and radius I: first metacarpal, radial side |
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What wrist flexors are innervated by the median nerve?
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Flexor Carpi Radialis (FCR)
Palmaris Longus (PL) |
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Flexor Carpi Radialis (FCR)
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flexion of wrist and radial deviation
O: medial epicondyle I: 2nd and 3rd metacarpal, base |
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Palmaris Longus (PL)
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flexion of wrist
O: medial epicondyle I: palmar aponeurosis |
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What wrist flexors are innervated by the ulnar nerve?
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Flexor Carpi Ulnaris (FCU)
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Flexor Carpi Ulnaris (FCU)
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flexion of wrist and ulnar deviation
O: medial epicondyle and proximal 2/3rds of the ulna I: pisiform and 5th metacarpal |
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What wrist extensors are innervated by the radial nerve?
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Extensor carpi radialis brevis (ECRB)
Extensor Carpi Radialis Longus (ECRL) Extensor Carpi Ulnaris (ECU) |
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Extensor Carpi Radial Brevis (ECRB)
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extension of wrist and radial deviation
O: lateral epicondyle I: 3rd metacarpal, base |
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Exensor Carpi Radialis Longus (ECRL)
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extension of wrist and radial deviation
O: supracondylar ridge of the humerus I: 2nd metacarpal, base |
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Extensor Carpi Ulnaris (ECU)
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extension of wrist and ulnar deviation
O: lateral epicondyle I: 5th metacarpal |
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What volar forearm muscles are innervated by the median nerve?
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Pronator Teres
Pronator Quadratus |
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Pronator Teres
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forearm pronation
O: medial epicondyle and coronoid process of ulna I: lateral surface of radius |
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Pronator Quadratus
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forearm pronation
O: distal ulna I: distal radius |
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What dorsal forearm muscles are innervated by the radial nerve?
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Supinator
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Supinator
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forearm supination
O: lateral epicondyle and ulna I: radius |
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What elbow muscles are innervated by the musculocutaneous nerve?
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Biceps
Brachialis |
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Biceps
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elbow flexion with forearm supinated
O: coracoid process and supraglenoid tubercle I: radial tuberosity |
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Brachialis
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elbow flexion with forearm pronated
O: distal 2/3rds of humerus I: ulnar tuberosity |
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What elbow muscles are innervated by the radial nerve?
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Brachioradialis
Triceps Anconeus |
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Brachioradialis
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elbow flexion with forearm neutral
O: supracondylar ridge I: distal radius |
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Triceps
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elbow extension
radial nerve innervation O: long head; infraglenoid tuberosity. Lateral head; posterior humerus. Medial head; distal to lateral head I: olecranon |
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Anconeus
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elbow extension
radial nerve innervation O: lateral epicondyle and capsule of elbow joint I: olecranon and upper 1/4th of dorsal ulna |
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Name the Rotator Cuff muscles
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Subscapularis
Supraspinatus Infraspinatus Teres Minor |
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Subscapularis
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internal rotation of shoulder
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Supraspinatus
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abduction and flexion of shoulder
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Infraspinatus
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external rotation of shoulder
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Teres Minor
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external rotation of shoulder
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What muscles perform shoulder flexion?
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Anterior Deltoid
Coracobrachialis Supraspinatus |
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What muscles perform shoulder abduction?
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Middle Deltoid
Supraspinatus |
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What muscles perform shoulder horizontal abduction?
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Posterior Deltoid
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What muscles perform shoulder horizontal adduction?
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Pectoralis major
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What muscles perform shoulder extension?
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Latissimus Dorsi
Teres Major Posterior Deltoid |
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What muscles perform scapular upward rotation?
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Trapezius (upper, middle, and lower)
Serratus Anterior |
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What muscles perform scapular downward rotation?
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Levator Scapulae
Rhomboids Serratus Anterior Latissiums Dorsi |
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What muscles perform scapular adduction?
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Middle Trapezius
Rhomboid Major |
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What muscles perform scapular abduction?
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Serratus Anterior
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What muscles perform scapular elevation?
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Upper Trapezius
Levator Scapulae |
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What muscles perform scapular depression?
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Lower Trapezius
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What is Dupuytren's Disease?
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- Disease of the fascia of the palm and digits
- The fascia becomes thick and contracted - Results in flexion deformities of the involved digits |
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How is Dupuytren's Disease treated?
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Surgical release is required as conservative treatment has not been successful
- Fasciotomy with Z plasty - Aponeurotomy - McCash Procedure (open palm) |
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What does OT intervention include for Dupuytren's Disease?
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- wound care: dressing changes and whirlpool as needed
- edema control: elevation - extension splint - A/PROM progressing to strengthening - scar management: massage, compression garment - functional tasks emphasizing flexion and extension |
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What is Skier's Thumb (Gamekeeper's Thumb)?
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Rupture of the ulnar collateral ligament of the MCP joint of the thumb
Etiology: most commonly caused by falling while skiing with thumb held in a ski pole |
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What does OT intervention include for Skier's Thumb?
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- Conservative treatment including a thumb splint (4-6 wks)
- AROM and pinch strengthening (at 6 wks) - ADLs requiring opposition and pinch strength - Post-op tx includes splint for 6 wks, followed by AROM; PROM at 8 wks and strengthening at 10 wks |
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What is Complex Regional Pain Syndrome (CRPS)?
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- Vasomotor dysfunction as a result of an abnormal reflex
- Can be localized to one area or spread to other parts of the extremity |
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What is the etiology of CRPS?
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may follow trauma or surgery, but actual cause is unknown
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What are the common symptoms of CRPS?
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severe pain, edema, discoloration, osteoporosis, sudomotor changes, temperature changes, trophic changes, and vasomotor instability
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What does OT intervention include for CRPS?
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- modalities to decrease pain
- AROM to involved joints - stress loading - splinting to prevent contractures - PROM, passive stretching, joint mobilization, casting |
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What medical treatment is used for Closed Reduction fractures?
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stabilization including casting, splint, sling, or fracture brace
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What medical treatment is used for Open Reduction Internal Fixation (ORIF)?
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nails, screws, plates, or wire
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What is Arthrodesis?
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fusion
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What is Arthroplasty?
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joint replacement
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What is a Colles' fracture?
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fracture of the distal radius with dorsal displacement
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What is a Smith's fracture?
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fracture of the distal radius with volar displacement
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What is the most common Carpal fracture?
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Most common is scaphoid fracture (60% of carpal fractures).
The proximal scaphoid has a poor blood supply and may become necrotic |
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What is a Boxer's fracture?
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a fracture of the 5th MCP
requires an ulnar gutter splint |
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Which digits are most commonly involved in proximal phalanx fractures?
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thumb and index
common complication: loss of PIP A/PROM |
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What is the most common type of finger fracture?
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Distal phalanx fracture
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What can result from a Distal Phalanx fracture?
What tendon is involved? |
Mallet finger which involves the terminal extensor tendon
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An elbow fracture involving the radial head may result in a limitation of what movement?
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rotation of the forearm
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Fractures of the greater tuberosity may result in what type of injury?
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Rotator cuff injuries
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Humeral shaft fractures may cause injury to what nerve?
What UE disorder results from injury to this nerve? |
May cause injury to the radial nerve resulting in wrist drop
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What do OT interventions for fractures consist of during the Immobilization phase?
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- stabilization and healing are the goals
- AROM of joints above and below the stabilized part - Edema control: elevation, retrograde massage, compression garments - light ADLs with no resistance, progress as tolerated |
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What do OT interventions for fractures consist of during the Mobilization phase?
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- consolidation is the goal
- Edema control: retrograde massage, contrast baths, and compression garments - progress toward PROM when approved by physician (4-8 wks) - EXCEPTION: humeral fractures - begin with PROM or AAROM |
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What are risk factors for Cumulative Trauma Disorders (CTD)?
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work related risk factors: repetition, static position, awkward postures, forceful exertions, and vibration
non-work risk factors: acute trauma, pregnancy, diabetes, arthritis, and wrist size and shape |
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What is DeQuervain's?
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Stenosing tenosynovitis of the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB)
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What are signs/symptoms of DeQuervain's?
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- pain and swelling over the radial styloid
- positive Finkelstein's test |
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What is conservative tx for DeQuervain's?
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- thumb spica splint
- activity modification - ice massage over radial wrist - gentle AROM of wrist and thumb |
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What is post-op tx for DeQuervain's?
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- thumb spica splint and gentle AROM (0-2 wks)
- strengthening and ADLs (2-6 wks) - unrestricted activity at 6 wks |
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What is Lateral Epicondylitis?
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overuse of wrist extensors, especially the extensor carpi radialis brevis
also called tennis elbow |
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What is Medial Epicondylitis?
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overuse of wrist flexors
also called golfer's elbow |
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What is conservative treatment for Lateral and Medial Epicondylitis?
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- elbow strap, wrist splint
- ice and deep friction massage - stretching - activity/work modification - as pain decreases, begin strengthening |
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What is Trigger finger and how is it caused?
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Tenosynovitis of the finger flexors: most commonly is the A1 Pully
Caused by repetition and the use of tools that are placed too far apart |
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What is conservative treatment for Trigger finger?
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- hand based trigger finger splint (MCP extended, IP joints free)
- scar massage - edema control - tendon gliding - activity/work modification |
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What is the Kleinert splint used for?
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early mobilization program for flexor tendon repair
passive flexion using rubber band traction and active extension to the hood of the splint |
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What is the early phase (0-4 weeks) of the Kleinert splint protocol?
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0-4 weeks (early phase)
Dorsal block splint. Wrist is positioned in 20-30 degrees flesion, MCP joints in 50-60 degrees of flexion and IP joints extended. Passive flexion and active extension within limits of splint |
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What is the intermediate phase (4-7 weeks) of the Kleinert splint protocol?
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4-7 weeks (intermediate phase)
Continue dorsal block splint, but adjust the wrist to neutral. Place/hold exercises and differential flexor tendon gliding exercises. Scar management. |
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What is involved during weeks 6-8 of the Kleinert splint protocol?
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6-8 weeks
AROM. Differential tendon gliding. Light purposeful and occupation-based activities. D/C splint. |
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What is involved during weeks 8-12 of the Kleinert splint protocol?
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8-12 weeks
Strengthening and work and leisure activities |
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What is the Duran splint used for?
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early mobilization program for flexor tendon repair
passive flexion and extension of digit wrist and MP joints are flexed, and fingers are strapped in IP joint extension when not exercising |
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What is the protocol for the Duran splint?
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- 0-4.5 weeks: dorsal blocking splint. Exercises in splint include passive flexion of PIP joint, DIP joint and to DPC. 10 reps every hour.
- 4.5-6 weeks: active flexion and extension within limits of splint. - 6-8 weeks: tendon gliding and differential tendon gliding, scar management, and light purposeful and occupation-based activites. - 8-12 weeks: strengthening and work activites |
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What zone is the Mallet finger deformity in? What splint is used?
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Zone I and II
0-6 weeks: DIP extension splint |
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What zone is the Boutonniere deformity in? What splint is used?
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Zone III and IV
- 0-4 weeks: PIP extension splint with DIP free. AROM of DIP while in splint - 4-6 weeks: begin AROM of DIP and flexion of digits to the DPC. |
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When a tendon repair occurs in zone V, VI, and VII, what splint is used?
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- weeks 0-2: volar wrist splint with wrist in 30 degrees of extension, MCPs in 0-10 degrees of flexion, and IP joints in full extension
- weeks 2-3: shorten splint to allow flexion and extension of IP joints - week 4: remove splint to begin MCP active flexion and extension - week 5: begin AROM with wrist and wear splint b/w exercise sessions - week 6: d/c splint |
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What is Carpal Tunnel Syndrome (CTS)?
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a median nerve compression caused by repetition, awkward postures, vibration, anatomical anomalies, and pregnancy
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What are common symptoms of Carpal Tunnel Syndrome?
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numbness and tingling of the thumb, index, middle, and radial half of the ring fingers
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What are common signs of Carpal Tunnel Syndrome?
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- paresthesias usually occur at night
- complains of dropping things - positive Tinel's sign at wrist - positive Phalen's sign - advanced CTS can result in muscle atrophy of the thenar eminence |
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What is conservative tx for CTS?
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- wrist splint in neutral: worn at night and during the day if performing repetitive activity
- median nerve gliding exercises and differential tendon gliding exercises - activity modification - proper ergonomics |
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What surgical intervention is used for CTS?
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carpal tunnel release
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What is the post-op tx of carpal tunnel release?
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- edema control: elevation, retrograde massage, compression glove and/or contrast bath
- AROM - nerve and tendon gliding exercises - sensory reeducation - strengthening of thenar muscles (6 weeks post-op) - work/activity modification |
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What is Pronantor Teres Syndrome (proximal volar forearm)?
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a median nerve compression between two heads of pronator teres resulting from repetitive pronation and supination and excessive pressure on volar forearm
symptoms: same as CTS and also aching pain in proximal forearm, positive Tinel's sign at the forearm, no night symptoms |
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What tx options are available for Pronator Teres Syndrome?
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Conservative tx: elbow splint at 90 degrees with forearm in neutral
Surgical tx: decompression Post-op: AROM, nerve gliding, strengthening (2 weeks post-op), sensory reeducation, work/activity modification |
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What is Guyon's canal?
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an ulnar nerve compression at the wrist caused by repetition, ganglion, pressure, and fascia thickening
symptoms: numbness and tingling in the ulnar nerve distribution of the hand, motor weakness of ulnar nerve-innervated muscles, positive Tinel's sign at Guyon's canal, advanced stages can include atrophy of muscles |
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What tx options are available for Guyon's canal?
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Conservative tx: wrist splint in neutral, activity modification
Surgical tx: decompression Post-op: edema control, AROM, nerve gliding, strengthening 2-4 weeks post-op (power grip), sensory reeducation |
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What is Cubital Tunnel Syndrome?
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an ulnar nerve compression resulting from pressure at the elbow and extreme elbow flexion
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What are common symptoms of Cubital Tunnel Syndrome?
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- numbness and tingling along ulnar aspect of forearm and hand
- pain at elbow with extreme position of elbow flexion - weakness of power grip - positive Tinel's sign at elbow - advanced stages can lead to atrophy |
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What tx options are available for Cubital Tunnel Syndrome?
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Conservative tx: elbow splint to prevent positions of extreme flexion, elbow pad to decrease compression of nerve when leaning on elbows, activity/work modification
Surgical tx: decompression or transposition Post-op: edema control, scar management, AROM and nerve gliding (2 weeks post-op), strengthening (4 weeks post-op), MCP flexion splint if clawing present |
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What is Radial Nerve Palsy (radial nerve compression)?
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Also know as Saturday Night Palsy; involves sleeping in a position that places stress on the radial nerve. Can also be caused by compression as a result of a humeral shaft fracture.
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What are common symptoms of Radial Nerve Palsy?
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- weakness or paralysis of extensors in the wrist, MCPs, and thumb
- wrist drop |
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What tx options are available for Radial Nerve Palsy?
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Conservative tx: dynamic extension splint, work/activity modifiation, strengthening wrist and finger extensors when motor function returns
Surgical tx: decompression Post-op: ROM, nerve gliding, strengthening (6-8 weeks post-op), ADL and meaningful role activities |
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What sensory loss occurs with a Median Nerve Laceration?
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- central palm (thumb to radial 1/2 of ring finger)
- palmar surface of digits 1-3 and radial 1/2 of digit 4 - dorsal surface of digits 2, 3, and radial 1/2 of digit 4 (middle and distal phalanges) |
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What motor loss occurs with a Median Nerve Laceration with a low lesion at the wrist?
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muscles: lumbricals I and II, opponens pollicis, abductor pollicis brevis, flexor pollicis brevis
function: MCP flexion of digits II and III, opposition, abduction, and flexion of thumb MCP |
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What motor loss occurs with a Median Nerve Laceration with a high lesion at or proximal to the elbow?
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muscles: all muscles involved with low level lesion, FDP to index and middle fingers, FLP, FCR
function: flexion of tip of digits 1-3, inability to flex to radial aspect of wirst |
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What deformities can result from a Median Nerve Laceration?
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- Ape Hand: flattening of thenar eminence
- Low level lesion: clawing of index and middle fingers - High level lesion: Benediction sign - digits 4&5 flexed at PIP joints |
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What functional loss occurs with a Median Nerve Laceration?
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- loss of thumb opposition
- weakness of pinch |
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What does OT tx consist of for a Median Nerve Laceration?
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- Dorsal protection splint with wrist positioned in 30 degree flexion for a low level lesion. Include elbow splinted at 90 degrees flexion for a high level lesion
- Begin A/PROM of digits with wrist in flexed position at 2 weeks post-op - scar management - AROM of wrist at 4 weeks; include elbow if a high lesion - strengthening at 9 weeks - sensory reeducation - begin when individual demonstrates a level of diminished protective sensation (4.31) on Semmes-Weinstein - consider a C-bar splint to preven thumb adduction contracture |
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What sensory loss occurs with an Ulnar Nerve Laceration?
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- ulnar aspects of palmar and dorsal surfaces
- ulnar 1/2 of ring and little finger on palmar and dorsal surfaces |
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What motor loss occurs with an Ulnar Nerve Laceration at the wrist?
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muscles: palmar and dorsal interossei, lubricals III & IV, FPB, adductor pollicis, ADM, ODM, FDM
function: adduction and abduction of MCP joints; MCP flexion of digits 4 & 5; flexion and adduction of thumb; abduction, opposition and flexion of digit 5 |
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What motor loss occurs with an Ulnar Nerve Laceraton with a high lesion wrist or above?
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includes all muscles affected with low level lesion
muscles: FCU, FDP IV & V function: flexion towards ulnar wrist; flexion of DIPs of digits 4 & 5 |
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What deformities can occur with an Ulnar Nerve Laceration?
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- Claw hand
- Flattened metacarpal arch - positive Froment's sign (assessment of thumb adductor while laterally pinching paper) |
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What functional loss occurs with an Ulnar Nerve Laceration?
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- loss of power grip
- decreased pinch strength |
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What does OT tx include for an Ulnar Nerve Laceration?
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- same as a median nerve repair
- splinting consideration: MCP flexion block splint - sensory reeducation: same as a median nerve repair |
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What sensory loss occurs with a Radial Nerve Laceration at the level of the humerus?
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- medial aspect of the dorsal forearm
- radial aspect of dorsal palm, thumb, and index - middle and radial 1/2 of ring finger |
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What motor loss occurs with a low level lesion at the forearm of a Radial Nerve Laceration?
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- loss of wrist extension due to absent or impaired innervation to ECU
muscles: EDC, EI, EDM, EPB, EPL, APL function: MCP extension, thumb extension |
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What motor loss occurs with a high lesion at the level of the humerus of a Radial Nerve Laceration?
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includes all muscles affected at a low level lesion
muscles: ECRB, ECRL, bracioradials, triceps function: elbow extension |
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What functional loss occurs with a Radial Nerve Laceration?
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- inability to extend digits to release objects
- difficulty manipulating objects |
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What deformities can occur with a Radial Nerve Laceration?
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- wrist drop
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What does OT tx consist of with a Radial Nerve Laceration?
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- dynamic extension splint
- ROM - sensory reeducation if needed - home program - activity modification |
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What muscles make up the Rotator Cuff and what are their functions?
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- Supraspinatus: abduction and flexion
- Infraspinatus: external rotation - Teres Minor: external rotation - Subscapularis: internal rotation All muscles work together to control the head of humerus in the glenoid fossa. |
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What is the site of impingement for Rotator Cuff Tendonitis?
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Coracoacromial Arch: acromion, coracoacromial ligament, and coracoid process
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What is the etiology of Rotator Cuff Tendonitis?
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- repetitive overuse
- curved or hook acromion - weakness of rotator cuff - weakness of scapula musculature - ligament and capsule tightness - trauma |
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What does conservative OT tx consist of for Rotator Cuff Tendonitis?
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- activity modification: avoid above shoulder level activities
- educate in sleeping posture: avoid sleeping with arm overhead or combined adduction and internal rotation - decrease pain: positioning, modalities, and rest - restore pain free ROM - strengthening below shoulder level - ADLs |
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What surgical options are available for Rotator Cuff Tendonitis?
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- Arthroscopic surgery
- Open repair: small, medium, large, and massive tears |
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What is OT post-op tx for a Rotator Cuff Tendonitis surgery?
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- PROM (0-6 weeks); progress to AA/AROM
- decrease pain: begin with ice and progress to heat - strengthening (6 weeks post-op): begin with isometrics and progress to isotonics below shoulder level - activity modification: light ADL and meaningful activites; progress as tolerated - leisure and work activities (8-12 weeks post-op) |
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What is the correct term for "frozen shoulder?"
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Adhesive Capsulitis
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What are the common symptoms of Adhesive Capsulitis?
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Restricted passive shoulder ROM - greatest limitation is external rotation, then abduction, internal rotation,a nd flexion
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What is the etiology of Adhesive Capulitis?
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- inflammation and immobility
- linked to diabetes mellitus and Parkinson's disease |
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What does conservative OT tx consist of for Adhesive Capsulitis?
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- encourage active use through ADL and role activities
- PROM - modalities |
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What surgical options are available for Adhesive Capsulitis?
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manipulation and arthroscopic surgery
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What does OT post-op intervention consist of for Adhesive Capsulitis?
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- PROM immediately following surgery
- pain relief: modalities - encourage use of extremity for all ADL and role activities |
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What type of shoulder dislocation is the most common?
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Anterior dislocation
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What is the etiology of Shoulder Dislocation?
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- trauma
- repetitive overuse |
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What is the OT intervention for Shoulder Dislocation?
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- begin ROM: avoid combined abduction and external rotation with anterior dislocation
- pain free ADL and role activities - strengthen rotator cuff |
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What is Rheumatoid Arthritis?
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- Systemic, symmetrical inflammation affecting many joints
- most commony affects the small joints of the hands - has remissions and exacerbations |
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What are the common symptoms associated with Rheumatoid Arthritis?
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- pain
- stiffness - limited ROM - fatigue - weight loss - limited ADL status - swelling - deformities |
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What deformities are common with Rheumatoid Arthritis?
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- ulnar deviation and subluxation of the wrists and MCP joints
- Boutonniere deformity - Swan neck deformity |
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What is a Boutonniere deformity?
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flexion of PIP joint and hyperextension of DIP joint
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Wht is a Swan Neck deformity?
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hyperextension of PIP joint and flexion of DIP joint
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What is Osteoarthritis?
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Degenerative joint disease
- not systemic but wear and tear - commonly affects large weight bearing joints - attacks hyaline cartilage |
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What is the etiology of Osteoarthritis?
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- genetic
- trauma - inflammation - cumulative trauma - endocrine and metabolic diseases |
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What are the common symptoms associated with Osteoarthritis?
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- pain
- stiffness - limited ROM - bone spurs |
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What are the bone spurs at the DIP joints called?
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Herberden's nodes
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What are the bone spurs at the PIP joints called?
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Bouchard's nodes
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When evaluating arthritis, how should ROM be evaluated?
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focus on AROM, as PROM should be avoided, especially in the inflammatory stage
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When evaluating arthritis, how should muscle strength be evaluated?
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- document strength in relation to function
- avoid MMT unless requested by physician - for grip strength, use a sphygmomanometer |
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When splinting for arthritis, what splint should be used in the acute stage?
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resting hand splint
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When splinting for arthritis, what splint should be used to prevent deformity?
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ulnar drift splint
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What splint should be used to prevent boutonniere and swan neck deformities?
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silver ring splints
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What splint should be used for post-op MCP arthroplasties?
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dynamic MCP extension splint with radial pull
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What splint should be used for CMC arthritis?
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hand base thumb splint
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What heat modalities are indicated for arthritis?
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- hot packs can be used before exercise but avoid during the inflammatory stage
- paraffin is recommended for the hands |
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What is Osteogenesis Imperfecta?
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An autosomal dominant inherited disorder
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What are the signs/symptoms for Osteogenesis Imperfecta?
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- fractures in utero, and during the birth process in the most severe cases
- brittle bones that fracture easily - multiple fractures as the child grows - deformities of the arms and legs - developmental growth problems - eye abnormalities (i.e., blue sclera, cataracts) - risk of hearing impairments |
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What medical management is used for Osteogenesis Imperfecta?
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- casts and braces
- pain management - audiological consultation - activity restrictions due to high risk of fractures |
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What does the OT evaluation include for Osteogenesis Imperfecta?
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- activity interests that can be safely pursued
- environmental risk factors |
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What does the OT intervention include for Osteogenesis Imperfecta?
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- activity adaptation and assistive devices
- environmental modifications for safety - preventive positioning and protective splinting/padding - activities to increase muscle strength - weightbearing activities to facilitate bone growth - family, caregiver, and teacher education |
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What is the medical management for hip fractures?
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- closed reduction for minimally displaced fractures
- ORIF - joint replacement |
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What should OT evaluation include for hip fractures?
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- review precautions and weight bearing status
- role requirements and expectations of patient - ADL: dressing, bathing, transfers - ROM and strength of upper extremities |
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What should OT intervention include for hip fractures?
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- bed mobility and bedside ADL
- upper extremity strengthening - functional ambulation and transfers with appropriate weight bearing status and ambulation device - train in use of assistive devices - ADLs/IADLs with proper weight bearing status |
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What complications can occur with hip fractures?
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- avascular necrosis
- non-union - degenerative joint disease - complications can lead to need for THA |
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What is the etiology of a THA?
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- trauma from hip fracture
- disease, usually arthritis; surgery is elective |
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What is a Total hip joint implant?
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replaces acetabulum and femoral head
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What is an Austin Moore: partial hip replacement?
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replaces only femoral head
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Which THA is more common, anterolateral or posterolateral?
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Posterolateral
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What should OT eval focus on for THA?
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- review precautions and weight bearing status
- occupational profile - ADL: dressing, bathing, transfers - ROM and upper extremity strength |
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What are the typical hip precautions associated with THA?
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- do not flex beyond 90 degrees
- do not adduct or cross legs - do not internally rotate hip (for anterolateral approach, avoid external rotation) - do not pivot at hip - sit only on raised chair/toilet - transfer sit to stand by keeping operated hip in slight abduction and extended out in front |
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What should OT intervention focus on for THA?
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- educate on hip precautions
- instruct in use of long handled equipment - transfer training - ADLs/IADLs using proper weight bearing status and ambulatory device |
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What is a Forequarter UE amputation?
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loss of clavicle, scapula and entire upper extremity
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What is a Shoulder Disarticulation UE amputation?
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loss of entire upper extremity
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What is an Above-elbow (AE) (long or short) UE amputation?
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amputation above the elbow at any level of the upper arm
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What is an Elbow Disarticulation UE amputation?
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amputation of the upper extremity distal to the elbow joint
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What is a Below-elbow (BE) (long or short) UE amputation?
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amputation below the elbow at any level of the forearm
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What is a Wrist Disarticulation UE amputation?
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amputation distal to the wrist joint; loss of entire hand
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What is a Finger amputation?
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amputation of digit(s) at any level
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What is a Hemipelvectomy LE amputation?
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amputation of half of pelvis and entire lower extremity
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What is a Hip Disarticulation LE amputation?
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amputation at the hip joint; loss of the entire lower extremity
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What is an Above-knee (transfemoral) LE amputation?
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amputation above knee at any level of the thigh
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What is a Knee Disarticulation LE amputation?
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amputation at the knee joint
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What is a Below-knee (transtibial) LE amputation?
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amputation below knee at any level on the calf
this is the most common type |
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What is a Complete Tarsal LE amputation?
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amputation at the ankle
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What is a Partial Tarsal LE amputation?
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amputation of metatarsals and phalanges
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What is a Complete Phalanges LE amputation?
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amputation of toe(s)
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What is a Voluntary opening (VO) terminal device?
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hook remains closed until tension is placed on cable and then it opens
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What is a Voluntary closing (VC) terminal device?
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hook remains opened until tension is placed on cable and then it closes
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What are complications of amputations?
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- neuromas
- skin breakdown - phantom limb syndrome - phantom limb pain - infection - knee flexion contractures in below-knee amputations - psychological impairments due to shock/grief |
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What are neuromas?
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nerve endings adhered to scar tissue
can be very painful and hypersensitive |
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What is Phantom Limb Syndrome?
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sensation of the presence of the amputated limb
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What is Phantom Limb Pain?
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sensation of the presence of the amputated limb but is also painful
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What are the characteristics of a Hooks VO Body Power terminal device?
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- unfavorable cosmesis
- 1 lb rubber band pinch force - precise/exact pinch prehension - lighter than hands 3-8 oz, durable, very good reliability - some proprioceptive feedback - effort to use increases with more rubber bands - lowest cost |
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What are the characterisitics of a VC TRS Grip Body Power terminal device?
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- unfavorable cosmesis
- controlled strong grip > 40 lb - pinch is more precise than hand, less than hook - 4-16 oz, durable and rugged, very good reliability - better proprioceptive feedback - more effort to sustain grasp; lock available - cost is higher than hook, less than hand |
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What are the characteristics of a Hands External Power terminal device?
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- favorable cosmesis
- strong grip, 22 lb - cylindrical grasp 3-point pinch - heavy 16 oz, not durable, good reliability (non-rugged activities) - some feedback through intensity of muscle contraction - low effort to activate - highest cost |
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What are the characteristics of a Hands VO Body Power terminal device?
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- favorable cosmesis
- pinch stronger than VO hook but weaker than externally powered terminal devices - cylindrical grasp 3-point pinch - heavy 10-14 oz, not durable, good reliability (non-rugged activities) - some proprioceptive feedback - more effort to open; can relax for grasp - cost is higher than hooks; lower than externally powered hand |
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What are the characteristics of a Greifer External Power terminal device?
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- unfavorable cosmesis
- strong pinch, 32 lbs - precise pinch and cylindrical grasp - heavy 19 oz, durable and rugged, very good reliability - some feedback through intensity of muscle contraction - low effort to activate - highest cost |
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What does Preprosthetic Treatment involve?
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- ROM of uninvolved joints
- prepare limb for a prosthesis - desensitization - wrapping to shape and shrink limb (distal to proximal) - ADL training |
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What does Prosthetic Treatment involve?
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- functional training with prosthesis: ADLs, leisure, etc
- donning and doffing prosthesis - increase prosthetic wearing tolerance |
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What does treatment for LE amputation involve?
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- wrapping to shape residual limb and decrease swelling
- desensitization - UE strengthening focusing on triceps - transfer training, stand pivot - ADL training - standing tolerance - w/c mobility |
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What movement for practice controls training is required for use of a Terminal Device?
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Humeral flexion with scapular abduction (protraction) on side of amputation; bilateral scapular abduction for midline use of TD or when strength is limited.
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What intervention is used to practice controls training for use of a Terminal Device?
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Manually guide patient through motions. For transhumeral prostheses, keep elbow unit locked in 90 degree flexion, teach TD control first.
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What movement for practice controls training is required for use of a Wrist Unit?
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Rotate TD to supination, midposition, or pronation. For unilateral amputation, patient uses good hand to rotate TD; For bilateral amputation, rotate TD against stationary object, between knees, or with contralateral TD
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What intervention is used to practice controls training for use of a Wrist Unit?
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Have patient analyze the task and determine the most efficient approach for grasp, avoiding excessive or awkward movements. Examples: TD in midposition for carrying a tray, in pronation for grasping object from table.
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What movement for practice controls training is required for use of an Elbow Unit?
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Depress arm while extending and abducting humerus to lock or unlock elbow mechanism.
Practice flexing and locking elbow in several planes. |
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What intervention is used to practice controls training for use of an Elbow Unit?
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Manually guide patient through motions. Begin with elbow unlocked. Patient listens for click as lock activates. Have patient exaggerage movements initially. Use a mirror.
Use humeral flexion to flex elbow; go beyond desired height, since the arm will drop with gravity pull as patient is in process of locking the elbow unit. |
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What movement for practice controls training is required for use of a Turntable?
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Rotate elbow turntable toward or away from body using good hand. With bilateral amputations, push or pull against stationary object to rotate.
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What intervention is used to practice controls training for use of a Turntable?
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Teach patient to analyze task to determine need to use this component for more efficiency.
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What are the characteristics of a Superficial (first degree) burn?
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- involves the epidermis only
- minimal pain and edema, no blisters - healing time is 3-7 days |
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What are the characteristics of a Superficial Partial Thickness (second degree) burn?
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- involves the epidermis and upper portion of dermis (e.g., sunburn)
- appearance: red, blistering, wet - painful, no grafting necessary, heals on its own - healing time is 7-21 days |
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What are the characteristics of a Deep Partial Thickness (deep second degree) burn?
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- involves the epidermis and deep portion of the dermis; hair follicles and sweat glands
- appearance: red, white, and elastic - sensation may be impaired - potential to convert to full thickness burn due to infection - healing time is 21-35 days |
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What are the characteristics of a Full Thickness (third degree) burn?
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- involves the epidermis and dermis; hair follicles, sweat glands, and nerve endings
- appearance: white, waxy, leathery, and non-elastic - sensation is absent, requires a skin graft - hypertrophic scar - healing time can take months |
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What are the characteristics of a Fourth degree burn?
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- involves fat, muscle, and bone
- Electrical burn: destruction of nerve along pathway |
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For the Rule of Nines for burn classification, what percentage of the body is the head?
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9%
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For the Rule of Nines for burn classification, what percentage of the body is each arm?
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9% for each arm
18% for both arms combined |
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For the Rule of Nines for burn classification, what percentage of the body is each leg?
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18% for each leg
36% for both legs combined |
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For the Rule of Nines for burn classification, what percentage of the body is the trunk/chest?
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36%
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For the Rule of Nines for burn classification, what percentage of the body is the genital area?
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1%
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What are the evaluation components for a Superficial Partial-Thickness burn, Deep Partial-Thickness burn, and a Full Thickness burn?
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- Occupational profile
- ROM, 72 hours post-op (5-7 days post-op for full thickness burn) - sensation, when wounds are healed - strength, when wounds are healed - ADL and meaninful role activities, ASAP |
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What are the intervention components for a Superficial Partial-Thickness burn?
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- wound care and debridement, sterile whirl-pool, and dressing changes
- gentle AROM and PROM as tolerated - edema control - splinting, if necessary - ADL and role activities |
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What are the intervention components for a Partial-Thickness burn?
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- wound care and debridement, sterile whirl-pool, and dressing changes
- gentle AROM and PROM as tolerated - edema control - splinting - occupational role activities and ADL - strengthening (when wounds are healed) |
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What are the post-op intervention components for a Full Thickness burn that requires grafting?
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- 72 hours: dressing changes, splint at all times
- 5-7 days: begin AROM, light ADL, sterile whirlpool - 7+ days: PROM as tolerated, ADL and meaningful activities - use massage when wounds are healed - order compression garments - provide otoform/elastomer inserts - strengthening |
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For an Anterior Neck burn, what is the contracture tendency?
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Neck flexion
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For an Anterior Neck burn, what is the anti-contracture positioning and/or typical splint used?
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- remove pillows
- use half mattress to extend neck - neck extension splint or collar |
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For an Axilla burn, what is the contracture tendency?
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Adduction of arm
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For an Axilla burn, what is the anti-contracture positioning and/or typical splint used?
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- 120 degree abduction with slight external rotation
- axilla splint or positioning wedges - watch for signs of brachial plexus strain |
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For an Anterior Elbow burn, what is the contracture tendency?
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Flexion of elbow
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For an Anterior Elbow burn, what is the anti-contracture positioning and/or typical splint used?
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Elbow extension splint in 5-10 degrees flexion
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For a Dorsal Wrist burn, what is the contracture tendency?
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Wrist extension
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For a Dorsal Wrist burn, what is the anti-contracture positioning and/or typical splint used?
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Wrist support in neutral
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For a Volar Wrist burn, what is the contracture tendency?
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Wrist flexion
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For a Volar Wrist burn, what is the anti-contracture positioning and/or typical splint used?
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Wrist cockup splint in 5-10 degrees flexion
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For a Hand Dorsal burn, what is the contracture tendency?
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Claw hand deformity
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For a Hand Dorsal burn, what is the anti-contracture positioning and/or typical splint used?
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Functional hand splint with MP joints 70-90 degrees, IP joints fully extended, first web open, thumb in opposition
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For a Hand Volar burn, what is the contracture tendency?
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Palmar contracture
Cupping of hand |
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For a Hand Volar burn, what is the anti-contracture positioning and/or typical splint used?
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For a palmar contracture: Palm extension splint
For cupping of hand: MPs in slight hyperextension |
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For a Hip-anterior burn, what is the contracture tendency?
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Hip flexion
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For a Hip-anterior burn, what is the anti-contracture positioning and/or typical splint used?
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- prone positioning
- weights on thigh in supine - knee immobilizers |
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For a Knee burn, what is the contracture tendency?
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Knee flexion
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For a Knee burn, what is the anti-contracture positioning and/or typical splint used?
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- knee extension positioning and/or splints
- prevent external rotation, which may cause peroneal nerve compression |
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For a Foot burn, what is the contracture tendency?
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Foot drop
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For a Foot burn, what is the anti-contracture positioning and/or typical splint used?
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- ankle at 90 degrees with foot board or splint
- watch for signs of heel ulcer |
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For burns to the hand, what are the characteristics of the splint that should be used?
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- wrist in 20-30 degrees extension
- MCP joints in 50-70 degrees flexion - IP joints in full extension - thumb abducted and extended |
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What are the characteristics of a Palmar extension splint that is used for burns to the volar surface of the hand?
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- wrist in 0-30 degrees extension
- MCP joints in neutral to slight extension and abducted (monitor collateral ligaments) - IP joints in full extension - thumb abducted and extended |
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What splint is used for a Web space burn?
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C-Splint
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When are hypertrophic scars most common?
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- most common with deep second and third degree burns
- appears 6-8 weeks after wound closure - takes 1-2 years to mature |
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How can OTs treat hypertrophic scars?
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Compression garments should be worn 24 hours daily
- applied when wounds are healed - recommendation is to wear 24 hours a day for 1-2 years until scare is matured Additional interventions include ROM, skin care, ADL, role activities, and patient/family education |
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What is the definition of pain?
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Personal sensation of hurt that can significantly affect an individual's quality of life
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What is Acute Pain?
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has a recent onset and usually lasts for a short duration
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What is Chronic Pain?
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has a long duration and can lead to depression
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What is Myofascial pain?
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pain that is specific to muscles, tendons, or fascia
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What is Myofascial Pain Syndrome (MPS)?
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- persistent, deep aching pains in muscle, nonarticular in origin
- characterized by well-defined, highly sensitive tender spots (trigger points) |
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What is Fibromyalgia Syndrome (FMS)?
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- a musculoskeletal pain and fatigue disorder that can vary in intensity
- widespread pain accompanied by tenderness of muscles and adjacent soft tissues - a nonarticular rheumatic disease of unknown origin |
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What is the etiology of Low Back pain?
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- poor posture: seated and standing
- repetitive bending using poor body mechanics - heavy lifting - sleeping with poor posture |
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What does the assessment of pain consist of?
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- location of pain
- intensity of pain (0-10 intensity scale, time of day) - onset and duration of pain - description of pain (sharp, throbbing, tender, burning) - functional assessment of pain - pain scales that are commonly used: McGill Pain Questionnaire, Pain Disability Index, Functional Interference Estimate |
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What does OT intervention consist of for pain?
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- PAMs and massage
- proper positioning techniques and proper body mechanics during daily activities - splinting - gentile ROM - relaxation techniques - correct standing and seated posture - modify activities and provide AE as needed - provide alternative exercise programs |
