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125 Cards in this Set
- Front
- Back
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DEFINE cumulative trauma
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a group of health disorders arising from repeated biomechanical stresses to muscles, tendons, ligs, joints, and neurovascular structures
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What are common cumulative trauma disorders?
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Repetitive stress disorder (RSI)
Repetitive motion injuries (RMI) overuse syndromes |
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what are common MOI for cumulative trauma disorders?
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*mechanical stress
*tissue irritation *inflammation *collagen organization *scarring *change in local gliding mechanisms |
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What are common cummulative disorders for tendon injuries in the arm?
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*DeQuervian's
*trigger finger *lateral and medial epicondylitis *bicipital and subraspinatous tendonitis |
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what are common cummulative disorders for nerve injuries in the arm?
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*carpal tunnel syndrome
*cubital and ulnar tunnel *radial tunnel *thoracic outlet syndrome |
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What are some activity assessments a therapist should make when a patient comes in complaining of pain in their UE?
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*total body postures
*work/home equipment *time on specific duties *task requirements that cause pain *length of time pain free, with pain, type, location, severity of pain |
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What are common body positions that can cuase pain and contribute to problems with the UE?
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*awkward positions
*overhead work *twisting and carrying loads *wrist deviations *contact stress *poor shoulder/wrist positions *lifting bulky loads *hand/arm vibration *whole body vibration |
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What are some examples of activity modifications?
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*rest & stretch
*spread out tasks *change your position *change position of task in relation to you *larger handles *incr/decrease friction *use tools for carrying/holding *minimize vibration and direct pressure *minimize repetition or sustained postures |
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What are common interventions for cumulative trauma?
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splint
activity modification |
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When should a splint be worn for acute cumulative trauma disorder?
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immobilize for 7-10 days (day and night)
off for gentle exercise |
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when should a splint be worn for chronic CTD splinting if the patient is prone to acute flare-ups?
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wear night splint
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When should a splint be worn for chronic CTD splinting if there are no acute flare-ups?
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no splint, or very limited use (soft splints)
avoid prolonged immobilization and encourage functional use |
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DEFINE lateral epicondylitis
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irritation of the common origin of the wrist extensors (ECRL, ECRB, EDC, ECU)
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What are the common MOIs for lateral epicondylitis?
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repetitive or sustained extension of the wrist, heavy gripping with repetitious pronation and supination
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What kind of splint would you use during the acute phase of lateral/medial epicondylitis?
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wrist cock-up
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What kind of splint would you use after the acute pain of lateral/medial epicondylitis has subsided?
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counterforce cuff (maybe--depends on patient)
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What kind of splint would you use for chronic, non healing lateral/medial epicondylitis?
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elbow/wrist immobilization with elbow in 90degrees flexion and wrist in 15-30degrees extension
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DEFINE medial epicondylitis
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"Golfer's elbow"
irritation of the mm originating off the medial epicondyle (FCR, PT, FCU, FDS) |
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What are common MOIs for medial epicondylitis?
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wrist flexion, pronation, gripping with wrist flexion
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DEFINE distal extensor tendonitis of the forearm
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extensor tendons are arranged in compartments, tednonitis can be localized to these specific compartments
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How many extensor tendon compartments are there?
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6
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What mm go through each of the 6 extensor tendon compartments?
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1: ABL, EPB
2: ECRL/ECRB 3: EPL 4: EDC/EI 5: EDM 6: ECU |
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With which other CTD should you always check for distal extensor tendonitis?
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medial/lateral epicondylitis
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De Quervain's syndrome is associated with which extensor tendon compartment
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1
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What are common symptoms of De Quervain's syndrome?
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*distal, radial, dorsal wrist pain
*dull, achy pain to sharp and shooting pain down to the thumb or up the forearm |
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What nerve can also be involved with De Quervain's syndrom?
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superficial radial nerve
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What sort of splint should you use for De Quervain's syndrom without superficial radial n involvement?
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thumb and wrist immobilization splint
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What sort of splint should you use for De Quervain's syndrome w/ superficial radial n involvement?
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soft splint
*still immobilize thumb and wrist |
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What degrees should each joint be placed in when using a splint to treat cubital tunnel (ulnar n)?
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elbow: 30-40 flex
forearm: neutral to slight pronation wrist: nuetral, slight flex if symptoms severe *anterior splinting so do not put pressure on ulnar n* |
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What degrees should each joint be placed when using a splint to treat radial tunnel?
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elbow: 90 flex
foreram: neutral wrist: slight extension |
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In what degree should joints be placed to splint for carpal tunnel?
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wrist: neutral to 30 extension
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When should a pt wear a splint for carpal tunnel?
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Usually: night wear, wrist free during the day
*if severe can wear splint during the day |
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What are common movements that can lead to carpal tunnel?
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wrist ext/flex
ulnar/radial deviation shoulder/elbow flexion |
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What are some client centered approaches when dealing with CTD?
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*facilitate client participation in all aspects of service delivery
*flexible, individualized care *enable clients to solve problems |
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What should be included in patient education with CTD?
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causes, pathology, prevention, course of treatment, expected outcomes, exacerbation tendencies
**surgery will not prevent reoccurrence if MOI not fixed |
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what are other aspects to be aware of when dealing with people with CTD?
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*correlation between pain and depression
*moderate to major stressors contribute to not returning to work |
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What are important reminders for therapist when treating CTD?
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*listen, validate pain, act as a support in order to facilitate return to work
*education about "safe pain" *evaluate work sites and make modifications |
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DEFINE cumulative trauma
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a group of health disorders arising from repeated biomechanical stresses to mm, tendons, ligs, joints and neurovascular structures
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What are common cummulative trauma disorders?
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repetitive stress disorder (RSI)
repetitive motion injuries (RMI) overuse syndromes |
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what are common MOI for cummulative trauma?
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mech stress
tissue irritation inflammation collagen organization scarring change in local gliding mechanisms |
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what should be included in a work task/activity assessment for someone with a cumulative trauma injury?
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*total body postures
*work/home equipment *time on specific duties *task requirements that cause pain *length of time pain free, with pain, type, location, severity of pain |
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what are common activity modification for activities that cause cumulative trauma?
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*res/stretch
*spread out tasks *change your position *change position of task in relation to you *larger handles *increase/decrease friction *use tools for carrying, holding *minimize vibration and direct pressure *minimize repetition or sustained postures |
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what are the 2 most common interventions for cumulative trauma?
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splint
activity modification |
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when do you splint for acute CTD?
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immobilize 7-10 days (day and night)
*off for gentle exercising |
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when do you splint for chronic CTD?
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night splint, only during acute flare-ups
*avoid prolonged immobilization and encourage functional use |
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DEFINE lateral epicondylitis
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irritation of the common origin of the wrist extensors
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MOI lateral epicondylitis
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repetitive or sustained extension of the wrist, heavy gripping with repetitious pronation and supination
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what splint would you use for acute lateral epicondylitis?
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wrist cock up
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what splint would you use after acute pain is resolved for lateral epicondylitis?
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counterforce cuff (not a lot of evidence supporting/discounting effectiveness)
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what splint would you use for chronic, non-healing lateral epicondylitis?
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elbow-wrist immob w/ elb flex (90) and wrist (15-30) extension
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DEFINE medial epicondylitis
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(golfer's elbow)
irriatation of the mm origination off the medial epicondyle |
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MOI medial epicondylitis
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wrist flexion, pronation, gripping with wrist flexion
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what splint would you use for acute medial epicondylitis?
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wrist cock up (neutral wrist)
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what splint would you use after acute pain is resolved for medial epicondylitis?
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counterforce cuff
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what splint would you use for chronic, non-healing medial epicondylitis?
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elbow-wrist immob with elb flex (90) and wrist flex (10-15)
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DEFINE distal extensor tendonitis
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extensor tendons are arranged in compartments
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how many compartment are there in the dorsal forearm?
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6
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Which mm are included in each of the 6 compartments of the dorsal forearm?
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1: abd pol long and ext pol brev
2: ECRL/ECRB 3: EPL 4: EDC/EI 5: EDM 6: ECU |
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DEFINE synovitis/vaginitis
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inflammation of the sheath around the tendons
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SYMPTOMS De Quervain's Tendonitis
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dull, achy to sharp and shooting pain down to thumb or up into forearm
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what nerve can also be involved with De Quervain's tendonitis?
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superficial radial n
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what splint would you use for De Quervain's tendonitis? what kind of splint is more comfortable for those that have superficial radial n involvement?
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*Radial thumb and wrist immob splint
*soft splint |
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In what position should you put the elbow/wrist for a splint if the patient has cubital tunnel?
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elbow flex 30-40
forearm: neutral to slight pronation wrist: neutral slight flexion if symptoms severe **anterior splint so no pressure on ulnar n** |
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what position should you put the elbow/wrist for a splint if the patient has radial tunnel?
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immob w/ elbow in flex (90), neutral forearm roatation and wrist extension
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what kind of splint do you use for carpal tunnel?
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cock-up
wrist neutral to 30 degrees extension *night wear only, unless severe |
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what aspects should a student pay attention to when dealing with CTD?
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*facilitate client participation in all aspects of servic delivery
*flexible, individualized care *enable clients to solve problems |
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DEFINE splint
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an orthopedic device to immobilize or support a part of the body (generally temporary)
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DEFINE orthosis
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a permanent device to replace or substiture for loss of mm function
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What are the 2 main types of locations that a splint can be placed?
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articular (wrist, elbow)
non-articular (forearm) |
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what is included in splint classification?
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location
direction intent |
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what are the 3 main intents of a splint?
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immobilization
mobilization restriction |
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what are the design principles of splints?
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*intent of splint
*design of splint *individual chara (age, skin) *function and sensation *cosmetics *cost *materials |
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What is the intent of an immobilization splint?
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no motion allow
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why would you use an immobilization splint?
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*symptom relief
*edema positioning *prevent joint contracture *protect healing structures *improve joint alignment *decrease pain *incr functional use |
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what is the intent of a mobilization splint?
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controlled tension alters cell proliteration: prescribed motion allowed
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Why is a mobilization splint used?
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*remodel scar tissue
*elongate soft tissue *incr PROM *assist in functional use by substituting for weak motion *provide exercise resistance |
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what is the intent of a restrictive splint?
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limit some aspect of joint motion
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why would you use a restrictive splint?
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*limit motion after nerve or tendon repair OR bone-ligament injury
*provide or improve joint stability *assist functional use |
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what are the 3 intents of a splint?
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immobilization
mobilization restriction |
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what are the 4 design classifications of a splint?
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static
serial static dynamic static progressive |
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DEFINE static splint
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no moving parts
immobize the joints they cross can be non articular most common splint made |
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DEFINE serial static splint
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no moving parts on splint
static splint that is remolded periodically to improve joint motion or mm length |
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DEFINE dynamic splint
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static base with mobilization force via elastic assistance (rubber bands, springs)
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DEFINE static progressive splint
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static base with mobilization force via non-elastic parts (nylon cords, hinges, turnbuckles)
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what are individual characteristics that you should take into account when making a splint?
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persons:
age skin integrity expected compliance healing stage occupational demands |
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what are common aspects of function and sensation that the therapist should remember when making splints?
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simple design
volar hand exposed when possible (incr sensation and fx) only include the fingers and thumb if necessary occupational demands |
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what is the number 1 reason a splint is not worn?
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ugliness
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what is included under cosmetics of a splint?
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ugliness
comfort durable ease to put on |
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what are advantages and disavantages of a custom splint?
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advantages:
-individualized and custom fit, able to modify disadvantages -more costly, time required to construct, appearance |
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what are advantages and disadvantages of a pre-fabricated splint?
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advantage
-less expensive, ready to use, appearance disadvantage -may not address all problem areas, lack of adequate support, may not be able to be modified |
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What are the some types of materials that are used to make splints?
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soft splints (neoprene)
plaster casting low temperature thermoplastics |
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at what temperature does the low temp thermoplastics melt?
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120-130 degrees
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How can low temp thermoplastics vary?
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*thickness (1/8-3/32)
*solid, perforated, color *handling characteristic *performance characteristics |
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DEFINE handling characteristics
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material properties during heating
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DEFINE performance characteristics
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performance after hardened
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what are some thermoplastic handling characteristics?
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self-bonding
elasticity memory drape heating time and work time |
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DEFINE self bonding
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degree that it sticks to itself; coated materials are less likely to stick to self
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DEFINE elasticity
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resistance to stretch; can be handled aggressively without losing form
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DEFINE memory
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the ability for the material to return to its former size and shape when reheated. allows reheating and reshaping several times
*good for beginners and serial splints |
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DEFINE drape
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the ability for the material to mold closely over the body part w/out manual assistance; gravity assisted. better for small splints (must handle gently)
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what are performance characteristics of thermoplastic?
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conformability
flexibility durability rigidity perforation finish |
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DEFINE conformability
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fit intimately into contoured areas (more comfortable)
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DEFINE flexibility
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can take repeated stresses (good for donning and doffing circumferential splints)
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DEFINE durability
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how long material lasts
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DEFINE rigidity
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strong and resistant to repeated stress; important for large splints which support weicht of limb
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DEFINE perforation
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cooler (but can overstretch holes)
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DEFINE finish
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texture of finished product; coated are easier to keep clean (but harder to afix velcro straps)
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what must you maintain in hand splints?
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3 arches of the hand:
proximal transverse distal transverse longitudinal |
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If the splint crosses a joint, how much of the extremity should it cover? Why?
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2/3; lack lever arm for resistance or support and/or pressure is not evenly distributed
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splints should be how much of the circumference of the part supported?
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1/2
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what should be included in patient edu when dealing with a splint?
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*purpose of splint
*activity modification *take splint on/off *hygeiene *cleaning and care of splint teach how to modify the splint if needed *precautions *wearing schedule |
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what do you need to document when providing a splint?
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need for splint
type of splint fabricated patient edu patient response |
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What should be included in a hand eval?
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history
OPP Document appearance of hand edema ROM Sensorimotor fx Standardized assessments |
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What should be documented on the of the hand in a hand eval?
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**document all abnormalities whether it is relevant or not**
scars amputations trophic changes discoloration sweating wrinkles atrophy edema |
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What are types of trophic changes of the hand?
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skin texture
atrophy of finger pulps nail changes hair growth more susceptible to injury and slower healing |
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What are some changes of skin texture that can occur?
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early changes--velvety or smooth bc atrophy of the epidermis has caused the finger creases to become less distinct; as damage cont, the skin becomes shiny, smooth and inelastic
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What are some nail changes that can occur?
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early changes--striations, ridges, slowed growth and increased hardness; later becomes changes in shape to match finger, "moon" is missing
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What is an important measurement for the therapist to determine response to treatment with hand therapy?
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edema
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DEFINE circumferential measurements
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can measure at very specific or multiple sites using a soft tape measure
**always perform bilaterally to compare to normal |
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Where are common sites for circumferential measurements?
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Biceps--7cm proximal to the olecrenon
Forearm--11 cm distal to the olecranon Wrist--ulnar styloid hand--mid palmer crease MP, PIP, DIP |
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DEFINE volumeter measurement
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uses water displacement in mL to measure edema as compared to the unaffected side.
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What is something you should be mindful of when measuring for edema?
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exercise increases volume recording immediately afterward and then a decline in volume at 10 min
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Should AROM, PROM, or both be measured when doing a hand eval? why?
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bc of intimacy of hand structures and the ability of scar tissue to impair AROM both AROM and PROM should be measured to differentiate between joint tightness and tendon excursion
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What are 2 ways of measuring ROM?
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conventional ROM method
Total motion (many clinics have moved to this) |
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DEFINE total motion
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expressed either actively (TAM) or passively (TPM)
Total motion=flexion (MP+PIP+DIP) - Extension lag (MP+PIP+DIP) |
