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51 Cards in this Set
- Front
- Back
What annular pulleys are the most crucial for normal digital function
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A2 and A4
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HOw many annular and Cruciform pulleys are there
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4 annular
3 cruciform |
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What promotes healing with the healing of a tendon
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the intrinsic vascular supply
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The vincula
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Vascular and nutritional supply to the tendons
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How do you test the FDS
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With adjacent fingers
in full extension, prohibiting FDP motion, efforts at finger flexion produce in normal hand isolated FDS function. |
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FDP testing
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Testing of FDP function.
Isolated DIP flexion can only be accomplished with intact FDP musculature. |
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Flexor zone 5
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Extends proximally from the proximal edge of the carpal ligament to the musculotendinous junction of the long flexor tendons.
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Flexor injuries in zone 5 are usually accompanied by
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major nerve injruies and possible arterial invovlement
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Therapeutic goal for zone 5 injury
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challenge:To restore differential gliding of the tendons as injuries at this level can easily adhere to skin and surrounding structures.
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Zone 4
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the tendons pass through the narrow carpal canal, which underlies the transverse carpal ligament. The proximal limit on the skin would correspond to the volar wrist crease.
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Injuries to Zone 4
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Involve both flexor tendons or can be just the superficialis. Can involve median and ulnar nerves.
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Therapeutic goal of zone 4 injury
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to restore tendon glide
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Zone 3
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Located in the palm
Proceeds proximally from the metacarpal neck to the distal end of the transverse carpal ligament Delineated by the boundaries of the flexor retinaculum |
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Zone 3 injuries
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level:Involve both flexor tendons or just the superficialis.
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How do zone 3 injuries heal
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typically quickly
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therapeutic goal for zone 3
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Intrinsic muscle contracture can result from adhesions and protective positioning during the first few weeks of healing especially if the therapist does not concentrate on tendon gliding exercises and MP ROM.
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Zone 2 is titled...
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"no Man's land"
Sheath area that is hard to get to by surgeons |
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Zone 2 is delineated by
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the boundaries of the flexor reticulum which extends fromt he mid portion of the middle phalanx proximally to the neck of the metacarpal
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Injuries at zone 2
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Can affect one or both of the flexor tendons
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Therapeutic challenge of zone 2
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to restore maximal tendon glide
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Zone 1
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Compromises the base of the distal phalanx to the middle of the middle phalanx. This zone is distal to the insertion of the flexor digitorum superficialis.
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Most common zone to experience injury..that we will see in practice
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Zone2
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Primary surgical option for tendon repair
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within 24 hours
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Delayed primary surgery option for tendon repair
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Performed 24 hours to 3 weeks post injruy
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secondary repair surgery option for tendon reapir
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more than 3 weeks after the injury
most at risk for scarring |
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Inflammatory phase
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48 -72 hours after
little collagen is laid donw |
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During inflammatory phase, tendon repairs are held together by
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the strength of the suture material
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when does strenght begin to come back after injury
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does not strengthen until 21 days
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Fibroplasia phase
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rapid scar formation
new scar is very weak repair can be easily disrupted by excessive force |
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time frame for fibroplasia phase
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5 days to 4 weeks
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Maturation phase
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Increased repair strength allows therapists to apply greater and greater stresses to the tendon, thus influencing scar remodeling
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complications after injury
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Rupture and Adhesions
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Implications for therapy after repair
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early controlled mobs
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when should mobilizations start
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during the inflammatory and fibroplasia stages
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When does AROM begin after surgery
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3 weeks or earlier
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At 3 weeks, how strong is the tendon?
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only at 20% of its tensile strength
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Factors affecting adhesions
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Age
Health Nutritional Status Means of Injury-initial trauma Surgical Technique Hx of smoking or alcohol consumption Systemic disease Gapping at repair site tendon immobilization Tendon Ischemia |
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Adhesions cause
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limited flexion due to scar tissue
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All protocols are based on
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the date of the repair
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How long does rehab typically last
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12-16 weeks
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Intervention priorities to consider
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Education
Protection - splinting Wound management Edema Mobilize joitns and tendon Prevent contractures |
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intervention approaches types
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immobilization
early Passive mobs Early active mobs |
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What is the most recent approach used for flexion protocol?
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Early active mobilization
based on minimizing work of flexors. wrist is positioned in neutral or slight ext. w\ |
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Common Protocols for Early passive mobs
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Kleinart
Duran Houser |
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Modified Duran is typically used for what zones?
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2 or 3
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Modified Duran proticol
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After tendon repair, a dorsal cast or splint is applied maintaining the wrist in 20to 30 of flexion, the MP in 50to 70 of flexion and the IPs in neutral.
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Kleinert was developed specifically for..
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Repairs in zone 2
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Kleinert uses...to facilitate
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Rubber band traction
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when do you start strengthening
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6-8 weeks
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when will a pt with a tendon repair be able to return to work
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10-12 weeks
with proper rehab |
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Precautions with Exercise
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Do not forecfully extend
Passive motion should be done in a slack and protected position Watch for contractures |