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Muscoskeletal Disorders
N/A
63
Health Care
01/25/2012

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Cards

Term
Dupuytren's Disease
Definition

Disease of the fascia of the palm and digits

a. fascia becomes thick and contracted

b. results in flexion deformities of involved digits

 

OT intervention: wound care, edema control, extension splint; initially at all times, A/PROM and progress to strengthening when wounds are healed, scar management, fx tasks emphasie flexion/ext (grasp/release)

Term
Skier's thumb
Definition
Rupture of the ulnar collateral ligament of the MCP joint of the thumb
Term
Skier's thumb tx
Definition
-thumb splint for 4-6 weeks
-PROM begin at 8 weeks
-Strengthening at 10 weeks
Term
Complex regional pain syndrome
Definition
Type I: RSD (no demonstrated nerve lesion)
Type II: formerly known as causalgia
-Vasomotor dysfuction a
Term
CRPS tx
Definition
-modalities
-AROM to involved joints
-WB
-Splinting to prevent contractures
INTERVENTIONS TO AVOID
-PROM, passive stretching, joint mob, dynamic splinting, and casting
Term
Colles fx
Definition
Fx of distal radius (dorsal)
Term
Smith's fx
Definition
Fx of distal radius (volar)
Term
Boxer's fx
Definition
Fx of the fifth metacarpal (ulnar gutter splint)
Term
Fx tx: immobilization phase
Definition
-AROM of joints above and below stabilized part
-edema control: elevation, retrograde massage and compression garments
-light ADL and activities with NO resistance
Term
Fx tx: mobilization phase
Definition
edema control
AROM
Term
Fx tx cont'd
Definition
Progress to PROM when approved by physician (4-8 weeks)
-Only exception are humerus fractures which often begin with PROM or AAROM
Term
DeQuervain's
Definition
Stenosing tenosynovitis of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB); pain and swelling over the medial styloid; positive finklestein test
Term
DeQuervain's conservative tx
Definition
Thumb spica splint (IP free)
Activity/work modification
Ice massage over radial wrist
Gentle AROM
Term
DeQuervain's post op tx
Definition
Thumb spica splint (0-2 weeks)
Strengthening, ADL, and role activities (2-6 weeks)
Unrestricted activity (6 weeks)
Term
Lateral epicondylitis
Definition
Overuse of the wrist extensors (esp. extensor carpi radialis brevis), also called tennis elbow
Term
Medial epicondylitis
Definition
overuse of wrist flexors (aka golfer's elbow
Term
Lateral and medial epicondylitis conservative tx
Definition
Elbow strap, wrist spling
ice and deep friction massage
stretching
activity/work modification
as pain decreases, begin strengthening
Term
Trigger finger
Definition
tenosynovitis of the finger flexors: most commonly A1 pulley
caused by repetition and use of tools that are placed too far apart
Term
Trigger finger conservative tx
Definition
hand based trigger finger splint (MCP extended, IP free)
scar massage
edema control
tendon gliding
activity/work modification
AVOID GRIPPING ACTIVITIES AND USING TOOLS TOO FAR APAR
Term
Kleinert protocol (flexor tendon mobilization program)
Definition
-active ext of digits w/ passive flexion (rubber band)
-protocol
a: 0-4 weeks: dorsal block splint
b: 4-6 weeks: wristlet. place/hold exercises. scar management
c: 6-8 weeks: AROM. tendon gliding and differential tendon gliding. light ADL and role activities. D/C SPLINT
d: 8-12 weeks: strengthening and work and leisure activities
Term
Duran protocol
Definition
passive flexion and ext of digit.
Protocol
a: 0-4 1/2 weeks: dorsal blocking splint. exercises in splint include passive flexion of PIP, DIP joints and to DPC. 10 reps every hour
b: 4 1/2-6 weeks: active flexion and ext w/ in limits of splint
c: 6-8 week: tendon gliding and differential tendon gliding, scar mgmt, light ADL
d: 8-12 weeks: strengthening and work activities
Term
Carpal tunnel syndrome
Definition
A median nerve compression
-symptoms: numbness, tingling of the thumb, index, middle, and 1/2 of ring finger.
Term
Carpal tunnel conservative tx
Definition
wrist splint in neutral: worn @ night and during day if performing repetitive activity
median nerve gliding exercises
activity modification (avoid activities with extreme wrist flexion position
ergonomics
Term
Carpal tunnel post-op tx
Definition
-edema control
-AROM
-nerve and tendon gliding exercises
-sensory re-education
-strengthening of thenar muscles
-work/activity modification
Term
Pronator teres syndrome
Definition
medial nerve compression b/w two heads of pronator teres
-symptoms same as CTS and also aching pain in proximal forearm
1) positive tinel's sign at forearm
2) NO NIGHT SYMPTOMS
Term
Pronator teres conservative tz
Definition
Elbow splint at 90 degrees w/ forearm in neutral
Avoid supination/pronation activities
Term
Pronator teres post-op tx
Definition
AROM
Nerve gliding
Strengthening (2 WEEKS post op)
Sensory re-education
Work/activity modification
Term
Guyon's canal
Definition
an ulnar nerve compression at the wrist
Symptoms: numbness and tingling in the ulnar nerve dist of the hand, motor weakness of ulnar nerve innervation, positive tinel's sign at guyon's canal, and later stages can lead to atrophy of hand musculature innervated by ulnar nerve
Term
Guyon's canal conservative tx
Definition
Wrist splint in neutral
Work/activity modification
Term
Guyon's canal post-op tx
Definition
Edema control
AROM
Nerve gliding
Strengthening (2-4 weeks): focus on power grip
Sensory re-education
Term
Cubital tunnel syndrome
Definition
an ulnar nerve compression at the ELBOW
Symptoms: 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 of FCU, FDP, to digits IV and V ant ulnar nerve-innervated intrinsic muscles of the hand
Term
Cubital tunnel conservative tx
Definition
-Elbow splint to prevent position of extreme flexion (ESPECIALLY AT NIGHT)
-Elbow pad to decrease compression of nerve when leaning on elbows
-Activity/work modificaton
Term
Cubital tunnel post-op tx
Definition
Edema control
Scar mgmt
AROM and nerve gliding (2 WEEKS POST-OP)
Strengthening (4 WEEKS POST-OP)
MCP flexion splint if clawing noted
Term
Radial nerve palsy
Definition
a radial nerve compression
Symptoms: weakness or paralysis of extensors to the wrist, MCPs, and thumb; wrist drop
Term
Radial nerve conservative tx
Definition
Dynamic ext splint
Work/activity modification
Strengthening wrist and finger extensors when motor function returns
Term
Radial nerve palsy post-op tx
Definition
ROM
Nerve gliding
Strengthening (6-8 weeks post-op)
ADL
Term
Medial nerve laceration sensory loss
Definition
central palm
palmar surface of thumb to radial 1/2 of ring finger
dorsal surface of index, middle, and radial 1/2 of ring fingers
Term
Medial N. laceration motor loss (low lesion at wrist)
Definition
Lumbricals I and II
Opponens pollicis brevis (opposition)
Abductor pollicis brevis (abduction
Flexor pollicis brevis (thumb MCP flexion)
Term
Medial N. laceration motor loss (high lesion at or proximal to elbow)
Definition
Includes all of medial N. low lesion
FDP to index and middle fingers, and FPL
FCR (inability to flex to radial aspect of wrist)
Term
Medial N laceration deformities
Definition
Flattening of thenar eminence (ape hand)
Clawing of index and middle fingers for a low lesion
Benediction sight for a high lesion
Term
Medial N tx
Definition
Dorsal protection splint (wrist in 30 degree flexion for low lesion). Include elbow (90 degree flexion) if a high lesion
Begin A/PROM of digits with wrist in flexed position 2 weeks post op
Scar mgmt
AROM of wrist 4 weeks; include elbow if high lesion
Splinting consideration: C bar to prevent thumb adduction contracture
Sensory re-education: begin when individual demonstrates a level of diminished protective sensation on Semmes-Weinstein.
Term
Ulnar N. laceration sensory loss
Definition
Ulnar aspets of palmar and dorsal surface
Ulnar 1/2 of ring and little finger on palmar and dorsal surfaces
Term
Ulnar n. laceration motor loss (low lesion @ wrist)
Definition
palmar and dorsal interossei (adduction and abduction of MCP joints)
lumbricals III a& IV (MCP flexion of digits 4 & 5)
FPB and adductor pollicis (flexion and adduction of the thumb
ADM, ODM, FDM (abduction, opposition, and flexion of 5th digit)
Term
Ulnar n. laceration motor loss (high lesion)
Definition
same as low lesion
FDP IV & V (flexion of DIPs of ring and little fingers)
Term
Ulnar n. laceration deformities
Definition
claw hand
flattened metacarpal arch
+ Froment's sign;
functional loss: loss of power grip and decreased pinch strength
Term
Ulnar n. tx
Definition
see median N. repair
Splinting considerations: MCP flexion block splint
Sensory re-education: same as median n.
Term
Radial n. laceration sensory loss
Definition
medial aspect of dorsal forearm. radial aspect of dorsal palm, thumb, and index, middle and radial 1/2 of ring phalanges.
Term
Radial n. motor loss (low lesion @ the forearm)
Definition
loss of wrist extension due to absent or imapired innervation to ECU
EDC, EI, EDM, (MCP ext.)
EPB, EPL, APL (thumb ext)
Term
Radial n. motor loss (high lesion @ the level of humerus)
Definition
All of the above, including ECRB, ECRL, and brachioradialis
if level of axiall, loss of triceps;
Functional loss: inability to extend to release objects, difficulty manipulating objects
Term
Radial n. tx
Definition
dynamic extension splint
ROM
Sensory re-education
Instruct in home program
activity modification
Term
Rotator cuff tendonitis
Definition
site of impingement: coracoacromial arch (acromion, coracoacromial ligament, and coracoid process
Term
Rotator cuff conservative tx
Definition
Activity modification: avoid above the shoulder level activities until pain subsides
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
Term
Rotator cuff post-op tx
Definition
PROM (0-6 weeks); progress to AA/AROM
Decrease pain: begin with ice, progress to heat
Strengthening (6 weeks post-op): begin with isometrics, progress to isotonic (below shoulder level)
Activity mod
Leisure and work activities (8-12 weeks post-op)
Term
Adhesive capsulitis (frozen shoulder)
Definition
Restricted passive shoulder range of motion; occurs when joint capsule becomes inflamed
Term
Adhesive capsulitis conservative tx
Definition
Encourage active use through ADL and role activities
PROM
modalities
Term
AC post op tx
Definition
PROM IMMEDIATELY
Pain relief: modalities
Term
Shoulder dislocation
Definition
anterior dislocation most common
Term
Shoulder dislocation tx
Definition
Regain ROM: avoid combined abduction and external rotation
Pain free ADL
Strengthen rotator cuff
Term
Arthritis OT evaluation
Definition
Occupational roles
ROM: Focus on AROM, PROM should be avoided especially during inflammatory stage, note deformities and nodules
Muscle strength: AVOID MMT unless requested by doctor, document strength in relation to function
Grip strength: use sphygmomanometer
ADL and role activities
Pain: use pain scales
Edema: use volumeter or tape measure
Term
Arthritis tx
Definition
Splinting: RESTING HAND SPLINT in the ACUTE stage, wrist splint only if arthritis is specific to wrist, ulnar drift splint to prevent deformity, silver ring splints to prevent boutinnere and swan neck deformities, dynamic MCP extension splint with radial pull, hand base thumb splint for CMC arthritis
Joint protection techniques
Energy conservation
ROM: focus on arom, gentle PROM if person unable to perform AROM
Heat modalities: hot packs before and after exercise, paraffin bath for hands
Strengthening: AVOID during inflammatory stage
Adaptive equipment as needed
Term
Osteogenesis Imperfecta
Definition
Fractures in utero
Brittle bone and 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
Term
OI tx
Definition
activity adaptation
environmental modifications
Preventive positioning
Activities to increase muscle strength
WB activities to facilitate bone growth
Family, caregiver and teacher education
Term
Posterior hip replacement precautions
Definition
Hip flexion past 90 degrees
No adduction or crossing of legs
No hip pivoting