Term
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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) |
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Term
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Definition
| Rupture of the ulnar collateral ligament of the MCP joint of the thumb |
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Term
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Definition
-thumb splint for 4-6 weeks
-PROM begin at 8 weeks
-Strengthening at 10 weeks |
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Term
| Complex regional pain syndrome |
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Definition
Type I: RSD (no demonstrated nerve lesion)
Type II: formerly known as causalgia
-Vasomotor dysfuction a |
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Term
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Definition
-modalities
-AROM to involved joints
-WB
-Splinting to prevent contractures
INTERVENTIONS TO AVOID
-PROM, passive stretching, joint mob, dynamic splinting, and casting |
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Term
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Definition
| Fx of distal radius (dorsal) |
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Term
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Definition
| Fx of distal radius (volar) |
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Term
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Definition
| Fx of the fifth metacarpal (ulnar gutter splint) |
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Term
| Fx tx: immobilization phase |
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Definition
-AROM of joints above and below stabilized part
-edema control: elevation, retrograde massage and compression garments
-light ADL and activities with NO resistance |
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Term
| Fx tx: mobilization phase |
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Definition
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Term
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Definition
Progress to PROM when approved by physician (4-8 weeks)
-Only exception are humerus fractures which often begin with PROM or AAROM |
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Term
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Definition
| Stenosing tenosynovitis of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB); pain and swelling over the medial styloid; positive finklestein test |
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Term
| DeQuervain's conservative tx |
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Definition
Thumb spica splint (IP free)
Activity/work modification
Ice massage over radial wrist
Gentle AROM |
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Term
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Definition
Thumb spica splint (0-2 weeks)
Strengthening, ADL, and role activities (2-6 weeks)
Unrestricted activity (6 weeks) |
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Term
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Definition
| Overuse of the wrist extensors (esp. extensor carpi radialis brevis), also called tennis elbow |
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Term
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Definition
| overuse of wrist flexors (aka golfer's elbow |
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Term
| Lateral and medial epicondylitis conservative tx |
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Definition
Elbow strap, wrist spling
ice and deep friction massage
stretching
activity/work modification
as pain decreases, begin strengthening |
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Term
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Definition
tenosynovitis of the finger flexors: most commonly A1 pulley
caused by repetition and use of tools that are placed too far apart |
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Term
| Trigger finger conservative tx |
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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 |
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Term
| Kleinert protocol (flexor tendon mobilization program) |
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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 |
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Term
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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 |
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Term
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Definition
A median nerve compression
-symptoms: numbness, tingling of the thumb, index, middle, and 1/2 of ring finger. |
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Term
| Carpal tunnel conservative tx |
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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 |
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Term
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Definition
-edema control
-AROM
-nerve and tendon gliding exercises
-sensory re-education
-strengthening of thenar muscles
-work/activity modification |
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Term
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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 |
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Term
| Pronator teres conservative tz |
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Definition
Elbow splint at 90 degrees w/ forearm in neutral
Avoid supination/pronation activities |
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Term
| Pronator teres post-op tx |
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Definition
AROM
Nerve gliding
Strengthening (2 WEEKS post op)
Sensory re-education
Work/activity modification |
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Term
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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 |
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Term
| Guyon's canal conservative tx |
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Definition
Wrist splint in neutral
Work/activity modification |
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Term
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Definition
Edema control
AROM
Nerve gliding
Strengthening (2-4 weeks): focus on power grip
Sensory re-education |
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Term
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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 |
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Term
| Cubital tunnel conservative tx |
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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 |
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Term
| Cubital tunnel post-op tx |
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Definition
Edema control
Scar mgmt
AROM and nerve gliding (2 WEEKS POST-OP)
Strengthening (4 WEEKS POST-OP)
MCP flexion splint if clawing noted |
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Term
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Definition
a radial nerve compression
Symptoms: weakness or paralysis of extensors to the wrist, MCPs, and thumb; wrist drop |
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Term
| Radial nerve conservative tx |
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Definition
Dynamic ext splint
Work/activity modification
Strengthening wrist and finger extensors when motor function returns |
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Term
| Radial nerve palsy post-op tx |
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Definition
ROM
Nerve gliding
Strengthening (6-8 weeks post-op)
ADL |
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Term
| Medial nerve laceration sensory loss |
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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 |
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Term
| Medial N. laceration motor loss (low lesion at wrist) |
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Definition
Lumbricals I and II
Opponens pollicis brevis (opposition)
Abductor pollicis brevis (abduction
Flexor pollicis brevis (thumb MCP flexion) |
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Term
| Medial N. laceration motor loss (high lesion at or proximal to elbow) |
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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) |
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Term
| Medial N laceration deformities |
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Definition
Flattening of thenar eminence (ape hand)
Clawing of index and middle fingers for a low lesion
Benediction sight for a high lesion |
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Term
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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. |
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Term
| Ulnar N. laceration sensory loss |
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Definition
Ulnar aspets of palmar and dorsal surface
Ulnar 1/2 of ring and little finger on palmar and dorsal surfaces |
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Term
| Ulnar n. laceration motor loss (low lesion @ wrist) |
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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) |
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Term
| Ulnar n. laceration motor loss (high lesion) |
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Definition
same as low lesion
FDP IV & V (flexion of DIPs of ring and little fingers) |
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Term
| Ulnar n. laceration deformities |
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Definition
claw hand
flattened metacarpal arch
+ Froment's sign;
functional loss: loss of power grip and decreased pinch strength |
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Term
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Definition
see median N. repair
Splinting considerations: MCP flexion block splint
Sensory re-education: same as median n. |
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Term
| Radial n. laceration sensory loss |
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Definition
| medial aspect of dorsal forearm. radial aspect of dorsal palm, thumb, and index, middle and radial 1/2 of ring phalanges. |
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Term
| Radial n. motor loss (low lesion @ the forearm) |
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Definition
loss of wrist extension due to absent or imapired innervation to ECU
EDC, EI, EDM, (MCP ext.)
EPB, EPL, APL (thumb ext) |
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Term
| Radial n. motor loss (high lesion @ the level of humerus) |
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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 |
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Term
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Definition
dynamic extension splint
ROM
Sensory re-education
Instruct in home program
activity modification |
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Term
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Definition
| site of impingement: coracoacromial arch (acromion, coracoacromial ligament, and coracoid process |
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Term
| Rotator cuff conservative tx |
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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 |
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Term
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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) |
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Term
| Adhesive capsulitis (frozen shoulder) |
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Definition
| Restricted passive shoulder range of motion; occurs when joint capsule becomes inflamed |
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Term
| Adhesive capsulitis conservative tx |
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Definition
Encourage active use through ADL and role activities
PROM
modalities |
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Term
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Definition
PROM IMMEDIATELY
Pain relief: modalities |
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Term
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Definition
| anterior dislocation most common |
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Term
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Definition
Regain ROM: avoid combined abduction and external rotation
Pain free ADL
Strengthen rotator cuff |
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Term
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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 |
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Term
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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 |
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Term
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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 |
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Term
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Definition
activity adaptation
environmental modifications
Preventive positioning
Activities to increase muscle strength
WB activities to facilitate bone growth
Family, caregiver and teacher education |
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Term
| Posterior hip replacement precautions |
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Definition
Hip flexion past 90 degrees
No adduction or crossing of legs
No hip pivoting |
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