Term
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Definition
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Term
|
Definition
Connective tissue (collagen, elastin)
Capillaries,lymphatic /blood vessels, hair follicles, smooth muscles, sebaceous glands, sweat glands, nerve endings |
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Term
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Definition
Onset -10 days
Vascular and cellular response
Monocytes/Neutrophils
Debride/clean/Initiate healing process
Edematous, painful, red/warm |
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Term
| Proliferation Phase-rebudding |
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Definition
Day 3 until wound heals (2-3 weeks)
Revascularization/reepitheliazation/contraction
Endothelial cells/fibroblasts
Poor tensile strength of new scar |
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Term
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Definition
Week 3-2years
Fibroblast exit
Collagen remodeling
Scar tensile strength increases to 80%
Can lead to overscaring. Need to watch it to make sure it is enough.
Need to keep collagen fibers in a parallel fashion-so they don’t cross. Stretch it out. |
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Term
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Definition
Occurs from the “inside-out”
Target appearance
Resemble a Crush injury
Muscle damage
Vascular compromise
Fluid retension/ edema
Compartment syndrome-something going on underneath. Infection/edema.
Organ trouble. They have a small entrance womb and then under the skin is even worse.
Contact Points
Hidden Injuries
Cardiac
Brain/nerve deficits
Lung
Internal injuries
Kidney failure |
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Term
| Superficial--first degree |
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Definition
Epidermis
No blistering
Pink
Painful
Heal on own in 3-7 days |
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Term
| Superficial Partial thickness-- superficial second degree |
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Definition
Complete loss of Epidermis
Minimal loss of dermis
Pink to red
Moist
Blisters
Painful
Weeping & shiny
Heal on own in 2 weeks
Only see if infection or cover much of
the body |
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Term
| Deep Partial Thickness- Deep second degree- |
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Definition
Loss of most of dermis
Pink, white, or tan
Minimal pain-still really painful
May convert to Full Thickness
Healing time 3-5 weeks
We will intervene with OT. |
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Term
| Full Thickness--third degree |
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Definition
Total loss of epidermis & dermis
White, charred, yellow, brown
Dry, leathery
No pain
May require escharotomy-Taking
dead tissue and removing it. Then
take skin in good area and move it.
Requires grafting |
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Term
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Definition
Destruction of all tissue & bone
Infection & gangrene
Possible amputation |
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Term
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Definition
2nd degree less than 15% TBSA
Less than 10% for children
3rd degree less than 2% TBSA |
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Term
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Definition
2nd degree of 15-25% TBSA excluding hands, feet, face
10-20% children
3rd degree of 2-10% TBSA |
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Term
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Definition
Deep Partial (2nd degree )greater than 30% TBSA
Full Thickness (3rd degree) greater than 10% TBSA
Subdermal (4th degree)burn
Respiratory involvement
Face, hand, feet, or genitalia burned
Trauma complication
Electrical--cardiac output for 48 hours
Chemical |
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Term
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Definition
Escharotomy or fasciotomy
Eschar-necrotic tissue
Need to allow for circulation when edema severe |
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Term
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Definition
Donor Sites
Meshing- stretched out and then poked holes in.
Graft contracts (thigh, buttocks,abdomen) |
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Term
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Definition
Donor sites (medial arm, groin)
Smaller grafts |
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Term
|
Definition
| from another site on body |
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Term
|
Definition
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Term
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Definition
| from another species, usually pig |
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Term
| Culture epidermal autografts (CEA) |
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Definition
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Term
| Acute Stage & Pre-Grafting |
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Definition
Pain care--stress management
Skin care/coverage
Musculoskeletal care
Edema Control
Positioning/splinting-to prevent contractures
Exercises-maintain ROM & strength
ADL—adaptive equipment
LEISURE |
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Term
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Definition
Immobilize graft—splinting
Pain/Edema control
ADL
Exercises
Donor site day 1
Graft sites 5-7days (gentle AROM)
Get MD orders for ROM post graft
Pressure garments (2 weeks)
Scar Massage (3-4 weeks)
Dynamic Splinting (6 weeks post)
Use these timelines as a guide. Check with MD before advancing therapy |
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Term
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Definition
Reduce edema, maintain ROM, prevent deformity, increase strength & endurance
Minimize scarring, educate on skin care
Maintain functional independence
Assist with psychological adjustment
Re-entry to work and community |
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Term
|
Definition
Scars contract 24/7 until
mature
18-24 months
Initially flat and red
Scar hypertrophy as healing continues
Delayed wound healing increases hypertrophy |
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Term
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Definition
Red
Raised
Rigid
6-8 weeks post wound closure
Cause-overgrowth of rigid tissue due to uneven collagen
Factors influencing immature scars
Positioning, exercise, splinting, compression |
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Term
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Definition
Overgrowth of granulation tissue
Grow beyond the boundaries of the original wound
More common in dark pigmented skin |
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Term
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Definition
Therapeutic Exercise/Home exercise Program
Scar Management
Compressive Therapy
Scar Massage
ADL’s
Support Group
Psychological Support
Strategic therapy
Community Re-entry
Return to work/work hardening |
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Term
| Complex Regional Pain Syndrome |
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Definition
Vasomotor dysfunction characterized by very severe pain, swelling, stiffness, and discoloration
Localized to one area of an extremity, to an entire extremity or more than one extremity
Pain is most outstanding complaint
Edema is most outstanding physical feature
Also known as Reflex Sympathetic Dystrophy, Shoulder-Hand Syndrome, Sudek’s atrophy, Causalgia (post nerve injury/surgery |
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Term
| Diagnosis Complex Regional Pain Syndrome |
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Definition
History
Physical Exam
X-rays (Mineral loss)
Bone Scan (Osteoporosis)
Thermography |
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Term
| Cause of Complex Regional Pain Syndrome |
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Definition
Unknown
Post injury, surgery, trauma, disease
May be minor or severe
Symptoms don’t necessarily match severity of primary cause |
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Term
| Primary “Cardinal” Symptoms of Complex Reginal Pain Syndrome |
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Definition
Pain
Allodynia :
pain with stim not typically painful
Hypersensitive response
Swelling
Stiffness
Discoloration |
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Term
| Secondary Symptoms of complex regional pain syndrome |
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Definition
Osseous demineralization
Sudomotor changes
Increased sweating
Temperature changes
Trophic changes
Skin texture, nail changes, hair growth
Vasomotor changes
Palmar fibromatosis
Nail changes color, shows ridges,
Black coarse hair against digits. |
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Term
| Acute Stage of complex regional stage |
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Definition
Onset to approx. 3 months
Symptoms:
Pain (burning/aching)
Skin changes: Redness, shiny/thin
Increased nail/hair growth
Hyperhidrosis (excessive sweating)
Limited ROM (secondary to pain)
X-rays may reveal demineralization/osteoporsis |
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Term
| Subacute Stage of complex regiona pain syndrome |
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Definition
Extends from 3-9 months
Symptoms:
Intense pain –spreads
Continued decreased ROM
Swelling is brawny and fixed
Skin:
Redness, sweating decrease
Mottled, white, blue, splotchy look
Nails
Split, brittle, grooved
Stiffness continues
Periarticular thickening around joints of digits
Palmar thickening
Osteoporosis is pronounced |
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Term
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Definition
May last for several months/years
May affect the entire limb
Symptoms
Pain/edema subside
Fibrotic changes
Continued joint stiffness – maybe permanent
Skin: pale and glossy – maybe irreversible
Difficult to gain full ROM-permanent contractures |
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Term
| Medical Treatment for Complex Regional Pain Syndrome |
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Definition
Blocks
Stellate: local anesthetic
Bier : regional anesthetic, into vein
Medication
Pain meds: Oral Steroids/Opioids
Sympatholytic medication: inhibits SNS
Surgery
Sympathectomy: sympathetic ganglia removed
Insert needle into ganglia area (clavicle area) insert meds to interrupt pain. Patients will come in to Ots for ROM and break up the “gel” inside the hand/arm. |
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Term
| OT Treatment for complex Regional Pain Syndrome |
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Definition
Acute:
Establish trust/patient education
Decrease pain and edema
TENs
Retrograde massage
Elevation
Compression
Desensitization
Fluidotherapy, retrograde massage, graded textures, protection (gloves, elastomer inserts etc.)
AROM exercises (aerobic exercise-walking)
Stress Loading
Splinting: depending on pt./level/symptoms
Static: 20 deg wrist extension, MP’s 70 deg of flex, IP’s 0
Consider patient’s emotional, psychological state
-Scrub and Carry
Subacute/Chronic
Increase ROM (A/PROM)
Stretches
CPM
Splinting: dynamic to increase ROM
Functional Activities |
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Term
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Definition
The scrub exercise is performed in 3-minute sessions, 3 times a day. (Progress to 10/day)
Scrub: all fours, scrub board/floor, apply as much pressure as possible
Carry: weighted purse/briefcase, whenever standing or walking (1-5 lbs as tolerated,
progressing to 10 min)
Distraction. Puts pressure through the joints.
Carry= gives them pressure in the arm and by swinging.
Not standardized. |
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Term
| Cumulative Trauma Disorders |
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Definition
Also called
Repetitive trauma disorder
Overuse syndrome
Repetitive strain injuries
Inflammatory response to overuse of anatomical structure
Tendonitis
Tenosynovitis
Nerve entrapment |
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Term
| Risk factors for Cumulative Trauma Disorders |
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Definition
Force
Repetition/Speed
Mechanical stress
Abnormal Joint Posture- bad posture
Temperature
Vibration
Working in static positions |
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Term
|
Definition
inflammation of tendon & tendon-muscle attachment
Injury
overuse |
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Term
| Symptoms of Tendon issues |
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Definition
Pain
Swelling
Tenderness
Localized weakness
Weakness due to pain and/or nerve compression |
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Term
| Treatment for tendon overuse |
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Definition
Rest
Ice
Compression
Elevation
Anti-inflammatory meds
Splinting
Ergonomic adjustments
Tendon gliding & gradual mobilization |
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Term
| Carpal Tunnel Syndrome symptoms |
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Definition
Parathesia (tingling) over thumb and 2 1/2 fingers
Burning pain
Decreased thumb
opposition or abduction
Awakened at night |
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Term
Carpal Tunnel
Stage I--mild |
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Definition
Sporadic symptoms and clumsiness
Response to activity
May have no abnormal signs at examination |
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Term
Carpal Tunnel Syndrome
Stage II |
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Definition
Pain, often burning
Some thenar weakness or atrophy
Sensory loss
Clumsiness or thick or their fingers are “slow”
Positive Phalens (tapping over nerve) or Tinels |
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Term
|
Definition
Pronounced thenar wasting/atrophy
Sensory loss
Loss of 2-point discrimination
Significant loss of dexterity
Functional difficulties
Poor prognosis due to nerve destruction |
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Term
|
Definition
Rest
Modify activity for wrist posture, vibration, decrease repetition
Wrist splint—wear night and day for 4-6 weeks then decrease
Nonsteroidal anti-inflammatory drugs or oral steroids
Diuretics
100-200 mg of vitamin B6
Local steroid injection
Tendon-gliding exercises
Surgery Indicagtions
If not responsive to above
Long-standing symptoms
Thenar atrophy |
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Term
| Post-surgery for Carpal Tunnel |
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Definition
Bulky dressing and wrist splint (wrist neutral) for 1 week
1 week volar wrist splint at night and during strenuous exercise
Get them in a splint and patient
education |
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Term
| Post-op Rehab for Carpal Tunnel |
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Definition
Therapy for 1-3 weeks
Edema control
Maintain ROM
Prevent adhesions
Protected hand use
Retrograde massage
Tendon gliding Exercises
Elbow and shoulder ex.
3 weeks post
Scar remodeling
Tx for hypersensitivity
Increase strength and functional use
8 weeks post
Work hardening |
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Term
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Definition
Ulnar nerve compression
Cubital Tunnel
Ulnar collateral ligament
Medial epicondylar groove-elbow
Causative factors
Recurrent subluxation, dislocation, RA, Excessive elbow valgus, bony spurs, cysts, trauma
Nerve will flip out of the track. |
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Term
|
Definition
Mild:
Intermittent paresthesia, c/o cluminess or decreased coordination,, difficulty crossing fingers
Moderate:
Above symptoms
Grip/pinch weakness
Severe
Above Symptoms
Persistent paresthesias, Decreased 2-pt, muscle atrophy, claw deformity |
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Term
|
Definition
Patient/Medical History
Provocative Tests
Positive Tinel’s at medial elbow
Positive elbow flexion test |
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Term
|
Definition
Mild/ Conservative
Pain and Inflammation reduction
Postural/ Positional education
Splinting
Elbow Flexed 30-45 degrees
Wrist neutral
3months – night and prn during the day
Elbow pad during the day
Moderate to Severe
Surgery
Decompression
Anterior submuscular transposition
Pronator teres
Medial Epicondylectomy |
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Term
|
Definition
Elbow splint: elbow 80-90degrees, wrist 20 flexion
10days to 2 weeks – gentle ROM (elbow with wrist supported)
Week 2 – elbow extension allowed
Week 5 – strengthening
***Follow MD orders post-op |
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Term
|
Definition
Pain / edema/ scar management
Sensory re-education
ROM and Strengthening
ADL/Work/ assessment |
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Term
|
Definition
Tennis elbow
Most common due to tears in common extensor tendon
Extensor carpi radialis brevis
Minor tear to complete rupture
Static wrist extension position
Brace elbow in extension to relax muscles |
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Term
| Symptoms for Lateral epicondylitis |
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Definition
Pain & tenderness over lateral epicondyle
Constant ache
Episodes of sharp pain
Increases with stretching & lifting
Forearm pain
Resisted wrist extension- over extension
Passive wrist flexion
Pain radiating into ring & little fingers
Inflammation
Redness & heat |
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Term
| Diagnosis for Lateral epicondylitis |
|
Definition
Resistive muscle testing
Elbow negative
Wrist extension positive
Wrist flexion negative
Palpation of extensor muscles
ROM
Inflammatory changes |
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Term
| Treatment for Lateral epicondylitis |
|
Definition
Pain/Edema Control
Icing
Anti-inflammatory modalities/meds
Rest 1-3 days
Splinting – Wrist cock up
Tennis elbow cuff/Taping
Gentle transverse friction massage
Ergonomic adjustments
Tendon gliding & gradual mobilization
Progression: Gentle ROM/stretching/strengthening
Ergonomic changes
Built-up handles
Modify work/leisure activities
Patient education
Return to work |
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Term
|
Definition
Golfer’s elbow
Pain with resisted wrist flexion and/or passive wrist extension
Pain over medial epicondyle
Same treatment
Neutral wrist splint |
|
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Term
|
Definition
Tenosynovitis-(inflammation of the tendon and tendon sheath)
Abductor pollicis longus & extensor pollicis brevis at the the first dorsal compartment (radial styloid and dorsal carpal ligament)
Due to excessive friction
Overuse
Arthritis
Inflammation |
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Term
| De Quervain’s Syndrome Symptoms |
|
Definition
Pain over radial styloid
May radiate distal or proximal
Thumb flexion and ulnar deviation
Pain with gripping-(exp: w/a hammer)
Swelling
Tenderness |
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Term
| Diagnosis for De Quervain’s Syndrome |
|
Definition
History
Examine thumb & forearm
Finkelstein test
Tuck thumb into closed fist
Ulnarly deviate wrist
Pain is a positive test |
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Term
| Treatment for De Quervain’s Syndrome |
|
Definition
Conservative
Rest
Taping/Splinting –Thumb spica
ROM in pain free range only
Treat inflammation and Pain
Anti-inflammatory modalities, injections, meds
Avoid wrist deviation
Built-up handles
Surgery
Open first compartment |
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Term
|
Definition
Stenosing tenosynovitis
Problem where flexors go through the A-1 pulley
Due to
Inflammation of tendon
Stenosis of pulley sheath |
|
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Term
|
Definition
Catching or snapping during active flexion or extension
Nodules prox to A1 pulley
May be painful
May restrict ROM or function |
|
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Term
|
Definition
Avoid prolonged flexion
Splinting
Reduce composite flexion
Night: splint in extension if locking at night
Modalities
Injection of tendon sheath/nodule w/anti-inflammatories
Surgery
Keep tendon moving |
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