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HAND AND UE

TermDefinition
Originate from lateral epicondyle extensors (ECRL, ECRB, ECU, ED, EDM), anconeus, brachioradialis, supinator
Originate from medial epicondyle flexors (FCR, FCU, FDS), palmaris longus, pronator teres
Pacinian corpuscles responsible for vibration
Ruffini end organs responsible for tension
Merkel cells responsible for pressure
Sensory test for nerve compression monofilament
Sensory test for nerve laceration 2-point discrimination
Proximal fracture MC fracture
Carpal bones, proximal to distal, lateral to medial scaphoid, lunate, triquetrum, pisiform trapezium, trapezoid, capitate, hamate Scaphoid most common fractured, lunate fracture associated with Keinbock's
Avulsion injuries tendon separates from the bone and its insertion and removes bone material with the tendon Mallet finger, boutiniere, swan neck
Mallet finger avulsion of the terminal tendon and is splinted in full extension for 6 weeks
Boutonniere deformity disruption of the central slip of the extensor tendon characterized by PIP flexion, DIP hyperextension PIP splinted in extension and isolated DIP flexion exercises are performed
Swan neck deformity PIP hyperextension and DIP flexion PIP splinted in slight flexion
Phases of healing (3) Inflammation: cellular activity Repair: callus for stabilization Remodel: deposits new bone
Colles fracture fx of distal radius with dorsal displacement most common
Smith's fracture fx of distal radius with palmar displacement
Bennett's fracture fracture of first metacarpal base
Median nerve injury carpal tunnel like symptoms-- palmar numbness and numbness of first digit to half of fourth finger with weakness and pain
Ulnar nerve injury ulnar claw deformity numbness of ulnar side of hand fifth and half of fourth digit with weakness and pain
Radial head fractures caused by a forceful load through an outstretched arm
Type 1 radial head fx nondisplaced, long arm sling
Type 2 radial head fx displaced with single fragment nonoperative immobilization for 2-3 weeks
Type 3 radial head fx comminuted fx operative immobiliztion and early motion within first week after operation
CRPS-- complex regional pain syndrome pain disproportionate to injury Type 1: after a painful event Type 2: after a nerve injury symptoms: allodynia, hyperalgia, hyperpathia, edema, contracture, red/shiny skin, abnormal sweating, muscle spasms
allodynia sensation misinterpreted as pain
hyperalgia increased response to painful stimuli
hyperpathia pain that continues after a stimuli is removed
Medical treatment for CRPS sympathetic block: local anesthetic intrathecal analgesia: pain med injection in SC removal of neuroma installation of SC stimulator: small electrical pulse generator installation of peripheral nerve stimulator: electrodes to send impulses
CRPS interventions NO PROM stress loading pain control edema control desensitization blocked exercises, tendon gliding joint protection and energy conservation
Cumulative trauma disorder trauma to soft tissue caused by repeated force mechanism for injury not diagnosis
CTD Grade 1 pain after activity, resolves quickly
CTD Grade 2 pain during activity, resolves when activity is stopped
CTD Grade 3 pain persists after activity affects work productivity, weakness and sensory loss
CTD Grade 4 use of extremity results in pain up to 75% of the time work is limited
CTD Grade 5 unrelenting pain unable to work
CTD acute phase intervention reduce inflammation and pain through PAM (ice, contrast baths, ultrasound, phonophoresis, iontophoresis, high voltage electric and interferential stimulation)
CTD subacute phase intervention slow stretching, myofascial release, progressive resistive exercises, body mechanics, education to identify triggers, acute treatment for flareups, static splint during activities
CTD return to work phase assessment of job site and tools used therapy using a work simulator
Extensor tendons: thumb zones Zone 1: IP joint Zone 2: proximal phalanx Zone 3: MCP joint Zone 4: MC Zone 5: over wrist
Extensor tendons: digits 2-5 Zone 1: DIP joint Zone 2: middle phalanx Zone 3: PIP joint Zone 4: proximal phalanx Zone 5: MCP joint Zone 6: MC Zone 7: wrist and carpal bones
Flexor tendons Zone 1: fingertip to middle of middle phalanx Zone 2: middle of middle phalanx to distal palmar crease Zone 3: distal palmar crease to transverse carpal ligament Zone 4: overlies transverse carpal ligament Zone 5: extends beyond transverse carpal lig
Flexor tendon protocol: Duran early passive ROM program
Flexor tendon protocol: Kleinert active extension of digits with passive flexion via traction (rubberbands)
Flexor tendon protocol: early active motion begins within days of surgery to prevent adhesions and promote tendon gliding and excursion
Flexor tendon protocol: immobilization for cognitively impaired or children casted for 6 weeks
Radial nerve injury, radial n palsy wrist drop, lack of finger and thumb extension
Radial tunnel syndrome entrapment of the radial nerve from radial head to supinator muscle presenting with burning pain in lateral forearm
Anterior interosseous syndrome compression to AIN motor loss in flexors and pronator quadratus
Pronator syndrome entrapment of the proximal median nerve between the heads of the pronator muscles presenting with deep pain in proximal forearm with activity
Median nerve injury ape hand deformity sensory loss in index, middle, and radial side of ringer finger loss of pinch, thumb opposition, index finger MCP and PIP flexion and decreased pronation
Double crush syndrome peripheral nerve is entrapped in more than one location presents with intermittent diffuse arm pain and paresthesia with specific postures
Carpal tunnel syndrome entrapment of median nerve as it courses through the carpal tunnel sensory impairment: numbness and tingling in thumb and index and middle fingers, esp at night motor: decreased FMC, advanced cases adductor pollicis atrophy
Tinel's sign test for carpal tunnel and cubital tunnel tap on median nerve at the wrist to elicit symptoms tap on ulnar nerve at elbow to elicit symptoms
Phalen's test for carpal tunnel holding the wrist in full flexion for 1 minute to elicit changes in sensation
Moberg pickup test picking up, holding, manipulating and identifying small objects used with children and cognitively impaired
Pillar pain pain on either side of the surgical release of CTS
Cubital tunnel syndrome proximal ULNAR n compression at elbow between medial epicondyle and olecranon process -decreased sensation in pinky and half of ring -decreased grip and pinch due to weak interossei, adductor pollicis, and FCU -tinels, froments, warternberg, elbow flex
Froment's sign thumb IP flexion with lateral pinch test for cubital tunnel and claw deformity
Wartenberg sign 5th finger abducted from 4th finger test for cubital tunnel and claw deformity
elbow flexion test for 5 minutes with wrist neutral to elicit symptoms cubital tunnel test
Jeanne's sign hyperextension of thumb MCP
deQuervian syndrome tenosynovitis of thumb m tendon unit (abductor pollicis longus and extensor pollicis brevis) and tendons of 1st dorsal compartment due to cumulative microtrauma
Claw deformity, guyon's canal distal ULNAR nerve compression or lesion at wrist MCP hyperextend, IP flexion, hand arches flattened
Digital stenosing tenosynovitis (trigger finger) sheath inflammation or nodules near a1 pulley
adhesive capsulitis frozen shoulder, restricted PROM
shoulder dislocation anterior most common
Dupuytren's disease of fascia of palm and digits, flexion deformities focus on grip and release
Skier's thumb rupture of ulnar collateral ligament
protective sensory reeducation visual compensation education, avoid machinery
discriminative sensory reeducation identify objects with and without vision vision tactile matching process
sensory recovery pain perception and progresses to vibration of 30 cycles per second, moving touch, and constant touch
desensitization applying different textures and tactile stimulation to reeducate nervous system so clients can tolerate sensations
wound closure primary: wound closed with sutures secondary: wound left open to close on its own delayed primary: wound is cleaned, debrided, and observed 4-5 days before suturing
wound healing phases inflammation proliferative remodeling
benefits of superficial heat relieves pain increase tissue extensibility (^ ROM) wound healing (^ blood flow) decrease muscle spasms
precautions/contraindications for heat postsurgical repairs acute injuries impaired sensation impaired vascular supply
benefits of cryotherapy relieves pain controls edema decreases abnormal tone facilitates muscle tone treat acute injuries and post surgical repairs
precautions and contraindications for cryotherapy sensory deficits including hypersensitivity impaired circulation raynauds disease
benefits of electrical stimulation pain control decrease swelling stimulate and strengthen muscle muscle reeducation stimulate denervated muscle
contraindications for electrical stimulation pacemaker phrenic or urinary bladder stimulators presence of thrombosis or thrombophlebitis over carotid sinus
benefits of continuous (thermal) ultrasound increase tissue extensibility (increase ROM, decrease joint stiffness) reduce pain increase blood flow and tissue permeability reduce muscle spasms reaches deeper tissues
benefits of pulsed ultrasound (nonthermal) decrease inflammation heals tissue
contraindications for ultrasound active malignant tumor pregnancy area near pacemaker some joint replacements (cemented or plastic) thrombophlebitis p/c: fractures, growth plates, breast implants
general contraindications for PAM cancer pacemaker pregnancy cognitive impairment sensory impairment vascular impairment DVThrombophlebitis