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HAND AND UE
| Term | Definition |
|---|---|
| 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 |
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