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42 Cards in this Set
- Front
- Back
Dupuytren's Disease
what happens?
Treatment?
OT Intervention: 1. 2. 3. 4. 5. 6. |
Fascia of palm and digits becomes thick and contracted, flexion deformities of involved digits* etiology=unknown
fasciotomy required
OT: wound care edema ctrl extension splint* AT ALL TIMES except ROM and bathing A/PROM --> strengthening once wounds heal Scar mgmt Occupation-based tasks (grasp and release) |
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Skier's Thumb/Gamekeeper's Thumb:
what happens?
etiology/cause:
OT Tx: 1. splint? (how many wks) 2. then? 3. what ax? (a, b) 4. If operated? what is post-op tx? a. splint for how long b. then..? c. d. |
Rupture of ulnar collateral ligament of thumb MCP joint
Etiology: fall while skiing
OT: 1. thumb splint 4-6 wks 2. 6 wks: AROM and pinch strength 3. adl ax that focus on opposition** and **pinch strength
4. post-op = thumb splint for 6 wk, then AROM. 8 wks = PROM 10 wks = strengthening |
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CRPS
what happens? etiology?
sx?
OT Tx? 1. 2. 3. 4. 5. 6. 7.
CONTRAS?
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vasomotor dysf as result of abnormal reflex
ca be 2/2 fx or surgery, etiol. unknown
sx: pain, edema, discoloration, osteoporosis, sudomotor changes, temp changes, vasomotor instability
OT Tx: modalities to decrease pain 2. edema mgmt 3. AROM 4. ADL w/ pain-free active use 5. Stress loading (wt bearing, joint distraction ax--SCRUB/CARRY) 6. splinting 7. self-mgmt encouragemt
Contraindicated: PROM, joint mobs, dynamic splint, cast |
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Colles' Fracture (what is it) |
fx of distal radius w/ dorsal displacement |
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Smith's fx: what is it? |
fx of distal radius with volar displacement |
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Boxer's fx? |
fx of the 5th metacarpal |
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Humerus fx:
etiology:
may result in _______ injuries or damage to ________ nerve
this is the only fx for which tx begins with.. ? |
fall onto outstretched uE
may be rotator cuff injuries
radial nerve -->wrist drop
only fx for which tx begins with PROM/AAROM |
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OT eval of fx: 1. 2. 3. 4. 5. |
1. hx = mechanism of injury, fx mgmt
2. xrays, MRI, etc.
3. edema
4. pain
5. AROM (NO PROM til doc says OK, exception - humerus fx)
6. Sensation
7. Roles, ADLs |
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OT Tx for fx:
A. Immobilization Phase 1. 2. 3.
B. Mobilization phase 1. 2 3. 4. 5. |
Immob: 1. AROM of joints above/below stabilized part 2. control edema-massage, compression, elev. 3. light ADL/role ax w/ no resistance
Mob: 1. edema ctrl (contrast baths), elevation, massage 2. AROM 3. 4-8 wks: PROM (*cept humerus) 4. pain mgmt: positioning, PAMS 5. strengthening: begin with isometrics** |
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de Quervain's
1. What happens/where? 2. sx? 3. What test?
4. OT Tx (cons): - - - -
5. OT Tx (post-op) 1. 0-2 wks: 2. 2-6 wks: 3. 6 wks; |
1. pain near snuff box 2/2 tendonitis positive finklestein's test
cons tx: -thumb spica splint -ax/work mod -ice massage -gentle AROM
Post-op: 1. thumb spica, gentle AROM 2. 2-6 wks: strengthening, ADL 3. unrestricted |
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Lateral/Medial Epicondylitis Tx: |
Lateral = tennis elbow, overuse of extensors
Medial = golfer's elbow, overuse of flexors
Tx: elbow strap/wrist splint ice and deep friction massage stretching ax/work mod isometric -- > isotonic, eccentric ex |
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Trigger Finger
what is it/cause?
conservative Tx? 1 2 3 4 5
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1. tendonitis of finger flexors 2/2 overuse
2. Tx: -hand-based trigger finger splint -scar massage -edema ctrl -tendon gliding -ax/work mod
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Kleinert Protocol for Flexor Tendons after Tendon Repair:
a. 0-4 weeks
b. 4-7 weeks
c. 6-8 weeks
d. 8-12 weks |
a. 0-4: dorsal block splint Wrist 20-30 degr flexion, MCP 50-60 degr flexion, IPs extended passive flexion, active extension
b. 4-7 wks: dorsal block splint adjust wrist to neutral
place and hold
flexor tendon gliding ex
scar mgmt
c. 6-8 wks: AROM, differential tendon gliding, occ-based light ax, D/C splint
d. 8-12: strengthening, work, leisure ax |
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Duran protocol for flexor tendons after tendon repair
0-4.5 wk:
b. 4.5-6 wk:
c. 6-8 wk
d. 8-12 wk |
a. dorsal block splint passive flexion of PIP and DIP 10 reps/hour
b. 4.5-6 wk: active flex/ext w/in splint
c. tendon glides, scar mgmt, light occ-based ax
d. strengthening, work ax |
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Mallet Finger |
extensor tendon disruption
Tx: 0-6 wks DIP extension splint |
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Boutonniere deformity
0-4 wks:
4-6 wks: |
0-4: PIP ext splint, AROM of DIP while in splint
4-6 wk: AROM of DIP, flexion of digits to DPC |
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Zone V, VI, and VII Extensor Tendon Injury Protocol 1. 2. 3. 4. 5. |
1. 0-2 wk: volar wrist splint; wrist in 20-30 *extension*, MCPs: 0-10 flexion, IP:ext
2. 2-3 wks: shorten splint, flex/ext IP joints 3. 4 wks: begin mcp ACTIVE FLEX/EXT 5 WK: ACTIVE WRIST rom, SPLINT B/T SESSIONS 6 WKS: d/c splint |
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Carpal Tunnel Syndrome
what nerve?
sx:
conservative TX: 1. 2. 3. 4.
post-op tx: 1. 2. 3. 4. 5. 6. |
median nerve
sx: numbness, tingling of thumb, index, middle, and radial half of ring finger paresthesias at night -person c/o dropping things - + Tinel's sign at wrist, Phalen's sign - muscle atrophy at thenar eminence
Tx: 1. wrist splint in neutral 2. median nerve glides, tendon glides 3. Ax modification (avoid wrist flexion and repeated finger flexion) 4. ergonomics: approp workstation
Post-op Tx: 1. edema trl 2. AROM* 3. Nerve and tendon glides 4. Sensory re-ed 5. strengthen thenar muscles 6. work/ax mod |
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Pronator Teres Syndrome
what nerve?
Sx:
Conservative Tx: 1. 2.
Post-op Tx: 1. 2. 3. 4. 5. |
sx: same as CTS, aching pain in prox forearm + Tinel's sign at forearm No night sx
Tx: 1. elbow splint at 90 degr w/ forearm neutral 2. avoid ax w/ repeated pron/supin
Post-op: 1. arom nerve glides strength (2 wks post op) sensory reed work/ax mod
(same as CTS) |
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Guyon's Canal Injury
what nerve?
Sx?
Conservative tx?
Post op?: |
Ulnar nerve compression at wrist*
Sx: numbness/tingling in ulnar nerve distr of hand motor weakness in ulnar nerve- musculature
+ Tinel's sign at Guyon's canal
atrophy of ulnar nerve innervated musculature (digiti minimi, lumbricals, thumb, interossei)
Tx: wrist splint, ax mod
Post-op: same as always strengthen-focus on power grip |
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Cubital Tunnel syndrome
what nerve:
Sx: 1. 2. what position brings about pain? 3. what is weak? 4. Tinel's sign where? 5.
Conservative Tx: 1. 2. 3.
Post-op: |
u. nerve compression at elbow
sx: 1. numb/tingles along ulnar aspect of forearm and hand 2. elbow pain in extreme flexion 3. weak power grip** 4. + Tinel's sign @ elbow 5. atrophy of ulnar nerve muscles : FCU, FDP
Cons Tx: 1. elbow splint 2. elbow pad 3. ax/work mod
Post-op: same as always.. edema, scar mgmt, AROM/nerve glides, strengthen, mCP flexion splint if clawing noted |
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Radial Nerve Palsy
Sx:
Conservative Tx:
Post-op Tx: when OK to start strengthening? |
Sx: weak/paralyzed extensors, wrist drop
Conservative: 1. dynamic extension splint 2. work/ax mdo 3. strengthening wrist and finger ext
Post-op: Strengthen 6-8 wks |
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Median Nerve Laceration
Sx: Sensory Loss: 1. 2. 3.
Motor Loss (what movements, not muscles): 1. 2. 3. 4.
Motor loss if high lesion above elbow? loss of flexion of what fingers? wrist?
What test/sign?
Deformity?
**fUNCTIONAL LOSS: 1. 2.
OT Tx: 1. 2. 3. 4. 5.
Sensory re-ed |
Sensory loss to: 1. central palm 2. palmar surface of thumb, ind, middle, and radial half of ring finger 3. dorsal index, mid, radial 1/2 of ring
Motor loss: 1. MCP flexion digits II and III 2. opposition 3. thumb ABD 4. flexion of thumb MCP
high lesion: loss of flexion of tip of index, mid, thumb radial aspect of wrist
Deformity: ape hand
Test/sign: Benediction Sign (high injury)
FXL LOSS: 1. opposition 2. pinch strength
OT Tx: Dorsal protection splint, wrist: 30 degr flexion elbow 90 degr flexion splint if high laceration
A/PROM 2 weeks post-op
Scar mgmt
AROM of wrist at 4 wks
9 wks: strengthening
sensory reed
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Ulnar Nerve Laceration:
1. sensory loss 1. 2.
2. Motor Loss (low lesion) 1. 2. 3. 4.
(High lesion) Motor:
Deformity: What + sign/test?
Fxl loss:
OT Intervention |
Sensory: ulnar aspects palmar and dorsal surfaces Ulnar 1/2 of ring and little fingers on palmar and dorsal surfaces
Motor (low): 1. adduction and abduction of MCP joints 2. MCP flexion of digits 4 & 5 3. flexion adduction of thumb 4. ABD, opp, and flexion of 5th digit
(high): 1. flexion twd ulnar wrist 2. flexion of ring/little fing DIPs
Claw hand deformity* flattened metacarpal arch
+ Froment's Sign (laterally pinching paper assessing thumb adductor)
FXL loss: 1. power grip 2. pinch strength
OT Tx: Same as Median Nerve
Splint: MCP flexion block splint sensory re-ed |
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Radial Nerve Laceration
Sensory Loss: 1. 2.
Motor loss (low): 1. 2. 3.
Motor Loss (high) 1. 2.
Functional Loss: 1. 2.
Deformity:
Ot Tx: 1. 2. 3. 4. 5. |
Sensory: 1. med aspect dorsal forearm 2, radial aspect dorsal palm, thumb, index, middle, and radial 1/2 of ring
Motor loss: 1. wrist extension 2. MCP extension 3. thumb extension
(high): 1. if @ axilla, loss of triceps
Fxl: -can't extend digits to release objects 2. manipulating objs difficult
wrist drop
OT: dynamic ext splint ROM sensory re-ed home program activity mod |
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OT Conservative Tx for Rotator Cuff Injuries: 1. avoid what movement? 2. sleeping? what to avoid 3. 4. 5.
Post-op Tx 1.2 . 3. 4.
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1. ax mod: avoid above sh level ax 2. avoid sleeping w/ arm in adduction and IR 3. decrease pain-positioning, modalities, rest 4. restore pain free ROM 5. strengthen below sh level 6. role-specific
Post-op: 1. 0-6 wk: PROM to begin* (think codman's, get blood flow there), then AAROM 2. ice--> heat 3. 6 wks: strengthen: isometric to isotonic below sh level 4. ax mod 5. roles 4. ax mod: light ADL/mgful role ax |
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Shoulder Dislocation:
OT Tx: avoid what position? |
avoid combined ABD and ER
pain free ADL ax
strengthen rotator cuff |
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Rheumatoid Arthritis
Sx
Common deformities? |
**Systemic
most commonly smal joints of hands affected
Sx: Pain, stiffness, limited ROM, fatigue, weight loss, limited ADL status, swelling, deformities
Common deformities: 1. ulnar dev, subluxation of wrist and MCP
2. Boutonniere deformity
3. Swan neck deformity |
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Osteoarthritis |
Not systemic, but degenerative commonly affects large wt bearing joints, attacks cartilage
Sx: pain, stiffness, limited ROM, bone spurs
spurs=(Heberden's nodes and Bouchard's nodes) |
|
Arthritis Eval:
PROM vs AROM?
muscle strength? use what to test grip? use what to measure edema? |
1. avoid PROM< esp inflamm stage, focus on AROM
2. avoid muscle testing unless doc request use sphygmomanometer strength related to fxn
3. ADL/role pain scales
edema: volumeter or tape measure |
|
OT Intervention for Arthritis: 1. Splinting
2. ROM?
3. modalities?
4. Strengthening? |
Splinting: a. acute stage=resting hand splints b. wrist if indicated c. ulnar drift splint d. silver ring splints e. dynamic MCP extension f. hand base thumb splint
joint protection energy cons
AROM
heat modalities (avoid during inflam stage) *paraffin rec.
Avoid strengthening during inflam stage
occ-based AE |
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Osteogenesis Imperfecta:
Etiology:
Sx:
OT Eval:
OT Tx: |
genetic, lack of collagen
sx: malformed bones, loose joints, sclera blue/purple, brittle teeth, hearing loss, respiratory probs, insufficient collagen
Tx: 1. activity adapt, assist device 2. environ mods 3. positioning/spilnting/padding 4. ax to increase muscle strgt 5. wt bearing ax 6. healthy lifestyle 7. caregiver ed
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Hip Fx OT INtervention 1. 2. 3. 4. 5. |
1. bed mobility 2. UE strengthening 3. Fxl ambulation/transfers w/ device 2/2 wbearing status 4. practice AE use 5. practice occbased ax |
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forequarter amputation
loss of what bones? |
clavicle, scapula, and entire UE |
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shoulder disarticulation amp |
loss of entire UE |
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elbow disarticulation amputation |
amp of UE distal to the elbow joint |
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wrist disarticulation amputation |
distal to wrist, loss of entire hand |
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hemipelvectomy amp |
amp of half pelvis and entire LE |
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Complications 2/2 amputation: 1. 2. 3. 4. 5. 6. 7. |
1. Neuromas: nerve endings adhered to scar tissue (can be painful/hypersens)
2. skin breakdown
3. phantom limb syndrome: sensation of presence of limb
4. phantom limb pain
5. infection 6. knee flexion contractures in transtib amp
7. psych impairments |
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Preprosthetic Tx: 1. 2. 3. 4. 5. 6. 7. |
1. change of dominance (R vs. L) ax if needed 2. ROM of uninvolved joints 3. prepare limb 4. desensitization 5. wrapping to shape/shrink residual limb 6. ADL training, ed in skin care 7. supportive counseling
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Prosthetic Tx: 1. 2. 3. 4.
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1. fxl training w/ prosthesis--ax of interest (teach pt to analyze task, determine most efficient way to use device; and/or guide pt manually thru motions)
2. don/doffing
3. ^ prosthetic wearing tolerance
4. individualize tx for phys/psych adjustment |
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Tx for LE Amps: 1-7 |
1. wrapping to shape resid limb, decrease swelling 2. desensitization 3. strengthen UE (esp triceps) 4. transfer training, stand pivot 5. ADL training, LE dressing 6. standing tolerance 7. w/c mob |