OT 525 Written Final

functional motion

-30 elbow extension 130 elbow flexion 50 supination/pronation

severe nerve compression

axonal loss. Major weakness/atrophy. Asensate. Rehabilitative FOR. NO regeneration.

Mild nerve compression

blood nerve barrier breakdown night time paresthesia, increase with activity. NO muscle weakness

wound dressing

contact layer- draws exudate away intermediate layer- gauze, absorbs blood and exudate. protects outer layer- absorbant, secures primary in place strikethrough: blood coming out into bulky dressing selective debridement: cut off excess eschar/necrotic tissue nonselective debridement: remove non-viable and viable tissue

why do you still have wrist flexion with a median nerve lesion

still have ulnar flexors

general tx guidelines

4-6 weeks: AROM 6-8 weeks: PROM 8-10 weeks: resistive/strength training

__% of weight goes through the radius, __% goes through the ulna

80% ; 20%

•A patient must have protective sensation (4.31) on the fingertips with monofilament testing before sensory reeducation can be initiated. If discriminative sensory re-education is begun before this sensibility is obtained, the treatment will not be beneficial and the patient may/will become discouraged and/or frustrated. True or False? •A. True B.False

A

Radial nerve muscles at upper arm

ACU, AD, ADM, APL, EPB, EPL, EI, Supinator, ECRL, ECRB, Brachioradialis Triceps (extends elbow)

Ulnar nerve muscles at the wrist

ADM (abducts 5 MCP) FDM (flex digit 5 MCP) ODM (opposes 5 MCP) Lumbricals 4 and 5 (flexes 4-5 MCP) DI (abducts digits 2,3,4) PI (adducts digits 2,4,5) FPB (flexes thumb) Add Pol (adducts thumb)

ulnar nerve muscles at the elbow

ADM, FDM, ODM, Lumbrical 4-5, DI, PI, FPB, Add Pol FCU (flexes wrist) FDP (flexes 4-5 DIP)

•Which of the following is true with regard to a stress loading program for patients with CRPS/RSD? •A. Avoid it during the early stages for it can increase pain •B. It consists of active interventions that requires stress to tissues with minimal joint motion •C. It is a passive program directed and administered by the OTR only in therapy •D. It uses exercise such as scrubbing and lifting and aggressive and forceful stretching

B

motion ____ strength

BEFORE

Mallet finger tx

DIP immobilized in extension full time

types of STM

Deep static pressure- for trigger point Shearing- scar Stroking- longitudinal. create homeostasis Transverse- 90 to direction of tendon. for tendonitis Circular- for adhesions Kneading- pinch/pull Static compression- desensitization Retrograde- edema

•The radial nerve splint as presented to the client within the Saturday Night Palsy scenario serves three purposes at least. Name two of the three noted on the Discussion Board.

Functonal, prevent the flexors from shortening, prevent extensors from overstretching

Median nerve muscles at the wrist

OP (opposes thumb) APB (abducts thumb) FPB (flexes thumb) Lumbricals 1 and 2 (flexes 2-3 MCP)

wound classification

tidy: clean, min tissue damage, heals via primary intention (heal on own with help of sutures) untidy: tissue damage, destruction to deeper tissues, heals via delayed primary closure wound w/tissue loss: other structures damaged, heals via secondary intention (would left open)

ulnar nerve lesion appearance

ulnar claw due to extrinsic MCP extension and extrinsic DIP flexion from FDP regeneration

•The Tinel's test, Phalen's test, Reverse Phalen's test are three special tests for Carpal Tunnel Syndrome? What might be a fourth as presented in this course? •A. Lumbrical test •B. Tenosynovitis test •C. Carpal bone shift test •D. Thermal test

A

•When fabricating a splint: What do you think? •A. "Always fit the splint to the persons hand" •B. "Always fit the persons hand to the splint"

A

•A 32 year old sustained a median nerve laceration at the elbow 6 months ago. The nerve was repaired. Manual muscle testing revealed a 4/5 for the pronator teres and a 3/5 for the flexor digitorum superficialis. What muscle would you expect to have returned as well? •A. Flexor digitorum profundus to the 2nd and 3rd digits •B. Flexor digitorum profundus to the 4th and 5th digits •C. Extensor carpi ulnaris D.Flexor digitiminimi

A

•An extra-articular fracture that results in an open/compound wound will need to be reduced via? •A. Open Reduction •B. Closed Reduction •C. Bariatric Band Surgery •D. Herbert's Screw •E. Both A and D

A

•DeQuervain's Tenosynovitis was one simulation, per Discussion Board posting, the biomechanical and the rehabilitation frame of references were employed. True or False? •A. True •B. False

A

•For a quick test of ulnar nerve status, what muscle might you test? •A. Abductor digiti minimi •B. Extensor indices •C. Abductor pollicis brevis •D. Palmaris longus

A

•In review of your assessment and intervention papers, some of you will have cited the Cooper text as a reference source. It is considered proper per the current APA edition that the author of the chapter is cited in the text of the paper as the initial/primary reference source and not the text editor, Cooper. True or False? (I am just trying to help you out with your research sequence of course work where your written work will be assessed in extraordinary detail) •A. True B.False

A

Boutanniere vs swan neck

Boutanniere- PIP flex, DIP hyperextend. lateral bands volarly displaced Swan neck- PIP hyperextend, DIP flex. lateral bands dorsally displaced

•Your patient injured her hand on the volar aspect of the palm at the metacarpal head on the radial side of the index finger, 3 inches from the fingertip. She is experiencing sensory loss from the injury site distally (radial side of digit 2). How long would you anticipate the nerve to take for her sensibility/feeling to completely return after the digital nerve repair? •A. 3 mos. B. 4 wks. C. 12 mos. D. 24 wks.

A

•J.E. was thrown from the back end of a pick up truck. He sustained a significant global brachial plexus injury. Upon a quick FROM test, he has absolutely no ability to flex his fingers or his thumb or his wrist actively. He is able to actively open his hand and extend his wrist. What two peripheral nerves are you suspecting as having been injured? Select TWO. •A. Median B. Ulnar C. Radial D. Musculotendin

A and B

•An 88 y/o patient of yours sits down, presents a script to you. You ask to see her hands and you notice she has complete atrophy of the thenar eminence. (1) Based on this isolated piece of information, what peripheral nerve is pathological? (2) Will this clinical scenario most benefit more from a biomechanical perspective or a rehabilitative approach? •(1) A. Median B. Ulnar C. Radial (2) A. RehabilitativeB. Biomechanical

A ; A

median nerve lesion appearance

Ape hand Benediction sign

•A button hook is an excellent piece of adaptive equipment for an individual that has to perform one handed buttoning, given their entire distal UE is casted due to a recent traumatic injury involving multiple fractures within the hand complex (some of your RA peer Discussion Board postings shed some light on this). True or False? •A. True B.False

B

•A secondary complication of Colles Fracture can occur, even RA. What most likely would that be? •A. Intercarpal - Distal Carpal Row - Ligamentous injury •B. Carpal Tunnel Syndrome •C. Extrinsic tendinitis •D. Syncope

B

•Chronic Digital Stenosing Tenosynovitis would benefit from iontophoresis with dexamethasone. True or False? •A. True •B. False

B

•Coban wrapping is contraindicated in 89-96% of the patient cases that you treat involving idiopathic edema due to the stress that it puts on the arterioles (Flawed, 2020). True or False? •A. True B.False

B

•Given the fact that the hydrotherapy tank is being used less and less due to the time that is required for set up and for cleaning, what might be the next best choice if your aim is to get a moderate dose of heat combined with an "active modality" that allows for "intermittent" rather than "constant" water submission secondary to edema? •A. Fluidotherapy •B. Hot water soak •C. Paraffin D.Moist heat/hot pack

B

•Given the scenario that you read about on the Discussion Board, relative to Secondary Frozen Shoulder, is strengthening the primary emphasis or is range of motion the primary focus? •A. Strengthening •B. Range of Motion •C. They are both equally important

B

•The OT should "prescribe" low back stretching and strengthening exercises as the preparatory phase of a Work (Hardening) Program. In other words, it's the OT's responsibility to prescribe these exercises in an occupation-based rehabilitation program? You should be able to come up with your response based on your peer Discussion Board postings on chronic LBP. True or False? •A. True B.False

B

•The dynamic radial nerve splint that was showcased in your Discussion Board peer postings relative to improving function within the intervention simulation: What general frame of reference(s) does it represent? •A. Biomechanical •B. Rehabilitative •C. Occupation Adaptation D. Cognitive Behavioral

B

•The rehabilitative frame of reference was showcased with the acute Left Index finger Zone II flexor tendon laceration with repair simulation. A built up handle was used on a knife to help "the patient cut his food using his affected left hand in one week". An adequate goal? •A. Yes B.No

B

•The time to begin a formal sensory reeducation program (beyond the stage of "education") is within the first few days post operative nerve repair. True or False? •A. True •B. False

B

•To stretch the forearm extrinsic extensors that are affected given the condition of elbow lateral epicondylitis, the elbow is extended and the wrist is positioned in extension. True or False? •A. True •B. False

B

•While treating an individual for Chronic Elbow Lateral Epicondylitis, your patient is complaining of an uncomfortable achy sensation due to the initiation of therapeutic thermal ultrasound. This can be avoided how so the best? •A. Lower the frequency (MHz) •B. Decrease the intensity (W/CM2) •C. Increase the size of the sound head/ultrasound wand •D. Consider the Beam Non-Uniformity Ratio (BNR) and switch machines

B

•You are treating a patient with a moderate ulnar nerve compression at the wrist, diagnosis "ulnar neuritis, overuse". One goal is to isolate and strengthen the intrinsic muscles associated with this nerve. Which preparatory method or activity is best suited for this patient? A. Joint blocking B. Pinching putty into a cone shape with the IP joint(s) held in extension C. Hyperextension of the MCP joint against rubberband traction D. Grip strength using a hand helper/ gross resistive gripping apparatus with maximal resistance

B

•A complete fracture of the proximal phalanx will most likely result in? •A. FDS/FDP Tenosynovitis •B. Trigger Finger •C. Boutonniere Deformity D.Extensor Digitorum Tenosynovitis

C

•Given a colles fracture with closed reduction x 6 weeks. Your patient has difficulty fully extending her fingers when her wrist is extended; she can fully extend her fingers when her wrist is in neutral position. This is indicative of? •A. Intrinsic tightness •B. Extrinsic extensor tightness •C. Extrinsic flexor tightness •D. None of the above

C

•Which condition is most likely to present with sudomotor, vasomotor, trophic and pilomotor changes and pain above and beyond what one would expect? •A. Peripheral Arterial Disease (PAD) •B. Diabetic Neuropathy •C. Chronic Regional Pain Syndrome/RSD •D. Horner's Syndrome

C

fracture patterns

simple vs compound complete vs incomplete vs comminuted pathologic vs greenstick vs buckle vs transverse displaced vs nondisplaced oblique vs spiral

•A 32 y/o sustained a brachial plexus injury. He can extend his elbow but can hardly perform shoulder abduction while seated. An objective is to initiate his graded active therapy program relative to improving AROM associated with shoulder abduction. What would be a good way to go about this initially? •A. Use against-gravity AROM •B. Use isometrics within the sagittal plane •C. Use concentrics and eccentrics both gravity-eliminated and against gravity within sagittal plane •D. Use gravity eliminated AROM

D

•A 36 y/o keyboarder complains of nocturnal numbness and tingling of the digits 4 and 5 in both forearm and hands. On examination, pinch and grip strength is normal. Overall sensibility is impaired for two point discrimination. What would be the most appropriate conservative treatment based on the choices below? •A. Ulnar nerve surgical decompression •B. Generac Dynamic splinting •C. Three months of short term disability •D. Night splinting with the elbow at 30 degrees of flexion

D

•A Zone 5 Flexor Carpi Ulnaris Tendon laceration with repair may eventually end up with an adhesion of the FCU and the overlying subcutaneous tissue. This is usually a rather uncomplicated adhesion, having minimal to no loss of AROM. Clinically, one would observe a "dimple" in the skin upon finger AROM. Nevertheless, a soft tissue mobilization (STM) technique may be used. State *one* best descriptor which would represent this STM approach. (This was a previous quiz question). •A. Transverse B. Complex C. Retrograde D. Shearing

D

•Acute DeQuervain's Tenosynovitis: What two tendons/muscles was the group focusing on relative to strengthening, that is the first treatment session post initial evaluation? •A. APL/EPB •B. FDS/FDP •C. APB/EPL •D. None

D

•All, except which one, are ways to break up adhesions within Zone II after a fully healed flexor tendon (FDS/FDP repair). The client is about 12 weeks post repair. •A. Resistive active/functional hand use within context •B. Deep scar massage •C. Blocking and Reverse Blocking to the PIP and DIP •D. All of the above are good choices

D

•Given a radial nerve neuropraxia (Saturday Night Palsy): The patient has absolutely no finger extension. What would be an example of appropriate documentation of extensor AROM? •A. "Digit Two MCP 0 degrees" •B. "Digit Two MCP +45 degrees" •C. "Digit Two MCP 0-45 degrees •D. "Digit Two MCP -45 degrees"

D

•Given a radial nerve neuropraxia: Your patient has absolutely no active wrist extension upon an FROM. How do you go about initially completing goniometry of AROM extension? •A. Start with wrist in its flexed resting position •B. Start with the wrist flexed, perform AROM in extension and simply document, for example, -40 degrees to - 40 degrees. •C. Start with forearm supinated against gravity •D. Start with the wrist at anatomical 0

D

•If someone has a deformity as a result of a healed complete fracture of the proximal phalanx of digit 2: You suspect a specific type of "deformity" thus when you measure AROM for DIP flexion, how do you go about doing this? (Goes back to question #4) •A. Patient's finger(s) in intrinsic minus position •B. Patient's finger is in a hook grasp position •C. Patient's finger(s) in intrinsic plus position •D. Patient's finger is straight

D

•Relative to the chronic low back pain group, body mechanics training equates to what verbiage/classification within the OT Framework? •A. Tendon Protection •B. Client Factors •C. Contexts - Vocational •D. Performance Patterns

D

•Several conditions can eventually lead to this medical emergency. Decubitus ulcers are such an example. What is this? •A. Medical Alert •B. Johnson-Partee Syndrome •C. Syncope D.Septicemia

D

•The critical demands, such as lifting, carrying, pushing, reaching, and standing that were addressed during the chronic low back simulation are considered what per the OT Framework? A. Client Factors B. Performance Patterns C. Areas of Occupation D. Performance Skills E. Contexts - Vocational

D

•What forearm muscle(s)/extrinsics would one do a MMT on given a suspected mild or moderate median nerve compression at wrist level? •A. Palmaris longus •B. Extensor Digitorum •C. Flexor digiti minimi •D. None of the above

D

•What type of therapeutic ultrasound was employed with the Saturday Night Palsy scenario, per your peer postings on Discussion Board? •A. Thermal •B. Pulsed •C. Modified •D. None

D

•You receive a referral to fabricate and provide an "antideformity splint" for an individual. The physician writes on the script, "to be worn 24 hrs./day x 12-14 days minimum". You have yet to see the patient or have any idea what the diagnosis is. You can however ascertain that a _____________________ splint will be necessary. •A. Elbow radial/ulnar gutter splint •B. Dorsal-based immobilization splint •C. Some type of dynamic anti-deformity splint •D. Intrinsic plus splint

D

Radial nerve lesion appearance

drop fingers/ drop wrist(ECRL/ECRB)

CRPS late phase

hair follicle changes, cyanotic, loss of muscle tone and strength, loss of ROM

Radial nerve muscles at the forearm

ECU (extends wrist) ED (extends 2-3 MCP) EDM (extends 5 MCP) APL (abducts thumb) EPL (extends thumb IP) EPB (extends thumb) EI (extends 2 MCP)

Radial nerve muscles at proximal elbow

ECU, ED, EDM, APL, EPB, EPL, EI, Supinator, ECRL, ECRB Brachioradialis (flexes elbow)

Radial nerve muscles at the elbow

ECU, ED, EDM, APL, EPL, EPB, EI Supinator (supinates forearm) ECRL/ECRB (extends wrist)

Ethical decision making involves the ________ of the situation and one's ___________.

Facts ; values

why can the IP joint still extend with a radial nerve lesion

lumbricals and the dorsal hood are ulnarly and medially innervated

Median nerve muscles at the elbow

OP, APB, FPB, Lumbricals 1 and 2 Pronator Teres (pronate forearm) FCR (flexes wrist) FDS (flexes 2-5 PIP) PL (flexes wrist) FPL (flexes thumb IP) FDP (flexes 2-3 DIP) PQ (pronate forearm)

The contact and the intermediate layer of a wound dressing makes up the _____________ dressing. The above dressing in addition to the outer layer makes up the _______________ wound dressing.

Primary ; bulky

•Relative to the elbow lateral epicondylitis simulation, a few potential orthoses/splints were noted as considerations for the individual experiencing this condition. What one was discussed on the Discussion Board that may be considered first, as the "lowest profile" of them all? Either state the name or draw an illustration.

counterforce band

moderate nerve compression

demyelination- slow nerve conduction persistent paresthesia. WEAKNESS. NO atrophy

sensory reeducation

if protective sensation is absent, first step is education/awareness early- sharp vs dull, static vs moving late- moving stimuli, identify textures, sensory bowl

treatment options for fractures

immobilization, closed-reduction (manually aligned/ pinning), open-reduction (surgery/ plate or screws)

CRPS very late phase

osteoporosis/hard end feels, contractures, decreased blood flow and loss of connective tissue

CRPS early phase

pain (achy, burning) edema (glossy, balloon, pitted, soft) hypersensitivity

most common carpal bone fx

scaphoid

types of fracture healing

primary healing: surgical/internal fixation secondary healing: external immobilization

purpose of wound dressings

protect from bacteria, immobilization, guard/protect, compression, soak up blood/exudate

red-yellow-black classification

red: good, epithelialization, tissue growth yellow: odor, drainage, infection black/eschar: scab taking up tissue volume, poor blood supply, ischemia, tissue dying

Froments sign

with paper. weak lateral pinch due to 1st DI and Add Pol

median nerve splint

wrist cock up or thumb webspace