Oth-606 exam 2

calcific tendonitis

build up of calcium increases and can be seen on x-ray, may cause increased pain and further impairment, tends to come on quicker and not respond to treatment as well

fractures classification

factors that influence fx treatment

Brachial Plexopathy

traction neuropathy components of TOS avoid stress on nerves: glide shorten structures that are tight around nerve and promote stretch as tool chronic pain

frequency of care ITIS

HEP, periodic evaluation and progression 2x/week until sx begin to resolve patient education to adapt activities, environment is critical sleep and work positions

Assessment daily note progress

"Ten degree Increase in AROM in Left elbow this week allows client to don shirt independently."

Interventions: Fractures - Non operative, Postoperative

(Brace) Acute: Pendulum, edema control, Cold to Heat Modalities, One handed ADLs, Distal AROM, scapular stabilizer isometrics (Rhomboids just pull back and hold arms, elbows at 90 degrees but don't extend your arms out in ER, Serratus Anterior same as Rhomboids but you go forward...shrugging shoulders nice and slow with good posture), distal AROM and strengthening (stress balls) 3-4 weeks: Gentle AAROM shoulder, not > than 60 degrees of elevation, Cane, towel on table (pushing and pulling back), pulleys 4-6 weeks: Sh AAROM (supine, sitting), isometric scapular protraction/retraction 8-10 weeks: stretching 10-12 weeks: Shoulder Isotonics

adhesive capsulitis (frozen shoulder)

50-70 years of age women>men more in sedentary workers, diabetics develops slowly with pain and tenderness over deltoid insertion motion aggravates pain decreased P/AROM of shoulder decreased ADL's and sleep shrugging shoulder motion progresses to very decreased ROM and increased pain (can take 1-2 years)

osteoarthritis

A slowly progressive uniarticular disorder of unknown cause, occurring late in life, principally affecting the hands and large weightbearing joints and characterized by pain (dull when resting, sharp when using), deformity and limitation of motion and pathologically by focal erosive lesions, cartilage destruction, subchondral sclerosis, cyst formation and large osteophytes at the margins of the joint very common in adults, 60% of people age 60 and over women >men

daily note: assessment

A: Presents with increased tone due to co-contraction pain response however responds with decreased tone to stroking massage and cues to relax antagonists, may be a candidate for biofeedback. Pt able to tolerate increased wt c scapular exercises pain A- "Deficits in UE strength and activity tolerance limit client's ability to complete basic self-care tasks." A - " Pain in L shoulder limits client's ability to carry out child-care and household management tasks" Contributing factor and how it limits a specific area of occupation

Physical rehab sample goal

ADL Problem: Pt. unable to manage fasteners due to limited R opposition to pad of index finger. LTG: Upon d/c pt. will achieve full opposition to all digits for indep. performance of dressing. STG: Within 3 TX sessions pt. will manage zipper on clothing with use of zipper pull with min. VC. Pt. will demonstrate thumb opposition to pad of index finger to allow for fastening 3 out of 4 buttons indep. within 2 weeks.

glenohumeral interventions nonoperative (4-8 weeks)

After reduction, the arm is immobilized in sling for 3 weeks, elbow distally needs to get exercise, strike zone movements Precautions include, no prom, ext rotation with abd or hyper / Do ext rot, with arm at side only to 50 degrees Strengthening: **int/ext rotators, int rotators and adductors need to be strong to support ant capsule** **ext rotators strong to cause humeral depression** **Begin with isometric exercises with joint at side pain free, 90 degree elbow with neutral or protective plane so keeping it easy, for ADD use a pillow and hug it against your body** Progress to isotonic ex still limiting ER<50 - theraband for constant tension, IR, ER, ADD and biceps in subimpingement range with light resistance do ER from full IR to neutral with arm at side, no 90 degrees of abduction At 5 weeks all pivots except 90 degrees of abd and ER Normal use when there is no weakness may take 2-4 months

COAST

C - Client O - Occupation A- Assist Level S - Specific Conditions T - Timeline "Client will go to bed before midnight at least 75% of weeknights within 2 weeks in order to obtain adequate sleep for effective participation at job."

C4, C5, C6, C7 dermatome

C4: upper deltoid, shoulder and onto side of neck C5: middle deltoid with biceps and forearm C6: biceps, forearm, thumb and pointer finger C7: triceps, dorsal side of forearm, pointer, middle, and ring finger

Stakeholders - Who looks at your chart?

Client Insurance Company Accreditation/ Inspections The Joint Commission - http://www.jointcommission.org/accreditation/hospitals.aspx CARF - http://www.carf.org/home/ NYS DOH- department of health Lawyers for the Client Quality Assurance/ Improvement - Internal to facility

psychosocial sample goals

Client will increase performance of leisure activities at the psychosocial clubhouse Client will follow daily clubhouse schedule and identify two preferred leisure activities (1 week) Client will initiate a prescheduled leisure activity (e.g. reading newspaper) independently (2 weeks) Client will sign up and attend one group leisure activity scheduled each weekend at the psychosocial clubhouse, with minimal assistance (3 weeks) Client will ask friend to participate in a leisure activity of their choice (e.g. going to the movies) twice a month, with minimal cuing (4 weeks)

Where does each statement go in a SOAP Note? (need to check)

Continue OT 3x/wk for MHP, massage, therapeutic activity with guided adaptations. Review HEP. - P Client spontaneously used his right hand to pick up his coffee cup. -O Client demonstrated proper ergonomics with good posture while typing a letter for 5 minutes.-O Right shoulder flexion AROM =135 with pain -O Patient reports X-ray was negative for Right shoulder.- S Patient tolerated moderate exercise today with less verbal cues. -A

*thoracic outlet syndrome conservative interventions* (essay)

DONT BREAK THE FRONTAL PLANE ↑ mobility of tight structures - massage, cardio, stretch (don't massage nerves so no over plexus) ↑ strength and endurance of weak ms Nerve gliding (flossing) (looks like ballet)(3-5 reps/2 times a day) Respiration training - (using diaphragm for breathing) https://www.youtube.com/watch?v=_7ySGgAFAAo Adapt activities - driving, purse on shoulders, bra strap (reminding them shouldn't have pain) No excessive breathing - no running cause it's shallow breathing patterns Watch patients at work Modalities to manage ms spasm, tension (hot packs) Safe sleeping positions that avoid stress on nerves/cx- avoid laying on affected side (put pillow under affected side)

FEAST

F- function - In order to return to work E - expectation - The patient will A - action - be able to lift 50# overhead S - specific conditions - for 4 hours T - timeline - in 3 weeks

P: plan

For intervention to include frequency per day/week - initial eval treatment pt will receive, and possible ways to grade includes short and long term goals (some settings include the goals in the A) For Daily Note Any changes you will make to intervention moving forward, referrals

osteoarthritis clinical picture

Inflammation of joint Pain at rest and with use Potential for deformity Stiffness

thoracic outlet syndrome signs and symptoms

Largely neurologic cases, more females than males Intermittent BP and vascular sx of pain, parasthesia, numbness (usually ring and little finger), weakness, discoloration and swelling Muscle length imbalances with tightness in anterior and weakness in posterior Faulty postures Poor endurance of postural muscles Shallow respiratory pattern Patient complains of difficulty sleeping, inability to hold weighted objects on affected side - heaviness Inability to maintain overhead work position or desk work

TUBS

Mechanism of instability: Anterior - usually with a force against the abducted, ER shoulder - labrum a problem also Posterior instability - forward flexed humerus or FOOSH Inferior instability - RC weakness Medical treatment: may need surgery - Bankhart repair - use subscapularis to support the anterior capsule Clinical picture/ functional limitations: Inability to reach or lift at shoulder level Restricted ability in many ADL's, leisure Pain when sleeping

management acute stage (lateral epicondylitis)

Medical management is NSAID's, cortisone Goal is to control pain, edema and spasm and to maintain soft tissue integrity and joint mobility Pt education is critical - adapt technique to avoid elbow extension with forceful grip - What to say to Clients in Cooper Text - p.386 Tennis elbow straps ?, wrist ext immob 35 degrees Rest muscles in splint if needed Avoid gripping activities Cold, modalities - Pulsed Ultrasound, iontophoresis, phonophoresis Remove splint 3x a day to do gentle AROM and stretch Gravity eliminated tenodesis AROM Transverse friction massage Go slow with any ex and progression

roles of OTR, COTA, OT aides

OTR: initial evaluation, closing, and goal writing COTA: can contribute to evaluation, treatments, can write goals, can do standardized assessments OT aides: allowed to get things for you, setting up, cleaning

daily note: plan

P - Continue current program, add ultrasound p MHP, d/c Ionto, Monitor HEP (home exercise program). Theresa Hand, OTD, OTR/L, CHT

cervical examination

Palpation: tenderness, muscle spasms, edema - sitting or supine AROM with passive overpressure to assess end feel Be careful with rotation and overpressure - may block vertebral artery - fainting Side (lateral) flexion - 20-45° Rotation - 70-90° PROM done in supine Resisted Isometric Movements

Joint Protection Principles for OA/RA

Recognize and acknowledge your pain Learn difference between discomfort and overuse, modify your activity should not have pain over an hour Avoid use of hands that may increase potential for deformities Avoid ulnar deviation, avoid making a tight fist, hold object with open hand and curved fingers, avoid resting head on knuckles, modify activities to avoid pressure (changing a pen to a gel pen to make it easier) (avoid carrying luggage use a wheeled one) Use correct body mechanics to protect your joints Slide objects instead of lifting, divide groceries into several bags and don't lift all at once, Use the strongest joints available for a job Support bags with forearms, carry against your body Change position often Release grip every 10-15 minutes Conserve energy

*thoracic outlet syndrome exercises* (essay)

Scapular retraction (don't want to break frontal plane so make sure to stop when pulling arms back) Stretch scalenes - chin tuck, straighten neck, side bend away, rotate toward 3 second hold for 3 reps (eventually can move up the seconds) Suboccipital stretch: can use a foam roller, chin tuck too/rotate Pec stretch - doorway with elevation first Scapular clock: imagine clock on shoulder 12 and 6 and elevation and depression and moving pivots by number of clock Modified superman Wall angels (however it's okay if they can't come back all the way)- start out low and build up 3-10 reps and then sets

writing goals

Short and Long Term Goals vs Goals and objectives Each goal must have four elements - ABCD audience - who will exhibit the skill behavior - what will the person do condition - under what circumstances degree - how well done Must have time frame Measurable Long term goals include overall functional goal with time frame.

special tests (cervical)

Spurling Test: Foraminal Compression - patient bends or side flexes head to one side, examiner carefully presses straight down on the head (coming in they may say they have radiating pain down neck prior) + if pain radiates into the arm on side of bend - pressure on nerve root Distraction Test: place one hand under patients chin and the other around the occiput, examiner should slowly lift patient's head +if pain is relieved or decreased - pressure has been relieved on nerve root Brachial Plexus Tension - ULTT- patient lies supine, examiner passively abducts the pts arm just behind the coronal plane to the point just short of pain Passively externally rotates while shoulder is depressed (bring shoulder down) Elbow extended with wrist extended Forearm supinated Reproduction of sx with above and added cervical side bend away ↑ Pain in the form of a stretch or ache in cubital fossa or tingling in median innerv hand area Adson's Maneuver - TOS (thoracic outlet, irritation of nerves after nerve root) Locate radial pulse Ask pt to rotate head to face test side Patient extends the head while the examiner externally rotates and extends the patients shoulder Pt takes a deep breath and holds it + disappearance of pulse Roos - Pt stands and abducts arms to 90° ER sh and flex elbows Open and close hands slowly for 3 minutes + for TOS if neural sx in hand

thoracic outlet syndrome

Symptoms are due to compression of blood vessels and nerves by structures in thoracic outlet region Compression sites include: Scalenes - BP or subclavian artery compression due to tight or hypertrophied ms First Rib - BP, subclavian artery or vein may be cx as they course under clavicle - heavy purse Pec minor - BP and axillary artery compression against ribs as they course under the pec if tight BP may stretch if arm is held in fully elevated position Contributing factors laxity in shoulder postural variations respiratory patterns - musicians

what is missing from goals

The client will prepare a complete meal for dinner with minimal pain: time frame, specific to where pain is, level of assist, what's included in meal Client will demonstrate proper lifting techniques in one week: how many times, assistance? Client will complete 10 reps of shoulder strengthening with 1 pound weights in order to reach overhead for ADLs in 2 weeks: never state what the patient is getting treated for, just the outcome... can say increase strength to 4/5 instead

Glenohumeral Instability: Dislocations

Traumatic Unidirectional instability (TUBS): lax connective tissue usually result of trauma in one direction (anterior, posterior or inferior) - may be damage to RC tendons and glenoid labrum Atraumatic multidirectional instability (AMBRII): physiologically lax connective tissue causing excess mobility - primary or multiple dislocation Acquired Instability: repetitive movements that stress the anterior capsule - throwing athletes - SLAP lesion - superior labrum anterior - posterior lesion - causes posterior superior instability

OT progress note

Used to update status - usually in preparation for doctor visit - every 2-4 weeks Allows you to update goals and communicate with doctor

upper cervical segment

above C3 greater degree of motion

fractures anatomical location

base (typically proximal end), mid shaft, neck (typically distal) or articular

lateral epicondylitis (tennis elbow)

caused by excessive use of the muscle, repetition, causing micro damage to tissue which does not heal properly- due to poor technique and or weak muscles (prox and distal) occurs when gripping due to stabilizing of wrist extensors recurring problems due to immobile or immature scar clinical picture: gradually increasing pain in elbow following activity pain with stretch or contraction, chronic recurrences of inflammation process, pain when gripping with full elbow extension-putting iron on high self (PROM, massage, heat, AROM)

lordosis

cervical and lumbar

tendonitis

clinical picture: predisposing factor: degeneration caused by nutritional deprivation (ischemia) and mechanical stress (usually your fault, exceeding demands of the muscle group) Causes debris containing containing calcium and breakdown of fibrils (collagen), microtears of fibrils leads to debris and inflammation pain is felt from insertion to origin

fractures relationship of fragments

closed (bony fragment did not go through the skin), open (bony fragment went through skin), complete (goes clean through the bone), incomplete (only a piece into it), dorsal (the direction it goes) and volar angulation (direction it goes)

methods of fixation for fractures

closed, open (surgery) or distracting techniques ORIF external fixators-distraction (metal bar with a distraction piece, screw into it to try to put it back into place) 8-12 weeks casting, splinting

reimbursement

codes: healthcare common procedure coding system (HCPCS) *diagnosis: ICD-10*: federal coding system established to show payers exactly what diagnosis you are treating *treatment: CPT* what we use to bill, typically three 15 minute sessions like 97110: therapeutic procedure one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility *Equipment: L-codes*

Acute phase treatment ITIS

conservative therapy adapt functional activities, work on ergonomics (90,90,90), sleep positions, heat or ice, sling but not long (only when absolutely have to), rest, codman's exercise (goes like a tick tock, allowing body to initiate motion)

median nerve

courses medial to tendon of biceps and brachial artery, then to pronator trees and under the FDS entrapment may be at pronator- pronator syndrome which will cause CTS Sx motor changes in wrist flexors and finger flexors, thenar eminence sensory at thumb, index and mid, tips also ape hand: benedictine hand (cause of how the pope blesses people with his fingers in the position)- FPL, all FDS, FDP and lumbricals index and middle

daily note: subjective section

date time period OT progress note S: "I did my exercises but they hurt" "I really don't think I can handle the iontophoresis any more, it burns too much) no complaints during treatment

evaluation of cervical

determine localized or peripheral History: etiology: did your head strike anything Pain - radiating, shooting or localized, following a dermatomal pattern? Headaches Sensory changes Activities that aggravate the pain or sx Sleeping posture Posture in activities What does the patient have difficulty doing? i.e. Looking over shoulder while driving Observation: Head in midline Head in midline Shoulder levels, Scapula position Facial grimacing with movements

brachial plexopathy evaluation

determine the source of sx determine if therapy can help neural evaluation with gentle glide

AAROM shoulder

doing exercises, weighted bar up and down (cane) pendulum exercises (letting arm down tick tock) wall walking with arm pulleys

Neer's stages of impingement syndrome

edema and hemorrhage fibrosis and tendinitis bone spurs

rheumatoid arthritis clinical picture

edema at joints pain with motion can detect increased temperature at joints muscle atrophy due to disuse fatigues easily medical treatment: medication, plaquenil, methotrexate

types of documentation

evaluation daily note progress report discharge note varying formats: SOAP, POMR, electronic

Cozen's test

examines thumb is on pt's lateral epicondyle, pt makes fist, pronates, RD, ext wrist, while examiner resists motion + if pain at lateral epicondyle indicates lateral epicondylitis

subacute phase Treatment ITIS

heat/ice, modalities (like massage to help loosen), wall climb e.g.: AAROM, pulleys, AROM as tool, can e.g: isometric, massage, stretch, functional abilities and adaptation PATIENT EDUCATION

Diagnosis-ICD 10

http://www.aota.org/Advocacy-Policy/Federal-Reg-Affairs/Coding.aspx Diagnosis codes, more commonly referred to as ICD-10-CM (International Classification of Diseases, 10th revision, clinical modification) codes are used to classify illness, injuries, and patient encounters with health care practitioners for services http://www.aota.org/Advocacy-Policy/Federal-Reg-Affairs/ICD-10- Diagnosis-Coding/conversion-mapping-tool/adult-treatment-code- list.aspx

bursitis

inflammation iof subdeltoid bursa overuse or injury to the joint at work or play can also increases person's risk of bursitis high risk activities: gardening, raking, carpentry, shoveling, painting, scrubbing, tennis, golf, skiing (all have repetitive ARC movement) tends to be a sharp pain especially when you palpate

sample LTG and STG

intervention long term goal: independent return to work and home activity with increased AROM and strength right shoulder in 2 months STG: patient will complete ADLs independently with increased AROM right shoulder flexion to 110 degrees in 2 weeks patient will sleep for 6 hours without pain using positioning techniques/aids in 2 weeks

Rheumatoid arthritis

is a systemic connective tissue disease whose onset and progression vary from mild joint symptoms with aching and stiffness to abrupt swelling, stiffness and progressive deformities, periods of exacerbations and remissions

O: objective

is the section where the results of the measurements performed, therapists objective observations are recorded hx taken from medical record be organized use categories use charts if needed

A: assessment

list the occupational performance concerns (sometimes called problem list) that you're going to address with intervention rehabilitation potential may be listed here poor, fair, good, excellent P.91-"ability to understand instructions and desire to return to living independently indicate good potential to return to prior living situation" in a progress note statement of progress or lack of don't put anything in A that is not supported in O 3 P's: problems, progress and potential

lower cervical segment

lower C3 to C7 nerves to UE

adhesive capsulitis pathology

many tissues: brush, glenohumeral capsule, biceps tenons, rotator cuff tendon capsular thickening repair of tissues is delayed or impaired by frequent irritation muscles atrophy freezing, frozen and thawing phases

adhesive capsulitis interventions

medical treatment: corticosteroids, manipulation under anesthesia arthroscopic release-anterior GH legs, coracohoumeral ligament silver level evidence that athrographic dissension with saline and steroid provides short-term benefits in pain, range of movement and function in adhesive capsulitis Intervention goals: guide in effective and efficient functional use and prevent motion loss then restore functional motion

treating the ITIS

medical: NSAID, cortisone shot

payment

medicare: for ages over 65, people under 65 with disabilities, run by federal government medicaid: lower income and run by the state workers compensation: company pays for rehab due to injury on duty private insurance: may be CDPHP or Blue Cross, may have co-pays self pay: you are paying out of pocket the amount charged no fault: depends on the state, insurance companies may be paying for a certain amount no matter what others depending on location

brachial plexopathy may show

multiple pain sites negative diagnostic testing long time to dx vasomotor changes multiple neural pathologies symptoms indicating inflammation around the nerve root, bp, other sites-multiple crush may take 24-36 hours to calm down once exacerbated tend to have pain all the time with all function latency of 5-6 hours after exacerbating activity was performed

osteoarthritis intervention

modalities: hot (15-20) or cold (10) depending on swelling and likeness, then do massage (position of patient, how long, and what you are massaging) stretching and/or active assistance ROM e.g. cane exercises flexion, stop with any discomfort, if they can get up high enough you can stretch them a little extra (timing try it out usually only a couple minutes) isometric exercises first (abduction, flexion, extension for shoulder elbow typically at 90 degrees) adaptation Joint protection techniques

rotator cuff intervention

modalities: ultrasound=no better than placebo TENS hot/cold Exercise: no one protocol includes PROM, AAROM, AROM, strengthening, manual therapy

active rest

modulating your activity, still moving but not really reaching the peak activity (could be in-between sessions just moving around), decrease resistance level, light functional use can be around day 5-7

posterior column

neural osseous canal, posterior ligaments, zygapophyseal (facet) joints and erector ms of the spine

fracture healing

normal bone is regenerated rate depends on age, fx characteristics, presence of disease, vascularity of bone segment infants: 4-6 weeks adolescents: 6-10 weeks adults: 8 weeks and on

palpation

note compression sites, *palpate radial head as pt supinates and pronates* (if their is subluxation the annular ligament is in problem) *ulnar nerve: near cubital (back of elbow)* *median nerve: in crease of elbow* assess varus/valgus assess pros and distal joints feel for lateral and medial epicondyles

if you make an error writing something

one line through it, write correct thing, initial and date

ORIF

open reduction internal fixation when the closed techniques won't worse, use Kirschner wires, interosseous screws, plates with screws

extensors

originate on the lateral epicondyle ECRB (extends the wrist and radial deviation), EDC (extends the MPs), EDM (extends the pinky), ECU (wrist extensor and ulnar deviation)

flexors

originate on the medial epicondyle pronator, FCR, PL, FCU

tendonitis symptoms

pain of arc for motion, vague HX of pain, weakness, edema, spasms in close muscles, pain in suprahumeral space of impingement

Golfer's Elbow test

palpate medial epicondyle, pt supinates, elbow and wrist flexion resisted by examiner, + if pain over medial epicondyle indicates medial epicondylitis

evaluation

palpation, pain and edema pain: site, radiation, and type edema: measure girth, check atrophy of muscles

ulnar nerve

passes through cubital tunnel and then through FCU heads secondary crush site is Guyon's canal in the hand compression: symptoms down arm to ring and little fingers and weakness of intrinsics claw hand: all interossei (deep dive in between meta carpals and is for abduction/adduction), ring, and little lumbricals (flexion), FDP ring and little, hypothenar

radial nerve

passes under origin of ECRB then divides, deep branch may become entrapped through supinator sensory changes occur in lateral aspect of forearm to radial side of dorsum of hand often confused for tennis elbow, brace compresses further wrist drop: ECRB/L (not able to extend wrist), EDC (Which means cannot extend MPs), EPL/B

assessment initial evaluation

patient has mod difficulty performing work tasks such as saddling horses secondary to decreased strength (3+/5) in right shoulder and scapular muscles patient is experiencing mod difficulty with safety during work activities such as lateral visual scanning while riding horses secondary to increased cervical stiffness and decreased AROM patient has min difficulty performing ADL's such as self-care activities secondary to decreased AROM in R shoulder patient currently unable to pursue goal of taking care of his children secondary to increased (5/10) pain in R shoulder Patient has mod difficulty sleeping secondary to increased (3/10) pain in R shoulder

SOAP notes

problem or dx: is usually stated before actual soap note, this area includes the past surgeries, past conditions, present conditions, test results, recent surgery (will be listed out sentences, have to choose which letter it falls into)

daily note: objective

pt treatment follow a sequence, logical order patient seen (in what setting) for (purpose of OT session) e.g. patient seen in clinic, tx included MHP R biceps x 15 mins c R elbow on gentle stretch, stroking massage x5 mins to biceps, A/AAROM R sh, elbow all pivots x 5-10 reps; cues given for positioning and to relax antagonists...gentle strengthening c prone scapular exercises x 10 reps c 1# wt (weight) with tapping to lower trap to facilitate proper exercise response...Iontophoresis c dexamethasone- 50 ma-min, 2.0ma to biceps insertion; redness noted post treatment...discussed HEP-instrcuted pt to decrease reps @ home until pain decreases... pt demonstrated proper level of activity with home and work activities

L3763 EWHO

rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

RA intervention

same as OA but more energy conservation and prevention of deformities typically avoid stretching on PROM however textbooks say it's okay (hit or miss)

S: Subjective

section which the therapist is able to state the information received from the patient that is relevant to the patient's present condition such as: pt tells about pt history, home situation, home situation, emotions, goals, response to treatment use pt states or family states "" use direct quotes for attitudes instead of judgmental statement will be brief in treatment notes but long run the initial eval

brachial plexopathy treatment

see TOS active rest modalities: watch for dependence on passive tx start at the neck patient education be sure to not activities that are difficult and simulate them in the clinic to progress goals and let pt know they are getting better go SLOW long time till resistance exercises

rotator cuff repair (post operative)

sling/abduction wedge for 1-6 weeks depending on surgeon goal: to return patient to full ADL/IADL Treatment: remove sling for therapy after one week, supervised PROM, HEP of cervical, scapular depression-retraction with shoulder at side and distal AROM, massage to scar site once healed, 1-3 weeks: Pendulums, PROM in limited shoulder planes 4-6 weeks: AAROM with gravity eliminated for abduction (supine with cane exercises) and ER (could lay prone with arm out and twist thumb out OR arm at side elbow 90 degrees with cane and go outward) 6 weeks: AROM 7-8 weeks: light isometrics

fractures origin

stress (small hair line fracture due to repetitive use), traumatic (something happened and you got a fracture), pathological (when something has gone wrong in the physiology e.g. osteoporosis, bone cysts)

intervention of nerve injury

stretching: gently stretch biceps: especially in children *vigorous stretching may cause myositis ossificans (heterotopic ossification)* remember concepts of passive insufficient for stretch positions teach pt self stretching of forearm musculature PROM: remember to prom in all pivots of forearm rotation (may be best to lie them down otherwise pillow under arm, hold for 30 seconds, can do 10 reps depending on pain) AROM: remember against gravity pivots and gravity eliminated resistive exercises: many different techniques (looking to get to about 5 pounds for ADLs) splinting: wrist often used for resting muscles of elbow

compression at elbow may cause

symptoms down arm to ring and little fingers weakness of intrinsics

Tinel's sign

tapping at compression sites + if radiates in appropriate innervated area indicates neuropathy

fractures fx line

transverse (straight across), oblique (diagonal), spiral (exactly what it sounds like), comminuted (chunks taken out and little pieces)

Treatment CPT

typically three 15 minute sessions like 97110: therapeutic procedure one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility

Froment's sign

ulnar nerve entrapment at wrist, when patient is asked to lateral pinch, thumb flexes to make up for lack of adductor this is a + Froment

anterior column

vertebrae, ligaments, and disks

passive rest

what you do lying on the couch, eating a bag of chips