654 midterm

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lumbricals innervation

1 and 2: median nerve 3 and 4: ulnar nerve

pin care external fixation

1-2 times per day hydrogen peroxide or sterile saline cover with dry gauze no petroleum products as they lead to breakdown

how much of the orthosis for circumference for wrist orthosis

1/2 of circumference

cubital tunnel immobilization after surgery

10 days

how many ue joints

19

DeQuarvain's Tenosynovitis surgery

1sst dorsal compartment release

cubital tunnel scar mgmt surgery

2 weeks

DeQuarvain's Tenosynovitis post surgery

2 weeks immobilize after 2 weeks prom strengthening 3-4 weeks

immobilize for lateral epicondylectomy

2-4 weeks 90 elbow flexion 30 wrist extension

distal pins DRF

2nd metacarpal shaft

how much of the orthosis for length of forearm orthosis

3/4 of length

lateral epicondylectomy post surg

4-5 weeks active stretch wean las week 6 progressive strength week 8

post surgery DRF grip

4-6 weeks

DeQuarvain's Tenosynovitis orthois rec

4-6 weeks avoid thumb flexion with wrist flexion

DIP fracture discontinue

4-6 weeks and begin desensitization

how to position for cubital tunnel orthotic

40-60 extension

cubital tunnel strengthening

6 weeks ulnar nerve glides

medial epicondylectomy PROM

6 weeks wean orthosis strength 6-8

long arm cast TFCC conservative

6 weeks elbow 90 degrees flexion forearm and wrist in neutral

AROM for metacarpal fracture

6 weeks or by md

typical phalanx immobilization

6 weeks with edema control when possible

typical fracture heal time

6-8 weeks

wrist strengthening post surgery DRF

6-8 weeks

loss of protective sensation

6.65 red

prom of wrist external fixator

7-8 weeks include weighted stretch and progressive strengthening

how many carpal bones

8

DeQuarvain's Tenosynovitis involves

APL EPB

wrist and hand muscles innervated by median nerve

APL OP Lumbricals 1/2 FPB

AROM lateral epicondylectomy

AROM elbow after 2 wseeks AROM of wrist forearmhand with elbow in flexion

6 weeks tfcc surgery

AROM for elbow wrist forearm LAC at night PROM elbow olnbly scar mgmt desense weighted elbow

another name for metacarpal fracture

Boxer's fracture

largest carpal

Capitate

radial nerve innervation 9

ECRL ECR ECU EDC EDM EPL EPB APL supinator

2nd dorsal compartment

ECRL ECRB

wrist extensors

ECRL ECRB ECU

muscles involved with lateral epicondylitis

ERCL ECRB ECU

wrist flexors

FCR FCU palmaris longus/brevis

muscles involved in medial epicondylitis

FCR FCU pronators

ulnar nerve innervation 10

FCU FDP 4/5 ADM ODM FDM lumbricals 3/4 PAD DAB FPB deep ADD p

forearm ain uscles innervated by meduian nerve 3

FDP 2/3 FPL PQ

What is in the flexor retinaculum

FPL tendon 4 FDP tendons 4 FDS tendonds median nerve

most commonly dislocated carpal

Lunate

safe position phalanx splint

MP 60-70 degrees IP 0 degrees

is safe position a hand based splint

NO

dynamic flexion splint and NMEs used with

PIP fracture with dorsal dislocation

hardest finger to rehab

PIP of 5th digit

axial load test

Position with elbow resting on table Therapist gentle ulnarly deviates and extends the wrist Apply pressure axially (vertically) toward elbow

test for lateral epicondylitis

Resisted wrist extension, passive wrist flexion

clavicle fracture requires exam of

SC and AC joints

floor of anatomical snuffbox

Scaphoid

distal radius fracture with volar displacement

Smith's fracture

allens test for arterial patency

Test to determine the radial and ulnar artery contribution to the hand

humeral shaft fractures

Usually the result from blunt trauma/direct blow to the upper arm

spiral fracture

a fracture in which the bone has been twisted apart

6 weeks tfcc conservative

a/aarom towrist and forearm gentle prosup immobilize between

1st dorsal compartment

abductor pollicis longus extensor pollicis brevis

anatomical snuffbox muscles

abductor pollicis longus extensor pollicis longus extensor pollicis brevis

dorsal interossei action

abducts fingers

memory

ability for material to return to original size shape and thickness

conservative exercises medial epicondylitis

achieve pain free AROM progress to active stretch progress to pain free passive stretch progress to pain free strengthening

transverse fracture

across the bone usually result of direct force

atrophy of thumb web

adductor pollicis

palmar interossei action

adducts fingers

Scar mgmt of external foxator

adhesions near pins common extrinsic extensor tightness

AROM to PROM with scaphoid

allow prom when one week of pain free arom

allowing palmar surface open

allows for contact with environment and improves sensory input

grind test

apply compression and rotation to thumb positive if grind at cmc

trapezium

articulates with 1st mc and comprises cmc

A/AA/PROM of digits with external fixation

as permitted by fixator A/PRO< for shoulder and md permit forearm

grind test for

assess cmc of oa

AROM elbow medial epi

at 3 weeks while pronated and wrist flexed

DIP fracture PROM

at 4-6 weeks

energy conservation

attitudes and emotions body mechanics work place leisure time work methods organization

types of phalanx fractures

base shaft tuft

trapezoid

base of 2nd mc

ECRL insertion

base of 2nd metacarpal

flexor carpi radialis insertion

base of 2nd metacarpal

ECRB insertion

base of 3rd metacarpal

ECU insertion

base of 5th metacarpal

high elasticity/resistance to stretch

be worked more aggresivley

DIP fracture AROM

begin 2-3 weeks post injury w splint in between and at night

greenstick fracture

bending and incomplete break of a bone; most often seen in children

orthotic theories

biomechanical sensorimotor rehabilitative

diminished light touch 3.61

blue

comminuated fracture

bone breaks into more than two pieces

malunion

bone heals but unsatisfactory alignment

compound fracture

break in the bone where the bone comes through the skin; open fracture

ADL assessment

buttoning zipping grasp pinch ADL/IADL ROM ADL/IADL work assessment

removal of external foxator

by 6 weeks

neoprene

can be simple to complex and include pockets for plastics and straps to influence material

caution with counterforce

can cut off circulation

carpal at base of 3rd mc

capitate

volkmans deformity/ischemia cause

caused by lack of bloodflow to the forearm brachial artery

tfcc surgery

central debridment repair of peripheral tear

ulnar nerver injury

claw hand/bishops hand atrophy of hypothenar interossei atrophy atrophy of thumb web froment sign flexion deformity of 4th and 5th

TFCC injury presentation pain

clicking/snapping w forearm rotation ulnar sided wrist pain druj instability pain with forearm rotation positive axial load paid with ud rd pain to tfcc area

resolving extrinsic extensor tightness post external fixation

close proximity to EIP and EPL

simple fracture

closed no damage to soft tissue

conservative`

closed reduction

conservative treatment DRF

closed reduction 6-8 weeks fingers free A/PROM for shoulders digits elbow

pendulum exercises

codmans pendulum exercises not active movement educate

distal radius fracture with dorsal displacement

colles fracture

proximal and distal humeral fractures

common result of fall

edema treatment interventions

compression garments retrograde massage contrast baths elevation PAMS AROM

volumetric assesment

contraindicated when wounds are present

tinels examines

damage compression point of regeneration with or without reflex hamer

osteoarthritis etiology

degenerative joint disease- noninflammatory deterioration of the articular cartilage- formation of osteophytes

three ways skin damaged by pressure/stress

degree duration direction

drapability

degree of ease in which material conforms to underlying shape without manual assistance

bonding

degree the material will stick to self when heated

blue

diinished light touc 3.61

purple

diminished protective sensation 4.31

tendinosis

diseased tendon state from build up of scar tissue

phalanx fractures often accompanied by

dislocation volar plate disruption

ulna in pronation

distal

triuetrium usually fractured by

distal radius crush

most common fracture

distal radius fracture

colles fracture

distal radius fracture with dorsal displacement

smiths fracture

distal radius fracture with volar displacement result of foosh

metacarpal arch

distal transverse arch

PIP fracture with DORSAL dislocation treatment

dorsal blocking gutter splint PIP 30-40 flexion begin edema control asap

temporary orthosis

during healing phases post peripheral injury stretch structures

healing complications

edema joint contractures atrophy spasms RSD/CRPS

Patient education

education on disease process and management teach signs of inflammation orthotic education and management use of PAMS at home energy conservation joint protection adaptive equipment home modification

orthotic position medial epicondylectomy

elbow 90 flexion forearm neutral wrist 15 degrees flexion

sugar tong splint used for

elbow/forearm injuries unstable proximal radius or ulna fractures distal humerus fracture both bone forearm fractures

conservative treatment DRF edema control

elevation ice retrograde massage

for decreased energy

energy conservation facilitate performance

for impaired grasp

enlarge circumference of the handles

6th dorsal compartment

extensor carpi ulnaris

5th dorsal compartment

extensor digit minimi

4th dorsal compartment

extensor digitorum communis extensor indicis

extrinsic extensors 6

extensor digitorum communis extensor indicis proprius extensor digiti minimi extensor pollicis brevis extensor pollicis longus abductor pollicis longus

3rd dorsal compartment

extensor pollicis longus

splinting

fabricating an orthosis

clavicle fracture treatment

figure 8 strap shoulder immobilizer ORIF/IM rodding but surgery rare

extrinsic flexors 4

flexor digitorum profundus flexor digitorum superficialis flexor pollicis longus flexor pollicis brevis

palmaris longus insertion

flexor retinaculum palmar aponeurosis

medial epicondylectomy

flexors and pronators incised epicondyle debrided muscles reattached to vascular bed

permanent orthosis

for cns dysfunction

coaptation splint

for humeral shaft and shoulder fractures, use with sling

medial epicondylitis caused by

forceful repetitions for the FCR pronator teres FCU

tension

forces are pressing outward joint distraction

compression

forces pressing inwards

what orthotic piece should you center first

forearm

cubital tunnel immobilization AROM/PROM

gentle 10 days to elbow forearm wrist and hand

static progressive orthosis

gradually stretches structures via prolonged static stretch

normal sensation 2.83

green

dynamic orthosis

has moving parts and multiple purposes

terrycloth

helpful to control tone and provide support can be used at night to influence structure and avoid high pressure areas

base fracture

horizontal

flexor carpi ulnaris origin

humeral head- medial epicondyle ulnar head- olecranon process

radial nerve injury common with

humeral shaft fractures

non articular orthosis example

humerla prace

positive froments sign

hyperextension of mp and flexion of ip

therapeutic intervention post surgery DRF

immediate AROM shoulders elbow digits

conservative management medial epicondylitis

immobilization lifting techniques orthosis and rest ultrasound iontophoresis heat/ice massage contrast bath activity modification ergonomic education

for joint deformities

increase leverage prevent static holding

key to managing stress

increase the area of which the force is applied increased forearm length wider straps

tendinitis

inflammation of a tendon

AROM PIP DORSAL dislocation

initiated within splint 3-5 days

volkmans deformity/ischemia results in

injury to muscle/nerve/tissue caused by increased pressure similar to compartment syndrome

flexor pollicis longus

inserts on distal phalanx of thubb

flexor pollicis brevis

inserts on proximal phalanx of thumb

lateral epicondylitis

is inflammatory response at lateral epicondyle involving wrist extensor muscles

extrinsic tightness

lack of flexion due to extensor tendon short/tight lack of PIP flexion when MP is flexed increased PIP flexion when MP is extended or hyperextended

positive intrinsic tightness

lack of pip flexion when mp extened

1st dorsal interossei

last to be innervated

ECRB origin

lateral epicondyle

ECU origin

lateral epicondyle posterior border of middle 1/3 of ulna

tennis elbow

lateral epicondylitis

ECRL origin

lateral supracondylar ridge of humerus

for decreased ROM

lengthen handle on objects organize within easy reach

intrinsic tightness

less PIP and DIP passive flexion with the MP joint extended

10-14 days tfcc surgery

long arm cast a/prom digits

Scaphoid orthosis

long arm thumb spica 16-20 weeks above elbow sometimes short arm

scaphoid surgical treatment

long or short spica post surgery short arm splint by 2-3 weeks AROM/PROM of fingers and ip of thumb

shaft fracture

longitudinal

red

loss of protectice sensation 6.65

intrinsic muscles

lumbricals palmar interossei dorsal interossei

main goal of orthoses

maintain structures of wrist and hand to preserve prehension and function

transverse carpal ligament

makes up volar aspect of carpal tunnel

metacarpal fracture complications

malrotation

rehabilitative approach

maximize function and focus on ability rather than disability

children considerations

may lack normal hand function lack of hand use for wb lack of developed arches

flexor carpi radialis origin

medial epicondyle

palmaris longus origin

medial epicondyle

surgical intervention for medial epicondylitis

medial epicondylectomy

golfers elbow

medial epicondylitis

tinels can indicate which nerves

median ulnar digitial

abductor pollicis brevis innervation

median nerve

flexor carpi radialis innervation

median nerve

opponens pollicis innervation

median nerve

palmaris longus innervation

median nerve

more drabability allows for

more conformability

reminders for metacarpal fracture splints

more room for pins mold transverse and longitudinal arch

lumbricals action

mp flexion

possible complications of clavicle injury

nerve and vascular damage

green

normal sensation 2.83

red lined

not testable >6.65

conservative treatment of DRF red flags (monitor cast)

numbness or tingling cold sensation discoloration of digits changes in skin temp

PIP fractures

often with dislocation articular surfaces compromised

ORIF on metacarpal fracture can

on prox phalanx there is not enough tissues and hardware can fray or snap tendon or come out

static orthosis

one piece provides support and immobilization

surgical

open reduction

hypothenar muscles

opponens digiti minimi abductor digiti minimi flexor digiti minimi brevis

thenar muscles

opponens pollicis abductor pollicis brevis adductor pollicis flexor pollicis brevis

multiple splints

orthoses

splint/noun

orthosis

adjective

orthotic

fracture etiology other orthopedic conditions

osteopenia osteoarthritis heterotrophic ossificans

benefit of splinting dorsally must

outweigh the possible skin breakdown associated woth splinting over bony prominences

order of sensory return first

pain and temp

lifting techniques for lateral epicondylitis

palm up avoid pronated pick up

PAMS

paraffin fluidotherapy TENS cold biofeedback Heat

if non union of scaphoid bad then

partial wrist fusion proximal row carpectomy

spint protocol PIP fracture w dorsal dislocation

pip 30-40 flexion increase splint extension 10-15 at week 4 and again at week 5 DC splint at week 6

flexor carpi ulnaris insertion

pisiform hamate 5th metacarpal

flexion goni

place dorsally

extensor goni

place volar

positioning client for orthosis

position before taking material out of water

10-12weeks tfcc surgery

progressive strengthening

delayed union

prolongation of expected healing time for a fracture

8 weeks tfcc surgery

prom wrist forearm dynamic orthosis cut down las wearing

sugar tong splint prevents

pronation and supination

forearm muscels innervated by median nerve 4

pronator teres palmaris longus FCR FDS

volar/palmar plate

provide stability prevent hyperextension

TFCC and druj

provide stability in pronation

ulna in supination

proximal

proximal pins DRF

proximal radius shaft

carpal arch

proximal transverse

diminhsed protective sensation 4.31

purple

ECU innervation

radial nerve

extensor carpi radialis longus and brevis innervation

radial nerve

last motion allowed with scaphoid injury

radial/ulnar deviation

primary mover in rotation

radius

DeQuarvain's Tenosynovitis due to

repetitive thumb motions mothers who cradle infant head

coated materials

require bonding agent and surface prep

elasticity

resistance to stretch

Dynamic extension splinting used for

resolve PIP extension lag once fracture is healed

External fixation used for

resolve bone length and proper alignment

dynamic splinting used to DRF

resolve residual wrist rom deficits

joint protection techniques

respect the pain maintain muscle strength and joint rom avoid positions that place stress on joints avoid staying in one position for too long use strongest muscle when available distribute workloads over multiple joints

permanent orthosis example

resting hand splint tenodesis orthosis anti spasticity orthosis

biomachanical principles across age

same with adults and children

floor of flexor retinaculum

scaphpoid lunate triquetrium hamate

scar mgmt de sens medial epicondlectomy

scar when healed edema immediate

tuft tracture

shattered to multiple fragments

worst force direction

shear

directions of force

shear tension compression

tfcc function

shock absorber stabilize druj fills gap during ud provide articular surface

factors that slow bone healing

smoking alcohol obesity infection damage to blood supply diabets steroid use

factors that contribute to fast bone healing

stability alignment compression

for instability

stabilize objects provide support for safety

order of sensory return last

stereognosis

medical interventions for epicondylitis

steroid injection protein rich plasma injection

8 weeks tfcc conservative

strengthening if painfree avoid loading until 1-2 weeks of strength

flexor pollicis brevis innervation

superficial median deep ulnar

volkmans deformity/ischemia associated with

supracondylar fracture of the humerus

conservative management humeral fracture

swath and sling coaption splint clamshell brace sugar tong splint pendulum exercises

when not to use iontophoresis

tendinosis

froments sign

test for ulnar nerve dysfunction

axial load test for

tfccinjury

treatment for humeral fracture

therapy shoulder replacement ORIF closed reduction casting/orthotics

three point pressure

three linear forces force in middle is directed the opposite

conservative mgmt for DeQuarvain's Tenosynovitis

thumb spica radial gutter

MCP/PIP collateral ligaments

tight in flexion loose in extension

DIP base/shaft/tuft fracture ortho

tip protection splint with DIP in extension A/PROM to all joints except DIP

transverse carpal ligaent attaches

to trapezium radially to pisiform ulnarly

low stress and low pressure

tolerated for longer periods but can even lead to capillary damage

nonunion

total failure of healing of a fracture in 4-6 months

fracture etiology

traumatic stress stress fracture- force applied to bone pathological disease of joint bone

nonunion of scaphoid

treated by bone stimulator

second most commonly fractured carpal

triquetrium

adductor pollicis innervation

ulnar nerve

dorsal interossei innervation

ulnar nerve

flexor carpi ulnaris innervation

ulnar nerve

hypothenar innervation

ulnar nerve

palmar interossei innervation

ulnar nerve

flexion deformity of 4th n 5th digit

ulnar nerve dysfunction paralysis of lumbricals

characterisitcs of median nerve injury

unable to oppose thumb unable to make complete fist atrophy of thenar eminence weak wrist flexion weak pronation

medial epicondylectomy AROM

unrestricted AROM wrist elbow at 4 weeks

non articular orthosis

uses 2 point pressure system

articular orthosis

uses 3 point pressure system most ue othotics

biomechanical approach

uses biomechanical principles of kinetics and forces acting on the body

bone stimulator

uses low electrical currents to stim bone growth

buddy tapping

using an anatomic splint by taping an injured finger or toe to an uninjured finger or toe next to it

sensorimotor approach

utilizes techniques inhinbiting or facilitating normal motion

which direction is lunate dislocayed

volarly

malrotation

when bone heals and one piece rotated out of place causing should point at scaphoid fingers look crossed impairs grip

shear

when parallel forces applied in equal and opposite forces

low elasticity/resistance to stretch

worked more lightly

Metacarpal fracture safe position splint

wrist 15 degrees extension MP 60-70 flexion PIPs 0 degrees

DeQuarvain's Tenosynovitis positioning for orthosis

wrist 15 degrees extension thumb between radial and palmar abduction mp 10 degree flexio ip free able to oppose

radial nerve injuries

wrist drop lack mp extension lack thumb ip extension lack thumb abduction grip affected associated with displaced humeral fractures

ECRB action

wrist extension

ECU action

wrist extension ulnar deviation

ECRL action

wrist extension radial deviation

palmaris longus action

wrist flexion

flexor carpi ulnaris action

wrist flexion ulnar deviation

flexor carpi radialis action

wrist flexion wrist radial deviation

how to test for medial epicondylitis

wrist flexion mmt elbow flexed 90 reports pain with resisted pronation and flexion


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