NBCOT Exam: Hand and UE Disorders and Injuries

Lower Extremity Level of Amputation

-Hemipelvectomy -Hip disarticulation -Above-knee amputation (transfemoral) -Knee disarticulation -Below-knee amputation -Complete tarsal -Partial tarsal -Complete phalanges

Fracture Types

-Interarticular vs Extraarticular Fractures -Closed vs Open Fractures -Dorsal Displacement vs Volar Displacement Fractures -Mid-shaft vs Neck vs Base Fractures -Complete vs Incomplete Fractures -Transverse vs Spiral vs Oblique Fractures -Non-Displacement vs Displacement Fractures -Comminuted Fractures

Low Back Pain (LBP)

-Most common work-related injury -Location: Lumbar lordosis -Etiology: poor posture (seated/standing), repetitive bending (using poor boys mechanics), heavy-lifting, sleeping with poor posture -Symptoms: pain, difficulty with self-care/sleep

Complications of Terminal Devices

-Neuromas -Skin breakdown -Phantom limb syndrome -Phantom limb pain -Infection -Knee flexion contractures in transtibial amputation -Psychological impairments due to shock/grief

Early Mobilization Program for Extensor Tendons Zone V, VI and VII

0-2wks volar wrist splints with wrist in 20*-30* of extension, MCP's in 0*-10* of flexion and IPj in full extension 2-3 wks: shorten splints to allow flexion and extension of IPj 4wks: remove splints to begin MCP active flexion and extension 5wks: begin active wrist ROM. Wear splint in between exercise sessions 6wks: discharge splint

Tendon Repairs OT Goals

Facilitate wound/tendon healing 1) Increase tendon excursion 2) Improve strength at repair site 3) Increase joint ROM 4) Prevent adhesion's formation 5) Facilitate resumption of meaningful roles, occupations and activities

OT Evaluation (Osteogenesis Imperfecta)

-Activities that can be safely pursued -Environmental risk factors

Hip Fractures (Types)

-Femoral neck fracture -Intertrochanteric fracture -Subtrochanteric fracture

Hip disarticulation

Amputation at the hip joint Loss of entire lower extremity

Early Mobilization Program for Extensor Tendons Zone III and IV

Boutonniere Deformity 0-4wks: PIP extension splint (DIP free) AROM of DIP while in splint 4-6wks: begin AROM of DIP and flexion and flexion of digits to the DPC

Carpal Tunnel: Muscles

Causes: 9 extrinsic flexor tendons • (FDS) superficialis (4) flex pip joint • (FDP) profundus (4) flex dip joint & digits 2 & 3 • (FPL) pollicis longus (1) flex ip joint of the thumb

What are the two major types of nerve injuries?

Compression Laceration: partial or complete

Amputation: Etiology

Congenital, peripheral, vascular disease, trauma, cancer, and infection

Intraarticular vs Extraarticular Fractures

Elbow fractures are divided into three categories that are subdivided based on their location and type: -Intraarticular fractures: have multiple classifications based on location of fracture within the capsule and the pattern of the fracture. ex. Boxer Fracture, Capiteller and Trochlear fractures -Extraarticular fractures: involve the medial/lateral epicondyles and supracondylar regions. Extra-articular fractures that extend distally along the supracondyles become intracapsular ex. Bennett's Fracture Dislocation, Smith's Fracture.

Forequater Amputation

Loss of clavicle, scapula, and entire UE

Shoulder disarticulation

Loss of entire UE

Complete tarsal amputation

amputation at the ankle

Knee disarticulation

amputation at the knee joint

Below elbow (BE) "long or short"

amputation below the elbow at any level of the forearm

Below Knee Amputation (BKA) transtibial

amputation below the knee at the level of the calf. (most common)

Arthritis

inflammation of a joint or joints Types: 1. Rheumatoid 2. Osteoarthritis

What are the three major peripheral nerves?

median, ulnar, radial

Total Hip Replacement / Arthroplasty (THR) (THA): OT Interventions Hip Precautions; (Posterolateral)

Educate on Hip Precautions -Do not flex beyond 90* -Don't abduct or cross legs -Do not internally rotate -Do not pivot at hips -Sit only on a raised chair or raised toilet seat -Transfer from sit to stand by keeping operated hip in slight abduction and extended out in front

Dorsal Displacement vs Volar Displacement Fractures

Fractures are either displaced or nondisplaced. A fracture with an offset of 2 mm or more in any plane or 2 mm offset involving the articular surface is considered displaced Dorsal Displacement: Examples -A Colles' Fracture -Dorsal-type Barton's is a fracture-dislocation of the dorsal rim of the radius Volar (palmar) Displacement: -Smith's Fracture -Volar-type Barton's is a fracture-dislocation of the volar rim of the radius

Full Thickness Burns

- 3rd degree burns -Involves the epidermis, dermis, hair follicles, sweat glands, and nerve endings -Appearance: white, waxy, leathery, and non-elastic -Sensation: absent, requires skin graft -Hypertrophic scar -Healing time could take months

Pain

Acute: Recent onset and usually last for a short duration Chronic: long duration and can lead to depression Myofascial Pain: specific to muscles, tendons, or fascia

Hemipelvectomy

Amputation of half the pelvis and entire LE

Elbow disarticulation

Amputation of the upper extremity distal to the elbow joint

Phantom Limb Syndrome

sensation of the presence of the amputated limb

Phantom Limb Pain

sensation of the presence of the amputated limb but is also painful

Web Space Burn

C-splint

Comminuted Fractures

Comminuted fracture implies at least three fracture fragments, the fracture lines of which interconnect. The individual fracture lines that form the comminuted fracture may be transverse, oblique, or spiral. Comminuted fractures are generally caused by high-energy trauma, as typified by automobile accidents, and are a common type of animal fracture Comminuted fractures are difficult to reduce and fix because they have no inherent stability. Constant external traction and alignment or internal fixation is required.

Hip Fractures: Medical Management

Closed Reduction: (minimal displacement) Open Reduction Internal Fixation: Joint Replacement

Occupational Therapy Interventions: Fractures

Immobilization phase: Stabilization and healing are the goals -AROM of joints above/below stabilized part -Edema control: evaluation, retrograde massage, and compression garments -Light ADLs and role activities with no resistance, progress as tolerated Mobilization phase: Consolidation is the goal - Edema control: evaluation, retrograde massage, contrast baths, and compression garments -AROM, then progress to PROM when approved by physician (4 to 8 wks), exceptions are humerus fractures which often begin with PROM or AAROM -Light functional/purposeful activities -Pain management: positioning and physical agent modalities -Strengthening: begin with isometrics when approved by physician.

Osteoarthritis (OA)

Degenerative joint disease; that most often affects middle-age to elderly people. It is commonly referred to as non systemic, and "wear and tear" of large weight bearing joints, involving the hyaline cartilage, joint lining, ligaments, and bone. The cartilage that cushions the ends of bones in your joints gradually deteriorates (bone-on-bone) Etiology: genetic, (cumulative) trauma, tenderness, stiffness, inflammation, endocrine and metabolic diseases. Grating sensation. You may hear or feel a grating sensation when you use the joint Symptoms: pain, stiffness, limited ROM, bone spurs (Heberden's nodes at the DIPj) (Bouchard's nodes at the PIPj)

Early Mobilization Programs for Flexor Tendons - Kleinert Protocols

Passive flexion (w/ rubber band traction) and active extension to hood of splint. 0-4wks: (early phase) dorsal blocking splint. wrist in 20*-30* flexion, MCP joints in 50*-60* flexion and IPJ extended. Passive flexion and active extension within splint limits 4-7wks (intermediate phase) dorsal blocking splint, adjust wrist to neutral. place/hold exercises and differential flexor tendon gliding exercises. scar management. 6-8wks AROM, differential tendon gliding, light/purposeful activities D/C splint 8-12wks strengthening. work/leisure activities

Early Mobilization Programs for Flexor Tendons - Duran Protocols

Passive flexion and extension of digits 0-4.5wks: dorsal blocking splint w/ exercises including passive flexion of PIPj, DIPj and to DPC 10 reps every 1hr 4.5-6wks: active flex/extension within splint limits 6-8wks: tendon gliding and differential tendon gliding, scar massage, and light activities 8-12wks: strengthening and work activities.

Cumulative Trauma Disorder (CTD)

Repetitive Strain Injury (RSI) A disorder that can affect the bones, muscles, tendons, nerves and other tissues due to repetitive motion, overuse syndromes, trauma, and/or musculoskeletal disorders Risk Factors: repetition, static position, awkward postures, forceful excretion, and vibration (e.g. assembly line workers) Non-work risk factors: acute trauma, pregnancy, diabetes, arthritis, and wrist size and shape Types: Dequervain's, and Lateral/Medial epicondylitis

Carpal Tunnel : Symptoms

Symptoms: Symptoms are often bilateral, Nocturnal Pain, Dysesthesias Diminished fine motor coordination Numbness, Tingling, , Weak grip/pinch strength, Clumsiness, dropping objects, muscle atrophy Thenar weakness Mild: less than 1 yr. Night pain Moderate: 1 yr. Night pain/tingling Severe: Longer than 1yr. Night & Day pain

Wrist disarticulation

amputation distal to the wrist joint. Loss of entire hand

Above Knee Amputation (AKA)

amputation of a leg above the knee at the level of the thigh

Finger amputation

amputation of digits at any level

Partial tarsal amputation

amputation of metatarsals and phalanges

Complete phalanges amputation

amputation of toes

Neuromas

painful nerve endings that adhere to scar tissue -very painful and hypersensitive

Smith's Fracture

(2nd most common distal radial fracture) Ventral displacement Known as a reverse Colles' fracture, these fractures are extra-articular transverse fractures Etiology: Complete fracture of the distal radius with palmar displacement of the distal fragment. - young males (most common) and elderly females 1, -Osteoporosis can increase likelyhood Causes: • Fall onto a flexed wrist • Direct blow to the back of the wrist -Car crash, Fall off bike Symptoms: -Numbness, Tingling, Pink finger, Wrist appears bent in wrong angle Treatment/Splinting: Depends on the type of fracture, stability and ability to successfully reduce the fracture. • In most cases, these fractures can be treated with closed reduction and cast application • Internal fixation to hold the fragment in alignment for healing (If the fracture can be reduced but remains unstable, or cannot be reduced): Wrist-cock-up splint (Type I) extra-articular transverse fracture through the distal radius most common: ~85% (Type II) intra-articular oblique fracture equivalent to a reverse Barton fracture ~13% (Type III) juxta-articular oblique fracture uncommon: <2%

Superficial burn

- 1st degree burn Involves epidermis only - Min. pain/edema, no blisters - Healing: 3 to 7 days

Terminal devices (TDs)

- Function to grasp and maintain hold on an object - The two main types of TDs are the hook and the hand: 1) voluntary opening (VO) = hook remains closed until tension is placed on cable and then it opens 2) voluntary closing (VC) = hook remains opened until tension is placed on cable and then it closes - Determination of the most appropriate TD is based upon the person's interests, roles, and preferences (TDs can be interchangeably used with prosthesis if the shaft size is the same)

Hip Fracture: Precautions

- Weight-bearing (WB) status & ROM determined by MD, -Time frames determined by MD

Volar surface of hand (Burns)

- Wrist in 0-30 degrees extension -MCP joints in neutral to slight extension and abducted (monitor collateral ligaments -IP joints in full extension -Thumb abducted and extended

Superficial partial thickness burn:

-2nd degree burn -Involves the epidermis and upper portion of dermis (sunburn) -Appearance: red, blister, and wet -Healing 7-21 days OT Evaluation: -Occupational Profile - ROM 72 hrs post-opt -Sensation when wounds heal -Strength when wounds heal -ADLs, role asap OT Intervention: -Wound care and debridement (sterile whirlpool/ dressing changes) - Gentle AROM and PROM to tolerance -Edema control -Splinting (as needed) -ADLs, role activities

Deep partial thickness burn

-2nd degree burn -Involves the epidermis, deep portion of dermis, hair follicles, and sweat glands -Appearance: red to white, and elastic -Sensation may be impaired -Potential to convert to full thickness burn due to infection - Healing 21-35 days OT Evaluation: -same as Superficial OT Intervention: -Wound care and debridement (sterile whirlpool/ dressing changes)

Pronator Teres Syndrome (Proximal Volar Forearm)

-A median nerve compression between the two heads of the pronator teres -Etiology: repetitive pronation/supination and excessive pressure on the volar forearm -Symptoms: CTS symptoms, along w/ aching pain in the proximal forearm -Positive Tinel's signs at the forearm, w/ no nighttime symptoms Conservative Treatment: elbow splints at 90* w/ forearm in neutral -Avoid repetitive forearm activities w/ pronation/supination Surgical Interventions: decompression -Positive operative Treatment: AROM, nerve gliding exercises, strengthening (2wks post-opt), sensory reeducation, work/activity modification

fibromyalgia syndrome

-A musculoskeletal pain and fatigue disorder that can vary in intensity. -widespread pain accompanied by tenderness of muscles and adjacent soft tissue -nonarticular rheumatic disease of unknown origin

Radial Nerve Palsy

-Acute trauma or compression of the radial nerve Etiology: Saturday Night Palsy, Honeymoon Palsy, or Crutch Palsy, caused by stress and/or compression as a result of humeral fracture Symptoms: Numbness/sensory loss/ weakness of muscles from the triceps down to the fingers •Problems extending the wrist or fingers, and supinator •Pinching and grasping problems •Wrist drop - MCP's and thumb are affected when the wrist hangs limply and the patient cannot lift it Conservative Treatment: Dynamic extension splint, work/activity modifications, strengthening (wrist/finger) extensors when motor function returns Surgical Intervention: decompression Post-operative Treatment: ROM, nerve gliding exercises, strengthening (6-8wks post-opt), ADLs and meaningful activities Splinting: •Custom made: Dorsal forearm-based dynamic splint •Colditz's low profile splint (daytime ware) dominant hand •Wrist-cockup splint (nighttime ware) dominant hand

Hip Fracture: Complications

-Avascular necrosis: of the femoral head is a relatively uncommon complication following an extracapsular hip fracture. Although it can occur following fixation of unstable 3-part or 4-part intertrochanteric fractures with significant posteromedial and posterolateral comminution, it remains a rare complication. -Non-union: When a broken bone fails to heal it is called a "nonunion." A "delayed union" is when a fracture takes longer than usual to hea -Degenerative joint disease: he most common type of hip arthritis is osteoarthritis a serious condition. While it is not "curable," it most certainly is treatable using activity modifications, medications, and/or injections. If those interventions don't work, hip replacement surgery often will relieve the pain associated with hip arthritis.

Preprosthetic Treatment

-Change of dominance activities, if needed -ROM of uninvolved joints -Prepare limb for a prosthesis -Desensitization -Wrapping to shape and shrink the residual limb: 1) wrap distal to proximal 2) tension should decrease with proximal wrapping -ADL training, including education in skin care -Supportive counseling to facilitate adjustment -Individualize treatment to enhance physical and psychological adjustment

Medical Treatment: Fractures

-Closed Reduction: stabilization including: short arm cast (SAC), long arm cast (LAC), splints, slings, or fracture brace -Open Reduction Internal Fixation (ORIF) include: nails, screws, plates, or wire -External Fixation -Arthrodesis: fusion -Arthroplasty: joint replacement

Most Common UE Fracture

-Colles Fracture: dorsal displacement -Smith's Fracture: volar displacement -Carpal Fracture: scaphoid bone (60%) of carpal fractures due to poor blood supply -Metacarpal Fracture: classified according to (head, neck, shaft, and base). boxer's fracture of 5th metacarpal (ulnar gutter splint) -Proximal Phalanx Fracture: common in thumb(1) and index (2) finger w/ loss of PIP A/PROM Distal Phalanx Fracture: Mallet Finger involving the extensor -Elbow Fracture: involves radial head and may result in limited forearm rotation -Humerus Fracture: displacement vs non-displacement

Assessments of Pain

-Determine location of pain -Evaluate intensity (0-10 scale) -Identify time of day the pain is most intense -Determine onset and duration of pain (gradual vs sudden) -Determine the length of time patient has been experiencing pain -Common descriptors: sharp, throbbing, tender, burning, shooting, aching

Osteogenesis Imperfecta (Etiology)

-Disorder caused by the dysfunction of one of several genes responsible for producing collagen to strengthen bones -The genes responsible for OI can be inherited from one or both parents -In some cases, the OI genes responsible for collagen begin to malfunction after the child is conceived.

Occupational Therapy Interventions: Median Nerve Laceration

-Dorsal protection splint; wrint in 30* flex if there is a low lesion, include elbow w/ 90* flex for high lesion -Begin A/PROM of digits w/ wrist in flex position 2wks post-opt, scar management -AROM of wrist 4wks; include elbow if high lesion -Strengthen at 9wks, Spinting w/ C-bar to prevent thumb add contrature, sensory re-education (Semmes-Weinstein)

OT Conservative Treatment: Cubital Tunnel Syndrome

-Elbow splint to prevent positions of extreme flexion (especially at night) -Elbow pads to decrease compression of the nerve when leaning on the elbow -Activity/work modifications -Surgical interventions: decompression or transposition -Positive operative treatment: edema control, scar management, AROM and nerve gliding (2wks post-opt), strengthening (4wks post-opt) -MCP flexion splint if clawing noted

Osteogenesis Imperfecta (Diagnosis)

-Family & Medical history -Results of physician exam and medical including: x-rays, collagen and blood test

Amputation: Classification and Amputations: UE Level

-Forequater: -Shoulder disarticulation: -Above elbow (AE): -Elbow disarticulation -Below-elbow (BE) -Wrist disarticulation -Finger amputation

Occupational Therapy Evaluations: Fractures

-History: mechanism of injury and fracture management -Testing: X-rays, MRI, and CT Scans -Edema control, and pain management -ROM: AROM -Do not assess PROM or strength without physicians orders unless Pt has a humerus fracture which often begins with PROM or AAROM -Consider sensation -Roles, occupations, ADLs, and activities related roles

Fourth Degree Burns

-Involves fat, muscle, and bone -Electrical burn: destruction of nerve along pathway

Osteogenesis Imperfecta (Sign & Symptoms)

-Malformed bones -Short, small body -Triangular face -Barrel-shaped rib cage -Brittle bones that fracture easily -Multiple fractures as the child grows -Developmental growth problems -Loose joints -Sclera of the whites of the eye look blue or purple -Brittle teeth -Hearing loss (often starting in the 20s or 30s) -Respiratory problems -Insufficient collagen

Hypertropic Scar

-Most common deep 3rd degree burn -Appears 6-8 wks after wound closure -One to Two years to mature -Compression garments should be worn 24 hrs a day (applied when wound is healed) (for 1-2 years until scar is matured) -Additional intervention: ROM, skin-care, ADLs, role activities, and patient/family education

Deep Partial- Thickness Burns (Evaluation & Interventions)

-Occupational Profile -ROM 72 hrs post-operative -sensation when wounds are healed -strength, when wounds are healed -ADLs and meaningful roles, activities ASAP Intervention: -wound care, dressing changes , debridement, sterile, whirlpool -gentle AROM and PRPOM to the patients tolerance -edema control -splinting if necessary -occupational roles activities ADLs -strengthening when wounds heal

Superficial Partial Thickness Burn (Evaluation & Interventions)

-Occupational Profile ROM 72 hrs post-operative -sensation when wounds are healed -strength, when wounds are healed -ADLs and meaningful roles, activities ASAP Intervention: -wound care, dressing changes , debridement, sterile, whirlpool -gentle AROM and PRPOM to the patients tolerance -edema control Splinting if necessary ADLs and role activities

Occupational Therapy Evaluation: Arthritis

-Occupational profile ROM: Focus on AROM, avoid PROM in inflammation stage, note deformities and nodules Muscle strength: avoid muscle testing unless physician requested, -Document strength in relation to function, -Check grip strength (use sphygmomanometer) -ADLs: note deficits related to pain, limitation in motion, deformity, weakness, or fatigue -Use pain scale -Edema: volumeter or tape measure

Hip Fractures : OT Evaluation

-Review precautions and weight-bearing status before evaluations -Occupational role requirements and expectations -ADLs: focus on dressing, bathing, and transfers -ROM and strength of UE -Conduct other assessments as needed (e.g. cognitive)

Treatment for LE Amputations

-Wrapping to shape residual limb and decrease swelling -Desensitization -Strengthening (UE) with the focus on triceps -Transfer training, stand pivot -ADL training; LE dressing is the most difficult -Standing tolerance -W/C mobility

Adhesion Capsulitis (Frozen Shoulder)

-Restrictive passive shoulder ROM (abd, flex, external/internal rotation) involving the glenohumeral ligaments and joint capsule Etiology: inflammation and immobility linked to diabetes and Parkinson's disease Symptoms: shoulder pain (at rest), sleep interruptions, pain w/ ADLs, palpitation reveals nonspecific tenderness at the shoulder. Freezing, frozen, thawing phases. Conservative Interventions: active use of shoulder through ADLs, PROM, modalities Surgical Interventions: arthroscopic surgery, and manipulation Post-operative Interventions: PROM immediately, pain relief: modalities, ADLs

Total Hip Replacement / Arthroplasty (THR) (THA): OT Evaluation

-Review precautions and weight-bearing status before evaluation -Complete an Occupational Profile -Assess ADL: focus on dressing, bathing, and transfers -Assess ROM, and strength of UE -Conduct other assessments as needed (eg. cognitive)

Radial Nerve Laceration

-Sensory loss: high lesions at the level of the humerous (fingers 1,2,3, and radial side of ring) -Motor loss: low lesion at the level of the forearm (wrist exten due to impaired ECU) (MCP extension) (thumb exten) -Motor loss: high lesion at the level of the humerous (all of the above including brachioradialis) (maybe loss of triceps/ elbow exten) -Functional loss (inability to exten digits/drop objects) -Deformity: wrist drop OT Interventions: Dynamic exten splint, ROM, sensory re-education, home program, activity modifications

Occupational Therapy Interventions :Arthritis

-Splinting: rest hand splints (acute phase), wrist splints, ulnar drift splints to prevent deformities, silver ring splints (boutonniere/swan deformity prevention), dynamic MCP extension splints (for radial pull post-opt MCP athroplasties), hand-based thumb splints for CMC arthritis. -Joint Protection Techniques -Energy conservation techniques -ROM: focus on AROM, PROM. pain free exercises -Heat Modalities: hot packs before exercise, but not during inflammation stages -Paraffin wax -Strengthening: avoid during inflammation stage, or with positions of deformity -ADLs: purposeful occupation-based w/ joint protection and energy conservation techniques. -Adaptive Equipment: to prevent deformity, decrease stress on small joints and inc. reach

Burns Classification

-Superficial (1st degree burn) -Superficial partial thickness burn -Deep partial thickness burn -Full thickness burn -Fourth degree burn -Rule of nine

Total Hip Replacement / Arthroplasty (THR) (THA): Types

-Total hip joint implant: replaces acetabulum and femoral head -Austin Moore: partial hip replacement (replace femoral head)

Hand Splints (Burns to the hand)

-Wrist in 20-30 degrees of extension -. MCPs in 70 degrees of flexion -. IPs in full extension -. Thumb abducted & extended

Transverse vs Spiral vs Oblique Fractures (complete fractures)

-Transverse Fracture: Tranverse fracture implies a fracture line that is transverse to the long axis of the bone. Transverse fractures may be relatively smooth or may be rough or have deep teeth on the fractured surfaces. Most are caused by bending forces. Roughness simplifies anatomical alignment and increases the likelihood of rotational stability once reduced. Once these fracture fragments have been reduced, fragment override should not occur Spiral Fracture: Spiral fracture indicates a fracture line that spirals along the long axis of the bone; it is caused by torsional twisting or rotational forces. Spiral fractures tend to have extremely sharp points and edges, which frequently accompany soft tissue trauma or an open fracture. Reduction of spiral fractures is difficult without constant traction or internal fixation, since these fractures tend to override and rotate into deformity Oblique Fracture: Oblique fracture implies a fracture line that is oblique to the long axis of the bone. The two cortices of each fragment are in the same plane without spiraling. The edges of an oblique fracture may be rough but are usually smooth. The cortical edges are flat, rather than sharp. These fractures generally result from bending, with superimposed axial compression. As a result of the obliquity of the fracture line, this fracture tends to override or rotate unless traction is maintained throughout the period of healing

Hip Fractures (Etiology)

-Trauma -Osteoporosis -Pathological fractures (i.e., cancer)

Total Hip Replacement / Arthroplasty (THR) (THA): Etiology

-Trauma from a fracture -Diseas, most often arthritis; surgery is then elective

OT Conservative Treatment: Carpal Tunnel

-Wrist splint in neutral: at night, and during the day if performing repetitive activities -Median nerve gliding exercises and differential tendon gliding exercises -Activity modifications: avoid extreme positioning of rest flexion w/ without repetitive finger flexion, and w/ a static grip -Ergonomic: appropriate work station design (most common work related injury of UE) -Surgical intervention: Carpal Tunnel Release (CTR) -Positive operative treatment: edema control, elevation, retrograde massage, compression gloves and/or contrast baths -AROM, nerve and tendon gliding exercises, sensory reeducation, strengthening of the the armed muscles (6wks post-operative)

Myofascial Pain Syndrome

Persistent, deep ache in muscle Nonarticular in origin Well-defined, highly-sensitive tender spots (trigger points)

Rule of Nines (adult)

9% R: arm 9% L: arm 9% for head 18% R: leg 18% L: leg 18% anterior trunk 18% posterior trunk 1% pelvis ------------------ 100% body

Mallet Finger

A deformity of the finger (distal interphalangeal DIP joint) caused when the tendon that straightens your finger (the extensor tendon) is damaged Typically, the DIP can be passively corrected to neutral, but the Ct is actively unable to extend it Etiology: • Rupture or laceration of the extensor digitorum tendon at the DIP • Hyper flexion of the extensor digitorum tendon during sports (softball etc) • DIP: hinge joint/bicondylar/capsular ligaments Causes: When the extensor tendon is cut or torn from the attached bone, causing the end of the finger to droop down and cannot be straightened • Blow to the finger w/ flexion force or by axial loading while DIP is extended • This condition is sometimes referred to as baseball finger • A fracture may occur w/ this injury Symptoms: Pain, Swelling around DIP Joint, DIP cannot straighten voluntarily, can be straightened w/ PROM, PIP joint extends Treatment: Test: Scrubbing Rug -Nonsurgical (usually w/ no fracture) -6wks continuous splinting (at all times) -6wks nighttime splinting Surgical -DIP Fixation: Metal pin across the DIP joint (internal splint) -Fracture Pinning -Finger Joint Fusion Splinting: Stack Splint (tip of the finger needs to be in hyperextension)

Rotator Cuff Tendonitis

Action: abd, flex, external/internal rotation Function: control of humerus head Site of impingement: corachoaromial arch Etiology: inflammation of a group of muscles (supraspinatus, infraspinatus, subscapularis) in the shoulder together with an inflammation of the lubrication mechanism called the BURSA. Cause: repetitive overuse, curved/hook acromion, weak cuff, weak scapula muscles, ligament/capsule tightness. Conservative Treatment: activity modification until pain subsides, educate in sleeping posture (avoid overhead/ add and internal rotation), dec pain (positioning, modalities, rest), restore ROM, strengthening below shoulder, ADLs task training) Surgical Interventions: athroscopic surgery, open repair Post-operative interventions: PROM (0-6wks) progress to AA/PROM, ice/progress to heat, strengthening (6wks post-opt) begin w/ isometric, progress to isotonic (below shoulder), activity modifications, light ADLs, leisure/work 8-12wks post-opt

Shoulder Dislocation

Anterior dislocation: is most common Etiology: trauma, repetitive overuse OT Intervention: Regain ROM (avoid combined ABD & ER w/ ant dislocation, pain mgmt, strengthen rotator cuff

Dupuytren's contracture

Disease of the fascia of the palm and digits Thickening and shrinking of the fascia of the palm with fingers being drawn into a flexed position -develops cords and bands that extend into the digits -results in flexion deformities of the digits -etiology: unknown -conservative treatment: not successful -surgical treatment: (surgical release); faciotomy with Z plasty, Aponeurotomy, McCash Procedure (open palm) Risk Factors: • Age: 50 and older • Sex: Men are more likely to develop Dupuytren's Disease • Ancestry: Northern European descent are at higher risk • Tobacco and alcohol use • Diabetes causes increased risk OT Treatment: -Dynamic flexion splinting wound care (dressing changes), edema control (elevation above heart) extension splint: worn all the time, except during ROM, and bathing A/PROM and progressive strengthening scar management OT-based task; emphasis on flexion (gripping), and extension (release) Ring (4) and pinky (5) finger are most commonly affected. Middle finger (3) may also be involved. Can occur in both hands, but usually affects one hand more severely

Total Hip Replacement / Arthroplasty (THR) (THA): OT Interventions Hip Precautions; (Antereolateral)

Educate on Hip Precautions -Do not externally rotate -Do not extend hip -Precautions may vary -Instruct in using long handled equipment -Provide transfer training (tub bench, raised toilet seat, car transfer, bed and chair transfers) -Practice occupation-based activities, using proper weight-bearing status, and functional mobility device.

Swans Neck Injury (Condition/Location)

Finger postures w/ PIPj hyperextension and DIPj flexion. The MP is flexed, and the finger appears zigzag Synovitis of the flexor tendon can erode the PIPj volar plate which normally helps PIPj hyperextension Etiology: Injuries: • DIP: terminal extensor tendon is disrupted (stretched/ruptured) leading to PIP hyperextension • PIP: Lateral bands are dorsally displaced, causing PIP hyperextension, therefore DIPj is flexed (FDS has been rupture/lengthened Causes: Rheumatoid Artthritis -Chronic PIPj swelling loosens the volar plate -Ligament tears/weaking (palm side of middle joint of the finger) -Tears of the tendon that flexes middle joint Symptoms: -Difficulty bending middle joint -Snapping sensation (during bending) -Stiffness (due to long lasting deformity) Treatment: Nonoperative Treatment -Splinting (PIP in slight flexion) Operative Treatment -FDS tenodesis or VP advancement procedures Splinting: • Dorsal blocking splint • Figure 8 splints • SIRIS (silver ring splint Splinting is used to prevent hyperextension at the PIPj and to promote PIP flexion Surgery: -Digit-based dorsal PIP splints 20-30 degrees of flexion -Pin site care -Wound care

Early Mobilization Program for Extensor Tendons Zone I and II

Mallet Finger Deformity 0-6wks: DIP extension splint

Ulnar Nerve Laceration

Sensory Loss: Ulnar aspect of palamr/dorsal surface -Ulnar 1/2 of ring and pinky finger Motor Loss: low lesion of wrist (adduction/abduction of MCP) (MCP flexion of digits 4 & 5) (flexion/Adduction of the thumb) (abduction, opposition, flexion of pinky) Motor Loss: high lesion; same as above w/ FCU flex towards ulnar wrist, and flex of DIP ring and pinky finger) Deformity: claw hand, flatten metacarpal arch, Froment's sign test of the wrist (o test for palsy of the ulnar nerve) Functional Loss: loss of power grip, dec pinch strength Dorsal protection splint with wrist positioned in 30* of flexion if low lesion -Include elbow (90* flexion) if high lesion -MCP flexion block splint

Carpal Tunnel: Splinting

Splinting: Wrist Cock-Up splint/ Neutral Wrist Splint in neutral to 10* degrees extension

DeQuervain's Tenosynovitis

Stenosing Tenovaginitis/Tenosynovitis Etiology: Inflammation of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) resulting in pain, crepitation and swelling over the radial styloid Causes: Forceful, repetitive, or sustained thumb abduction with ulnar deviation of the wrist. 4X more likely to occur in woman than men between 35-55, pregnant woman in the 3rd trimester and mothers of young children. Wringing out rags, opening jars, and needlepoint may provoke pain Testing: Finklestein's test is typically positive, and pain with resisted thumb exten/abd Conservative intervention includes: activity modification. orthotic positioning, tendon gliding exercises, ergonomic education Operative Treatment:

Carpal Tunnel : Treatment

Treatment: Positive Phalen's Test/Wrist Flex Test, Positibe Tinel's signs, Lifestyle modifications , Oral Meds, Corticosteroid Injection, Splinting (six to eight weeks/ pre-surgery) Surgery: open carpal tunnel release surgery, the transverse carpal ligament (flexor retinaculum) is cut, releasing the median nerve. Size/shape of the incision may vary

Rheumatoid Arthritis (RA)

(autoimmune disease) -Systemic, chronic disease that symmetrically affects many joints. (most commonly small joints) synovial inflammation (synovitis) Etiology: Unknown: 2 main theories (1) Infection theory (2) Autoimmune theory Affects woman more than men between 40-60 yrs of age. with individualized therapeutic treatment. Most commonly affects the joints of the hands, feet, wrists, elbows, knees and ankles Symptoms: pain, stiffness, limited ROM, fatigue, weightless, swelling, deformities, (ulnar deviation & subluxation) (Boutonniere deformity) (Swans Neck deformity) limited/diminished ability to perform ADLs -Characterized by remissions and exacerbation -Begins in the acute phase as an inflammatory process of the synovial lining

Prosthetic Treatment

- Functional training with prosthesis: practice engagement in activities of interest and occupational role activities - Donning and doffing the prosthesis - Increased prosthetic wearing tolerance - Individualize treatment to enhance physical and psychological adjustment

Closed vs Open Fractures

-Open Fracture (compound fracture) a fracture in which there is an open wound or break in the skin near the site of the broken bone. Most often, this wound is caused by a fragment of bone breaking through the skin at the moment of the injury. Cause: high-energy event—such as a gunshot or motor vehicle accident. can also result from a lower-energy incident, such as a simple fall at home or an injury playing sports. -Closed Fracture: a broken bone that does not penetrate the skin. May still require surgery from proper treatment, but most often this surgery is not an emergency and can be performed in the days or weeks following the injury. ex: broken wrist, hip or ankle fractures, and spinal compression fractures.

OT Interventions (Osteogenesis Imperfecta)

-adaptions & assistive devices -fabrications to facilitate participation in ADLs -environmental modification for safety -preventative positions and protective splinting pads -activities to increase muscle strength -weight-bearing activities to facilitate bone growth -health education to promote healthy lifestyle (diet/weight control) (avoid smoking, caffeine, alcohol, steroids) (exercises: swimming, walking, water therapy) -Family, caregiver, teacher education about proper handling (et. everything above)

Full Thickness Burns (Evaluation & Interventions)

-grafting ROM (5-7 days post-operative) Occupational Profile -ROM 72 hrs post-operative -sensation when wounds are healed -strength, when wounds are healed -ADLs and meaningful roles, activities ASAP Post-operative interventions: -72 hours: dressing changes, splints at all times -5-7 days: begin AROM, light ADL and meaningful activities, sterile, whirlpool -Over 7 days: PROM as tolerated, ADL and meaningful activities -When wounds are healed, use massage -Order compression garments -Provide otoform/elastomer inserts -Strengthening

Occupational Therapy Interventions (Pain)

-physical agents, modalities, massage in preparation for activities -teach proper positioning techniques -Splint Pt in resting position -Gentle ROM -Teach relaxation exercises -Use proper body mechanics during self-care, work, leisure -Correct environmental factors (seating and standing posture) -Modify activities and provide ADL training and AE as needed -Provide alternative exercise programs

Osteogenesis Imperfecta (Medical Management)

1. Care of broken bones 2. Dental acre of brittle teeth 3. Medication for pain 4. Surgery -fix/prevent bone malformations -"Rodding" metal rods are put inside the long bones

Total Hip Replacement / Arthroplasty (THR) (THA): Surgical Procedure

Cemented vs Uncemented: -Cemented: Cemented THA use polymethylmethacrylate (PMMA) to function as a grout, producing an interlocking fit between cancellous bone and prosthesis -Uncemeted: Uncemented hips rely on biological fixation of bone to a surface coating on the prosthesis Anterolateral vs Posterolateral (common) -Anterolateral: Candidates for this approach are not significantly overweight, have no femur deformities, and normal pelvis anatomy. This is a technically challenging procedure. Higher risk of femur fracture due to more difficult exposure. Higher risk of injury to lateral femoral cutaneous nerve, which may cause numbness in the outer thigh. -Posterolateral: The majority of patients are a candidate for this type of surgery. It is the most common approach and provides the greatest patient safety. Very low risk of fracture due to easier exposure. Very small (less than 1%) risk of sciatic nerve damage from excessive retraction during surgery.

Colles Fracture

Distal radius fracture (FOOSH injury) Dorsal displacement Occurs when the area of the radius near the wrist breaks Most common distal radius fracture Etiology: Complete fracture of the distal radius w/ dorsal displacement of the distal fragment and radial shortening. Broken end (fragment) of the radius tilts upward. Possibly the ulnar styloid may be fractured A low energy, (silver/dinner fork deformity) Causes: Usually occurs in Pts. 50 years old that attempt to break a fall onto an outstretched hand •Common in patients with postmenopausal women osteoporosis (elderly females) •High impact trauma: sports, motorcycle/car accidents. (younger Pts.) 50 or older or High impact trauma Symptoms: Pain (dorsal wrist) • Tenderness/ Bruising • Swelling (edema) • Dec. ROM/ strength • Deformity "dinner fork" (wrist hangs in odd or bent way) • Increased angulation of the distal radius • Inability to grasp objects Mild: Closed reduction Severe: Open reduction, external/internal fixation Depends on angulation and displacement of the bone Treatment: Depends on type of fracture and age of Pts. • Casting Surgical Treatment • External fixation, • Internal fixation, • Percutaneous pinning, • Bone substitutes. (osteotomy) Early Rehabilitation • Mobilize the wrist (7-8) external/internal fixation plate Wrist cock-up splint

Carpal Tunnel Syndrome (CTS)

Low median nerve entrapment/compression involving the palm of the hand, wrist, and the fingers, especially the thumb, index and middle (radial half) of fingers Etiology: Swelling of the lining of the flexor tendons, called tenosynovitis, Joint dislocations, Diabetes, Fluid retention (pregnancy or menopause, High blood pressure, Rheumatoid arthritis, Fractures, Repetitive maneuvers, Obesity, Hypothyroidism, Trauma, Dupuytren's disease (repetition, awkward posture, vibration, anatomical anomalies, and pregnancy) 10 days: 48hr following suture removal, scar mobilization (massage w/ lotion) AROM and PROM Manual desensitization exercises 3wks: Gentle stretching, (ball/putty) 3-4X per day for 5min 4-6wks: Progressive strengthening hand exercises 1-3 lbs 6wks: Return to work Avoid repetitive use, high vibrations, encompass ergonomically designed hand tools

Complex Regional Pain Syndrome (Condition/Location)

Type I: formerly known as reflex sympathetic dystrophy (RSD) Type II: formerly known as causalgia Vasomotor dysfunction as a result of an abnormal reflex. -Chronic pain that usually affects an arm or leg. -Can be localized to one area or spread to other parts of the extremity Etiology: May follow trauma (i.e. Colles' Fracture) or surgery, but actual cause is unknown. Typically develops after an injury (arm or leg), surgery, stroke, sprained ankle, infection, or heart attack. This can include a crushing injury, fracture or amputation. May be due to a dysfunctional interaction between the central and peripheral nervous systems and inappropriate inflammatory responses Severe pain • Edema • Discoloration • Osteoporosis • Swelling & Stiffness • Temperature changes • Vasomotor instability Tissue wasting (atrophy): skin, bone, and muscles begin to deteriorate and weaken if Pt. avoids moving arms and legs because of pain and stiffness Muscle tightening (contractures): OT Treatment: Modalities to decrease pain, Edema management (elevation, manual edema mobilization, compression glove), AROM, pain-free ADLs, Stress Loading (weight-bearing/joint distraction activities), splinting (resting hand splint (relieve muscle spasms), encourage self-management, avoid or proceed w/ PROM stretching, dynamic splinting and casting

Boutionniere Deformity

The extensor tendon (zone I) attached to the middle phalanx is injured due to: the result of an injury to the tendons that straightens the middle joint of your finger. • Synovitis causes the central tendon to become weakened, lengthened, or disrupted from the bony and capsular attachments allowing the PIPj to rest in flexion Etiology: Finger postures in PIP flexion and DIP hyperextension (open or closed) injury -Closed injury: development is slow but noticeable within 2 to 3 weeks after injury -Ct may have PIP extensor lag or PIP flexion contracture (therapy choice is affected) Causes: Laceration, Tear, Avulsion, Volar dislocation of the middle phalanx, Rheumatoid Arthritis Symptoms: Signs can develop immediately following an injury to the finger or may develop a week to 3 wks later • The finger at the middle joint can't be straightened and the fingertip can't be bent • Swelling and pain occur and continue on the top of the middle joint of the finger Treatment: Nonoperative Treatment • PIP splinting in ext. • Isolated DIP flex. Exercises (PROM/AROM) • PIP active exercises Splinting: If Pt has PIP flexion contracture • Serial splinting • Serial casting • Static progressive splints • Dynamic splint

Trigger Finger

(Digital Stenosing Tenosynovitis) of the finger flexors most commonly the A1 pulley. Characteristic symptoms is an inability to perform smooth digital flexion/extension most often involving the ring and thumb (trigger thumb) , but can occur in all other fingers Etiology: The A1 pulley becomes inflamed or thickened, making it harder for the flexor tendon to glide through it as the finger bends. Over time, the flexor tendon may also become inflamed and develop a small nodule on its surface. When the finger flexes and the nodule passes through the pulley, there is a sensation of catching or popping. This is often painful. Woman/Children are more likely than men to develop trigger finger, and differential diagnosis including flexor tendon masses medical conditions: diabetes and rheumatoid arthritis, gout, carpal tunnel syndrome, and Dupuytren's Contracture and/or forceful activities: repetition and use of tools that are placed too far apart may be associated Conservative Treatment: hand-based volar splint (MCPJ extension 0* neutral position/ IPJ free), scar massage, edema control, tendon gliding, activity/work modifications: avoid gripping, perform hook-fist exercises w/ splint 20 reps. Night gutter splints are used to correct contracture. Operative Treatment: Surgical release of the A! pulley

Lateral Epicondylitis (Tennis Elbow)

A painful condition involving the tendons that attach to the bone on the outside (lateral) part of the elbow. Your dominant arm is most often affected; however both arms can be affected. Etiology: The muscle involved in this condition: • Extensor carpi radialis brevis • Extensor carpi radialis longus • Extensor carpi ulnaris • Forearm tendons — often called extensors Commonly affects individuals between 30 and 50 years old. Can occur in all ages and in both men and women Causes: inflammation of the tendons that join the forearm muscles on the outside of the elbow • Overuse: "repetitive" gripping and grasping, pushing, pulling, lifting activities • Trauma: a direct blow to the elbow may result in swelling of the tendon that can lead to degeneration. • Can occur without any recognized repetitive injury. This occurrence is called "insidious" or of an unknown cause Symptoms: Pain in forearm, distal and anterior to lateral elbow -Worse with extension of wrist and gripping and supination -TTP over lateral elbow Develop gradually: Pain, Burning, Weak grip strength Treatment: Initially RICE, NSAIDs and activity modification • Rest • Staggered exercise programs (stretching wrist extensor muscles) • Non-steroidal anti-inflammatory medicines. • Brace • Steroid injections • Extracorporeal shock wave therapy • Open/ Arthroscopic surgery Splinting: Counter force strap on lateral elbow two fingers width away from lateral epicondyle. Cushion placed on muscle belly of forearm extensors.

Osteogenesis Imperfecta (Classification)

Eight main types classified by the genes that are involved: -Types 2, 3, 7, and 8: severe symptoms -Types 4, 5, and 6: moderate symptoms -Type 1: mild symptoms

Medial Epicondylitis

Gofers or Baseball Elbow Pain from the elbow (to the wrist on the inside (medial side) of the elbow, on the same side as the little finger. inflammation of the flexor pronator muscle mass originating at the medial epicondyle of the elbow. Etiology: Caused by damage and/or excessive force to the tendons that bend the wrist toward the palm. Muscles involved: • Flexor carpi radialis* • Pronator teres* • Flexor carpi ulnaris • Flexor digitorum superficialis Causes: Swinging a golf club or pitching a baseball. • Serving with great force in tennis or using a spin serve • Weak shoulder and wrist muscles • Frequent use of other hand tools on a continuous basis Symptoms: The pain can be felt when bending the wrist toward the palm against resistance, or when squeezing a rubber ball usually felt in the inner aspect of the elbow. Pain occurs in the flexor pronator tendons (attached to the medial epicondyle) and in the medial epicondyle when the wrist is flexed or pronated against resistance. Treatment: Rest (modification of activity) Resistive exercises (later) Ice pack application (to reduce inflammation) Strengthening exercises Anti-inflammatory medicine Bracing Corticosteroid injections Surgery (rare) Splinting: Counter force strap on medial elbow two fingers width away from medial epicondyle. Cushion placed on muscle belly of forearm flexors

Neck vs Mid-shaft vs Base Fractures

Humerus Fracture: -Neck (proximal) Humerus Fractures: Fractures of the proximal humerus typically occur as the result of a trauma,There are several treatment options for these fractures, but the most common are non-surgical treatments. Typically classified as non-displaced or displaced, and therapy will typically begin 1 to 4 weeks following the surgery, depending on the specific surgical intervention required -Mid-Shaft Humerus Fracture: typically does not involve the shoulder or elbow joints. This type of fracture represents about 3% of all broken bones. The most common cause of a humeral shaft fracture is a fall, but high-energy injuries (motor vehicle collisions, sports injuries) and penetrating trauma (gunshot wounds) also can cause this injury. l Treatment: most common are non-surgical treatments Base (distal) Fractures: a break in the lower end of the upper arm bone (humerus). A fracture in this area can be very painful and make elbow motion difficult or impossible. Most distal humerus fractures are caused by some type of high-energy event—such as receiving a direct blow to the elbow during a car collision. Treatment for a distal humerus fracture usually involves surgery to restore the normal anatomy and motion of the elbow OT Treatment: ROM, manual therapy, strengthening, modalities, and functional training

Median Nerve Laceration

Sensory loss -Central Palm (thumb to radial 1/2 of ring finger) -Palmar side of thumb, index, middle, and radial 1/2 of ring finger -Dorsal surface of index, middle, and radial 1/2 of ring finger (middle/distal phalanges) - Motor loss for a low lesion at the wrist (Lumbricals I & II, (opposition), (abduction), (flexion of thumb MCP) -Motor loss for a high lesion at or proximal to the elbow. (FDP & FPL flexion of tip of indlex, middle, and thumb) -Deformity (Flattening of thenar eminence, "ape hand"/Clawing of index and middle fingers for a low lesion/ -Benediction sign for a high-lesion)-Functional loss (opposition, weak pinch)

Cubital Tunnel Syndrome

Ulnar nerve entrapment which occurs when the Ulnar nerve in the arm becomes compressed or irritated Usually is felt in the ring and small finger. Second most common sight of nerve compression Etiology: Pressure or stretching of the ulnar nerve ; Elbow (also known as the "funny bone" nerve), The ulnar nerve can be compressed at the (the groove between the medial epicondyle and the olecranon of the ulna) at the elbow. Higher level Causes: Prior fracture or dislocations of the elbow Bone spurs/ arthritis of the elbow Swelling of the elbow joint Cysts near the elbow joint Repetitive or prolonged activities that require the elbow to be bent or flexed Symptoms: Pain (pin/needles), positive Tinsel's sign at elbow • Loss of sensation • Tingling • Weakness (of power grip) • Parathesis, atrophy (FCU & FDP to digits IV and V) • Numbeness Advance Stages: weakness and atrophy at the hypothenar muscles and thumb abductors Abductor digiti minimi, Flexor digiti minimi brevis Opponens digiti minimi Treatment: Non-surgical treatment: Non-steroidal anti-inflammatory medicines, Bracing or splinting, Nerve gliding exercises. Surgical Treatment, Ulnar nerve anterior transposition, Medial epicondylectomy, Cubital tunnel release Cubital tunnel release. In this operation, the ligament "roof" of the cubital tunnel is cut and divided. This increases the size of the tunnel and decreases pressure on the nerve Splinting: Elbow flexion block splint Gel padding Elbow positioning 30-40 degrees of extension 3-5 days: dressing removed, edema control Active and gentle PROM exercise (elbow, forearm, and wrist) 10 min 2hrs per day 10-14 days: 48hrs after sutures removed (scar massage), manual desensitization exercises 6 wks: progressive strengthening exercises (1lb) 6-8 wks: may return to normal use

Skier's Thumb

(Gamekeeper's Thumb) Rupture of the ulnar collateral ligament of the MCP joint of the thumb -Trauma to the thumb, due to sudden and forced stretching in an outer direction (fall onto an outstretched hand) -etiology: Acute injury to a ligament of the thumb, and often seen among skiers. Most common cause is falls while skiing with the thumb held in a ski pole Symptoms: Tenderness, Swelling, Bruising: (along the inner aspect of the thumb at the first knuckle), Loss of side-to-side stability Thumb will be unstable at the 1st knuckle (if torn) Conservative treatment: • Thumb splint (4-6wks) • AROM and pinch strengthening (6wks) • ADLs: that require opposition and pinch strength Post-operative Treatment: • Thumb splint (6wks), AROM, PROM can begin at (8wks), and strengthening at (10wks) Thumb immobilization splint w/ CMC joint in 40 degree of palmar abduction Post-operative treatment: thumb spiinting (thumb immobilization splint) for 6wks followed by AROM. PROM (8wks) and strengthening at 10wks

Above-elbow (AE)

(long or short) amputation above the eblow at any level on the upper arm

Hip Fractures : OT Intervention

-Bed mobility and bedside ADLs -UE strengthening -Functional mobility and transfer with appropriate weight-bearing status and functional mobility device (e.g. walker, crutches) -The functional mobility device is determined by the Pt's weight-bearing status -Educate in, and practice use of assistive devices for home use (e.g. shower chair, commode seat) -Practice occupation-based activities (e.g. meal prep) using proper weight-bearing status and functional mobility devices

Complete vs Incomplete Fractures

-Complete Fractures: fractures where the parts of the bone that have been fractured are completely separated from each other. There is complete separation of the cortex circumferentially single fracture: bone is broken in one place into two pieces comminuted fracture:bone is broken or crushed into three or more pieces compression fracture:bone collapses under pressure nondisplaced fracture: bone breaks into pieces that stay in their normal alignment displaced fracture: bone breaks into pieces that move out of their normal alignment segmental fracture: bone is broken in two places in a way that leaves at least one segment floating and unattached Incomplete Fractures: A minor fracture is also known as an incomplete fracture. Where the bone doesn't break completely. Often occurs in children hairline fracture: bone is broken in a thin crack greenstick fracture: bone is broken on one side, while the other side is bent buckle or torus fracture: bone is broken on one side and a bump or raised buckle develops on the other side

Guyon's Canal Syndrome: (Ulnar Tunnel Syndrome)

Ulnar and Nerve Compression/Entrapment at the wrist (rare peripheral nerve neuropathy) C8-T1 of the brachial plexus Etiology: injury through compression, inflammation, trauma or vascular insufficiency: Hook of Hamate fracture, tumor, (repetition, ganglion pressure/cyst, and facia thickening, positive tinel's sign, symptoms on ulnar side) Hypothenar Hammer Syndrome (HHS) is a unique mechanism of ulnar nerve injury secondary to ulnar artery thrombosis and/or aneurysm Symptoms: sign and symptoms can be purely motor, purely sensory, or mixed. Hypothenar atrophy may be present in advance stages numbness and tingling, and pin & needles feeling in the ulnar nerve distribution on the hand (ring & pinky). Before progressing to a loss of sensation and/or impaired function of the intrinsic muscles of the hand that innervate the ulnar nerve. Risk: cyclist, Treatment: depends on duration/ severity of symptoms conservative: neutral wrist splint (nighttime 12wks), work/activity modification (avoiding mechanical compression/ repetitive stress of canal) Surgical intervention: decompression post-op: edema, AROM, gliding, strengthen grip (2-4 wks), sensory re-education

Rheumatoid Arthritis (Stages)

here are four distinct stages of RA progression, and each has their own treatment courses. Stage 1: This is early stage RA. This stage involves the initial inflammation in the joint capsule and swelling of synovial tissue. The swelling causes the symptoms of joint pain, swelling, and stiffness. Stage 2: In the moderate stage of RA, the inflammation of the synovial tissue becomes severe enough that it creates cartilage damage. In this stage, symptoms of loss of mobility and decreased joint range of motion become more frequent. Stage 3: Once the disease has progressed to stage three, it is considered severe RA. Inflammation in the synovium is now destroying not only the cartilage of the joint but the bone as well. Potential symptoms of this stage include increased pain and swelling and a further decrease in mobility and even muscle strength. Physical deformities of the joint may start to develop as well. Stage 4: In the end stage of RA, the inflammatory process ceases and joints stop functioning altogether. Pain, swelling, stiffness and loss of mobility are still the primary symptoms in this stage