450 Formula UE

PAMs associated with RA

allows for a wider variety -heat, TENs, cold

evaluation for arthritis

assess motion and stability of each joint in thumb and fingers

RA

autoimmune condition that attacks joints

which PAM is commonly associated with edema and acute injury

cold/cryotherapy

ultrasound works best with

collagen based structures (tendons, bone) and less well on muscles

intrinsic muscles

completely within the hand

cold PAMs

constrict circulation, numb pain -used for acute injury

lateral collateral ligaments

contribute to deformities of fingers -when bent they are relaxed and when straight they are stretched

medial collateral ligament/valgus instability

lateral deviation of the elbow -michael and gus love guns

tennis elbow

lateral epicondylitis -painful extrinsic extensor tendons near elbow -painful to touch and use -decreases grip strength (opposing flexors)

minimi

little finger

oval 8 splints are used for

boutonniere and swan neck deformities

with a fractured finger you usually splint a

buddy finger to help stabilize fractured finger

longus

long

carpal fracture

low blood supply, longer healing times, may require surgery

intrinsic muscles of hand

lumbricals and interossei

isometric

maintaining one position with resistance (holding a weight still)

focus for arthritis

manage and prevent worsening symptoms and maximize function

lateral collateral ligament/varus instability

medial deviation of elbow -lucille has her hands in lap like a lady

boxer's fracture

metacarpal fracture-typically 4th and 5th metacarpals -fix with an ulnar gutter splint to flex MCPs

LCL/varus instability is

more common -stabilized best with elbow flexion and pronation -lucille gets stressed often

concentric

muscle shortens

treatment for frozen shoulder

pain free AROM and compensation strategies/environmental modifications until it thaws naturally

with arthritis focus on

pain free ROM -frequent AROM through pain-free ROM -pain=damage to the joints

TENS

pain management via gate control theory (increase traffic) -best for ACUTE pain (fractures, tendon/ligament repairs, sprains, edema) -can reduce trigger points

which PAM is commonly associated with arthritis, specifically OA

paraffin

flexor digitorum profundus

passes all the way through to the DIPs

edema deformity results in

position opposite of antideformity splint (loss of metacarpal arch-straight knuckles) similar to ape hand with all fingers -results in collateral ligament and volar plate deformity

contraindications for compression

-DVT, severe cardiovascular concern, peripheral neuropathy, active TB

arthritis treatment: JAPO

-Joint protection -AROM (pain free of wrists and digits, maybe strengthening but gentle and pain free) -PAMs -Orthoses

joint protection

-activity modification, avoidance and positioning, decrease inflammation -compensatory strategies (use larger more proximal joints, spread the force by using both hands) -adaptive equipment: built up handles or other AE to perform ADLs with minimal stress on joints -once joints are happy --> resume modified version of task

AMBRI/TUBS

-always been loose -torn loose

posterior elbow splint

-for MCL/LCL injury -elbow injury recovery

boutonniere splint

-for boutonniere syndrome or arthritis -oval 8

long thumb spica (long opponens)

-for de quervain syndrome -kevin the unicorn

wrist cock up splint

-for radial nerve injury, radial tunnel syndrome, and carpal tunnel syndrome -looks like a squid (fingers are free to move)

swan neck splint

-for swan neck or injury of tendons -oval 9

hand based/forearm based ulnar gutter

-if proximal: use forearm based -if distal: use hand based

mallet splint

-immobilize DIP in full extension for 6-8 weeks without flexing

acronym for edema treatment: MASTECCT

-manual edema mobilization: requires training and certification -AROM -splint: antideformity splint/intrinsic plus -taping: not that effective -elevation -compression -cold -think

in general eval for UE: NEW SPORC

-nerves, edema, wounds -strength, pain, occupations, ROM, coordination

antideformity splints (intrinsic plus)

-positioning after trauma/edema -looks like an alligator

arthritis orthoses: antideformity position

-stabilize deformed joints, emphasize stabilizing proximal affected joints and freeing distal unaffected ones where possible -night and day use

short thumb spica (short opponens)

-thumb in opposition -arthritis of CMC and MP of thumb -looks like a unicorn

measure edema

-volumeter (unless open wound/burn) -figure 8 circumferential measurement

rotator cuff tests: several tests to check RC stability, particularly supraspinatus

-with thumbs down: -empty can test (pretend to be holding a can and dump it out) -hawkins kennedy (flapping wings like a hawk-shoulder is moving) -neer's impingement test (shoulder=neerest joint to your arm)

heat PAMs

relaxes muscles, increase circulation, superficial or deep

brevis

short

PAMs should not be applied to

somewhere something abnormal is happening, wounds, cancer, pregnancy

flexor digitorum superficialis

splits and spots at PIP

thumb spica is used for

stabilize MP and CMC in opposition (because most functional) for arthritis

for the elbow you follow

standard ROM progression

for wrist fractures you use

standard ROM progression

e-stimulation PAMs

stimulate muscle contraction and sensation

most wrist fractures will have a cast so you move

surrounding joints via tendon sliding and elbow movement

policis

thumb

klumpke's palsy

trouble with your keys with Klumpke's -atrophy of arm or hand, claw hand, muscle weakness, limited ROM of arm, pain, paralysis of arm or head

t/f: edema in the first few days of injury is normal

true

t/f: you only need to splint the affected joints

true -others should be free to move

MCL/acute valgus stresses/instability

typically for throwing athletes -michael is a fast pitcher -stabilized best with elbow flexion and supination

deep heat

ultrasound

Erb's palsy

upper brachial plexus injury, upper arm deficits -that nerd erb is always raising his hand in class -waiter's tip hand

for hand fractures

use splintrinsic plus splint and then standard mobility progression

if progress plateaus

use static progressive splints (ones that adjust) or serial static splints (heat up thermoplastic to new ROM)

OA

wearing down of cartilage elements of joints (bone on bone)

carpi

wrist

for elbow treatment

1. immobilize/stabilize: posterior elbow splint in 90 degree in flexion 2. AROM in max position of stability: lying in supine, shoulder flexed 90, pronated forearm (Egyptian elbows while in supine so gravity helps it) then progress to typical movements and positions but continue to avoid the ones that put stress on the affected area 3. after 6-8 weeks-no movement precautions and begin strengthening

stages of healing: proliferation for bones

6-8 weeks for bones to stabilize and cautiously grade movement/activity

typical stage of healing

6-8 weeks of immobilization

contraindications of PAMs

C: cognition (dementia, small child) V: vascular (cardiac concerns) S: sensation compromised

OA affects

CMC and IPs -finger deformities: mallet finger, boutonniere deformity, dorsal subluxation

RA affects

MPs and wrist/carpals -finger deformities: ulnar drift at MPs, swan neck and boutonniere, wrist-radial subluxation (zig zag)

tests used for lateral epicondylosis

Mill's test, Maudley's test, Cozen's test -showed up later to maudsley's cozy mill

RA acronym for deformities

Right Angle: thumb and MPs wRist Also Really Anything: presentation may be more varied and tx can be really anything

which PAM is commonly associated with trigger points

TENS

serial static splint

a series of static splints or a static splint that is reheated and adjusted to the client's new available ROM to improve it

glenohumeral instability

frequent impingement or dislocations, strengthen RC muscles to compensate

manual edema mobilization is contraindicated for

damaged lymph, infection, blood clots, CHF, kidney problems, and cancer

ultrasound PAMs

deep penetrating heat modality, useful for deep heat and also healing

digitorum

digits

AROM should be pain free, avoid stress in __________

direction of deformity

colle's fracture

distal radius/wrist fracture results from FOOSH

proximal stability leads to

distal stability -compromised joint in hand will commonly result in deformity of more distal joints -be aware of where problem is and address that FIRST

high volt pulsed current (HVPC)

edema, pain, healing, small muscle re-education

edema

excessive fluid built up in tissues -outside of first few days after an injury, edema may be a sign of infection

NMES and PES

exercise and functional use (i.e. post stroke)

extrinsic muscles of hand

flexors/extensors

which PAM is commonly associated with CRPS

fluidotherapy

for hand fractures you

follow standard ROM progression

resting hand splints are typically used for

general comfort -i.e. after stroke -look like a parrot resting on your shoulder

static splint

generic splint, immobilizes and protects

nerve injury or impingement at the brachial plexus/thoracic outlet syndrome

give it space and keep it mobile

PAMs: OA responds best to

heat (paraffin)

eccentric

holding resistance and lowering it -muscle is lengthening

superficial heat

hot packs, paraffin, fluidotherapy

standard ROM progression

immobilization, AROM, PROM, isometric, eccentric, concentric

purposes of orthoses

immobilize early to protect, mobilize later to correct

extrinsic muscles

in forearm with tendons leading into the hand

indices

index finger