CHT exam 2018

30 mm Hg

critical Pressure in cubital tunnel

C deg x 1.8 + 32 = F deg

deg C to deg F conversion

up to 2 cm

depth of penetration with superficial heat

most common PIP dislocation type

dorsal; volar is rare

-shoulder=deceleration phase -elbow=late cocking/early acceleration phase

during pitching/throwing - which phase most likely to injure - shoulder? elbow?

on time/off time AKA

duty cycle

posterolateral

elbow dislocation - most common type

ASIA muscles for functional motor level C7

elbow extensors

ASIA muscles for functional motor level C5

elbow flexors

bony=corocoid process; soft=MCL/UCL

elbow stability - bony and soft structures

1) MCL/UCL 2) Radial head

elbow stabilizers to valgus stress (2)

A2 & A4

pulleys that prevent bowstringing

thumb position s/p Bennett's fracture

pulls dorsally and adducts

neurogenic TOS symptoms

pure neuorgenic=painless atrophy of intrinsics + paresthesias

CIND - which ligaments

extrinsic

FDS

finger flexion muscles with 4 separate bellies

ASIA muscles for functional motor level C8

finger flexors

carpals move what direction with RD

flexion

pronation

forearm position with + ulnar variance

in the 1st 30 days = increased acceptance

"Golden Period" for fitting a prosthesis

Motion most limited with RTC disease

-IR (reaching behind back) -flexion

# lumbricals

4

% loss of whole person - entire UE loss (amputation at shoulder)

60%

Ulnar A supplies __% of hand

60%

transverse

fracture type that is not usually unstable

2nd degree

frostbite - degree of injury with clear blisters

75%

fully healed skin=__% normal tissue strength

1) regulate skin & body temp 2) energy storage (fat) 2) provide protective padding

function of subQ or hypodermis (3)

61/60/39

functional flexion of MP/PIP/DIP

21/18

functional flexion thumb MP/IP

decreased power grip strength

functional loss with Reverse Bennett's fx that is not reduced

Cozen's = resisted wrist ext with elbow flexed & extended

Best test for lat epicondylitis

SLAP tear; prox long head biceps tendon cut & re-attached more proximally to humerus

Biceps tenodesis - sx for what

OA deformity at PIP

Bouchard's nodes

Axillary

Brachial Plexus surrounds which Artery

Sauve Kapandji

fuse DRUJ, cut distal ulna then create new joint for supination/pronation at distal ulna; PQ is redirected through excised area of ulna to create new joint

10-40%

fusion = how much loss flex/ext at LT

-Only palm = wrist neutral/slight ext, fingers full ext and abd, thumb radial abd/ext -Palm + = wrist 15 deg ext, MCP's 60-70 deg flex, IP's full ext, thumb midway between radial & palmar abd, thumb MCP flexed 10 deg, thumb IP fully extended

Burn splint for "only palm" vs. palm + fingers/wrist

torso=18%, each leg=18%, each arm=9%, head=9% ***hand only = 3%, palm only = 1%

Burns TBSA - adult

torso=18%, each leg=14%, each arm=9%, head=18%

Burns TBSA - child

150 min (moderate), or 75 min (vigorous)/wk

general exercise guidelines (min/wk)

convex on concave - direction of glide

glide is opposite direction from bone that's moving

5-10%

grip strength difference between dominant and non-dominant hands

75-80% of uninvolved side

grip strength s/p 4-corner fusion

Crystal found with pseudogout

CPPD (Calcium pyrophosphate dihydrate disease)

arthritis of hand - joints most ->least common (4)

DIP -> thumb CMC -> PIP -> MCP

Most violent phase of pitching & injuries associated with this phase

Deceleration; RTC injury due to ER during deceleration phase; 90% body weight displacement during this phase

1) Belfast & Sheffield 2) Strickland & Cannon 3) Evans & Thompson 4) Sandow & MacMahon

EAM protocols - flexor tendon repair (4)

Tendon t/f for EPL

EIP

Splint for MCL repair, cubital tunnel, radial tunnel

Elbow 90, forearm neutral or supination, wrist extension

Most common benign bone tumor of hand

Enchondroma

most common BP injury

Erb-Duchenne's Palsy

Dessication

Extreme drying/dryness

Trap (moves distal acromion med & superior)/SA (moves inf angle laterally)

F couple that initiates upward rotation of scapula

RC=63%, UC=37% ***if ulnocarpal abutment is presents, F through ulnocarpal joint is even more

F through radiocarpal vs. ulnocarpal joint with pronation

RC=80%, UC=20%

F through radiocarpal vs. ulnocarpal joint with supination

muscles involved with medial epicondylitis

FCU & PT

77 deg

Finger temp ergonomics standard

1st = Angry/Painful 2nd = Worsening stiffness 3rd = Improving/Loosening

Frozen shoulder - Stages

Stage 3 = Improving/Loosening stage ***may be 1 - 1 1/2 years after sx started; pt may need to continue doing ex's x 6 mo

Frozen shoulder - stage most amenable to therapy

Resist rotation force on skin of fingers

Function Cleland's, Grayson's ligaments

RA Type IV thumb

Gamekeeper's

Second most common soft tissue tumor

Giant cell tumor ***ganglion cyst is most common

6 wk post injury; SS can further displace fracture if moved too soon

Greater tuberosity fracture - when to start AROM

Type 1= motor & sensory Type 2=motor only Type 3=sensory only

Handlebar palsy types (3)

Most force for tennis serve comes from where?

Hip and trunk rotation

(Brian) - PIP at absolute zero x 6 wk (central slip, Boutinerre deformity)

How to splint zone 3 extensor tendon injury

Variant of Mongeggia's fx; non-displaced olecranon fx with ant dislocation of RH

Hume fracture

-no higher than 40 mm HG -3:1 or 4:1 -not to exceed DIASTOLIC BP

Intermittent compression - parameters, ratio inflation: deflation, BP precaution

Main flexor of MP's

Interossei; lumbricals are secondary

1st & 2nd

Intersection Syndrome - which compartments

Most common inflammatory disease in <16 year olds

JIA (aka JRA)

ligament injured with posterolateral instability

LUCL

visceral organs, cardiac muscle; exits SC via ventral root along with motor neurons

Lateral horn - innervates what, where exits SC

Fair +

MMT grade to D/C NMES

4/5 - full ROM, takes some resistance

MMT needed for tendon t/f donor

flexion

MP - PCL is tight in __

extension

MP ACL is tight in __

"safe" position

MP's 70-90 deg flex, IP's 0-10 deg flex

tx created by Mulligan

Mobilization with Movement (MWM)

Shoulder impingement tests

Neer, Jobe/Empty Can, Hawkins, Yocum -Neer = IR & max forward flexion GH joint -Jobe/Empty Can = scaption & full IR; GH joint, apply downward pressure w/ pt pushing upward -Hawkins = GH flex to 90 deg, apply pressure into IR -Yocum = active test; pt reaches across to opposite shoulder and attempts to raise elbow

Tumor arising from Schwann cells

Neurofibroma; removal damages nerve fibers

1st sign of Dupytren's

Nodules

< 2 sec

Normal capillary refill time

"innocent until proven guilty"

Null hypothesis

DIP, CMC

OA- 1st joints affected

biceps

OBPI (Obstetric Brachial Plexus Injury) - recovery of which muscle considered an indication for prognosis?

Most important pulley in thumb

Oblique pulley

Most popular Dupytren's release

Open limited fasciectomy

Origin: Radial sigmoid notch Insertion: Base of ulnar styloid

Origin/insertion of TFCC

biceps

Reflex test for C5

Cold = 40 deg F (4 deg C) Hot = 115-120 deg F (46 deg C)

Temperature testing, cold vs. hot

"relating to moods, feelings, attitudes"; anxiety, depression, irritability/hostility, disgust, cosmetic concerns

Types of Affective adjustment s/p traumatic injury

flashbacks, nightmares, poor concentration, poor attention

Types of cognitive adjustment s/p traumatic injury

thumb MCP ligament most commonly injured

UCL

anterior bundle

UCL - part that is critical stabilizer

MCL

UCL AKA

Parkinson's, ALS (also LMN), MS (also LMN)

UMN diseases

between SS & subscap tendons

Where does biceps penetrate RTC

3 MHz, because it heats faster

Which setting with US (1 MHz or 3 MHz) requires lower intensity & why

P1's UD, MC's RD, wrist UD

Zig Zag wrist with RA

SAM (Evans) which zone for extensor tendons

Zone 3

-if proximal to JT = affected + adjacent fingers MP's at 0 deg -if distal to JT = affected @ 0 deg, adjacent 30 deg flex (uses JT to pull distally and reduce gapping at repair)

Zone VI extensor tendon repair - how to determine how to splint fingers

95%

__% of TOS is neurogenic

above T6

autonomic dysreflexia - what SCI levels

muscle at high risk for tear with elbow dislocation

brachialis (attaches to coronoid)

end of bone slides SAME direction as movement ("people stay together in a cave")

concave bone movement with joint

BR & PT

cubital fossa - borders

FCU

cubital tunnel - treat which muscle

effect of cold on strength

decreases strength

effect of heat on strength

decreases strength in initial 30 min; increases to above pre-tx strength 2 hr after

pseudoboutinerre initially (AKA flexion contracture); will develop into swan's neck if left untreated

deformity with dorsal PIP dislocation

well-conditioned males

distal biceps tendon avulsion - most common in what population

closed chain

distal segment is fixed

3%

dominant hand - how much larger is it?

pinky; thin tendon, blocking could cause gapping

don't do tendon blocking with which finger?

most common PIP dislocation

dorsal = 85%

dorsal PIP dislocation splint

dorsal blocking 20-30 deg flex

position of stability s/p elbow dislocation

elbow flexion, pronation

C8, T1

intrinsics innervated at what SC level

digit=12 hr, proximal to carpus=6 hr ***half of cold ischemic time

max warm ischemic time for digit/prox to carpus replantation

Ulnar N & sup/inf Ulnar Collateral A

medial intermuscular septum - what perforates it

Zones 4 & 5 (4=carpal tunnel, 5= wrist/muscle-tendon junction

median & ulnar N injury most often found in which flexor tendon zones

Colle's fracture - most common complication

median N damage

posterior

most common direction elbow dislocation

flexion contracture

most common elbow fracture/dislocation complication

metacarpal

most common extra-articular fracture of hand

FCU (often bilaterally)

most common flexor tendon tendinopathy (distal attachment)

#1=clavicle, #2=radius

most common fractures (top 2)

dorsal

most common hand burn (dorsal or volar

Boutinerre (pinky most common)

most common hand deformity with burns

distal phalanx of thumb, middle finger

most common hand fracture, which fingers

paronychia

most common hand infection

paronychia at fingernail fold

most common hand infection

#1=shoulder, #2=finger, #3=elbow

most common joint dislocations (top 3)

AC joint separation

most common joint injured in sports

synovial/diarthrosis joints

most common joint type in body

anterior (almost all)

most common shoulder dislocation

posterior

most common shoulder instability

radial head

most commonly injured bone with FOOSH

3-point orthosis

most effective splint to re-gain elbow extension with >30 deg contracture

PIP flexion contracture

most serious complication s/p proximal phalanx fracture

lateral pinch

motion to avoid with RA thumb

biscapular abduction

motion to bring prosthesis to middle s/p transradial amputation

glenohumeral flexion

motion to open hand s/p transradial amputation

shoulder depression, shoulder extension, shoulder abd

motions to lock/unlock elbow s/p transhumeral amputation

pronation with gripping

movement to avoid with gripping after TFCC injury

30 deg anterior to frontal plane

normal scapular rotation

DSN = C4-5; LS, Rhomboids

only N that divides off BP at C4-5, muscles it innervates

pisiform (FCU)

only carpal bone with tendon insertion

subscap

only muscle transected and repaired with TSA

coracoclavicular ligament & AC ligament

only non-muscle structures attaching scapula to clavicle

PL (Camitz), FDS of ring finger

opponensplasty - 2 muscles used

activities that can cause elbow UCL/MCL injury

overhead sports, overuse injury

classic sign of CIND

pain/clunk/click with wrist circles, or with UD/RD

1%

palm represents __% for TBSA

CMC position in splint with OA of thumb

palmar abduction and supination; avoid pronation

125-127 deg F

paraffin temp

ASIA muscles for functional motor level T1

pinky abductor

Teres Major, teres minor, humerus, triceps

quadrangular space - borders

Axillary N, posterior circumflex A

quadrangular space - contents

22-23 deg (frontal plane)

radial inclination - radius - which plane

22-23 deg (dorsal view)

radial inclination of wrist

proximally

radius migrates what direction with pronation

distally

radius migrates what direction with supination

Rise time AKA

ramp/surge

UMN loss

reflex testing - hyperreflexive - loss of what

LMN loss

reflex testing - hypo reflexive - loss of what

6 wk

s/p tendon repair - when can do strong contractions

s/p 4 wk

s/p tendon t/f - when to start AROM

50%

s/p wrist fusion - % motion re-gain expected

12 wk

safe to test grip/pinch strength s/p tendon repair

6-12 wk post-injury/surgery

scar altering techniques are most effective at __wk post-injury

15-17"

seat pan length for standard office chair

3/4 of thighs, 1-2 fingers behind knees

seat support parameters for ergonomic chair

entrapment @ cubital tunnel vs. Guyon's (due to dorsal cutaneous involvement)

sensory deficit at dorsal ulnar digits indicates what?

10 to the 5th/g tissue

sepsis - level of organism/g tissue

Deltoid SS IS Tm Subscap Biceps (long)

shoulder abduction - muscles

tissue elongation with SP splint is called

stress relaxation

FCU

stronger wrist muscle

subscap (50% of RTC strength)

strongest RTC muscle

Add Pollicus

strongest intrinsic muscle of hand

volar are much stronger

strongest wrist ligaments

check rein ligaments

structure most implicated with PIP contracture

dorsal oblique ligament

structure that provides stability with thumb abd & opposition

AOL/volar beak ligament

structure that resists dorsal subluxation with key pinch

with RA, carpal row deforms how?

supination away from ulna=caput ulna + metacarpals radially deviate

ECU snaps in what position (3 combined movements)

supination, UD, flexion

supination=radius migrates distally, negative ulnar variance pronation=radius migrates proximally , positive ulnar variance

supination/pronation - migration of radius & effect on ulnar variance

4-5 cm

tendon excursion - finger extensors

3.5 cm

tendon excursion - wrist

7 cm

tendon excursion finger flexors

3 mm

tendon excursion needed to decrease gap formation

FDS

tendon involved with trigger finger

FPB

tendon involved with trigger thumb

4 strands

tendon repair - # strands can withstand early active motion

2 strands

tendon repair - # strands most common

3-5 days post-op

tendon repair weakest when

L'Episcipo transfer (LD & TM inserted into new posterior/lateral insertion on humerus making them into ER's instead of IR's)

tendon t/f for irreparable RTC injury or BP injury to restore ER

OA - common thumb deformity

thumb adduction with MCP hyperextension

APB

thumb opposition - which muscle strongest

oblique

thumb pulley critical for IP function

splint for s/p LRTI, how long to wear it

thumb spica x 4 wk

3 mo after N injury if no signs of regeneration

time frame for when tendon t/f's are considered

4-6 inches (avg worker palm=4 inches)

tool handle - how big to decrease P on carpal tunnel

adults=# 1 shoulder, #2 elbow; children=#1 elbow

top joints most commonly injured in adults and children

TERT

total end range time

OpSite, Tegaderm

transparent dressings used to cover and protect wounds

FDS

trigger finger - which tendon most common

1= pain, 2=active catch, 3=passive catch, 4=contracture

trigger finger stages

dart-thrower's position advantage

uses mid-carpal vs. radoiocarpal joint

thumb UCL accessory ligament resists

valgus load with thumb extension

thumb UCL proper ligament resists

valgus load with thumb flexion

position that causes elbow UCL/MCL injury

valgus stress with elbow flexion 30-90 deg

Xeroform (yellow), Adaptic (white)

vaseline gauze dressings, non-adherent, used to prevent desiccation (drying out of wound)

Ventral=motor, efferent (MOVE) Dorsal=sensory, afferent (SAD

ventral, motor roots of SC - sensory or motor, afferent or efferent

18-26"

viewing distance for monitor placement

critical corner

where volar plate and accessory and proper collateral ligaments converge at PIP

SMP (sympathetic maintained pain) better prognosis because sympathetic nerve blocks are effective (pain has not reached CNS yet); SIP (sympathetic independent pain) worse prognosis because nerve blocks don't help

with CRPS - better prognosis for SMP or SIP

C5-6

with SCI - what levels are tendon t/f's considered

Gender most affected by RA

women

fibrin

wound clotting cell

2 yr post injury; 1 yr to re-grow N, 1 year for sensory re-ed

wrist N recovery - when to final eval

Kienbock's (AVN of lunate)

wrist diagnosis associated with - ulnar variance

ECRB=strongest, most efficient wrist extensor

wrist extensor muscle with longest moment arm & largest cross-sectional area

ASIA muscles for functional motor level C6

wrist extensors

flex=5 deg, ext=30 deg, RD=1 deg, UD=15 deg or flex/ext combined=40 deg, UD/RD combined=40 deg

wrist functional ROM

ECU

wrist muscle active in all positions

wrist 2 deg flex, 3 deg UD

wrist splint position for CTS

Zones 4-7 ICAM protocol = immediate controlled active motion

yoke orthosis used for what ext tendon zones; what protocol

Raynaud's disease most common (age, gender, uni or bilateral)

young women, bil hands

8 (5 annular, 3 cruciate)

# flexor pulleys - finger

pole for lidocaine & use

+, pain

Temp for frostbite to occur

-2 to -4 deg C; 24 to 28 deg F

AC joint ligaments

-AC ligament -CC ligament (conoid, trapezoid)

AC joint ligaments

-AC ligament -coracoclavicular ligament (trapezoid and conoid are parts of CC ligament)

# joints involved with JIA - Oligoarthritis, Polyarthritis

-Olig=less than 4 joints -Poly=more than 4 joints

Wartenbergs' sign vs syndrome

-sign=pinky involuntary abduction -syndrome=DSRN irritation

CTS - ideal splint position

0-2 deg flex, 3 deg UD

slower frequency = longer wavelength = penetrates deeper

1 MHz US - why deeper

5 deg at fingertip

1 deg rotation at MP = __deg rotation at fingertip

Nerve regeneration in hand

1 mm/day; 1 inch/month

Early active mobilization protocols (5)

1) Belfast & Sheffield 2) Strickland & Cannon 3) Silfverskiold & May 4) Evans & Thompson 5) Sandow & MacMahon

flexor tendon repair - early passive motion protocols (3)

1) Duran & Houser 2) Modified Duran 3) Kleinert

Early passive motion protocols - unique points of each (3)

1)Duran & Houser - DBS w/ rubber bands, progress to wristlet at 4.5 wk; do exercises twice a day x 6-8 reps (PROM of DIP or PIP individually, w/ other joints flexed; active extension) - allows 3-5 mm tendon glide 2)Modified Duran - DBS w/ rubber bands omitted, fingers strapped in extension betw ex and at night; in addition to above exercises, do composite passive individual & composite flex/ex, active extension; do SWM (tenodesis) exercises in therapy only; do exercises more frequently than with original Duran protocol (q 1-2 hr) 3)Kleinert - DBS w/ rubber bands; do exercises every hour, actively extend, passive flex digits x 10 reps; D/C splint at 4 wk & start gentle active flexion

OA quintet

1)Herberden's nodes 2)mucoid cysts 3)OA @ CMC 4)trigger finger 5)CTS

Axon regrowth rate - laceration

1-3 mm/day

Elbow dislocation - immobilize for how long?

1-5 days

neutrophils

1st cells to arrive during phagocytosis

3 MHz tissue depth

2 cm

When does elbow ectopic ossification start?

2 wk s/p traumatic event

water temp vasoconstriction and analgesia

2-13 deg C (35-55 deg F)

# compartments in dorsal forearm

2-3 (mobile wad may be considered separate compartment, or a part of posterior compartment)

When does N repair start

2-3 weeks post injury; remyelinization starts at 6-8 wk

length and width forearm trough for wrist extension splint

2/3 length forearm, 1/2 circumference

grip strength minimum for most ADLs

20 lb

% entrapment neuropathy with RA

20% (23-69% of these are carpal tunnel)

<6 mm

2PD - WNL

Normal=0-5 mm Fair=6-10 mm Poor=11-15 mm

2PD scoring for hand (Normal, Fair, Poor)

# palmar interossei

3

faster frequency = shorter wavelength = can't penetrate as deep

3 MHz US - why more superficial

Incidence of hand/wrist injuries in athletes

3-25%

# steroid injections allowed/year

3-4 (every 3 months)

Axon regrowth rate - crush

3-4 mm/day ***laceration = 1-3 mm/day

How many weeks before elbow is stable s/p dislocation

3-4 wk

Degree flexion contracture at MP that qualifies for Dupytren's release

30 deg - or when pt notices functional deficit

wear time with SP splint

30 min sessions 3x/day

Which lumbricals are bipennate

3rd and 4th

# dorsal interossei

4

Suture requirements for early active motion flexor tendon protocol

4 core strands with epitendinous suture

capitate, hamate, lunate, triquetrum; scaphoid usually excised

4 corner fusion bones

How many interossei are there?

4 dorsal, 3 palmar

lymphedema bandages applied with __%overlap

50-70%

How many Divisions in BP

6=3 anterior+3 posterior

Tendon repair weakest

7-10 days post surgery

Weight of gallon of milk

8 lb

How long to avoid AROM elbow flexion & supination s/p distal biceps rupture?

8 wk

normal tissue pressure

8-10 mm Hg

wear time with dynamic splint

8-12 hr/day

Nerve regeneration rate in upper arm

8.5 mm/day

scleroderma - __% also have Raynaud's

85%

1) AC 2) CC (conoid & trapezoid)

AC joint - 2 ligaments most important

MCP ACL, PCL tight position

ACL=extension, PCL=flexion

12 mm

radial height

subscap

rarest RTC tear

Frequency AKA

rate, pps, Hz

1.7:1

ratio of humerus:scapula motion with reaching overhead (humeral elevation)

3 (2 annular, 1 oblique)

# flexor pulleys - thumb

9 (4 FDS, 4 FDP, 1 FPL)

# flexor tendons - digits

primary deforming force with Bennett's fracture

APL (EPL & APB also contribute)

Intersection syndrome - tendons involved

APL/EPB cross over ECRL/ECRB (compartments 1 & 2)

5 annular, 3 cruciate

# pulleys in fingers

10 (1 med N, 4 FDS, F FDP, 1 FPL)

# structures in carpal tunnel

Wrist ganglion - # 1 & 2 most common locations

#1 - SL ligament (dorsal); #2 - scaphoid tubercle (volar)

wear gloves

#1 way to prevent blood-borne pathogen spread

wash hands

#1 way to stop germs

OA - joints most commonly affected (#1 & 2)

#1-DIP, #2=thumb CMC

triquetral avulsion fracture

#2 most commonly fracture carpal bone

Bankart lesion associated with

Anterior shoulder dislocation

8% loss/2 mm shortening

% grip strength loss/2 mm MC shortening

8% grip loss/2mm shortening of MC

% grip strength loss/2 mm shortening of MC

N repair - how long to immobilize

At least 3 weeks

Grade IV Sunderland

Axon + Endoneurium + Perineurium involved

40%

% hand function contributed by thumb

40% ulnohumeral, 60% radiocapitellar

% load transmitted across elbow joint in full ext

20%

% of all fractures that are in the hand

30-50%

% of intracellular space that accumulates before you can SEE edema

50% (EDM is still present to extend pinky)

% people that have a pinky EDC tendon

85%

% population that has a palmaris longus

85%

% population with PL

92%

% resolution for Radial N palsy s/p closed humerus fx

50%

% sexual dysfunction s/p traumatic hand injury

pole for tap H2O & use

+ & negative (switch), hyperhydrosis

pole for hydrocorisone & use

+, inflammation

5.5 months (.5-2 mm/week)

how long does it take to grow a new nail plate from germinal matrix ->edge tip

3-4 months

how long is silicone rod left in before flexor tendon grafting

6 - they determine the extensor tendon compartments

how many extensor tendon synovial sheaths are there

1 common sheath in palm that extends up pinky finger; 1 FPL sheath in palm extending up thumb; 3 separate sheaths at index, middle, and ring fingers

how many flexor tendon synovial sheaths are there

move electrodes further apart

how to increase depth of FMES

most common level SC injury

C5

biceps

C5 muscle to clear to R/O radicular pain

piano key sign tests for

DRUJ instability

Hand dysfunction with Klumpke's

Decreased use of finger intrinsics and flexors

RTC tests

Drop Arm (SS) , Jobe's/Empty Can (SS, RTC, subacrom impingement), Hornblower's (TM), Belly Press (subscap)

Grayson's (NOT Cleland's) "Ground substance for Dupytren's"

Dupytren's - ligament involved

Normal=bands Abnormal=cords

Dupytren's - normal vs. abnormal tissue

Ulnar N, Ulnar A

Guyon's canal - contents

roof=palmar carpal ligament floor=flexor retinaculum & hypothenar muscles medial border=pisiform lateral border=hamate

Guyon's canal borders

20-25 deg

How many degrees flexion allowed with Zone 3 flexor tendon injury initially

lumbricals

IP's - primary muscles that extend

1) difficulty reaching behind back 2) pain with overhead use of arm 3) weakness of shoulder muscles

Impingement signs

LICHTMAN CLASSIFICATION 5 1=X-ray normal, but shows up on MRI 2=shows up on X-ray 3a & 3b=bone fragments & collapse 4=secondary mid carpal arthritis, inter carpal degeneration

Kienbock's - what is classification called, how many stages

C8-T1 (lower trunk)

Klumpke's palsy nerve root levels

Sensory N than can be compressed lateral to biceps

LABC (branch of Axillary N)

Elbow 45-70 deg flex, forearm/wrist neutral

LAS for olecranon fracture - arm position

Olecranon (Type I)= Elbow 45-70 deg flex, forearm/wrist neutral; Radial Head (Type II & III)= elbow 90 deg flex, forearm/wrist neutral

LAS for olecranon vs RH fracture

elbow primary restraint to lateral stress

LCL

pronation

LCL disruption - what forearm position for splint

attrition rupture - most common sites

Lister's tubercle, distal ulna

between subscap & SS tendons

Loc of long head biceps in relation to RTC

Cold sensitivity, muscle wasting, Raynaud's; swelling is an acute, but not long-term sx

Long-term consequences of frost-bite

very light P; U, J, L strokes; begin proximal to clear those nodes, then strokes move distal to proximal

Lymphatic massage technique

<25 g with Haldex pinch; 300 g internal F on tendon

MAMTT Evans' program - amount of pressure allowed for extensor tendons

supination

MCL disruption - what forearm position for splint

throwing

MCL/UCL most commonly injury by what activity

MCP deformity or swan neck corrected 1st?

MCP corrected 1st - with cross intrinsic t/f or arthroplasty

swan-neck with RA caused by

MCP joint volar subluxation = intrinsic tightness

interossei

MCP's - primary muscles that flex

Kaltenborn - position of max contact between concave and convex surfaces of joint

MCPP - max close packed position

US frequency expressed as

MHz

Kaltenborn - position for joint play testing

MLPP - max loose packed position

Grade I - Small amplitude rhythmic oscillating mobilization in early range of movement Grade II - Large amplitude rhythmic oscillating mobilization in midrange of movement Grade III - Large amplitude rhythmic oscillating mobilization to point of limitation in range of movement Grade IV - Small amplitude rhythmic oscillating mobilization at endrange of movement Grade V (Thrust Manipulation) - Small amplitude, quick thrust at endrange of movement

Maitland Joint Mobilization Grading Scale

work therapy

job training - acute rehab

1) PT 2) FCR ***AKA "golfer's elbow" ***according to orthobullets

Med epicondylitis - muscles involved with & AKA

work hardening

job training -chronic

Type II ( through physis & metaphysis)

Most common Salter-Harris fx

Hematoma

Most common cause graft failure

Venous insufficiency

Most common cause of finger replant failure

PT -> ECRB -elb 90 deg, forearm pronated, wrist ext 30 deg

Most common tendon t/f for radial N injury & splint

LT Nerve; Rucksack palsy = winging of scapula

N injured with heavy backpack, name of condition

Type of crush injury that requires repair

Neurontmesis (Seddon)

30-60 deg

Normal SL angle

1 SD=68%, 2 SD=95%, 3 SD=99%

Normal distribution of 1, 2, 3 SD=__%

6 mo - 3 yr

Nursemaid's elbow - age range most common

SLAP tear tests

O'Brien's, Crank test

3-4 wk

P1 base, head/neck fractures - how long to heal

Precautions with LRTI

PROM at 4 wk - only abduction and extension; avoid pinch

Part of N that provides elastic properties to N

Perineurium

Part of N that is part of BBB

Perineurium (blood brain barrier)

Progression of ROM in rehab with RTC disease (Phases I & II)

Phase I: supine flexion and ER; Phase II: ext, IR, adduction

Stretch Shortening Cycle; 1. Eccentric pre-stretch 2. Amortization (time between 1 & 3; if shorter = more powerful Concentric contraction) 3. Concentric

Plyometric ex AKA, phases

stabilizes VP

Primary role of ACL @ PIP

Quadrigia vs. Lumbrical Plus finger

Quadregia effect = overtightening/scarring of FDP tendon; decreased finger flexion in adjacent fingers s/p FDP repair ***weak grasp Pathoanatomy FDP tendons of long, ring, and little fingers share a common muscle belly therefore excursion of the combined tendons is equal to the shortest tendon; improper shortening of a tendon during repair results in inability to fully flex adjacent fingers Lumbrical Plus finger = lax/disrupted FDP tendon which results in tension on lumbricals; during finger flexion, the cut/lax FDP tendon retracts toward palm, placing increase tension on lumbricals; they then extend the PIP ***one finger sticks out when attempting to hold an object

MCP, PIP, wrist

RA - 1st joints affected

pinky, then moves in radial sequence

RA - most common extensor tendon rupture

ligaments that stabilize radial head

RCL & annular ligament

Excessive shoulder ER, loss of shoulder IR (humerus rotates internally)

ROM affected with posterior shoulder instability

flex/ext=50%, RD/UD=75%, supination/pronation WNL

ROM s/p 4-corner fusion

Stage 1 = Edema & hemmorhage (reversible) Stage 2 = Tendonitis Stage 3 = Partial thickness tear Stage 4 = Full thickness tear

RTC Disorders - Stages (4)

deceleration

RTC injuries occur during which throwing phase

space between SS & subscap

RTC interval

supraspinatus

RTC tendon most commonly injured

N most likely injured with humeral shaft fracture

Radial

deep palmar arch

Radial A supplies which arch in hand

1 wk sling, with AROM immediately following

Radial Head fracture - Type 1 - how long immobilized in sling

within supinator - at Arcade of Frohse

Radial N complications in forearm - most common location

57 deg

Radian=__deg

brachioradialis

Reflex test for C6

Grades I & II - do for pain relief, only in available ROM

joint mob grades safe to do s/p stable fracture

15-20 g with Haldex pinch meter

SAM/MAMTT Evans' program - amount pressure allowed for flexor tendons

Racquet sports - common conditions

SICK scapula, GIRD, ECU subluxation, FCU tendinitis

SP vs. dynamic - which increases ROM faster

SP

2.83 (Green)

SWMF - last level WNL

60-70%

Scaphoid fractures - % of all carpal fractures

Anatomical snuffbox contents

Scaphoid, radial artery, DSRN

1) difficulty reaching behind back 2) pain with overhead use of arm 3) shoulder muscle weakness

Shoulder impingement signs (3)

transport capacity __x greater than amount lymphatic loads

TC=10x greater than LL

w/b area, non-vascular, injured with deterioration or trauma

TFCC - central part - purpose, blood supply, how injured

Acromion type that increases chance of RTC tear

Type III (hook); Type II (curved) can also increase chance of RTC tear

Most painful activity with wrist ganglion cyst

W/b (i.e. push-ups)

Cheiralgia paresthetica AKA

Wartenburg' s syndrome, SRBN neuritis

APB

Which muscle can bring thumb IP into ext if EPL is lost?

UE=95%, whole person=57%

loss of hand function __% for UE, __% for whole person

SL interval > 4 mm "Terry Thomas sign"

X-ray feature with SL disruption

140-160 deg

low temp thermoplastics - degrees to heat

which bone do we look at to determine VISI/DISI

lunate

Brachial A - splits into Radial and Ulnar A

main arterial supply of forearm/hand

AOL/"Beak" ligament

main stabilizing structure of CMC

6-8 wk

mallet finger - how long splinted in extension

digit=24 hr, proximal to carpus=12 hr

max cold ischemic time for digit/prox to carpus replantation

Ibuprofen limits COX-1 & COX-2, limits synthesis of prostaglandin

medicine that helps limit tendon adhesions

sensory and motor function of the trunk, extremities, face, & speech

middle cerebral A controls what

20 lb

min grip strength for ADLs

9 cm

minimal handle length for hand tools

Erb Duchenne's (upper trunk)

most common Brachial Plexus injury

dorsal ***ulna subluxes dorsally with pronation

most common DRUJ subluxation

Martin-Gruber

most common N anastamosis

dorsal (volar plate rupture)=85%

most common PIP dislocation

dog

most common animal bite

C4/5, C5/6

most common areas of N compression C-spine

Bennett's (between base 1st MC & trapezium)

most common thumb fracture

endochondroma

most common tumor in hand

ER->abd->IR->flexion

most limited movements with frozen shoulder (capsular pattern)

proximal pole

most poorly vascularized region of scaphoid

what is muscle insertion

moves with contraction

FCU

muscle directly overlying anterior bundle of MCL

APB (restore with tendon t/f's)

muscle most important for thumb opposition

Subscap TM LD (crest of lesser tubercle)

muscles that attach to lesser tubercle

FCU tendon envelopes it; FDM attaches to it

muscles that contact pisiform

scalenes

muscles that elevate 1st rib

1) Scap stabilizers (SA & trap most important; LS, Rhomboids, Lats) 2) RTC

muscles to strengthen for pain-free elevation of arm

Axillary

n frequently injured with anterior shoulder dislocation

base of skull (occiput) + C1 (atlas)

neck flexion comes from

C1 (atlas) on C2 (axis/odontoid)

neck rotation comes from

pole for saline & use

negative (Cloride ion), hydrate scar

pole for dex & use

negative, inflammation

vasodilator in endothelium

nitric oxide

intensity (w/cm2)

amount of energy absorbed in target tissues with US

positive pole (A+)

anode - negative or positive

100 lb

avg grip strength for males

precautions with MCP joint replacement

avoid lateral stress=avoid UD of P1

cavitation & acoustic streaming

non-thermal effects of US

injury to volar TFCC results in (effect of forearm rotation on radius)

palmar dislocation of radius with pronation ***VO/PRO = volar radioulnar ligaments are tight with pronation, providing restraint to dorsal dislocation of ulna; injury to volar ligaments allows normally restrained ulna to dislocate dorsally, radius then dislocates the other way (volarly)

late cocking/early acceleration phase (going from flexion to extension)

peak of valgus F at medial elbow during pitching

passive flexion of DIP with PIP held in extension

position of max stretch for ORL

most common row for CID

proximal

trapezoid (capitate also rare)

carpal bone - least likely fractured

scaphoid=60-70%

carpal bone most commonly fractured & %

CID

carpal instability dissociative - separation of carpal bones in SAME row

CIND

carpal instability non-dissociative - separation of carpal bones BETWEEN rows

twice at the rheabase intensity "Rheabase X 2 = chomaXie"

chomaxie

days 5-7; strength of repair decreased by 10-50%

common time for rupture s/p tendon repair; most at risk

decreased flexion ROM due to loss of typical volar tilt

complication s/p Colle's fracture with pinning

tissue elongation with dynamic splint is called

creep

50% football

sports-related hand injuries - what sport, %

lateral arm

supraspinatus - referred pain

Zone 2 flexor tendons

"No Man's Land"

Zone II flexor tendon injury

"No Man's Land" according to Bunnell

Coronoid means

"Triangular" - like a crown

neutral movement position for proximal carpal row

"dart thrower's"

wrist ext 10 deg less than max ext; MPs 60-70 deg flex, IPs ext, thumb fist projection

"safe" position

Erb's palsy UE positioning

"waiter's tip"

Brachialis = active during all elbow flexion movement

"workhorse" muscle during elbow flexion

Abductor Pollicus Brevis (APB)

# 1 thenar M to atrophy s/p Median N involvement

6

# extensor compartments

2 annular, 1 oblique

# pulleys in thumb

Expanded Splint/Orthosis Classification System (ESCS)

6 criteria: 1) articulating or non-articulating 2) anatomical focus 3) kinematic direction 4) primary purpose 5) type/# secondary joint levels 6) total number of joints included

Nerve regeneration in forearm

6 mm/day

elbow primary constraint to valgus

AOL (anterior bundle of MCL/UCL)

RA - common thumb deformity

Boutinerre thumb (Type 1 thumb) or "Z" thumb

Middle Cerebral A

CVA type resulting in sensory and motor dysfunction of UE, face, & trunk, speech deficit - which Artery?

Primary mechanism for rehab to improve shoulder stability

Concavity compression

Smith's - distal fragment is volarly displaced with fall onto flexed wrist

DRF most likely to have Median N damage

10 min sessions, 3-4 x/day

Desensitization ex protocol

first 24-72 hr post burn; maximize function/ROM to minimize deforming effects

Emergent phase of burn - when is it and therapy goals during this time

FDP 3-5; 2 has it's own muscle belly

Finger flexors with common muscle belly

Least = Appraisal/Projected (image of injury, and just after injury, image beyond real injury) Most = Replay (promotes mastery of injury and events leading up to it) RAP R= Most AP=Least

Flashbacks - least and most likely to return to work

Most injured hockey player

Forward

(Almost) all except for OLECRANON fractures, elbow at 90 deg flex; all except EPICONDYLES & EXTRA-ARTICULAR INTRACAPSULAR, forearm is neutral Olecranon (Type I)= elbow 45-70 deg flex Medial Epicondyle= forearm pronated Lateral Epicondyle= forearm supinated

General rules for LAS for elbow injuries

Seddon Neurapraxia - what Sunderland level

Grade I

Seddon Axontmesis - what Sunderland level

Grade II

AROM @ 2-4 wk; no angular stress, no PROM

Grade II PIP joint collat lig injury - when to start motion

Seddon Neurotmesis - what Sunderland level

Grade V

8 House classification = use of hand with CP

House classification - how many levels

does not use hand

House classification - level 0

actively grasps objects and holds weakly

House classification - level 4

Zones 4-7 EXTENSOR tendons

Immediate Controlled Active Motion (ICAM) - which zones

Job Accommodations Network - Dept of Labor; deals with disability employment issues

JAN stands for

Ring finger; lack of independent extension of ring finger secondary to JT; weakest FDP insertion

Jersey finger - most common & why

actual demands of job

Job Demands Analysis (JDA) assesses

they are basically the same with regards to joint mobilization

Joint glide vs translation

JIA - what is it, most common form, & %

Juvenile Idiopathic Arthritis (aka JRA); Oligoarthritis is most common=40% of cases of JIA

1=no movement, 3=Normal, 6=complete instability

Kalterhorn Quality of Movement Grades (1, 3, 6)

1) LUCL 2) RCL 3) annular ligament 4) accessory collateral ligament

LCL consists of (4)

laser type used in therapy

LLLT - low level, cold; 5-500 mV

EPL

Lister's tubercle - muscle that takes a 45 deg turn @

Main extensor of IP's

Lumbricals

What muscle contracts when FDP relaxes

Lumbricals

starts with post-op cast

Main characteristic - Belfast & Sheffield

exercise only 2x/day; DBS x 4 wk, then wristlet with RB

Main characteristic - Duran/Modified Duran

Ulnar

N most likely injured at elbow

Gender most affected by OA, RA

OA = women RA = women

-Sedentary = occasional 10 lb -Medium = occasional 25-50 lb, frequent 10-25 lb, constant 10 lb -Very Heavy = occasional = >100 lb, frequent >50 lb, constant = >20 lb

Occupational Requirements for Physical Exertion -Sedentary -Medium -Very Heavy

Arcade of Frohse

PIN - most common impingement site

palsy without pain

PIN symptoms

dorsal (85%)

PIP dislocation - most common

1) check rein ligaments 2) VP 3) collateral ligaments

PIP flexion contracture - structures implicated (3)

volar PIP dislocation splint

PIP full extension with DIP free

Dupuytren' s cord leading to MCP contracture

Pretendinous cord

Primary = developmental abnormality Secondary = mechanical insufficiency due to insult - sx, radiation, CA, infection, tumor

Primary vs. secondary lymphedema

Camitz transfer - relocates PL to APB

Procedure to restore APB function with severe CTS

1)Brands = free tendon (plantaris) divided, sutured to ECRL, passed thru interosseous space 2)Zancolli = FDS divided & looped thru A1 pulley 3)Bunnell = FDS split & passed thru lumbrical canals

Procedures to restore intrinsic function of MCP flexion (reduce claw deformity) 1) Brands intrinsic t/f (ECRL 4-tail) 2)Zancolli's lasso 3)Bunnell t/f

between 2 heads supinator

Radial N enters forearm where

ECU

Reverse Bennett's Fracture - deforming force

Most common jersey finger

Ring (75%)

Jersey finger - most frequent digit

Ring finger

4.31 (purple) = protective sensation

SWMF - must achieve this level before starting sensory re-ed

1.65-2.83 (Green)

SWMF Normal level

best surgery for unstable DRUJ secondary to RA

Sauve Kapandji

RTC repair - 1st ROM

Shoulder elevation & ER to 30 deg

1) Upward rotation 2) Posterior tilt **Force couple = SA, UT, LT

Shoulder impingement - scap motions to decrease sx by increasing subacromial space & Force couple that achieves these motions

Flexion, Adduction, IR = too much stretch on injured structures -bench press, incline/decline/military press, push- ups

Shoulder instability - motions to avoid initially

Biceps tendinitis tests

Speed's, Yergason's

Stiff = no capsular pattern Frozen = capsular patter (ER most limited, then abd, then IR)

Stiff shoulder vs. frozen shoulder

1) Check rein ligaments 2) Volar plate 3) PIP collateral ligaments

Structures implicated with PIP flexion contracture (3)

vascular TOS involves what vessels

Subclavian A & N

Trigger point that mimics frozen shoulder

Subscap

Positive ulnar variance decreases what motion

Supination

Tight volar DRUJ limits what AROM

Supination VO/PRO = volar ligaments are tight in pronation; want to keep forearm pronated and not allow supination

RA thumb - 2nd most common collapse deformity & Type

Swan's Neck - Type III thumb

vascularized, injured with direct F

TFCC - peripheral part - blood supply, how injured

12 wk

Tenolysis - soonest it's recommended s/p tendon repair

-Structures that make up terminal tendon - thumb -Structures that make up extensor mechanism - thumb

Terminal tendon thumb: -EPL -Adductor Pollicus Extensor Mechanism thumb: -Adductor Pollicus on ulnar side -APB on radial side -EPL

1) Radial head fracture 2) Posterolateral dislocation 3) Coronoid process fracture

Terrible Triad

4-5 in, 9-12 cm

Tool handle length - ergonomic

Surgery or choice for elderly pt with CMC OA

Trapeziectomy with LRTI

most common RA thumb type

Type I - Boutinerre thumb

0-5 mm

Weber 2PD Normal level

Radial Head fracture

adult elbow fracture - most common type

ER, abduction

arm position that encourages SS tendinitis

scaphoid

bone excised with 4 corner fusion

4 FDP, 4FDS, 1 FPL, Median N

carpal tunnel - contents

10-50% decrease gapping

decreased incidence in tendon gapping with epitendinous suture

Stage III RA characterized by

decreased pain, increased deformity

what is muscle origin

fixed attachment

55%

fusion= how much loss flex/ext at RC

Amplitude AKA

intensity

shoulder shrug

myotome screening C2-4

shoulder abduction

myotome screening C5

wrist flexion & elbow ext

myotome screening C7

Taping - to relax/inhibit

start @ insertion, end @ origin

dorsal PIP dislocation common deformity

swan neck

30%-vascular mesotenons (like vinculae) 70% synovial diffusion (esp under retinaculum)

what delivers nutrition for healing to extensor tendons

in PNS - anterior column of SC, cranial N nuclei, cranial nerves - link muscles to UMN's "MOVE = Motor, Ventral Horn, Efferent" ***hypo-reflexive if injured

what is a LMN

in CNS - motor cortex, brain - carry brain down to LMN's via spinal cord ***hyper-reflexia if damaged

what is an UMN

CLUNK=labrum tear or SLAP lesion

what is the finding with a positive O'Brien's Test

1) strengthen ER 2) improve posterior scap tilt 3) decrease posterior capsular tightness

what to improve for pain-free shoulder elevation (3)

3-5 days post-op

when are tendons weakest s/p repair

@ 4 mo can return to gentle, short program)

when can athlete return to throwing s/p UCL repair

@3-4 wk post injury

when does N regeneration start?

# compartments in hand

10

PIP ACL, PCL tight position

ACL=extension, PCL=flexion

Tendon involved with Dupytren's in pinky

ADM - abductor digiti minimi

Muscles that attach to pisiform

ADM, FCU (along with hook of hamate & base of 5th metacarpal)

muscle weakness & atrophy start distally & progress proximally; eventually visceral M (swallowing, oral motor control) cease working

ALS - progression of sx

ligament responsible for thumb CMC arthritis

AOL/Beak ligament

Grade V Sunderland

Axon + Endoneurium + Perineurium + Epineurium involved

Grade III Sunderland

Axon + Endoneurium involved

Wallerian degeneration occurs at what Seddon level?

Axontmesis

BMI>30

BMI=obesity

Watershed area

Between longitudinal and vincular vessels at mid-P1 level; avascular area of FDP

Upper brachial plexus levels

C5, C6, C7

2 types

CRPS - how many types

Major supporting structure for clavicle

Coracoclavicular ligament

PT

ECRB - tendon t/f #1 choice

Medication and other tx for early HO

Indomethician low dose radiation

AOL of MCL (resists valgus stress @ 30-90 deg flex = ROM for functional & throwing activities)

Ligament most frequently injured in throwers

C5

N root for deltoids

Tissue resistance flow order - electricity (least -> most resistance)

Nerve -> blood vessel -> muscle -> skin -> tendon -> fat -> bone "Been Fat Ten Summers, Must Be Naked"

3JC

Palmar prehension AKA

Every 3-4 mo

Pediatric prosthesis - when to make adjustments/resize

3 MHz

Setting for fastest thermal effects with US

EPL

Tendon that turns 45 deg at Lister's tubercle

30%

above-elbow non-dominant prosthesis - % of use

ACL & PCL - tight position for fingers MCP & PIP, thumb MCP

all are the same: ACL=tight in extension, PCL=tight in flexion

300 g

amount of Force to avoid exceeding with stiff finger

5 mm, .5 Radians, 28.64 deg

amount of extrinsic extensor tendon excursion needed to minimize adhesions

20-30 mm Hg

amount of pressure needed for burn pressure garments to be effective

3-5 mm

amount of tendon excursion with Early Active approach

300 g

amount of tension in flexor tendons with 30 deg flex to 0 deg ext

1.5 mm

amount of translation of humeral head on glenoid with functional reaching & overhead motion

30 deg - @ distal end, lateral to medial

angle of humeral shaft

proximal pole

avascularized portion of scaphoid

5-15 deg angle between humerus and ulna

carrying angle

formation of gas bubbles in response to vibration (caVitation=Vibration bubbles formed)

cavitation

myofibroblast

cell that is primary in wound closure

vasoconstrictor in endothelium

endothelin

wrist neutral (no UD), elbow flexed, arm close to body

ergonomic positon for tools

concave on convex - direction of glide

glide is same direction as bone that's moving

fibroblast

main cell involved in collagen synthesis in healing wound

subscap

main stabilizer of the scapula (muscle)

q 3-4 mo

pediatric prosthetics - how often to re-check

sine (curved) vs. peak (pointed)

smoother way to deliver direct current

Plyometric phases

1) Eccentric - pre-stretch 2) Amortization 3) Concentric shortening

E=motor + sensory are normal

ASIA Impairment Scale - normal function

Most common joint dislocation - for adults? For children?

Adults=shoulder, children=elbow

Where does PIN start?

Arcade of Frohse, radial head

ECRL, ECRB, BR

C6 muscles to clear to R/O radicular pain

1) RTC pathology 2) SA weakness 3) abnormal humeral head translation

Causes of painful arc when lowering arm (3)

pronation

ECU is wrist UD in which forearm pos

Early Passive Motion: 1) Duran 2) Modified Duran 3) Kleinert

EPM protocols - flexor tendon repair (3)

Most common soft tissue tumor

Ganglion cyst

uses hand completely independently

House classification - level 8

immobilize x 3-4 wk, continue to wear splint 5-6 weeks total

Immobilization technique s/p flexor tendon repair - how long

posterolateral dislocation

LUCL most commonly injured by (what injury type)

35-55 pps

NMES - pulse rate to form contraction

flexes, glides dorsally, translates ulnarly ***think about what scaphoid does (flexes with RD)

Prox carpal row - movement with RD

extends, glides volarly, translates radially "EVER" Proximal row - think about what Scaphoid does (extends with UD)

Prox carpal row - movement with UD

T3 spinous process

Spine of scapula ends medially at which vertebra

Wrist extension, pronation, RD (position of stability)

Splint position for ECU subluxation/tendonitis

Adductor aponeurosis

Stener's lesion - deforming force

major blood supply to fingers

Superficial palmar arch (from Ulnar A)

RA Type III thumb

Swan Neck

BP, Subclavian A, Subclavian V

TOS - structures involved

Most important functional loss with EPL rupture

Thumb MCP extension

between 2 heads FCU

Ulnar N enters forearm where

best return to work training tool

Valpar standardized work sample

end of week 1; but this may not occur with early motion

When are tendon repairs weakest

supination

biceps flexion - what forearm position

dogs = 90%, cats=3x more likely to get infected

bites - most common, most likely to get infected

HIV, Hep B, Hep C

blood borne diseases - greatest risk in healthcare (3)

adults=4-6 wk children=3-4 wk

bone healing time - adults, children

trigger finger - does it happen with RA or OA

both

volar PIP dislocation common deformity

boutinerre

volar dislocation of PIP results in

boutinerre deformity secondary to central slip disruption

(midcarpal instability)=clunk with UD

clinical characteristic of CIND

L-codes

codes for billing - UE orthotics

convex OPPOSITE direction for joint gliding and bone movement

convex - joint gliding & bone movement

open chain

distal segment is free

8 hr

duration for wearing functional prosthesis

CRPS most common - gender, age, location

female, 70 y/o, UE

PCL is tight in what position

flexion

LUCL/RCL

ligaments associated with posterolateral instability

SA

scapula Force couple - IR

4 per finger (1 vinculae longus and 1 brevis per FDP and FDS)

# vinculae in fingers

8 fingers, 5 thumb

# zones - extensor tendons

5 finger, 3 thumb

# zones - flexor tendons

40%

% AVN with scaphoid fracture at proximal pole

2 splints for hand transplant

1. crane outrigger 2. anti-claw

% force across RH joint with full elbow extension

60%

most commonly injured flexor pulley

A2

I & II = AC ligament affected, CC ligament uninjured III=AC affected, CC partially affected IV, V, VI = both ligaments affected = surgery

AC joint separation classification system

Type I-III=conservative (sling); Type IV-VI=surgical

AC jt injury type - management

AC joint -primary restraint to posterior translation

AC ligament

>6 sec

Allen Test - abnormal capillary refill time

>7 sec

Allen's test - abnormal blood flow

Galvanic Current

Another name for DC current

2-3 wk

Anterior shoulder dislocation - when to D/C sling

includes known PN injury (aka causalgia)

CRPS Type II & AKA

APB

CTS - muscle with most obvious atrophy

Common conditions with CMC arthritis

CTS, DeQuervain's, trigger finger/thumb

Pseudogout crystals

Calcium pyrophosfate dihydrate crystals

transverse carpal ligament/flexor retinaculum

Carpal tunnel - structures forming roof

hook of hamate & pisiform

Carpal tunnel - ulnar border

10-27 deg

Carrying angle - women

#1=direct injury, #2=ischemic necrosis

Causes of death of forearm muscles (2)

Dupuytren' s cords leading to PIP contracture

Central, spiral, lateral cords

SL injury; S-L Ballotement, Watson Shift Test

Clenched fist confirms what; other tests to confirm

1)Fibroblast 2) Turns into myofibroblast 3) New capillaries/collagen fibers form 4) Granulation of tissue 5) Healthy new tissue

Collagen synthesis - steps (5)

grip with pronation

Colle's fracture, TFCC injury, ulnar abutment - what motion increased pain with grip

Reverse Froment's secondary to

Combined ulnar and median nerve laceration

1) Pain with PROM 2) Pallor 3) Pulselessness 4) Parasthesias/paresis (secondary to N compression)

Compartment Syndrome - 4 P's

meds used to tx RA

DMARDs & anti-TNF's with NSAIDs

volar plate

Dorsal dislocation PIP - which soft structure most likely injured

Bacterial infection of digital pulp

Felon

flexion=120 deg, abduction=90-120 deg

GH joint contributes __deg AROM for flexion, abduction

Most common soft tissue tumor or hands/wrist

Ganglion cysts (retinacular, mucous)

burns, UMN injuries (brain, SC)

HO higher incidence with what conditions (2)

4.5-20%

HO incidence s/p elbow trauma

type of e-stim used to decrease edema

HVPC - hi voltage pulse current

OA deformity at DIP

Herberden's nodes

ECRL, ECU

High median N injury - muscles used for transfer

posterolateral humeral head compression fracture, typically secondary to recurrent anterior shoulder dislocations, as the humeral head comes to rest against the anteroinferior part of the glenoid.

Hill-Sachs lesion

35-40% of anterior dislocations, 80% of recurrent dislocations

Hill-Sachs lesion incidence with anterior dislocations, recurrent dislocations

hand function with CP

House classification used to assess what

relationship to axillary A (subclavian A becomes Axillary after it crosses 1st rib)

How are BP cords named?

Salter-Harris fracture types that cross growth plate

III, IV, & V

#1=FCU, #2=PT

Medial epicondylitis - which muscles (top 2)

N that passes under Ligament of Struthers

Median

mini-open = deltoid is split, not detached standard open = deltoid is detached, then re-attached

Mini-open vs. standard open RTC repair

DIP -> CMC -> PIP -> MCP

OA - most to least common joints affected (4)

Finger commonly missing FDS

Pinky

triceps

Reflex test for C7

-Triceps: C7 -BR: C6 -Biceps: C5

Reflexes: -Triceps -BR -Biceps

scaphoid, lunate, capitate, radius

SLAC wrist - bones involved

Type II (through physis and metaphysis; epiphysis (growth plate) is not involved)

Salter-Harris fracture - most common type

proximal pole

Scaphoid - part affected by AVN

30 deg

Scapula lies __ deg anterior to frontal plane

scapula = downward rotation; medial border not parallel with spine; inf angle is close to vertebrae than superior angle shoulder = neck appears longer, slope of shoulders increased sx = can compress BP & cause parasthesias

Scapular/shoulder position, symptoms - pt with heavy arms or breasts

Stage I (setting stage): 0-30 deg, GH joint, scapula is stable Stage II: 30-90 deg, GH & ST joints 2:1 ratio Stage III: 90-120/150 deg, GH & ST joints, continued 2:1 ratio

Scapulohumeral Rhythm (scaption) - phases, degrees, joints contributing

initial 60 deg of flex, initial 30 deg of abd; scapula seeks position of stability; movement primarily at GH joint

Scapulohumeral Rhythm - setting phase

clicking, catching, crepitus

Shoulder instability - pt c/o

N most likely injured with elbow fracture

Ulnar

Pain N fiber types

Unmyelinated C, thinly myelinated A-Delta

11-15 mm

Weber 2PD Poor level

ERA - effective radiating area

area on US sound head that emits waves

high elasticity splint material properties

can be re-molded, more difficult to mold, resists fingerprints

volar

chronic instability of DRUJ with supination - where is the pain

7 deg extensor lag, 8% grip strength loss

complications with 2 mm shortening of metacarpal (ROM, grip strength)

#1=CTS, #2=cubital tunnel

compressive neuropathy - top 2 most common types

frequency (MHz)

determines depth of US

Anterior bundle

elbow UCL complex - most important for elbow stability

frequency of serial casting changes

every other day

15-25%

healed skin at 3 wk=__% normal tissue strength

95%

impairment rating for UE with hand loss

work conditioning

job training - early referrals

Perineurium

part of N that is part of BBB

90/90/90

position to avoid with unstable shoulder

50%

power grasp - % intrinsics contribute

most carpal movement from which row

proximal row - scaphoid, lunate, triquetrum

corticospinal tract

spinal tract for UMN's

carpus is unloaded in what position

supination

at least 12 wk post surgery

tenolysis - when to consider

brief, intense

type of TENS mode used to decrease pain with painful procedure

Type II - fx with CC ligament disruption

type of clavicle fx that is surgically repaired

splint for LT injury

ulnar gutter - ulnar-sided pain

US intensity expressed as

w/cm2

70%

% SL ligament injury with scaphoid fracture

20%

% axial load through TFCC

60-80%

% grasp is weakened with Ulnar N palsy

major blood supply to hand (2)

1) Superficial palmar arch (from Ulnar A mainly, Radial A also contributes) 2) Deep palmar arch (from Radial A)

Ideal position for arthrodesis - PIP

20-40 deg flexion

Whirlpool - temp

96-104 deg F (36-40 deg F)

MCP capsulectomy candidate

<65 deg flexion at MCP's

-AC joint = arm is adducted at side -Ant disloc/Bankart lesion = arm is outstretched

AC joint injury vs. anterior shoulder dislocation/Bankart lesion - mechanism of injury

small/slow twitch/Type I

AROM stimulates which muscle fibers

APL & AdP

Bennett's Fracture -deforming force

women & girls

CRPS - which gender most affected

Spinal Muscular Atrophy, ALS (also UMN), MS (also UMN)

LMN diseases

between 2 heads PT

Median N enters forearm where

7-10 days

Nerve repair - how long immobilized

When to start AROM s/p Type I radial head fracture

S/p 1 week start A/AAROM

Advantage of plyometric exercises

They decrease joint reactive forces

thumb and ring fingers

Trigger finger - most common (2)

ACL at PIP stands for

accessory collateral ligament

ORL tightness

cause of DIP hyperextension with boutinerre deformity

Parsonage-Turner/Neuro Amyotrophy

diagnosis often confused with TOS

ACL is tight in what position

extension

ligaments pull scaphoid which direction

flexion

SAN; ER's (IS, post deltoid) are unopposed by trap=medial scapular border lifts off

flip sign secondary to damage to which N & what is it

-2 deg C, 28.4 deg F

frostbite occurs at what temp

used to decrease scar adhesion with iontophoresis

iodine with methyl salicylate

3JC

most common pinch type

AC joint injury - direct F to shoulder in adducted position

most common sports shoulder injury

DeQuervain's, trigger finger

most common tenovaginitis/tenosynovitis

PCL at PIP stands for

proper collateral ligament

pinky

pseudoboutinerre - finger most common

Guyon's canal - sensory changes

volar/ulnar pain and volar 4th & 5th digits

AdP & APB - they insert onto extensor expansion

which muscles can extend thumb IP to neutral if EPL is lost

PIN - which compartment does it run in, with which muscles

4th compartment; EDC, EI

APL

Bennett's fracture - muscle that subluxes 1st metacarpal with Bennett's fracture

FPL

Carpal tunnel - most radial structure

Gout crystals

Mono sodium urate crystals

Web space contractures

Natatory cords result in

RA Type VI thumb

VI = arthritis mutilans (skeletal collapse)

"curving out"/domed; head of humerus

convex; bone example

scaphoid fracture

humpback deformity occurs with what condition

Grade V (5)

joint mob grade with high velocity thrust

most functional pinch type

lateral pinch

posterior

most common part of shoulder capsule that is tight

distal phalanx

most common phalanx fracture

wrist extension & elbow flexion

myotome screening C6

pole for iodine with methylsalicylate & use

negative, decrease scar tissue

2nd-7th T-spine

normal SC vertebral level for location of scapula

2:1 (humerus:scapula) - this is overall for the 180 deg of total motion; it's more of a 1:1 ratio after 60 deg flex & 30 deg abd

normal SH rhythm

1.5 mm

normal humeral head translation in glenoid fossa

25 mm Hg

optimal capillary P to decrease hypertrophic scar

11-12 deg (sagittal plane)

palmar tilt - radius - which plane

1) eccentric 2) amoritization 3) concentric

plyometric phases (3)

purpose of short opponens splint

prevents adduction deformity of thumb (hyperextension a MCP jt)

Early active mobilization protocols - unique points of each (5)

1) Belfast & Sheffield - DBS; start exercises 24-48 hr post sx - full passive flex, active flex, active ext of all fingers, 2 reps ea q 2 hr, do exercises in splint; D/C splint @ 4 wk 2) Strickland & Cannon - uses 2 splints - DBS worn most of the time, and hinged exercise splint; exercise includes Modified Duran in DBS + place and hold flexion (SWM/tenodesis) in exercise splint; do exercises every hour; D/C exercise splint ~4-7 wk, D/C DBS~7-8 wk 3)Silfverskiold & May - adds active hold component to early passive mobilization protocol 4) Evans & Thompson - DBS; MAMTT; do exercises only under therapist supervision - place in 20 deg wrist ext, 83/75/40 MP/PIP/DIP and pt lightly contracts to hold; Haldex gauge used, keep contraction to 50g or less 5) Sandow & MacMahon - position wrist in extension; starts active flexion in OR; do exercises hourly; D/C splint to buddy straps at 6 wk; progress same as other tendon programs

joint mob - concave/convex rule

1) concave on convex=mob same direction as desired movement 2) convex on concave=mob opposite direction as desired movement

goals of NMES - # of contractions

10 quality contractions

acute stage of RA - how much sleep should patient get?

10-12 hr

s/p UCL elbow injury - can return to throwing in how many weeks?

10-12 wk

ice massage - tx area and time

10-15 cm covered in 5-10 min

Fluido - temp

102-125 deg F (39-52 deg C)

tissue temp increase needed for heat benefits

104-113 deg F (40-45 deg C)

Paraffin - temp

113-129 deg F (45-53 deg C)

Temp test - hot

115-120 deg F (46-49 deg C)

Hot pack -temp

157-168 deg F (69-75 deg C)

Which lumbricals are unipennate

1st and 2nd

dorsal PIP dislocation - splint if stable following reduction @ __ deg

25 deg flex; if unstable here=will need surgery

% TOS with vascular compression

3% (1% arterial, 2% venous)

lymphedema bandages applied with __% pre-stretch

30-40%

Critical pressure in a compartment

30-45 mm HG

NMES frequency to achieve tetany

30-80 pps

Metacarpal shaft fracture - when to start dynamic (corrective) splinting

4 weeks

Temp test - cold

40 deg F (4 deg C)

temperature for max benefit of therapeutic heat

40-45 deg C (104-113 deg F)

Total active flex/ext s/p wrist arthroplasty

40-60 deg total arc

1 MHz tissue depth

5 cm

1.5 cm; >5 deg rotation at MP = 2 cm overlap

5 deg rotation at MP=__cm overlap at fingertips

Carrying angle - men

5-17 deg

pinch strength minimum for most ADLs

5-7 lb

Wallerian degeneration is complete - how many weeks post injury

5-8 weeks

% loss of hand function - thumb amputation

50%

% workers with vibration jobs that get Raynaud's

50%

% loss of whole person - hand amputation at MP's

54%

Tendon repair max strength

6 months

Shoulder instability - how long immobilized

6 wk

% tendon divided that will need surgical repair

60% divided; less than 50%=no surgical repair b/c repair will further weaken and increase rupture risk

non-nutritional thermoregulatory beds __%

80-90% total flow of digital circulation

water temp ideal for exercise

81-92 deg C (27-33 deg F)

Position for anterior shoulder dislocation

90 deg abduction, 90 deg ER

% body weight distraction during deceleration phase of pitching

90%

% loss of UE - hand amputation at MP's

90%

with RA, activity should be modified if pain lasts >?? hours

>2 hr after completion of activity

Where does SBRN start?

@ supinator

Can extend thumb IP if EPL is absent

APB slip to extensor mechanism; also AdPollicus

A=no motor or sensory function below level of injury

ASIA Impairment Scale - complete lesion

B=sensory preserved, no motor below lesion C=motor preserved below lesion, > 1/2 key muscles below lesion have MMT <3 D=motor preserved below lesion, at least 1/2 key muscles below lesion have MMT or 3 or greater

ASIA Impairment Scale - incomplete lesion

lunate=most common with repetitive use scaphoid=most common with trauma

AVN of lunate and scaphoid - most common with repetitive use or trauma

Motions to limit to decreased incidence of shoulder dislocation

Abduction an ER (90/90/90)

1) 0-20 deg; Supraspinatus, Suprascpular N 2) 20-90 deg; Deltoid, Axillary N 3) 90-150 deg; Supraspinatus, Suprascapular N

Abduction of shoulder - muscles, N, and degrees

Free nerve endings detect

Abundant stretch, pain, temp

Botulism injection - frequent muscles

Ad Pollicus, FCU

TOS tests

Adson's, Wright, ROOS/EAST, Cyriax -Adson's = VASCULAR; rotate head toward affected side & extend head, shoulder ext/ER, deep breath & hold, check pulse -Wright = hyperabduction test; 90 abd/90 ER (Pm stretched), full abd -Cyriax = therapist stands behind & passively elevates scapulae, see if sx disappear -Roos/EAST = shoulder abd 90/elbow flex 90; open/close hands x 3 min

anterior shoulder dislocation (increased stress ant capsule during pull-through phase)

Back stroke - common shoulder injury

Barton's = wrist dislocation most obvious on X-ray, then fracture Colle's & Smith's = fx most obvious

Barton's vs. Colle's & Smith's fractures

RA - Type II thumb

Boutinerre + CMC subluxation (***rare)

RA - Type I thumb

Boutinerre - due to EPL sublux/EPB rupture (***most common)

RA thumb - most common collapse deformity & Type

Boutinerre or Type I thumb

C5-6; biceps & deltoid; Group 1 Narakas classification; good prognosis

Brachial Plexus injury - most common - which roots, muscles, Narakas classification, prognosis

1st degree = only epithelium, redness, mild discomfort 2nd degree superficial = upper level of dermis, blisters, thin eschar, severe pain; heals 10-14 days 2nd degree deep = entired depth of dermis, no blisters, injures hair follicles & sweat glands; heals 14-21 days 3rd degree = full thickness burn, thick eschar, no re-epithelization, skin grafts likely, not painful 4th degree = prolonged thermal exposure, involves underlying bone, tendon

Burn classificiation

Triceps, wrist flexors, finger extensors (tenodesis)

C7 mules to clear to R/O radicular pain

Lower brachial plexus levels and main nerve

C8, T1 - Ulnar nerve ***Upper = C5,6,7

physiological events with ice massage

CBAN (cold, burning, aching, numbness)

Base 2nd and 3rd digits

CMC boss location

serial static mobilization orthosis

CMMT - what type of orthosis

coefficient of variance=variation between trials

COV

Inefficient coefficient of variable

COV >15%

>15%

COV that indicates inconsistent effort

Indications: elevation, A/AAROM, retrograde massage, MEM, TENS/IFC, light compression Contra: no ice, no contrast baths

CRPS - edema control - indications & contraindications

DRF

CRPS - most common injury resulting in

over stellate ganglion

CRPS - where to place US head

no PN inury

CRPS Type I

Frayed tendon protocol authors and basic guidelines

Cannon & Strickland; s/p tenolysis for Poor quality tendons; place and hold ex in full flexion, and active digit extension

3rd most common carpal bone fracture; which athletes commonly have this fracture

Capitate; gymnasts #1 = Scaphoid #2 = Triquetrum #3 = Capitate

ER limited to 30 deg - protects from rupture, but prevents excessive stiffness

Capsular shift surgery - ER limitation x 6 wk & why

Resection = Bowers hemi-resection, Darrach resection Arthrodesis = Sauve-Kapandji

Caput ulna surgeries - resection (2) & arthrodesis (1)

radial = scaphoid tubercle & trapezium ulnar = hook of hamate & pisiform

Carpal tunnel - radial border, ulnar border

proximal carpal row

Carpal tunnel - structures forming floor

Catch-Up Clunk vs. Watson's SS Test

Catch Up=midcarpal joint instability; CIND; clunk with RD->UD Watson's=SL problem; CID; clunk with UD/extension->RD/flexion, with P applied over scaphoid tubercle

Diabetes

Condition that increases chances of radial side of hand contractures

AC joint - primary restraint to superior translation

Conoid (part of CC ligament)

2 parts of CC ligament

Conoid, trapezoid

Colle's fracture - position to avoid with casting

Cotton-Loder (wrist flexion, UD, pronation

1. adequate power to motor recipient tendon 2. similar tendon excursion to recipient 3. function is synergistic with recipient

Criteria for tendon t/f donor candidate

30-45 mm HG

Critical Pressure for tissue (compartment syndrome)

MCL posterior and transverse (transverse = AKA ligament of Coopers) band, elbow joint capsule

Cubital tunnel - structures forming floor

arcuate ligament of Osborne, FCU fascia

Cubital tunnel - structures forming roof

med epicondyle & olecranon

Cubital tunnel - structures forming walls

skin can sustain 25 mm Hg

Custom burn pressure garments - when to start using

Delayed onset muscle soreness = cryotherapy

DOMS - modality to treat

Which arch is most important landmark for splints

DPC

-Pronation = Palmar dislocation of radius, dorsal dislocation of ulna; due to injury of volar margin of TFCC -Supination = Dorsal dislocation of radius, volar dislocation of ulna

DRUJ instability - what happens with Pronation? Supination? - what happens to radius & ulna, why?

wrist flex, UD, fast/repetitive supination/pronation (scissoring between BR & ECRL)

DSRN - irritated with which motions?

Factors that precipitate gouty arthritis

Dehydration, surgery

Intrinsic shoulder muscles

Deltoid, teres major, RTC (scapula/clavicle to humerus)

Function = protect underlying parts of body Contents: -hair follicles -sweat glands -connective tissue -N endings (are also in epidermis) -blood vesels

Dermis - function & contents

most common type Raynaud's

Disease (more common than syndrome) Raynaud's disease (ME!) = idiopathic Raynaud's phenomenon; exists in isolation, is not due to another disorder; occurs in 3-5% of population Raynaud's syndrome = Raynaud's phenomenon due to underlying disease (i.e. scleroderma)

extends, glides volarly, translates radially

Distal carpal row - movement with RD

flexes, glides dorsally, translates ulnarly

Distal carpal row - movement with UD

Pretendinous cords - starts with nodule at MCP crease; results in MCP contracture

Dupytren's - most superficial cords in palm

30 deg flex

Dupytren's contracture at MCP=surgery

PIP = 20 deg flex MCP = 30 deg flex

Dupytren's contracture at PIP, MCP=surgery

3-5 mm

Duran & Houser - amount of tendon excursion needed to prevent adhesions

-pronation = UD -supination = wrist extension

ECU function in -pronation -supination

supination

ECU is wrist extensor in which forearm pos

Ulnar-sided pain, pain with supination, pain with palpating of distal ulna, swelling ulnar wrist, "popping" with movement

ECU tendinitis with subluxation symptoms

Motion most limited with frozen shoulder

ER

ER:IR strength difference in normal shoulder

ER is 60% as strong as IR (IR is stronger)

3-4 wk post-repair

Early passive mobilization - when can start active flexion s/p flexor tendon repair

HVPC (hi voltage pulsed current e-stim) uses in therapy

Edema, pain, wound healing

Connective tissue between fascicles

Epineurium -dense, irregular, usually surrounds several fascicles

Middle finger zone 6

Extensor tendon - finger and zone most commonly injured

Structures that make up terminal tendon - finger

Extensor tendon, lateral bands when they joint at triangular ligament (made up of interossei & lumbricals)

FDP & EDC **FDS has separate muscle bellies

Extrinsic finger muscles that have one belly

muscle that uses scaphoid tubercle as pivot

FCR ***FPL also traverses ulnar to scaphoid tuberosity then trapezium tubercle

finger flexor muscle with common belly

FDP - long, ring, small share belly

Jersey finger tendon & zone

FDP avulsion injury, zone 1

Flexor tendon - most common rupture with RA

FPL

- has only 1 vincula & no lumbricals originate on it = will retract into palm with laceration due to lack of restraints -travels alone in it's flexor sheath -goes through CT

FPL - unique characteristics

Factitious = deliberately fakes symptoms, NO motivation for personal gain Malingerer = deliberately fakes symptoms WITH MOTIVATION FOR PERSONAL GAIN (work comp)

Factitious vs. Malingerer

1) Autonomic/sympathetic response. 2) Detection of touch. 3) Touch discrimination. 4) Quantification. 5) Identification

Fess & LaMotte - Hierarchial Sensibility Levels

anteroinferior joint capsule

Frozen Shoulder - where are most adhesions located?

Common infection - dental workers

Herpetic whitlow

Primary mechanism for capsular shift to improve shoulder stability

Increases capsular restraint

MCP arthroplasty - expected flexion (index/middle, ring/small)

Index/middle=45-60 deg, ring/small=70 deg

Farthest FDP contracts with laceration

Into palm (Type I - Leddy)

4 wk

K-wires - when are they removed

4/5

MMT grade for tendon t/f

MAMTT; Haldex pinch gauge; place & hold in clinic with therapist only; passive ex at home

Main characteristic - Evans & Thompson

DBS with RB

Main characteristic - Kleinert

splint 20 deg ext vs flex; active flexion in OR; progress to buddy strap

Main characteristic - Sandow & MacMahon

uses 2 splints - DBS + hinged wrist splint; active hold, place & hold exercises

Main characteristic - Strickland & Cannon

1) Corticosteriods (most effective for adults, but not children) 2) Adrenergic compounds 3) Ca channel blockers 4) Bisphosphonates 5) 500 mg vit C daily (with DRF)

Meds used to manage CRPS (4)

Brachialis - very vascular, crosses anterior elbow joint capsule, high risk bleeding/scarring, can develop ectopic bone

Muscle associated with elbow contracture s/p elbow dislocation

Subscap; limit ER (40 deg at 4 wk post)

Muscle reflected with TSA & precaution to protect it

Radial = ECRL Median = "OK sign" = FDP, FPL (not PQ b/c pronator also does this motion Ulnar= FDP

Muscles to test for high vs. low level N injury - Radial, Median, Ulnar

Suprascapular

N injured with traction and compression injuries

Radial - is 3 mm away from anterolateral portal (3 cm distal and 3 cm anterior to lat epicondyle; penetrates ECRB muscle)

N most at risk with elbow arthroplasty

Axillary

N most commonly injured with proximal humerus fracture

1 mm/day, 3cm/mo, 36 cm/yr

N regeneration rate (day, month, year)

large/fast twitch/Type II

NMES stimulates which muscle fibers

#1=CTS, #2=cubital tunnel

Nerve compression - most common (2)

SWMF

Nerve compression - most sensitive test

JIA (JRA) types most to least common

Oligoarthritis (40%), Polyarthritis (25%), Systemic (10%)

6-8 wk ***takes longer than head/neck fractures; head/neck = only 3-4 wk to heal

P1 mid-shaft fractures - how long to heal

ligament that stabilize ulnohumeral joint in flexion

POL (posterior bundle of MCL/UCL)

follow-through phase sports; periscapular muscles (SA, LS, Pm, Trap) fatigue & shift dynamic restraint of humeral head to other passive stabilizers (GH ligaments, labrum) & they fail

Posterior shoulder instability - cause

No tip pinch x 8 wk

Precaution s/p thumb UCL repair at MCP (Gamekeeper's thumb)

Type 1 = small tear (<1 cm); sling x 7-10 days, full ROM in 4-6 wk Type 2 = mid/large tear (2-4 cm); sling x 2-3 wk, full ROM in 8-10 wk Type 3 = large/massive tear (>5 cm); abd pillow x 1-2 wk, sling x 2-3 wk, full ROM in 10-14 wk

RTC Repair, general guidelines Types 1-3

Deceleration (90% pitcher's weight translated through GH joint)

RTC injury most likely - what phase pitching

1) Night pain ("toothache like") 2) inability to sleep on affected side

RTC tendinitis/tear - hallmark symptoms (2)

pain without palsy

Radial Tunnel symptoms

Types of Raynaud's Phenomenon: 1) Raynaud's Disease = idiopathic; arises spontaneously, no known cause 2) Raynaud's Syndrome = known cause - scleroderma, RA, cold exposure, vibration

Raynaud's disease vs. syndrome vs. phenomenon

4 mm

SAM Zone 3-4 flexor tendon excursion allowed

CI-3

SCI level for vent-dependent

fluido and paraffin - Specific Heat compared to H2O

SH is lower than H2O, so higher temps are tolerated

repetitive overhead throwing, fall and catch self

SLAP lesion - mechanism of injury

4.31 (purple); start sensory re-ed here

SWMF - Protective Sensation

1.65-4.08 = 3x per targeted area 4.17 & higher = 1x per targeted area

SWMF - how many times to test each area

Seddon vs. Sunderland - how many levels

Seddon - 3 (neurapraxia, axontmesis, neurotmesis); Sunderland - 5

1 MHz

Setting for deepest penetration effects with US

posterior capsule is tight

Shoulder capsule - which part tight with swimmers & overhead throwers?

RTC repair - motions to avoid/protect

Shoulder extension & abduction

Position for posterior shoulder dislocation

Shoulder flexion, adduction, IR

posterior capsule

Shoulder impingement - Part of capsule most likely affected

1) stabilize scapula with SA strengthening 2) SS eccentric strengthening 3) posterior capsule stretch

Shoulder impingement - focus of conservative tx (3)

-under Coracoacromial arch: acromion, coracoid process, coracoacromial ligament -SS tendon, subacrom bursa, biceps tendon , GH joint capsule (superior aspect) impinged

Shoulder impingement - where, what is impinged

highly repetitive forces exert increased work load on peri-scapular M, causes increased stress on passive stabilizers (GH ligaments, labrum) & then they fail -> i.e. athletes with follow through phase (thrower, take-away phase tennis backhand, tennis serve, repeated misses by batters)

Shoulder instability - cause

grip with supination

Smith's fracture @ DRUJ - what motion increased pain with grip

1) collagen - protein 2) elastin - elastic protein 3) fibrin - blood protein

Soft tissue is composed of (3)

stage to begin functional day splint with RA

Stage III (chronic active or destructive stage)

Bacteria associated with cellulitis

Streptococcus

Vitamin B complex 100 once daily

Supplement to help with N problems (CTS)

RA Type V thumb

Swan Neck with MCP disease (VP laxity)

Vertebra at scapular spine level

T3

hand=3%, whole UE=9%

TBSA __% for hand, __% for whole UE

3% according to rule of 9's

TBSA hand=__%

9% according to rule of 9's (is 9% for adults AND children)

TBSA whole arm=__%

Type I = Traumatic -> fall on extended wrist with pronation, compressive load with UD, traction injury to ulnar wrist Type II = Degenerative ->+ulnar variance, ulnocarpal impaction

TFCC - injury Types

4-5

TOS - numbness/tingling of which digits

30 mm Hg

TOS - radial pulse difference due to TOS compared to other side

Adson's, Wright's, Halstead's, EAST/Roos

TOS tests (4)

68 deg F or 32 deg C

Temp that manual dexterity decreases

FCR

Tendon that goes over scaphoid tubercle

HIGH COLLAGEN CONTENT: tendons, ligament, joint capsules, fascia

Tissues US heats

Extrinsic shoulder muscles

Trap, pec major, SA, LD, Rhomboid major and minor, LS (scapula/clavicle to skeleton)

Ring finger = FDS Thumb = FPB (@ sesamoid bones where FPB inserts)

Trigger finger - most common 2 fingers, muscles involved

incorrect rejection of a true null hypothesis (also known as a "false positive" finding); "One is Needlessly Executed")

Type I Error

incorrectly accepting/retaining a false null hypothesis (also known as a "false negative" finding); "The Wicked get Out"

Type II Error

Radial head fracture type - happens with elbow dislocation

Type III

RH fracture with posterior dislocation

Type IV radial head fracture

30-90 deg flexion

UCL anterior band - stabilizes elbow during __deg flexion

60-140 deg flexion

UCL posterior band - stabilizes elbow during __deg flexion

ligament graft from coronoid to medial epicondyle; "Tommy John"

UCL reconstruction involves, is called

1) AOL 2) POL 3) Transverse ligament (Ligament of Cooper's)

UCL/MCL consists of (3)

adults=UE, children=LE

UE or LE more commonly affected with CRPS; adults, children

~6 mo; when child sits without support

UE prosthesis - age to start with

3-5 cm (most popularly used)

US - depth of 1 MHz

1-2 cm

US - depth of 3 MHz

1) promote soft tissue healing 2) release growth factors from macrophages 3) facilitate collagen production

US benefits (3)

conversion

US heats by__

duty cycle

US on:off time

Arcade of Struthers - which nerve gets entrapped here

Ulnar

Guyon's canal

Ulnar A passes through what structure to get to the hand

superficial palmar arch

Ulnar A supplies which arch in hand

Masse sign is due to? Presents as:

Ulnar N injury; flattened palm

Carpals deviate in what direction with RA

Ulnarly

Lunate

VISI & DISI - determined in reference to what bone?

Contributors to decrease supination s/p DRF

Volar soft tissue injury leads to PQ shortening, jt capsule adhesions, DRUJ mal-alignment

1-2 mo

Wallerian degeneration - lasts how long?

SLAP lesion associated with

Weak link at labrum due to biceps attachment to to GH joint; impingement; RTC tear;instability

only 1 point is perceived

Weber 2PD Protective Sensation

Moves center of rotation to increase role of deltoid for elevation of arm; end-stage RTC arthropathy

What does reverse TSA do to shoulder mechanics? Indications for this surgery

ECRB overlies supinator in pronation, placing additional stress on supinator

Why does pronation increase sx in dorsal forearm

Vaughn-Jackson Syndrome

With RA, extensor tendon ruptures extensor compartments 4 & 5

Stemmer's sign

a thickened skin fold at the base of the second toe or second finger that is a diagnostic sign for lymphedema.

movement of fluids/gas bubbles within cells in response to vibration (streaming=bubbles moving in a stream)

acoustic streaming

Type II=curved, Type III=hooked

acromion types most likely to tear RTC

78 x/hr; 23.7%/hr

average office worker mouse usage time (/hr)

SC levels for paraplegia

between T1 & L1

upper cervical root or upper BP injury

burner/stinger sports injury secondary to

most common invasive A procedures

cannulation of distal Radial A for pressure monitoring and gas analysis

supination; - ulnar variance = decreased stress on TFCC & carpals

carpus unloaded in what position & why

negative pole (C-)

cathode - negative or positive

UMN damage to brain motor cortex

cause of spastic paralysis

Mast cell

cell that mediates inflammatory response

collagen

cell that most contributes to stiff joints

1) Platelets = 1st on scene - contribute to fibrin, fibroplasia, angiogenesis 2) Macrophages = phagocytosis & growth hormone release

cells that release growth factor essential for tissue repair

20 min on, 1 hr off; up to 10 x/day

cold pack duration for post-trauma edema

30%

collagen makes up __% protein in the body

3-5 days post injury (fibroplasia stage)

collagen synthesis starts when

SICK scapula, GIRD

common shoulder conditions with racquet sports

anterior shoulder dislocation

common shoulder injury with backstroke swimmer

BR -> FPL

common t/f to restore thumb flexion w/ high Median N injury

EPL

common tendon rupture s/p Colle's fx

EPL, curves around Lister's tubercle, 3rd compartment

common tendon rupture s/p plating for DRF, location, compartment

EPL rupture with loss of hyperextension and retropulsion (can't lift thumb off table while keeping palm flat)

complication @ thumb s/p distal radius fracture

SL dissociation frequently

complication s/p Chauffeur fx

eye level or slightly below eye level

computer monitor placement

concAve sAme direction for joint gliding and bone movement

concave - joint gliding & bone movement

"curving in"; scapula

concave; bone example

PA = DIP involvement

condition of the fingers that is differential dx for RA vs PA

scaphoid tubercle

convergence point for digits

end of bone slides in OPPOSITE direction as movement

convex bone movement with joint

black = surgical debridement yellow=aggressive scrub

debridement for wounds: -black -yellow

120 deg; structures have cleared acromion

deg ROM where pain deceases with shoulder elevation and why

injury to dorsal TFCC results in (effect of forearm rotation on radius)

dorsal dislocation of radius with supination ***dorsal radioulnar ligaments are tight with supination, providing restraint to volar dislocation of ulna; injury to dorsal ligaments allows normally restrained ulna to dislocate volarly, radius then dislocates the other way (dorsally)

direction of subluxation at CMC

dorsoradial (secondary to AOL being overstretched)

36 hr post injury

edema formation peaks with burns when

creates smoother, not stronger, contraction

effect of increasing pps on muscle contraction

position of re-dislocation for elbow

elbow extension, supination

position that causes elbow posterolateral instability

elbow forced into valgus from supinated/extended position

carpals move what direction with UD

extension

ligaments pull triquetrum which direction

extension

30 deg

extensor lag - functional limitations noticed at

DIP=1, PIP=3, MCP=5, wrist=7

extensor tendon zones DIP, PIP, MCP, wrist

middle finger Zone 6 (over metacarpals)

finger and zone most likely injured extensor tendon

FDP

finger flexion muscles that share a common belly

pinky

finger most likely to get boutinerre from a burn

Appraisal/projected=only 10.3% return to work

flashback type - least likely to return to work

Replay flashback

flashback type - most easily rehabbed with return to work rate of 95%

why splint PIP in extension

flexion easier to get back than extension

flex= 130 deg, ext=30 deg, sup/pron=50 deg ea

functional ROM elbow

30-130 deg

functional elbow ROM

dorsal angulation, wrist is deformed, increased Force on ulnar side, increased ulnar-sided pain

functional loss with decreased palmar tilt

decreased grip strength & ROM

functional result of decreased radial inclination

27%

fusion=how much loss flex/ext crossing inter carpal row

12%

fusion=how much loss flex/ext within a row

downward rotation

heavy arms/large breasts do what to scapula

uticaria

histamine response to cold=red wheals or hives

direct trauma to dorsal wrist or extreme dorsiflexion & RD (gymnast)

how is capitate fractured

for 30 sec every 60 min

how often to take mini-breaks at work? how long?

make cathode (-) twice the size of anode (+)

how to decrease burn risk with ionto

test last innervated muscle(s) of high level to see if functioning; if it is, it's a low level injury, if not, it's high

how to figure out if N injury is high or low

gripping with pronation

how to increase + ulnar variance

increase Intensity (amperage)

how to increase strength of muscle contraction with e-stim

1.5 mm

humeral translation on glenoid fossa during functional arm motions

fibroblasts

hydrogen peroxide is toxic to

UMN compromise

hyper-reflexia is indicative of ??

motions that dislocate the elbow

hyperextension and posterolateral rotation

increased length of time for wound closure

hypertrophic scars - most important factor for developing

30 deg ea abd, flex, IR

ideal shoulder position for arthrodesis/fusion

large enough that thumb and digits just touch but don't overlap

ideal tool handle diameter

1 1/4 to 2 inches

ideal tool handle diameter for non-powered power tasks

1/4 to 1/2 inches

ideal tool handle diameter for non-powered precision tasks

ER & IR

impingement with overhead activities - muscles to strengthen

splint covering ulnar styloid - forearm position

in pronation - styloid is more prominent in this position

29x

increased risk of wrist tendinopathy with highly repetitive & forceful jobs

PIP joint replacement - not an option for which fingers

index and pinky secondary to grip and pinch demands

base 3rd MC

insertion ECRB

base 2nd MC

insertion ECRL

CID - which ligaments

instrinsic

40-80 mA/min

into setting for trigger finger

swan-neck deformity - activity to avoid

intrinsic + activities (knit, crochet)

swan-neck exercises

intrinsic minus, max PIP flexion

Add Pollicus, FPB

intrinsic thumb muscles that have 2 heads

max grip strength - what type of contraction/assessment

isometric

heat - effect on strength

isotonic strength decreases x 2 hr, then increases for 30 min

series of events leading to volar subluxation & ulnar drift of MCPs with RA

joint synovitits > radial hood sagittal fiber stretching > concomitant volar plate stretching > extrinsic extensor tendons subluxate ulnarly > lax collateral ligaments allow ulnar deviation deformity > ulnar intrinsics contract further worsening the deformity > wrist radial deviation further worsens > flexor tendon eventually drifts ulnar

LUCL or LCL

lat elbow ligament most often injured

pain more proximal than PIN or RTS

lateral epicondylitis pain symptoms location vs. PIN/RTS

Radial N & Brachial A

lateral intermuscular septum - what perforates it

Bankart lesion

lesion often associated with Hill-Sachs lesion

perpendicular distance from an axis to the line of action of a force. In other words, moment arm determines the quality of the torque. Longer lever arm = more torque

lever arm/moment arm

annular

ligament associated with Nursemaid's Elbow

transverse carpal ligament (term often substituted with flexor retinaculum)

ligament cut with CTR

LUCL/LCL injured

ligament injured with posterolateral rotary instability

SL

ligament involved with DISI

LT

ligament involved with VISI

AOL of MCL

ligament most frequently injured by throwers

lunate fossa=46%, scaphoid fossa=43%, TFCC=11% ***lunate fossa is partially on radius and partially on ulna, so part of it's load is transmitted to each

load transmission through wrist at neutral - lunate fossa, scaphoid fossa, TFCC

80% radius, 20% ulna

load transmission through wrist at neutral - radius & ulna

radius=65%, ulna=35%

load transmission with 35 deg dorsiflex - radius & ulna

C1-7=above vertebrae; C8=below 7th vertebra

location for N root laceration of C-spine (above/below vertebrae)

T1-S1=below vertebrae ***C8 also below

location for N root laceration of T/L/S spine (above/below vertebrae)

4 wk post surgery (some other t/f's start moving at 3 days - 1 wk)

long wrist/finger flexor tendon transfers - how long immobilized?

initial lymph vessels

lymph capillaries

#1 = PT, #2 = FCR

main 2 muscles with medial epicondylitis

Ulnar A = 60%

main blood supply of hand

supination

major weakness with distal biceps rupture

90 deg

max abd to avoid increase tension to Brachial Plexus

50 g/cm2 or 35 mmHg or 100-300 g

max amount of continuous Force with an orthosis

10 to the 5th colony forming units (CFU's)

minimal microbial count to be ready for skin graft

pronation with extension/hyperextension

most TFCC injuries happen with what motion combinations

#1=scaphoid, #2=triquetrum

most common carpal bone fracture (top 2)

SL ligament injury

most common cause of wrist instability

#1=hematoma, #2=infection

most common causes of skin graft failure

thumb & FPL (IP fixed in flexion)

most common congenital finger & muscle involved

neck

most common metacarpal fracture

#1=forearm, #2=hand

most common of all fractures - top 2 (general body part)

TFCC

most common soft tissue injury associated with DRUJ

posterolateral

most common type of elbow dislocation

68-78 deg F with 20-60% humidity

most favorable working temp & humidity

elbow flexion

most important UE motion to restore

2 & 4 - prevent bowstringing

most important flexor tendon pulleys & why

APB

most important muscle for thumb opposition

bandages too tight; vascular insufficiency

most likely cause of flap failure

APL=only muscle to insert at MC base of thumb; can also be deforming force

muscle that contributes to CMC stability

SA, loss of UT/LT force couples

muscle weakness that cause shoulder dyskinesis

ECRL & ECU

muscles most commonly used to power FDP & FPL with high Median N palsy

SS IS Tm

muscles that attach to greater tubercle

-Rhomboids, LS, Traps, SCM (DSN & SAN muscles) -mobile arm support for feeding, mouth stick - telescope for customized length

muscles that still work with C4 injury, function activity possible with C4 injury

N that can be disrupted to reduce vasospastic disease

nerve of Henle (runs with Ulnar N)

pointing toward scaphoid tuberosity

normal finger position with gripping

10 to the 3rd/g tissue

normal tissue - level of organism/g tissue

C2 Atlas = CI Axis (includes ondontoid/dens) = C2

odontoid is part of which vertebra

11-12 deg (lateral view on radial side) - p. 397 Purple Book

palmar tilt wrist

most common cause of lymphedema

parasite infection - Elephantiasis (lymphatic filariasis)

posterior ***BUT anterior is tight with frozen shoulder

part of GH capsule most likely to get stiff

wrist 20 deg ext, MP's 83 deg flex, PIPs 75 deg flex, DIPs 40 deg flex

place and hold position for early active flexion protocol with MAMTT or SAM

A-beta

primary sensory fiber type

primary=structural secondary=failure of dynamic stabilizers (RTC, biceps tendon)

primary vs secondary impingement

deltoid

primary workhorse of the shoulder

How often should an RA pt change positions

q 20-30 min

desensitization protocol

rank 10 textures; take 1st tolerable but unpleasant and do 3-4 x/day x 10 min, then move to next most unpleasant

cause for PIN irritation; anatomy, groups susceptible

repetitive pronosupination; gymnast, weightlifters (wrist hyperextension)

5-8 mo

return to sport s/p open release of med or lat elbow tendinosis

minimum intensity to elicit a visible contraction when duration is infinite

rheabase

types of accessory movements

rolling, spinning, gliding (***are not voluntary)

20/20/20 - every 20 min look 20 ft away for 20 sec

rule for using video monitor - ergonomics

50-60%

s/p 4-corner fusion - % AROM

80%

s/p 4-corner fusion - % grip strength

- PROM @ 4 wk only abduction, extension ***avoid pinch!!

s/p LRTI - precautions

index/middle = 45-60 deg; ring/small = 70 deg

s/p MCP arthroplasty - flexion AROM goal (index/middle, ring/small)

at 6-8 wk; start sensory re-ed

s/p N injury, when is regeneration apparent

3 wk

s/p N repair - how long to wait before glide/stretch of nerve

2-3 days post-op

s/p PIP ORIF - when to start moving joints

~50% each, compared to uninvolved side

s/p PRC - % ROM, grip strength

11-16 wk

s/p RTC repair - when can start active shoulder abd

PT

s/p Radial N injury - tendon used to restore wrist extension

absolute=24-72 hr sufficient=3-7 days minimal=3-6 wk

s/p fracture fixation - when to start ROM according to level of stability (absolute, sufficient, minimal)

10/40 after splinting x 9 wk

s/p mallet finger - ROM return

flex and ext=60%, UD and RD=40%

s/p radioscaphoid fusion - % motion

4 wk post skin graft

s/p skin graft - when can start strengthening

Psoriatic arthritis (PA) - classic sign

scaly, erythematous skin rash

DTM (dart-throwing motion) pattern decreases stress on what?

scaphoid, lunate, SL ligament injury, wrist fractures

Mid Trap/Rhomboids

scapula Force couple - ER

UT/LT, SA

scapula Force couple - abduction

Pec minor, Rhomboids, LS

scapula Force couple - adduction

Pec minor

scapula Force couple - ant tilt

Pec minor, LT, subclavius, LD

scapula Force couple - depression

Pec minor, Rhomboids, LS

scapula Force couple - downward rotation

combined ant tilt, downward rotation, & depression Force couples

scapula Force couple - extension

UT/LT, SA

scapula Force couple - flexion

Pm

scapula ant tilt

PM Pm LD Trap (lower)

scapula depression - muslces

LS Rhomboids LD Pm (coracoid process)

scapula downward rotation

Trap (upper) LS Rhomboids

scapula elevation - muscles

SA PM Pm LD (attachment @ inf angle scapula)

scapula protraction

Trap Rhomboids

scapula retraction

Trap SA

scapula upward rotation

loss of posterior tilt and upward rotation of scapula cause dyskinesis

scapular dyskinesis

scapular plane is 30 deg anterior to coronal

scapular plane in relation to coronal plane

2:1 (GH:ST) in 1st 90 deg flex and abd

scapulothoracic rhythm

30 deg forward flex, 30 deg abd, 30 deg IR

shoulder arthrodesis - position most comfortable

posterior capsule

shoulder capsule - part that is tight with impingement

Deltoid (post) TM Tm LD Triceps (long)

shoulder extension - muscles (5)

Deltoid (ant) PM CB Biceps

shoulder flexion - muscles (4)

Deltoid (posterior) Tm IS

shoulder horizontal abd - muscles

PM deltoid (ant) LD

shoulder horizontal adduction - muscles

finger - most common extensor tendon rupture

small finger; thumb EPL also common

fascicle = bundle of N Fibers

smallest unit of N structure that can be manipulated surgically

4-5 wk

splint time - bone injuries

6-8 wk

splint time - tendon injuries

Stemmer's sign occurs with

stage 2-3 lymphedema

Taping - to facilitate/support muscle

start @ origin, end @ insertion

splint type for severe long-term contracture

static progressive (use dynamic for more acute)

1) Subacrom bursa 2) SS tendon 3) biceps tendon - long head

structures in subacromial space (3)

protected position for AROM s/p elbow dislocation

supine with shoulder flexed to 90 deg; avoid extension and supination together

varus; "gunstock" deformity

supracondylar fracture with child - #1 deformity

ulnar resectioning/shortening

surgery of choice for ulnar abutment without DRUJ involvement

dorsal dislocation of PIP results in what deformity and why

swan's neck secondary to VP and collateral ligament disruption

pain with flexion, adduction, and internal rotation of the arm

symptoms with posterior shoulder instability

3rd web space

syndactyly most common where?

within 1st wk

tendon early motion protocol - when to start AROM

Huber transfer (ADM inserted at level of APB)

tendon t/f for reconstruction of congenital thumb hypoplasia

Boye's transfer (FDS to EDC)

tendon t/f to restore digital extension

Bunnell transfer (pulley at pisiform to recreate opposition with FDS tendon); opponensplasty

tendon t/f to restore thumb opposition

what is SWM

tenodesis exercises after flexor tendon repair

C6 = wrist extensors intact

tenodesis is preserved at what SCI level

largest lymphatic vessel

thoracic duct (75% lymph passes through it)

diaphragmatic breathing affects

thoracic duct (AKA pulmonary pump)

RA - which extensor tendons rupture 1st

ulnar to radial side (pinky then ring then middle then index)

supination; splint in this position to unload ulnar side

ulnocarpal force decreases in what position

with RA, MP's sublux how?

volarly and ulnarly

6 hr

warm ischemic time to carry out replantation surgery - # hours

vit A gel - steroids stop the inflammatory process - Vit A can start it again to help chronic wounds to heal

what can be used to counteract effect of steroids in chronic wounds

decreased flexion of adjacent fingers s/p FDP repair, due to advancement of tendon too far, places tension on adjacent tendons that share a muscle belly

what causes quadrigia

24 hr post surgery

when can clean, sutured wound be cleaned with mild soap and H2O?

when is matures = 6 mo after formation

when is HO excised

>1.5 cm pulp loss

when is flap considered with fingertip injuries

fibroblastic phase = 2-8 wk

when to start SP splinting

Vibration 30 MHz perceived, moving touch perceived, SWMF 4.31

when to start sensory re-ed & SWMF level

inner wall of blood & lymphatic vessels - allows them to travel to wound and oxygenate/distribute nutrients

where are epithelial cells located

Dermis (epidermis has NO collagen)

where is collagen located in the skin

IR is 2/3 stronger

which is stronger IR or ER?

pinky; 40%

which metacarpal most commonly fractured & %

Raynaud's color changes

white/black -> blue -> purple -> red

Pulse duration AKA

width

FCU

with CP - tendon used to restore wrist extension