450 Formula UE
PAMs associated with RA
allows for a wider variety -heat, TENs, cold
evaluation for arthritis
assess motion and stability of each joint in thumb and fingers
RA
autoimmune condition that attacks joints
which PAM is commonly associated with edema and acute injury
cold/cryotherapy
ultrasound works best with
collagen based structures (tendons, bone) and less well on muscles
intrinsic muscles
completely within the hand
cold PAMs
constrict circulation, numb pain -used for acute injury
lateral collateral ligaments
contribute to deformities of fingers -when bent they are relaxed and when straight they are stretched
medial collateral ligament/valgus instability
lateral deviation of the elbow -michael and gus love guns
tennis elbow
lateral epicondylitis -painful extrinsic extensor tendons near elbow -painful to touch and use -decreases grip strength (opposing flexors)
minimi
little finger
oval 8 splints are used for
boutonniere and swan neck deformities
with a fractured finger you usually splint a
buddy finger to help stabilize fractured finger
longus
long
carpal fracture
low blood supply, longer healing times, may require surgery
intrinsic muscles of hand
lumbricals and interossei
isometric
maintaining one position with resistance (holding a weight still)
focus for arthritis
manage and prevent worsening symptoms and maximize function
lateral collateral ligament/varus instability
medial deviation of elbow -lucille has her hands in lap like a lady
boxer's fracture
metacarpal fracture-typically 4th and 5th metacarpals -fix with an ulnar gutter splint to flex MCPs
LCL/varus instability is
more common -stabilized best with elbow flexion and pronation -lucille gets stressed often
concentric
muscle shortens
treatment for frozen shoulder
pain free AROM and compensation strategies/environmental modifications until it thaws naturally
with arthritis focus on
pain free ROM -frequent AROM through pain-free ROM -pain=damage to the joints
TENS
pain management via gate control theory (increase traffic) -best for ACUTE pain (fractures, tendon/ligament repairs, sprains, edema) -can reduce trigger points
which PAM is commonly associated with arthritis, specifically OA
paraffin
flexor digitorum profundus
passes all the way through to the DIPs
edema deformity results in
position opposite of antideformity splint (loss of metacarpal arch-straight knuckles) similar to ape hand with all fingers -results in collateral ligament and volar plate deformity
contraindications for compression
-DVT, severe cardiovascular concern, peripheral neuropathy, active TB
arthritis treatment: JAPO
-Joint protection -AROM (pain free of wrists and digits, maybe strengthening but gentle and pain free) -PAMs -Orthoses
joint protection
-activity modification, avoidance and positioning, decrease inflammation -compensatory strategies (use larger more proximal joints, spread the force by using both hands) -adaptive equipment: built up handles or other AE to perform ADLs with minimal stress on joints -once joints are happy --> resume modified version of task
AMBRI/TUBS
-always been loose -torn loose
posterior elbow splint
-for MCL/LCL injury -elbow injury recovery
boutonniere splint
-for boutonniere syndrome or arthritis -oval 8
long thumb spica (long opponens)
-for de quervain syndrome -kevin the unicorn
wrist cock up splint
-for radial nerve injury, radial tunnel syndrome, and carpal tunnel syndrome -looks like a squid (fingers are free to move)
swan neck splint
-for swan neck or injury of tendons -oval 9
hand based/forearm based ulnar gutter
-if proximal: use forearm based -if distal: use hand based
mallet splint
-immobilize DIP in full extension for 6-8 weeks without flexing
acronym for edema treatment: MASTECCT
-manual edema mobilization: requires training and certification -AROM -splint: antideformity splint/intrinsic plus -taping: not that effective -elevation -compression -cold -think
in general eval for UE: NEW SPORC
-nerves, edema, wounds -strength, pain, occupations, ROM, coordination
antideformity splints (intrinsic plus)
-positioning after trauma/edema -looks like an alligator
arthritis orthoses: antideformity position
-stabilize deformed joints, emphasize stabilizing proximal affected joints and freeing distal unaffected ones where possible -night and day use
short thumb spica (short opponens)
-thumb in opposition -arthritis of CMC and MP of thumb -looks like a unicorn
measure edema
-volumeter (unless open wound/burn) -figure 8 circumferential measurement
rotator cuff tests: several tests to check RC stability, particularly supraspinatus
-with thumbs down: -empty can test (pretend to be holding a can and dump it out) -hawkins kennedy (flapping wings like a hawk-shoulder is moving) -neer's impingement test (shoulder=neerest joint to your arm)
heat PAMs
relaxes muscles, increase circulation, superficial or deep
brevis
short
PAMs should not be applied to
somewhere something abnormal is happening, wounds, cancer, pregnancy
flexor digitorum superficialis
splits and spots at PIP
thumb spica is used for
stabilize MP and CMC in opposition (because most functional) for arthritis
for the elbow you follow
standard ROM progression
for wrist fractures you use
standard ROM progression
e-stimulation PAMs
stimulate muscle contraction and sensation
most wrist fractures will have a cast so you move
surrounding joints via tendon sliding and elbow movement
policis
thumb
klumpke's palsy
trouble with your keys with Klumpke's -atrophy of arm or hand, claw hand, muscle weakness, limited ROM of arm, pain, paralysis of arm or head
t/f: edema in the first few days of injury is normal
true
t/f: you only need to splint the affected joints
true -others should be free to move
MCL/acute valgus stresses/instability
typically for throwing athletes -michael is a fast pitcher -stabilized best with elbow flexion and supination
deep heat
ultrasound
Erb's palsy
upper brachial plexus injury, upper arm deficits -that nerd erb is always raising his hand in class -waiter's tip hand
for hand fractures
use splintrinsic plus splint and then standard mobility progression
if progress plateaus
use static progressive splints (ones that adjust) or serial static splints (heat up thermoplastic to new ROM)
OA
wearing down of cartilage elements of joints (bone on bone)
carpi
wrist
for elbow treatment
1. immobilize/stabilize: posterior elbow splint in 90 degree in flexion 2. AROM in max position of stability: lying in supine, shoulder flexed 90, pronated forearm (Egyptian elbows while in supine so gravity helps it) then progress to typical movements and positions but continue to avoid the ones that put stress on the affected area 3. after 6-8 weeks-no movement precautions and begin strengthening
stages of healing: proliferation for bones
6-8 weeks for bones to stabilize and cautiously grade movement/activity
typical stage of healing
6-8 weeks of immobilization
contraindications of PAMs
C: cognition (dementia, small child) V: vascular (cardiac concerns) S: sensation compromised
OA affects
CMC and IPs -finger deformities: mallet finger, boutonniere deformity, dorsal subluxation
RA affects
MPs and wrist/carpals -finger deformities: ulnar drift at MPs, swan neck and boutonniere, wrist-radial subluxation (zig zag)
tests used for lateral epicondylosis
Mill's test, Maudley's test, Cozen's test -showed up later to maudsley's cozy mill
RA acronym for deformities
Right Angle: thumb and MPs wRist Also Really Anything: presentation may be more varied and tx can be really anything
which PAM is commonly associated with trigger points
TENS
serial static splint
a series of static splints or a static splint that is reheated and adjusted to the client's new available ROM to improve it
glenohumeral instability
frequent impingement or dislocations, strengthen RC muscles to compensate
manual edema mobilization is contraindicated for
damaged lymph, infection, blood clots, CHF, kidney problems, and cancer
ultrasound PAMs
deep penetrating heat modality, useful for deep heat and also healing
digitorum
digits
AROM should be pain free, avoid stress in __________
direction of deformity
colle's fracture
distal radius/wrist fracture results from FOOSH
proximal stability leads to
distal stability -compromised joint in hand will commonly result in deformity of more distal joints -be aware of where problem is and address that FIRST
high volt pulsed current (HVPC)
edema, pain, healing, small muscle re-education
edema
excessive fluid built up in tissues -outside of first few days after an injury, edema may be a sign of infection
NMES and PES
exercise and functional use (i.e. post stroke)
extrinsic muscles of hand
flexors/extensors
which PAM is commonly associated with CRPS
fluidotherapy
for hand fractures you
follow standard ROM progression
resting hand splints are typically used for
general comfort -i.e. after stroke -look like a parrot resting on your shoulder
static splint
generic splint, immobilizes and protects
nerve injury or impingement at the brachial plexus/thoracic outlet syndrome
give it space and keep it mobile
PAMs: OA responds best to
heat (paraffin)
eccentric
holding resistance and lowering it -muscle is lengthening
superficial heat
hot packs, paraffin, fluidotherapy
standard ROM progression
immobilization, AROM, PROM, isometric, eccentric, concentric
purposes of orthoses
immobilize early to protect, mobilize later to correct
extrinsic muscles
in forearm with tendons leading into the hand
indices
index finger