Lecture Week 4 - Hand and UE Injuries

The TAM of all PIPs (across all 5 digits) would be a range of 0 to

110

The TAM of the MCPs, PIP and DIP would a range of 0 to

260

The typical healing time for a wrist fracture is _________ weeks

4-8

The TAM of all DIPs (across all 5 digits) would be a range of 0 to

60

The TAM of all MCPs (across all 5 digits) would be a range of 0 to

90

The following example is a type of extensor tendon injury called referred to as

DIP extensor lag

Which PAM can be used for sensory re-education (such as after a PNI tendon transfer?)

Fluido (corn husks)

For a patient with metal hardware inside of them to heal a fracture, which PAMs would not be a good idea?

Ultrasound or E-Stim

_______________ is degeneration of axons distal to an injury

Wallerian degeneration

TAM is important for ___________ tendon injuries so that OTs can determine whether they person is able to go to 0 degrees flexion

extensor

The quick DASH is an example of a __________ used in hand OT

outcome measure

The following are all types of ______________: - Jebsen Hand Function Test - Quantitative Test of Upper Extremity Function - Purdue Pegboard - Minnesota Manual Dexterity Test - 9 Hole Peg Test

standardized tests

A ____________ orthosis is meant to hold a joint in place, whereas a ___________ orthosis has different components that promote movement

static; dynamic

_____________ and __________ are the most common complications of a fracture

stiffness; pain

A tendon transfer must occur _________ after loss of innervation

1 year

The following are general principles of postoperative management of nerve repair EXCEPT: - Immobilization of the hand to prevent tension on nerve for 2-3 weeks - Protected stretching of joints - Light dynamic orthotics or functional orthotics can be used - Activity, strengthening and ADLs are adapted, monitored and progressed as able - Begin mobility exercises immediately following surgery - Sensory re-education

Begin mobility exercises immediately following surgery

In an ulnar nerve injury, clawing is often seen because of the unchecked

EDC (extensor digitorum communis)

The following are all additional considerations for complex injuries EXCEPT: - Excessive bleeding (treated with gauze, stitches, wound-wraps and disinfecting agents) - Edema (treated with elevation, manual edema mobilization (MEM), AROM, and compression) - Wound and scars (treated with wound care and dressings, pressure, massage, AROM, and E-stim) - Pain syndromes (such as desensitization, neuromas, CRPS)(may be treated with TENS) - Joint stiffness (treated with AROM, PROM< orthotics, and joint mobilization)

Excessive bleeding (treated with gauze, stitches, wound-wraps and disinfecting agents)

Mrs. Jones and Mr. Peterson both have wrist fractures and come into the clinic looking to begin mobility exercises. Mrs. Jones fractured her wrist months ago and has been healing for a couples weeks, with no surgery and an orthosis. Mr. Peterson, on the other hand, underwent surgery two days prior. Which patient can begin mobility exercises?

Mr. Peterson

A person with a wrist fx will have a ______ status on their hands, meaning they should not partake in resistive exercises

NWB

The following are symptoms of a _________; weakness or paralysis of the muscle innervated by the nerve and/or sensory loss in the area innervated by the nerve

PNI

Hand injuries are more prevalent in adults for the following reasons EXCEPT: - There is more repetition of movement as one gets older -People use their hands wrong their entire life without knowing it - Jobs, hobbies and interests can be taxing - There is general joint wear and tear as one gets older - Younger adults are thrill seekers and partake in activities that can be injurious (like skiing)

People use their hands wrong their entire life without knowing it

Treatment for an ulnar nerve injury includes an a __________ splint and education to protect from injury

anti-clawing

The following are all assessments of performance skills and client factors EXCEPT: - Cervical neck and shoulder screening - Assessment of strength - Assessment of movement - Assessment of peripheral nerve status - Assessment of sensation - Assessment of coordination - Assessment of edema

assessment of strength

A ___________ fracture occurs when a small chunk of bone attached to a tendon or ligament gets pulled away from the main part of the bone

avulsion

_____________ is when nerve fibers below an injury regeneration

axonotmesis

Joe got frustrated during a football game and punched the sheetrock in his bedroom. He came into the clinic presenting with a fracture of his fifth metacarpal bone; this fracture is best known as a __________

boxers fracture

A _______- on the wrist could indicate a fracture

bump

Neuropraxia is seen most commonly as _______

carpal tunnel

The following are symptoms of ___________: - Pain in the hand and arm - Numbness and tingling in index and middle fingers (and thumb)

carpal tunnel (median nerve compression)

The following are symptoms of __________: - Numbness and tingling in the hand (esp ring and little finger) (and especially when the elbow is bent) - Hand pain - Aching pain on the inside of the elbow - Weakened grip - Clumsiness when holding onto things

cubital tunnel (ulnar nerve compression)

The term ____________ disorder is a description of the mechanism of injury (multiple factors contributing to the injury) and not the diagnosis.

cumulative trauma

A client presents with a cut on his index finger. When his hands are wet, all the fingers prune except his index finger. As the OT, you suspect he may have an injury to the __________ or _________ nerve

digital; median

A _________ fracture is commonly caused by a fall on an outstretched hand (FOOSH)

distal radius

Treatment of a radial nerve injury may involve a __________ to prevent outstretch during healing.

dynamic orthosis

___________ may be a good option for flexor tendon injuries if the patient can follow directions well and has a good relationship with the therapist

early active mobilization

If the OT teaches a patient how to do tendon gliding, this is an example of an ___________ intervention approach

education

In patients with ulnar nerve injuries, it is important to also asses the ____________

elbow

Fractures can be immobilized or stabilized. This is accomplished through _________or __________

external fixation; internal fixation

T/F Paying special attention to the branch of a nerve that has been affected by a PNI will not be helpful in treatment

false

T/F A radial nerve injury is very impactful of functioning

false

T/F EBP is not relevant in hand therapy since rehab information has been the same for decades

false

T/F Grip and pinch strength should be measured immediately following a recent trauma or surgery

false

T/F Hand injuries only have a mechanical impact on a person's life

false

The following image is of a ___________ tendon injury

flexor

________ tendon injuries are often challenging to treat because of the delicacy of the repair and the amount of protection that needs to be in place. There are three different approaches to rehab that can be utilized based on the surgeon's recommendations, the needs of the client and their ability to comply with the program. These include: - Immobilization - Early Passive Mobilization - Early Active Mobilization

flexor

Tennis elbow occurs from overuse of the ___________ due to repetitive or strenuous activity

forearm

In hand therapy, a ____________ assessment may involve observation and a topographic assessment

functional

_______________ should begin as soon as you meet the client in the waiting room, the OT should observe how they take off their coat, sign their name, remove cards from their wallet, pull out a chair to sit etc.

functional observation

Following postoperative management of a flexor tendon injury, tendon _______ is important in restoring hand function

gliding

The following are signs of _____________: - Pain and tenderness on the inner side of the elbow (sometimes extending to inner side of the forearm) - Stiffness in the elbow -Pain when making a fist - Weakness in the hands and wrists - Numbness or tingling

golfers elbow (medial epicondylitis)

______- strength is measured using dynamometers, a pinch meter, MMT, and maximum voluntary effort

grip and pinch

Grip and pinch strength should be completed after the ________ phase

healing

For a patient who has had surgery and has scar soreness and stiffness, all of the following PAMs would be mostly free of complications EXCEPT: - Paraffin - Heat - Whirlpool - Ice

heat (also warms up internal metal)

Extensor tendon repairs in zones I-IV typically require __________ for 6 weeks. This is necessary since the resting hand position is flexed (we don't rest in full extension).

immobilization

___________ is not preferred for a flexor tendon injury since scar tissue will impede mobility. However, it may be a good option for clients who don't follow directions well (such as children, those with cognitive impairments, those with a TBI or those in a coma).

immobilization

Hand therapy can be seen in all the following settings EXCEPT: - private settings - outpatient rehab clinics - hospitals - inpatient rehab hospitals - work places - surgeon's offices

inpatient rehab hospitals

Dominic, your client, presents with an injury impacting his thumb, index, middle and ring fingers. While he has intact sensory function on the back of his hand, he cannot feel anything at the majority of the palmar side of his hand. What nerve is injured?

median nerve

Total active motion (TAM) and total passive motion (TPM) should be used to report joint motion when working with tendon injuries. This is calculated based on the amount of flexion in a joint _________ the extension lag with the DIP, PIP and MP added together

minus

Hand therapist's treat hand injuries of the upper quadrant. This includes all of the following EXCEPT: - Hand - Wrist - Elbow - Shoulder - Scapula - Neck

neck

The following are the three categories of _____________ injuries: - Neuropraxia - Axonotmesis - Neurotmesis

nerve

Carpal tunnel and cubital tunnel syndrome are all types of ___________ (CTD)

nerve compression

______________ is nerve contusion without Wallerian degeneration

neuropraxia

______________ is a complete laceration of the nerve requiring surgical repair

neurotmesis

____________ involves taking notice of the appearance and position of the hand/arm, the client's posture, attention to their extremity, the way in which the disease or injury is treated, cervical and shoulder appearance, the presence of muscle atrophy, skin condition, the presence of edema, the presence of contractures, and the relationship between the hand and arm function during movement

observation

OT needs to focus on the unique contribution of _________ as it related to hand injuries in order to differentiate itself from PT and remain relevant in hand therapy

occupation

If the OT is helping a patient build tendon glides into their daily exercise routine, this is an example of an intervention approach categorized as _____________

occupations/activities

For a flexor tendon injury that has undergone a tendon repair, tendon gliding done by the OT can be helpful whereas active motion by the client can be harmful. This is because the _________ movement doesn't pull the tendon repair apart

passive

The following are all types of _____________: - Quick DASH - SF-36 - Michigan Hand Questionnaire - Forearm Evaluation Questionnaire

patient questionnaires

____________ is when the surgeon has to insert a plate in order for healing to occur

primary healing

OTs can begin to move a fracture that has undergone ________ healing right away; we need to give a fracture that has undergone __________ healing 4-6 weeks before beginning mobilization.

primary; secondary

The following are all true regarding complex injuries EXCEPT: - Are usually the result of significant trauma, crush injuries, deglovings, burns, gunshots, machinery accidents etc. - Are very complicated to treat and outcomes vary - Psychosocial factors are rarely an issue - Injuries often involve all of the structures of the hand (skin, muscles, tendons, nerve, blood vessels, bones) - Many of the treatment protocols for an individual injury contradicts a protocol for another type of injury that may also be present

psychosocial factors are rarely an issue

Your client, Sam, has sensory loss at the back of his hand and digits 1-4; however, this does not really impact his functioning. What nerve is injured?

radial nerve

____________ is when the body heals itself after a fracture; bone formation happens at about 4-6 weeks

secondary healing

For a median nerve injury, orthoses are used to assist with function and prevent clawing; the main focus is to return __________ if possible

sensation

When intervening with a fracture, mobilization can occur only after bone __________ has been achieved

stability

If the OT is doing tendon glides for the patient passively, or if the patient is doing it as part of an exercise, this is an intervention approach to _________

support activities/occupations

_____________ is designed to slowly slide our tendons through the carpal tunnel. This is meant to improve the flow of the tendon through the carpal tunnel.

tendon gliding

The following describes a ___________: - 1-year post nerve repair without motor innervation, a surgeon will move a tendon to the area that is injured to restore function. Immobilization occurs for 3-5 weeks after the surgery, and the focus of OT is then on training the muscle to function in its new place

tendon transfer

Lateral Epicondylitis (Tennis Elbow), Medial Epicondylitis (Golfer's Elbow), DeQuervain's Tenosynovitis and Trigger Finger are all types of __________ (CTD)

tendonitis

The following are symptoms of ____________: - Burning or pain on the outer elbow (that may travel to the wrist) - Pain worsens at night - Pain when twisting or bending the arm - Stiffness or pain when extending the arm - A swollen elbow joint that is tender to the touch

tennis elbow (lateral epicondylitis)

The following are all purposes of a hand evaluation EXCEPT: - To identify physical limitations - To identify functional limitations - To spot substitution patterns or compensations - To plan effective interventions - To spot abnormalities

to plan effective interventions

If the OT is having a patient do tendon glides repeatedly, this is an example of ________

training

T/F A person with an axonotmesis type PNI will have nerve fibers that can regenerate

true

T/F A physical assessment should come first to identify function. This assessment should not be completed on the area of concern.

true

T/F The median nerve is called the "eyes of the hand" and laceration and compression typically will cause an injury.

true

T/F A CHT can be either a PT or an OT

true

T/F A person with neurogenesis will require surgery

true

T/F Diagnoses associated with cumulative trauma disorder usually fall into one of these three categories: - Tendonitis - Nerve compression - Myofascial pain

true

T/F In an outpatient setting, the OT may need to obtain a lot of info from the client since they may not obtain a lot of documentation from the surgeon who referred them

true

T/F In hand therapy, the client is viewed more as a consumer than a patient

true

T/F PNIs can occur following a fracture, laceration or crush injury

true

T/F Reimbursement, limited insurance coverage, and the push for improved outcome measures makes service delivery of hand therapy a challenge

true

T/F The following is a good sample goal using TAM: - The client will go from 200 degrees TAM of the index finger to 230 degrees TAM of the index finger by 3/.01/23.

true

T/F Wrist fractures are the most common UE fracture

true

A client presents with a flexed pinky and index finger while all other digits are extended. As the OT, you suspect that have a _____________ injury

ulnar nerve

Mrs. Robinson is a client who has clawing at her pinky and ring finger. What nerve is impacted?

ulnar nerve

You see a client who has had an open carpal tunnel repair surgery. He also has a smaller thenar eminence in one of his hands, indicating that the muscle is ____________ from a lack of innervation

wasting