654 midterm
lumbricals innervation
1 and 2: median nerve 3 and 4: ulnar nerve
pin care external fixation
1-2 times per day hydrogen peroxide or sterile saline cover with dry gauze no petroleum products as they lead to breakdown
how much of the orthosis for circumference for wrist orthosis
1/2 of circumference
cubital tunnel immobilization after surgery
10 days
how many ue joints
19
DeQuarvain's Tenosynovitis surgery
1sst dorsal compartment release
cubital tunnel scar mgmt surgery
2 weeks
DeQuarvain's Tenosynovitis post surgery
2 weeks immobilize after 2 weeks prom strengthening 3-4 weeks
immobilize for lateral epicondylectomy
2-4 weeks 90 elbow flexion 30 wrist extension
distal pins DRF
2nd metacarpal shaft
how much of the orthosis for length of forearm orthosis
3/4 of length
lateral epicondylectomy post surg
4-5 weeks active stretch wean las week 6 progressive strength week 8
post surgery DRF grip
4-6 weeks
DeQuarvain's Tenosynovitis orthois rec
4-6 weeks avoid thumb flexion with wrist flexion
DIP fracture discontinue
4-6 weeks and begin desensitization
how to position for cubital tunnel orthotic
40-60 extension
cubital tunnel strengthening
6 weeks ulnar nerve glides
medial epicondylectomy PROM
6 weeks wean orthosis strength 6-8
long arm cast TFCC conservative
6 weeks elbow 90 degrees flexion forearm and wrist in neutral
AROM for metacarpal fracture
6 weeks or by md
typical phalanx immobilization
6 weeks with edema control when possible
typical fracture heal time
6-8 weeks
wrist strengthening post surgery DRF
6-8 weeks
loss of protective sensation
6.65 red
prom of wrist external fixator
7-8 weeks include weighted stretch and progressive strengthening
how many carpal bones
8
DeQuarvain's Tenosynovitis involves
APL EPB
wrist and hand muscles innervated by median nerve
APL OP Lumbricals 1/2 FPB
AROM lateral epicondylectomy
AROM elbow after 2 wseeks AROM of wrist forearmhand with elbow in flexion
6 weeks tfcc surgery
AROM for elbow wrist forearm LAC at night PROM elbow olnbly scar mgmt desense weighted elbow
another name for metacarpal fracture
Boxer's fracture
largest carpal
Capitate
radial nerve innervation 9
ECRL ECR ECU EDC EDM EPL EPB APL supinator
2nd dorsal compartment
ECRL ECRB
wrist extensors
ECRL ECRB ECU
muscles involved with lateral epicondylitis
ERCL ECRB ECU
wrist flexors
FCR FCU palmaris longus/brevis
muscles involved in medial epicondylitis
FCR FCU pronators
ulnar nerve innervation 10
FCU FDP 4/5 ADM ODM FDM lumbricals 3/4 PAD DAB FPB deep ADD p
forearm ain uscles innervated by meduian nerve 3
FDP 2/3 FPL PQ
What is in the flexor retinaculum
FPL tendon 4 FDP tendons 4 FDS tendonds median nerve
most commonly dislocated carpal
Lunate
safe position phalanx splint
MP 60-70 degrees IP 0 degrees
is safe position a hand based splint
NO
dynamic flexion splint and NMEs used with
PIP fracture with dorsal dislocation
hardest finger to rehab
PIP of 5th digit
axial load test
Position with elbow resting on table Therapist gentle ulnarly deviates and extends the wrist Apply pressure axially (vertically) toward elbow
test for lateral epicondylitis
Resisted wrist extension, passive wrist flexion
clavicle fracture requires exam of
SC and AC joints
floor of anatomical snuffbox
Scaphoid
distal radius fracture with volar displacement
Smith's fracture
allens test for arterial patency
Test to determine the radial and ulnar artery contribution to the hand
humeral shaft fractures
Usually the result from blunt trauma/direct blow to the upper arm
spiral fracture
a fracture in which the bone has been twisted apart
6 weeks tfcc conservative
a/aarom towrist and forearm gentle prosup immobilize between
1st dorsal compartment
abductor pollicis longus extensor pollicis brevis
anatomical snuffbox muscles
abductor pollicis longus extensor pollicis longus extensor pollicis brevis
dorsal interossei action
abducts fingers
memory
ability for material to return to original size shape and thickness
conservative exercises medial epicondylitis
achieve pain free AROM progress to active stretch progress to pain free passive stretch progress to pain free strengthening
transverse fracture
across the bone usually result of direct force
atrophy of thumb web
adductor pollicis
palmar interossei action
adducts fingers
Scar mgmt of external foxator
adhesions near pins common extrinsic extensor tightness
AROM to PROM with scaphoid
allow prom when one week of pain free arom
allowing palmar surface open
allows for contact with environment and improves sensory input
grind test
apply compression and rotation to thumb positive if grind at cmc
trapezium
articulates with 1st mc and comprises cmc
A/AA/PROM of digits with external fixation
as permitted by fixator A/PRO< for shoulder and md permit forearm
grind test for
assess cmc of oa
AROM elbow medial epi
at 3 weeks while pronated and wrist flexed
DIP fracture PROM
at 4-6 weeks
energy conservation
attitudes and emotions body mechanics work place leisure time work methods organization
types of phalanx fractures
base shaft tuft
trapezoid
base of 2nd mc
ECRL insertion
base of 2nd metacarpal
flexor carpi radialis insertion
base of 2nd metacarpal
ECRB insertion
base of 3rd metacarpal
ECU insertion
base of 5th metacarpal
high elasticity/resistance to stretch
be worked more aggresivley
DIP fracture AROM
begin 2-3 weeks post injury w splint in between and at night
greenstick fracture
bending and incomplete break of a bone; most often seen in children
orthotic theories
biomechanical sensorimotor rehabilitative
diminished light touch 3.61
blue
comminuated fracture
bone breaks into more than two pieces
malunion
bone heals but unsatisfactory alignment
compound fracture
break in the bone where the bone comes through the skin; open fracture
ADL assessment
buttoning zipping grasp pinch ADL/IADL ROM ADL/IADL work assessment
removal of external foxator
by 6 weeks
neoprene
can be simple to complex and include pockets for plastics and straps to influence material
caution with counterforce
can cut off circulation
carpal at base of 3rd mc
capitate
volkmans deformity/ischemia cause
caused by lack of bloodflow to the forearm brachial artery
tfcc surgery
central debridment repair of peripheral tear
ulnar nerver injury
claw hand/bishops hand atrophy of hypothenar interossei atrophy atrophy of thumb web froment sign flexion deformity of 4th and 5th
TFCC injury presentation pain
clicking/snapping w forearm rotation ulnar sided wrist pain druj instability pain with forearm rotation positive axial load paid with ud rd pain to tfcc area
resolving extrinsic extensor tightness post external fixation
close proximity to EIP and EPL
simple fracture
closed no damage to soft tissue
conservative`
closed reduction
conservative treatment DRF
closed reduction 6-8 weeks fingers free A/PROM for shoulders digits elbow
pendulum exercises
codmans pendulum exercises not active movement educate
distal radius fracture with dorsal displacement
colles fracture
proximal and distal humeral fractures
common result of fall
edema treatment interventions
compression garments retrograde massage contrast baths elevation PAMS AROM
volumetric assesment
contraindicated when wounds are present
tinels examines
damage compression point of regeneration with or without reflex hamer
osteoarthritis etiology
degenerative joint disease- noninflammatory deterioration of the articular cartilage- formation of osteophytes
three ways skin damaged by pressure/stress
degree duration direction
drapability
degree of ease in which material conforms to underlying shape without manual assistance
bonding
degree the material will stick to self when heated
blue
diinished light touc 3.61
purple
diminished protective sensation 4.31
tendinosis
diseased tendon state from build up of scar tissue
phalanx fractures often accompanied by
dislocation volar plate disruption
ulna in pronation
distal
triuetrium usually fractured by
distal radius crush
most common fracture
distal radius fracture
colles fracture
distal radius fracture with dorsal displacement
smiths fracture
distal radius fracture with volar displacement result of foosh
metacarpal arch
distal transverse arch
PIP fracture with DORSAL dislocation treatment
dorsal blocking gutter splint PIP 30-40 flexion begin edema control asap
temporary orthosis
during healing phases post peripheral injury stretch structures
healing complications
edema joint contractures atrophy spasms RSD/CRPS
Patient education
education on disease process and management teach signs of inflammation orthotic education and management use of PAMS at home energy conservation joint protection adaptive equipment home modification
orthotic position medial epicondylectomy
elbow 90 flexion forearm neutral wrist 15 degrees flexion
sugar tong splint used for
elbow/forearm injuries unstable proximal radius or ulna fractures distal humerus fracture both bone forearm fractures
conservative treatment DRF edema control
elevation ice retrograde massage
for decreased energy
energy conservation facilitate performance
for impaired grasp
enlarge circumference of the handles
6th dorsal compartment
extensor carpi ulnaris
5th dorsal compartment
extensor digit minimi
4th dorsal compartment
extensor digitorum communis extensor indicis
extrinsic extensors 6
extensor digitorum communis extensor indicis proprius extensor digiti minimi extensor pollicis brevis extensor pollicis longus abductor pollicis longus
3rd dorsal compartment
extensor pollicis longus
splinting
fabricating an orthosis
clavicle fracture treatment
figure 8 strap shoulder immobilizer ORIF/IM rodding but surgery rare
extrinsic flexors 4
flexor digitorum profundus flexor digitorum superficialis flexor pollicis longus flexor pollicis brevis
palmaris longus insertion
flexor retinaculum palmar aponeurosis
medial epicondylectomy
flexors and pronators incised epicondyle debrided muscles reattached to vascular bed
permanent orthosis
for cns dysfunction
coaptation splint
for humeral shaft and shoulder fractures, use with sling
medial epicondylitis caused by
forceful repetitions for the FCR pronator teres FCU
tension
forces are pressing outward joint distraction
compression
forces pressing inwards
what orthotic piece should you center first
forearm
cubital tunnel immobilization AROM/PROM
gentle 10 days to elbow forearm wrist and hand
static progressive orthosis
gradually stretches structures via prolonged static stretch
normal sensation 2.83
green
dynamic orthosis
has moving parts and multiple purposes
terrycloth
helpful to control tone and provide support can be used at night to influence structure and avoid high pressure areas
base fracture
horizontal
flexor carpi ulnaris origin
humeral head- medial epicondyle ulnar head- olecranon process
radial nerve injury common with
humeral shaft fractures
non articular orthosis example
humerla prace
positive froments sign
hyperextension of mp and flexion of ip
therapeutic intervention post surgery DRF
immediate AROM shoulders elbow digits
conservative management medial epicondylitis
immobilization lifting techniques orthosis and rest ultrasound iontophoresis heat/ice massage contrast bath activity modification ergonomic education
for joint deformities
increase leverage prevent static holding
key to managing stress
increase the area of which the force is applied increased forearm length wider straps
tendinitis
inflammation of a tendon
AROM PIP DORSAL dislocation
initiated within splint 3-5 days
volkmans deformity/ischemia results in
injury to muscle/nerve/tissue caused by increased pressure similar to compartment syndrome
flexor pollicis longus
inserts on distal phalanx of thubb
flexor pollicis brevis
inserts on proximal phalanx of thumb
lateral epicondylitis
is inflammatory response at lateral epicondyle involving wrist extensor muscles
extrinsic tightness
lack of flexion due to extensor tendon short/tight lack of PIP flexion when MP is flexed increased PIP flexion when MP is extended or hyperextended
positive intrinsic tightness
lack of pip flexion when mp extened
1st dorsal interossei
last to be innervated
ECRB origin
lateral epicondyle
ECU origin
lateral epicondyle posterior border of middle 1/3 of ulna
tennis elbow
lateral epicondylitis
ECRL origin
lateral supracondylar ridge of humerus
for decreased ROM
lengthen handle on objects organize within easy reach
intrinsic tightness
less PIP and DIP passive flexion with the MP joint extended
10-14 days tfcc surgery
long arm cast a/prom digits
Scaphoid orthosis
long arm thumb spica 16-20 weeks above elbow sometimes short arm
scaphoid surgical treatment
long or short spica post surgery short arm splint by 2-3 weeks AROM/PROM of fingers and ip of thumb
shaft fracture
longitudinal
red
loss of protectice sensation 6.65
intrinsic muscles
lumbricals palmar interossei dorsal interossei
main goal of orthoses
maintain structures of wrist and hand to preserve prehension and function
transverse carpal ligament
makes up volar aspect of carpal tunnel
metacarpal fracture complications
malrotation
rehabilitative approach
maximize function and focus on ability rather than disability
children considerations
may lack normal hand function lack of hand use for wb lack of developed arches
flexor carpi radialis origin
medial epicondyle
palmaris longus origin
medial epicondyle
surgical intervention for medial epicondylitis
medial epicondylectomy
golfers elbow
medial epicondylitis
tinels can indicate which nerves
median ulnar digitial
abductor pollicis brevis innervation
median nerve
flexor carpi radialis innervation
median nerve
opponens pollicis innervation
median nerve
palmaris longus innervation
median nerve
more drabability allows for
more conformability
reminders for metacarpal fracture splints
more room for pins mold transverse and longitudinal arch
lumbricals action
mp flexion
possible complications of clavicle injury
nerve and vascular damage
green
normal sensation 2.83
red lined
not testable >6.65
conservative treatment of DRF red flags (monitor cast)
numbness or tingling cold sensation discoloration of digits changes in skin temp
PIP fractures
often with dislocation articular surfaces compromised
ORIF on metacarpal fracture can
on prox phalanx there is not enough tissues and hardware can fray or snap tendon or come out
static orthosis
one piece provides support and immobilization
surgical
open reduction
hypothenar muscles
opponens digiti minimi abductor digiti minimi flexor digiti minimi brevis
thenar muscles
opponens pollicis abductor pollicis brevis adductor pollicis flexor pollicis brevis
multiple splints
orthoses
splint/noun
orthosis
adjective
orthotic
fracture etiology other orthopedic conditions
osteopenia osteoarthritis heterotrophic ossificans
benefit of splinting dorsally must
outweigh the possible skin breakdown associated woth splinting over bony prominences
order of sensory return first
pain and temp
lifting techniques for lateral epicondylitis
palm up avoid pronated pick up
PAMS
paraffin fluidotherapy TENS cold biofeedback Heat
if non union of scaphoid bad then
partial wrist fusion proximal row carpectomy
spint protocol PIP fracture w dorsal dislocation
pip 30-40 flexion increase splint extension 10-15 at week 4 and again at week 5 DC splint at week 6
flexor carpi ulnaris insertion
pisiform hamate 5th metacarpal
flexion goni
place dorsally
extensor goni
place volar
positioning client for orthosis
position before taking material out of water
10-12weeks tfcc surgery
progressive strengthening
delayed union
prolongation of expected healing time for a fracture
8 weeks tfcc surgery
prom wrist forearm dynamic orthosis cut down las wearing
sugar tong splint prevents
pronation and supination
forearm muscels innervated by median nerve 4
pronator teres palmaris longus FCR FDS
volar/palmar plate
provide stability prevent hyperextension
TFCC and druj
provide stability in pronation
ulna in supination
proximal
proximal pins DRF
proximal radius shaft
carpal arch
proximal transverse
diminhsed protective sensation 4.31
purple
ECU innervation
radial nerve
extensor carpi radialis longus and brevis innervation
radial nerve
last motion allowed with scaphoid injury
radial/ulnar deviation
primary mover in rotation
radius
DeQuarvain's Tenosynovitis due to
repetitive thumb motions mothers who cradle infant head
coated materials
require bonding agent and surface prep
elasticity
resistance to stretch
Dynamic extension splinting used for
resolve PIP extension lag once fracture is healed
External fixation used for
resolve bone length and proper alignment
dynamic splinting used to DRF
resolve residual wrist rom deficits
joint protection techniques
respect the pain maintain muscle strength and joint rom avoid positions that place stress on joints avoid staying in one position for too long use strongest muscle when available distribute workloads over multiple joints
permanent orthosis example
resting hand splint tenodesis orthosis anti spasticity orthosis
biomachanical principles across age
same with adults and children
floor of flexor retinaculum
scaphpoid lunate triquetrium hamate
scar mgmt de sens medial epicondlectomy
scar when healed edema immediate
tuft tracture
shattered to multiple fragments
worst force direction
shear
directions of force
shear tension compression
tfcc function
shock absorber stabilize druj fills gap during ud provide articular surface
factors that slow bone healing
smoking alcohol obesity infection damage to blood supply diabets steroid use
factors that contribute to fast bone healing
stability alignment compression
for instability
stabilize objects provide support for safety
order of sensory return last
stereognosis
medical interventions for epicondylitis
steroid injection protein rich plasma injection
8 weeks tfcc conservative
strengthening if painfree avoid loading until 1-2 weeks of strength
flexor pollicis brevis innervation
superficial median deep ulnar
volkmans deformity/ischemia associated with
supracondylar fracture of the humerus
conservative management humeral fracture
swath and sling coaption splint clamshell brace sugar tong splint pendulum exercises
when not to use iontophoresis
tendinosis
froments sign
test for ulnar nerve dysfunction
axial load test for
tfccinjury
treatment for humeral fracture
therapy shoulder replacement ORIF closed reduction casting/orthotics
three point pressure
three linear forces force in middle is directed the opposite
conservative mgmt for DeQuarvain's Tenosynovitis
thumb spica radial gutter
MCP/PIP collateral ligaments
tight in flexion loose in extension
DIP base/shaft/tuft fracture ortho
tip protection splint with DIP in extension A/PROM to all joints except DIP
transverse carpal ligaent attaches
to trapezium radially to pisiform ulnarly
low stress and low pressure
tolerated for longer periods but can even lead to capillary damage
nonunion
total failure of healing of a fracture in 4-6 months
fracture etiology
traumatic stress stress fracture- force applied to bone pathological disease of joint bone
nonunion of scaphoid
treated by bone stimulator
second most commonly fractured carpal
triquetrium
adductor pollicis innervation
ulnar nerve
dorsal interossei innervation
ulnar nerve
flexor carpi ulnaris innervation
ulnar nerve
hypothenar innervation
ulnar nerve
palmar interossei innervation
ulnar nerve
flexion deformity of 4th n 5th digit
ulnar nerve dysfunction paralysis of lumbricals
characterisitcs of median nerve injury
unable to oppose thumb unable to make complete fist atrophy of thenar eminence weak wrist flexion weak pronation
medial epicondylectomy AROM
unrestricted AROM wrist elbow at 4 weeks
non articular orthosis
uses 2 point pressure system
articular orthosis
uses 3 point pressure system most ue othotics
biomechanical approach
uses biomechanical principles of kinetics and forces acting on the body
bone stimulator
uses low electrical currents to stim bone growth
buddy tapping
using an anatomic splint by taping an injured finger or toe to an uninjured finger or toe next to it
sensorimotor approach
utilizes techniques inhinbiting or facilitating normal motion
which direction is lunate dislocayed
volarly
malrotation
when bone heals and one piece rotated out of place causing should point at scaphoid fingers look crossed impairs grip
shear
when parallel forces applied in equal and opposite forces
low elasticity/resistance to stretch
worked more lightly
Metacarpal fracture safe position splint
wrist 15 degrees extension MP 60-70 flexion PIPs 0 degrees
DeQuarvain's Tenosynovitis positioning for orthosis
wrist 15 degrees extension thumb between radial and palmar abduction mp 10 degree flexio ip free able to oppose
radial nerve injuries
wrist drop lack mp extension lack thumb ip extension lack thumb abduction grip affected associated with displaced humeral fractures
ECRB action
wrist extension
ECU action
wrist extension ulnar deviation
ECRL action
wrist extension radial deviation
palmaris longus action
wrist flexion
flexor carpi ulnaris action
wrist flexion ulnar deviation
flexor carpi radialis action
wrist flexion wrist radial deviation
how to test for medial epicondylitis
wrist flexion mmt elbow flexed 90 reports pain with resisted pronation and flexion
