Physical Dysfunction Unit 3 Exam
What are the symptoms of rheumatoid arthritis?
- 4 cardinal signs of inflammation during exacerbation: heat, swelling, pain, redness - Tender, warm, swollen joints - Morning stiffness lasting several hours - Rheumatoid nodules (small bumps under the skin) - Fatigue, fever, and weight loss - Fusiform swelling: entire finger or one joint swells and loses the definition of the individual phalanges
What is a congenital UE amputation?
- Absence of limb or part of limb at birth - UE prostheses are generally fitted when the child is able to sit (~ 6 months of age)
How are rotator cuff tears classified?
- Acute: singular, accelerating traumatic event such as FOOSH, may accompany fracture/dislocation - Chronic: extension of shoulder impingement where microtears (tendinosis) leads to larger tears
How is sensation assessed? What are the different aspects that are measured?
- Autonomic response tests: - Threshold tests: ex: touch-pressure threshold to sense light touch and deep pressure (Semmes Weinstein monofilament test) - Discrimination tests: ex: touch discrimination (two-point test) - Functional tests: ex: stereognosis or object indentification (Moberg Pickup Test)
What are the bones and joints that the shoulder complex is made up of?
- Bones: clavicle, scapula, humerus - Joints (synovial): glenouhumeral, acromioclavicular, sternoclavicular
What are the joint deformities associated with osteoarthritis?
- Bouchard's nodes: inflammation causes permanent swelling and deformity at the PIP joint - Heberden's nodes: inflammation causes permanent swelling and deformity at the DIP joint
What are the joint deformities associated with rheumatoid arthritis?
- Boutonniere deformity: flexion of the PIP joint (caused by the detachment of the central slip of an extensor tendon) - Swan-neck deformity: hyperextension of the PIP joint (tends to result in greater loss of function for the client) - Subluxation: partial separation of joint surfaces (at base of proximal phalanges in the MCP joints - Ulnar drift: deviation of MCP joints toward ulnar side of the hand
What is frozen shoulder (adhesive capsulitis)?
- Cause: synovium of GHJ becomes inflamed (synovitis), and the soft tissue becomes thick with fibrous adhesions (fibrosis) - Symptoms: pain and significant loss in shoulder ROM - Has 4 stages: mimics other rotator cuff diseases, freezing stage, frozen stage, thawing stage
What are the causes of UE amputations?
- Congenital - Acquired
What are the characteristics of osteoarthritis?
- Degenerative joint disease (destruction of cartilage) - Complications: bone spurs - Meds: for pain - Most common (21 million) - Incidence increases with age - Localized or generalized (weight-bearing joints) - Primary - no known cause - Secondary - identifiable cause (injury, repetitive motion or stress on a joint, or after joint inflammation) - Develops slowly - No cure
Explain the role of OT in phase 3 (prosthetic training).
- Donning and doffing prosthesis - Controls training for elbow, wrist, and terminal device of: body-powered prosthesis or myoelectric prosthesis - Proportional control - ADL activity using affected UE as an assist
What does OT treatment of osteoarthritis include?
- Education and training regarding energy conservation, work simplification, and body mechanics - Lifestyle changes such as decreasing weight and increasing exercise may help reduce pain and improve function - Adaptive equipment for ADLs/IADLs, work, school, or leisure activities - Environmental modifications
What is a resting hand orthosis used for? (also called safe position, resting pan - can be fixed or moveable)
- Fixed: arthritis, CVA, burns, TBI, trauma - Movable: progressive or changing conditions
What are the levels of UE amputation?
- Forequarter - Shoulder disarticulation - Short or long transhumeral - Short or long transradial - Wrist disarticulation - Transmetacarpal
What are the causes and risk factors of fibromyalgia?
- Genetics - Infections - Physical or emotional trauma
Explain the role of OT in phase 4 (advanced prosthetic use).
- Incorporating UE prosthesis use into ADLs, IADLs, work, and leisure - Minimizing compensatory movements and biomechanical stress to uninvolved limb - Participation in ADL, IADL, work, and leisure activities with LE prosthesis
Explain the role of OT in the components of phase 2 (preprosthetic program - preparation and training).
- Increasing general endurance and stamina - Limb strengthening and ROM - Participation in ADLs - use of affected and unaffected limbs - adaptive equipment - education and training (one-handed and cross dominance training) - Myosite training
What are the three phases of fracture healing?
- Inflammation: bleeding that forms a hematoma - Reparative: bone production - Remodeling: continued healing of bone
What are the characteristics of rheumatoid arthritis?
- Inflammatory (destruction of synovium) - Complications: immune system suppressed - Meds: NSAIDs, DMARDs. corticosteroids - 2.1 million affected - ~ 40-60 years - Many joints involved (systemic-may affect eyes, organs) - Chronic autoimmune - No known cause - Sudden onset, may have exacerbations/remission; pain will increase if no movement, fatigue also - No cure
What are the symptoms of gout?
- Intense pain - Swelling - Redness - Heat/warm joint - Joint stiffness - Joint deformity
What is trigger finger?
- Involves pulleys and tendons that flex digits - Characterized by "catching" or "locking" - Produces swelling and pain - Increased incidence in persons with gout, diabetes, and RA
What is ROM and how is it measured? What are the two different kinds of ROM?
- Joint ROM is the amount of motion available at a specific joint, and in the UE it is measured with a goniometer - AROM: the amount of motion the client can actively perform without assistance (motor control and functional ability) - PROM: the amount of motion at the joint when an outside force, such as an OT practitioner, moves the joint (joint capsule, muscles, soft0tissue limitations)
How can hand injuries be prevented?
- Joint protection (avoid sustained grip or pinch, stretching exercises, use of wrist supports) - Ergonomics (work stations) - Energy conservation (pace self, short frequent rest breaks, delegate tasks)
What is an acquired UE amputation?
- Loss of limb or part of limb due to trauma or surgery - Over 2/3rds of traumatic amputations are of the UE
Body mechanics principles reflect using the body in the way it was meant to function, with correct postures and movements. What are these principles?
- Maintain proper posture and alignment - Have appropriate support - Work at the right height - Use proper bending and lifting techniques - Avoid excessive bending, lifting, or carrying
How is strength assessed? What are the different kinds of tests?
- Manual muscle testing (MMT): graded according being able to hold against resistance (O score is no muscle activity - 5 is normal) - Strength testing: to assess gross grip and pinch strength through use of dynamometer and pinch gauge (contraindicated for unstable fractures or pain such as with OA)
What are the modifiable and nonmodifiable risk factors of osteoarthritis?
- Modifiable: excess body weight, joint injury, knee pain, occupation, and structural misalignment due to muscle weakness - Nonmodifiable: gender (women more prone), age (risk increases with age), race (some Asian populations are less likely to develop OA), and predisposition to genetic factors
Identify the classifications of nerve injury according to severity.
- Neuropraxia: mildest form, result of nerve compression or repetitive stress - sensory changes, recovery expected (i.e. carpal tunnel, cubital tunnel) - Axonotmesis: more severe, result of a crush or traction injury - motor loss, long recovery - Neurotmesis: nerve is lacerated or transected, require surgery
What is the treatment for CMC osteoarthritis?
- Nonsurgical treatment: orthosis for positioning, activity modification, joint protection, patient education, modalities, stabilization exercises - After CMC joint arthroplasty: orthosis, scar management, edema management, ROM exercises
What are inflammation reduction techniques both at the onset of injury and during wound healing?
- Onset: elevation, ice, gentle compression, AROM exercises - Wound healing: manual mobilization, gentle compression, elevation, AROM exercises, e-stim
What are the classifications of fractures?
- Open: break in the skin - Closed: skin intact - Displaced: broken bones have moved out of proper position or alignment - Patterns include transverse, oblique, spiral, and comminuted
Describe hand position in regard to opening or closing a jar. How is this contraindicated for those with osteoarthritis specifically ulnar drift? What is ulnar drift?
- Opening: counterclockwise - to radial side - Closing: clockwise - to ulnar side It is contraindicated for individuals with ulnar drift to move wrist in a clockwise direction. - deviation of MCP joints toward ulnar side of hand
What are the five most common types of arthritis?
- Osteoarthritis (OA), Rheumatoid arthritis (RA), Fibromyalgia, Lupus, Gout - May be inflammatory, autoimmune, infectious, metabolic
What are the symptoms of fibromyalgia?
- Pain: symmetrical and widespread - Faitigue: fatigued upon waking and experience sleep disorders - Cognitive impairment: focus/attention issues - Other: depression and psychosocial issues
What is DeQuervain's tenosynovitis? How is it treated?
- Painful inflammation of the tendon sheaths that control thumb movement (abductor pollicus longus and extensor pollicus brevis) - Conservative management may include rest, splinting, gentle stretching, and use of ice
When evaluating the wrist and hand, what do OT practitioners use to isolate specific anatomical structures?
- Palpation (for localizing pain and determining what anatomical structures may be involved) - Provocative testing (helps "rule out" certain diagnosis, i.e. Finklestein's)
Wounds are classified by color: red, yellow, black. Explain the meaning of each.
- Red: healthy wound, new tissue growth - Yellow: indicates infection (pus) - Black: necrotic or dead tissue
What is the most common site for fractures and what is usually the cause.
- Site: proximal humerus - Cause: FOOSH
What are the various sensory tests?
- Stereognosis (Moberg Pickup Test - hand dexterity and motor activity) - Two Point Discrimination - Light Touch - Semmes Weinstein Monofilaments
What are the muscles that make up the rotator cuff? What are their functions individually and as a whole?
- Supraspinatus: humeral abduction, most active in first 15 degrees of movement - Infraspinatus: external rotation, shoulder stability - Teres minor: external rotation - Subscapularis: internal rotation As a whole the rotator cuff stabilizes the shoulder and holds the head of the humerus into the glenoid cavity and counterbalance the deltoid
What are the symptoms and aggravating motions of lateral epicondylitis?
- Symptoms: localized swelling and tenderness, pain at lateral elbow - Aggravating motions: repetitive elbow flexion and extension, repetitive gripping, wrist extended
What are the symptoms and aggravating motions of CMC osteoarthritis?
- Symptoms: pain at base of thumb, swelling, weakness, stiffness, deformity (subluxation) - Aggravating motions: pinching, grasping
What are the symptoms and aggravating motions of cubital tunnel syndrome?
- Symptoms: pain, numbness, tingling in ulnar nerve distribution (4th/5th digits) - Aggravating motions: excessive elbow flexion, sustained elbow flexion more than 90 degrees
What are the symptoms and aggravating motions of carpal tunnel syndrome?
- Symptoms: pain, numbness/tingling, swelling - Aggravating motions: static gripping, pinching, exaggerated wrist motions
What are the symptoms and aggravating motions of tendonitis?
- Symptoms: pain, swelling - Aggravating motions: gripping, pinching, wrist motions
Explain the various diseases of the tendon in regard to the rotator cuff. - Tendinitis - Tendinosis - Tendinopathy - Bursitis
- Tendinitis: repetitive strain or overuse leads to microtears and is often marked by an acute inflammatory reaction - Tendinosis: tendon degeneration; often at supraspinatus and infraspinatus as a result of low blood supply - Tendinopathy: disease of the tendon, includes tenderness on palpation and pain with movement - Bursitis: inflammation or irritation of bursa
Energy conservation and work simplification techniques are based on principles designed to reduce energy demands and eliminate unnecessary work and body motion. Give examples of EC/WS techniques.
- Use automated, lightweight, or ergonomic tools and equipment - Eliminate unnecessary tasks - Eliminate any unnecessary bending, reaching, or walking - Sit when possible - Plan work, and work according to the plan - Store frequently used items within easy reach - Spread the workload throughout the day/week - Do not start activities that cannot be stopped - Ask for help when needed
The purpose of joint protection is to reduce joint stress, decrease pain, and preserve joint structure - identify the joint protection principles?
- Use the strongest or largest joint possible to accomplish a task - Distribute the load over several joints - Avoid positions of deformity and deforming stress - Avoid holding joints in one position or repetitive movements for any excessive length of time
When treating clients with arthritic conditions, the education is one of the most important and beneficial tools OT practitioners can provide. What are some of the ways education can be provided?
- Verbal instructions and/or discussion (speak on their level, but many times they want to know specifics of what is going on in their body) - Written information/materials (handouts) - Demonstration (train and have client return demonstration)
What is the post-surgical residual limb care after an amputation?
- Wound care - Limb shrinking - Skin care - Positioning (can prevent contracture/edema) - Strengthening, balance, ROM - Pain management
Explain the role of OT in the components of limb care in phase 1 (early management and wound healing).
- Wound management - Immediate postoperative prosthesis (IPOP) and early postoperative prosthesis (EPOP) - Skin care - Limb shrinking and shaping - Desensitization
How is edema measured?
- circumferential edema measurement - always measure affected and non-affected side - measuring at the finger joints - volumeter (contraindications: open wounds, casting)
What is important to remember when considering working with patients experiencing pain?
- clients must respect pain - distinguish between discomfort and pain
What modalities should be used in the acute phase of arthritis?
- cold applications, usually at end of session for pain relief - education about precautions and contraindications needed for client to use at home - no more than 15 minutes at a time
What is a thumb spica used for? (also called short or long opponens, thumb gauntlet, thumb immobilization)
- deQuervain's tenosynovitis, trauma, scaphoid fractures, arthritis, ulnar collateral ligament injuries - As opponens, used to support thumb weakness to promote functional opposition
The most optimal outcomes are achieved when the patient is fitted for a prosthesis within 30 days of the amputation. Why is early prosthetic fit important?
- decreased edema - decreased pain - accelerated healing - supports bimanual skills - decreased LOS - increased use/acceptance of prosthesis - increased proprioceptive input - improved psychological adjustment - improved rehab outcomes
What two tools asses strength?
- dynamometer: gross grip strength - pinch gauge: pinch strength (lateral key pinch, tip pinch, 3 jaw chuck pinch
What is mirror therapy (MT)?
- effective in reducing PLP and does not require medications - Client sits parallel to a mirror or a mirror box with the view of affected limb(s) blocked - Making movements with unaffected limb facilitates cortical reorganization in the brain and reduces PLP.
What are the side effects of orally administered corticosteroids?
- fluid retention/swelling in the LEs - elevated blood pressure - weight gain - effects on mood, memory, and behavior - elevated pressure in the eyes (glaucoma)
What does OT treatment look like for distal radius fractures?
- goals: decrease pain, improve ROM, return to normal hand function - immobilization, referred to OT after clinically healed and fitted for volar wrist orthosis - gentle AROM, progressed activity, emphasize pain-free motion (CRPS can co-occur)
What is shoulder instability?
- head of humerus moves too far forward/back - common in clients with hyperlax joints, but it may also occur in clients with normal joint laxity (loose ligaments)
What modalities should be used in the chronic phase of arthritis?
- heat applications, usually used as preparatory activity - education about precautions and contraindications needed for client to use at home
What does an assessment of the UE include?
- history (onset of condition/mechanism of injury, past medical history, current complaints/symptoms, physical examination, muscle atrophy, skin changes, abnormal posture) - range of motion (ROM), strength (MMT), sensation, edema, integumentary, and vascularity
What is a soft orthosis used for?
- increased positional choices (changing ROM) such as with multiple sclerosis - poor skin integrity, protection and stability of hand - carpal tunnel syndrome, cubital tunnel syndrome, deQuervian's, lateral epicondilytis, RA, OA, joint instabilities
What are the available treatments for phantom sensations and pain?
- medication - transcutaneous electrical nerve stimulation (TENS) - mirror therapy (MT) - biofeedback/behavioral treatment - surgical intervention
What is a ganglion cyst?
- most common soft-tissue mass in the UE - develop on the synovial lining of a joint or tendon sheath - may be associated with OA - OT: suture care, scar management, ROM and strengthening exercises
What are the precautions to orthotic use?
- must have sensate skin - must be able to perform skin inspection - attend routine reassesments - edema
What functional considerations should be made with an UE amputation for the ADL of self-feeding?
- one-handed techniques - AE such as a rocker knife, roller knife, bendable or curved utensils, speciality TDs with utensil endings - modified techniques
What are the symptoms of lupus?
- painful, swollen joints - extreme fatigue and unexplained fever - butterfly-shaped rash over the nose and cheeks - photosensitivity
What are the contraindications to orthotic use?
- poor skin integrity - decreased cognitive status - undiagnosed joint instability - pain - unwillingness to accept responsibility for the use of an orthosis - age of the client and/or diagnosis
What is the treatment for Boxer's fracture?
- position in MCP joint flexion to prevent MCP collateral ligament tightness. ROM exercises as healing begins, progression to strengthening
What is Dupuytren's contracture?
- progressive contraction of the fascia in the palm of the hand - causes nodules in the falm that may lead to fixed flexion of the MCP and PIP joints, making it difficult to extend the fingers (usually in ring/small fingers) - OT: custom extension orthosis, suture care, scar management, ROM and strengthening exercises
What are the contributing factors of tendonitis?
- repetitive overhead work (tendonitis in long head of biceps) - poor posture, poor body mechanics, and the formation of bone spurs on the underside of the acromion process (may lead to impingement syndrome or subacromial decompression)
how does a scaphoid fracture occur? What is the treatment?
- results from FOOSH, most common - long time to heal due to its own blood supply - intervention: thumb spica orthosis, gentle ROM, progression to strengthening
What functional considerations should be made with an UE amputation for the ADL of grooming?
- retraining remaining limb and hand to complete tasks - AE such as long-handled comb, comb with a curved handle, or large-handled toothbrush, speciality TDs
What functional considerations should be made with an UE amputation for the ADL of toileting?
- retraining the other hand to perform toilet hygeine - specific TD, toilet aid or bidet
How can edema be managed?
- retrograde massage - elevation of limb above heart level - compression gloves
What kind of therapeutic exercise/activity should be used during active inflammation of arthritis?
- slow active movements with pain free range - prevent stiffness/loss of motion - stretch/ROM in morning before getting up - horizontal plane, gravity eliminated - ADL/IADL activities
What are the three classifications of orthoses?
- static - static progressive - dynamic
What are the contraindications for MMT?
- strength testing should not be performed on clients with new or unstable fractures or open wounds - perform testing with caution with painful conditions such as osteoarthritis
What kind of therapeutic exercise/activity should be used during chronic stage/remission of arthritis?
- strength, ROM, joint stability, endurance, fine motor coordination - active movements may stretch just beyond pain free range to increase ROM - resistive activities (theraputty, resistance bands, light weights) - bean bags/water bottles for home progressive resistance exercise - fine motor activities - walking, yoga, dance, water exercise, cycling to comfort
What is deQuervain's Tendinopathy?
- tenosynovitis (inflammation) of the first dorsal compartment - radial side of the wrist - result of repetitive thumb abduction and wrist ulnar deviation - provocative test used is Finkelstein's - OT: orthosis to rest APL and EPB tendons, modalities, AROM tendon gliding exercises, scar management, grip and pinch strengthening
What is trigger finger?
- tenosynovitis of the flexor tendons at the A1 pulley - once finger is flexed it will lock into position and be difficult to straighten (palpable nodule in the palm) - OT: positional orthosis to block full flexion, AROM tendon gliding exercises, scar management, grip and pinch strengthening, static extension orthosis for stiffness
What does range of motion inlude?
- use of goniometers - AROM, PROM, AAROM - shoulder (flexion, extension, abduction) - elbow (flexion, extension) - wrist (flexion, extension, ulnar deviation, radial deviation) - digits (MCP, DIP, PIP, thumb CMC, palmar abduction)
What functional considerations should be made with an UE amputation for the ADL of bathing?
- using a wash mitt with Velcro fastener on residual limb (depends on length of limb) - installation of shampoo/soap containers on wall - using bath sponges attached to suction cups on wall
What functional considerations should be made with an UE amputation for the ADL of dressing?
- using the prosthesis to fasten clothing by using the TD - using AE such as a button hook, elastic shoe laces
What are the tendon gliding exercises?
1. All fingers in an extended position 2. A "hook" fist (MCPs extended and IPs flexed) 3. To a "rooftop" (MCPs flexed and IPs extended) 4. To a "straight fist" (MCPs flexed, PIPs flexed and DIP joints extended) 5. To a "full fist" (MCP, PIP, and DIP joints flexed) 6. Then returning all fingers to an extended position
What assessments of the wrist and hand should be performed prior to beginning therapy?
Assessments of ROM, strength, sensation, edema, and vascularity
What is carpal tunnel syndrome?
Compression of the median nerve as it runs through the narrow space created by transverse carpal ligament and tendons of deep and superficial forearm flexor muscles
What does OT treatment of rheumatoid arthritis include?
Depends on exacerbation or remission state. - Exacerbation: joints rest and limit therapeutic exercise, client education, reducing pain/inflammation, orthotics, joint protection techniques, AE - Remission: gently progressive exercise
What is a static orthosis?
Does not have moveable parts and is usually designed to protect, restrict motion, and provide proper positioning. - immobilization, protection, and prevention of deformities
If sensation is absent for the radial nerve distribution of a hand, fine motor skills in that hand will likely be impaired. True or false?
False
When would an orthosis be used for protection?
Following a stable fracture, for tendon repairs(surgical or nonsurgical), and traumatic hand injuries
What are the risk factors for rheumatoid arthritis?
Gender (women are more likely to develop RA), age (commonly begins between 40 and 60 years of age), family history
What is a dynamic orthosis?
Has moveable or elastic parts and is used to improve motion, provide controlled motion, or compensate for loss of motion.
What is the difference between inflammation and edema?
Inflammation is the body's natural response to injury and is a common occurence in the wrist and hand while edema is excess fluid trapped in the body tissues, typically as the result of a disease or even a medication
What is tendonitis?
Inflammation of a tendon anywhere in the body
What are the signs and symptoms of osteoarthritis?
Joint pain, joint stiffness (after rest, or in morning after sleep), decreased ROM, inflammation (including swelling of joints affected), difficulty performing ADLs/IADLs, visible joint changes (Heberden's nodes and Bouchard's nodes), muscle weakness from decreased activity tolerance
What is the difference between mechanical and myoelectric UE prostheses?
Mechanical - durable - less expensive - gross movements Myoelectric - less durable - more expensive - cosmetically pleasing
When would an orthosis be used for increasing ROM?
Mobilization orthosis for passive ROM or compensate for lack of motion with stiffness resulting from scarring or lost motion after nerve compression injuries or SCI
When would an orthosis be used for positioning?
Nerve compression injuries (carpal tunnel or cubital tunnel), arthritic conditions (position against deformity), and awaiting functional return (i.e. radial nerve palsy, traumatic finger amputation, hypertonicity, normalize tone after CVA, SCI, TBI)
What is a volar wrist orthosis used for? (also called wrist cock up, wrist immobilization)
Nerve compression wrist fractures, trauma, carpal tunnel syndrome, tendonitis, ligament injuries, wrist sprain, radial nerve palsy, wrist ganglion cysts
What does OT treatment of fibromyalgia include?
No surgery possible and treatment is generally directed at relieving pain through therapeutic exercises (swimming, strengthening, stretching)
What is arthritis?
Not 1 disease but an umbrella term for a group of about 100 different forms and related diseases associated with pain, inflammation, destruction of joints, limited joint motion, and difficulty performing everyday tasks
What is cubital tunnel syndrome?
Occurs when the ulnar nerve is compressed in the cubital tunnel, located under the medial epicondyle of the humerus
What is phantom limb pain versus phantom limb sensation?
PLS: Client perceives a sensation in a specific part of, or throughout, the whole limb that was amputated such as pulling, tingling, numbness, or other sensations. PLP: The sensations experienced are specifically pain.
What is impingement syndrome?
Pinching of the supraspinatus/biceps tendon in the space under the acromion process as a result of tendons and bursa becoming irritated, trapped, or compressed by movement at shoulder.
What are the functions of an orthosis?
Protection, positioning, and improving ROM
What is the OT treatment for gout?
Recommendations for dietary modifications
What is lateral epicondylitis (tennis elbow)?
Results from microtears in the tendons attached to the lateral epicondyle of the humerus
What is the function of a passive functional prosthesis?
Similar in appearance to nonaffected limb and is passive (no movement).
With carpal tunnel syndrome, in what fingers would you expect to have numbness or tingling?
The first 3 digits (thumb, index, and middle fingers)
What are the causes of osteoarthritis?
Unknown, factors such as hereditary, injury, and lifestyle may contribute
What are the causes of rheumatoid arthritis?
Unknown, genetics plays a role, environmental factors
What is the function of a myoelectric prosthesis?
Uses electrical motors to move the TD (hand or hook), wrist, and elbow. The client controls prosthesis through the use of myoelectric signals which are piched up by electrodes in the socket.
What is a static progressive orthosis?
Uses inelastic parts to position a joint at the available end ROM with the intent of improving PROM. - decrease joint stiffness
What is the function of a body-powered prosthesis?
Uses the client's gross body movements to control an excursion on a cable attached to the harness, which then moves the TD and elbow locking mechanism - for transhumeral amputation
What are the causes and risk factors of gout?
When the kidneys are unable to filter uric acid it deposits tiny needle-like crystals into the joints and soft tissues - contributing factor is diet
What is tenodesis?
When the wrist is passively or actively flexed, the fingers extend, and when the wrist is passively or actively extended, the fingers flex
A client has been referred to the client for a static orthosis 3 days after he had sustained a fracture to the hand. In this situation, a static orthosis is used for: a. Immobilization and protection b. To gain motion c. To assist with promoting deformities d. To dynamically move joints
a.
A client has difficulty initiating humeral abduction. In addition to the deltoid muscles, what rotator cuff muscle should be evaluated to determine potential source of dysfunction? a. Supraspinatus b. Infraspinatus c. Teres minor d. Subscapularis
a.
A physician is new to your community and asks if your clinic is able to provide therapy services to his patient population. He specifically asks about fabricating and fitting orthoses. You explain to him that an orthosis is used: a. To rest painful joints, to gain motion, and to assist with loss of function b. To cause the client discomfort c. To decrease function d. To replace therapy sessions
a.
A self-reported outcome measure is usually performed at the time of evaluation and at the time of reassessment. The OTA can help to gather this data, which: a. Measures progress over time b. Provides information from the caregiver's perspective c. Provides an objective measure comparable to ROM measurements d. Wastes the therapist's and client's time
a.
An OTA has been working with a client with painful CMC joint osteoarthritis. Which of the following does the treatment plan most likely include? a. A supportive brace, modalities for pain relief, and instruction in joint protection principles b. A strengthening program, wound care, and graded motor imagery c. Graded motor imagery, electrical stimulation, and edema management d. Edema management, wound care, and ice
a.
Clients who undergo shoulder surgery often have rest and sleep disruptions. Rest and sleep is one of the occupations that needs to be addressed by OT practitioners to promote a sense of wellness and quality of life. All of the following are important recommendations that the OT practitioner should make to the client to promote better rest and sleep except: a. When prone, use a pillow under and behind the arm and shoulder for support b. Engage in quiet and pleasant activities, such as listening to soothing music and light reading, at least 1 hour before scheduled sleep c. Diminish potentially exciting stimuli by dimming lights, turning off television, and adjusting the room temperature d. Try relaxation and meditation techniques
a.
Mr. Stein has difficulty placing his hand into his jean pocket due to the inability to extend his ring finger. Which of the following conditions is Mr. Stein most likely experiencing? a. Dupuytren's contracture b. Carpal tunnel syndrome c. de Quervain's d. Rotator cuff impingement
a.
Mrs. McCoy, 72 years of age, is a widow and lives alone in a small, one bedroom apartment. She has OA in her hips, knees, and hands. She has difficulty standing for long periods of time. She wants to teach her teenage granddaughter how to make cookies from her favorite family recipe. Which of the following would you recommend for Mrs. McCoy? a. Placing a stool in the kitchen to sit while measuring and mixing ingredients b. Preparing the dry ingredients the day before her granddaughter arrives c. Purchasing a countertop mini convection oven d. Purchasing prepared cookie dough
a.
The occupational therapist tells you to incorporate cryotherapy and light massage and demonstrate light compression gloves for your client with SLE. What condition are you addressing with the client? a. Edema b. Spasticity c. Joint stiffness d. Joint pain
a.
When fabricating an orthosis, which of the following is a characteristic or property of the thermoplastic materials that you will consider when choosing the material to use? a. Drape b. Heat c. Hardness d. Stability
a.
When is it important to address shaping of a residual limb with a client? a. Before the client gets the prosthesis b. When the client is having phantom pain c. Only in the first week of prosthesis wearing d. Only when the client cannot fit into the prosthesis
a.
You are an OTA working in a skilled nursing facility. After completing the initial evaluation on a client 1 week after a total shoulder arthroplasty secondary to rheumatoid arthritis, the OT discussed with you the goal of instructing the client on how to properly doff and don the shoulder immobilizer. What would be the best method to remove the abductor pillow of the shoulder immobilizer? a. Gently pull the abductor pillow of the shoulder immobilizer from underneath and out to the front of the client b. Gently pull the abductor pillow of the shoulder immobilizer laterally outward from the client c. Gently pull the abductor pillow of the shoulder immobilizer directly in the front of the client d. Gently pull the abductor pillow of the shoulder immobilizer medially and inward from the client
a.
You are seeing a client in subacute/short-term rehabilitation setting 10 days after ORIF of a proximal humerus fracture. She identified increased independence in self-care routines as her goal. Which would be the most appropriate short-term goal for the next 1 to 2 weeks? a. Client will be able to dress independently b. Client will be able to complete meal preparation c. Client will be able to drive independently d. Client will be able to have a full bath with the aid of adaptive equipment
a.
You received an order from the physician to fabricate an orthosis for a client with a fracture. Which of the following terms are used to describe fractures in the upper extremity and may be written on the order: a. Closed, open, displaced b. Painful, swollen, red c. Hot, itchy, uncomfortable d. Cold, mild, severe
a.
A client who was to undergo a rotator cuff repair was referred for preoperative intervention. Following an OT evaluation, preoperative education was identified as a need. Which three of the following is the minimum information that the OTA must provide to the client? a. Cryotherapy b. Activity precautions c. Surgical procedures; edema management d. Exercise postsurgery e. Wound care f. Immobilization precautions
a. b. f.
After going through 6 weeks of short-term rehabilitation, a client who underwent shoulder arthroplasty was discharged home with home health services. The client's therapy protocol transitions to the "mobilization phase." Which three of the following intervention methods are appropriate at this stage? a. Restorative range of motion exercises b. Zumba classes for aerobic therapy c. Light self-care and home management activities d. Cryotherapy and moist heat, as needed e. Return to work f. Return to driving
a. c. d.
Which three of the following arthritic conditions often include fever as a presenting symptom? a. Rheumatoid arthritis b. Gout c. Systemic lupus erythematosus d. Fibromyalgia e. Osteoarthritis f. Systemic juvenile idiopathic arthritis
a. c. f.
A client is referred to the outpatient clinic with a flareup of rheumatoid arthritis affecting her right shoulder, left wrist, and both hands. Which three OT interventions would you most likely incorporate into her treatment? a. Use of a wrist-hand orthotic b. Theraband exercises for shoulder ROM c. Moist heat before exercising d. Pulling on Velcro checkers to strengthen her wrist e. Doing gentle AROM exercises in bed before getting up in the morning f. Receiving instruction in joint protection techniques
a. e. f.
What is lupus characterized by?
autoimmune, systemic - affecting many body systems and organs as well as the joints; symptoms mimic those of other conditions
A client with unilateral transhumeral amputation is ready to begin prosthetic training with a body-powered prosthesis. During the first session, after the initial evaluation, the client mentions to the OTA that she would like to work on folding clothing during the session. What should the OTA explain to the client is the recommended sequence of training with the prosthesis? a. Use of bimanual drills before repetitive drills b. Use of repetitive drills before practicing folding clothing c. Folding clothing multiple times before doing repetitive drills d. Performing meal preparation before doing bimanual drills
b.
During initial training of a client with transradial amputation on how to use a myoelectric prosthesis, the client asks the OTA, "I want to learn all the grips that this hand has." What concepts should the client be educated on at this point in the training? a. How to change to different grasp patterns available for the myoelectric hand b. Prepositioning of the terminal device (TD) c. Proportional control of TD d. Desensitization of the residual limb
b.
Serial casting has been used to treat both orthopedic and neurological conditions. Because of its effect on tissue lengthening, serial casting was first used in orthopedic applications to treat which of the following? a. Frozen shoulder b. Club foot c. Wrist sprains d. Mobility
b.
You are an OTA working in outpatient rehabilitation. After the OT completes the initial evaluation on a client 3 weeks after a rotator cuff repair, he states that the client's occupational performance of specific ADLs needs further assessment. Which of the following is an appropriate OTA role during the ongoing assessment process? a. Perform orthopedic screening tests b. Observe the client's performance in self-care tasks and perform a task analysis which tasks are most challenging for the client c. Interview the client on what activities are meaningful to him or her d. Assess the client by using the Barthel Index
b.
You have a new client who is being seen after a tendon laceration and repair in your outpatient clinic. For this client, which of the following statements regarding strength testing is true? a. Strength should always be assessed on the first therapy visit b. Strength testing should only be performed when the client's condition is stable c. Only the treating occupational therapist may perform strength testing d. Strength is tested on a scale from 1 to 10
b.
Your client had a flexor tendon repair to the right dominant hand one week ago. Which of the following is the most likely current course of treatment for the client? a. Active exercises and no protective orthosis b. Sutures in place with a dorsal blocking protective orthosis c. A protective extension orthosis just to the finger d. A cast over the ulnar two digits with the MP joints flexed
b.
Your client is having a severe flareup of gout. Which energy conservation tip might be most useful to review with him during your OT session today? a. Use long-handled utensils b. Sit when possible c. Avoid prolonged grasp d. Use lightweight tools
b.
Your client with RA complains that in the morning her hands are so stiff that she has difficulty with dressing and grooming activities, thus making her late for work. What do you recommend for her morning routine? a. Get up 30 to 60 minutes earlier b. Soak her hands in a sink of warm water for 5 minutes before starting ADLs c. Use a TENS unit for 15 minutes first thing in the morning d. Ask her spouse to assist her with her ADLs in the morning
b.
A client has been referred for a custom orthosis; however, during initial assessment, she is found to have decreased ROM, edema, and impaired sensation in her wrist and hand. Which three of the following are precautions when fitting this orthosis? a. Decreased ROM b. Edema c. Impaired sensation d. Poor skin integrity e. Application to the dominant hand f. The presence of complex regional pain syndrome
b. c. d.
Which three of the following are common symptoms of fibromyalgia? a. Fusiform swelling of joints b. Fatigue c. Depression d. Memory impairment e. Nodules under the skin f. Rash
b. c. d.
After reviewing the initial evaluation, you find that your client has muscle strength of zero in the right dominant wrist extensors. Which three of the following best describe your client? a. Has normal strength at this time b. Is able to take resistance when pulled into extension c. Is unable to lift the wrist up against gravity d. Is unable to flex the wrist e. Has difficulty using a hairbrush or screwdriver f. Is able to actively grasp and release a foam ball
b. c. e.
The OT completed a careful evaluation on the hand of an injured worker as he uses his wrist and hand to perform gripping and the manipulation of small objects. An OTA will see the client on the first return appointment. Which three of the following should this treatment session include? a. A sensory evaluation b. Review of the home exercise program c. A discussion regarding activities that exacerbate symptoms d. A client-reported outcome measure e. Modalities that the client is requesting and that are part of the plan of care f. A workplace evaluation
b. c. e.
The OTA walks into the client's inpatient rehabilitation room on the third day following his upper extremity amputation, and the client states, "I am having pain in my fingers even though I know they aren't there. Is there anything we can do about it?" Which three of the following would be the best treatment strategy to try for this client complaint? a. Use of weight-bearing techniques b. Use of transcutaneous neuromuscular stimulation (TENS) c. Speaking with the physician regarding this complaint so that she can consider medication management d. Recommend wearing a prosthesis to reduce the phantom limb pain e. Use of repetitive residual limb movements f. Use of mirror therapy
b. c. f.
While in the inpatient rehabilitation setting, which three of the following should be the focus of the early OT treatment plan for the client with upper limb loss? a. Having the client do repetitive drills with the prosthesis b. Educating the client on the use of assistive/adaptive equipment during self-care tasks c. Increasing the client's ROM and strength d. Training the client on how to fold clothing with the prosthesis e. Teaching the client to don/doff the prosthesis f. Educating the client on one-handed techniques
b. c. f.
A client with carpal tunnel syndrome could benefit from a wrist orthosis, but the client's insurance will not pay for a custom-made orthosis. Which three of the following do you recommend? a. Tell the client to just pay out of pocket for the custom orthosis b. Inform the referring physician that the client is unable to pay for the custom orthosis c. Make the orthosis, and do not charge the client d. Advise the client where he or she can find a suitable alternative e. Explain the purpose of the orthosis, and have the client try a prefabricated version of the orthosis f. Recommend that the client borrow an orthosis from a friend who used it for the same condition
b. d. e.
List the following in order, starting with what is closest to the skin: a. socket b. shrinker c. socks
b. shrinker c. socks a. socket
A client has been referred for shoulder stiffness. This client has been wearing a sling much longer than what was prescribed by her physician provider. The client is able to shrug her shoulders and protract and retract her scapula with little to no problem. However, shoulder abduction, flexion, and internal and external rotation are diminished. The most likely explanation is stiffness of the connective tissues surrounding the: a. Sternoclavicular joint b. Acromioclavicular joint c. Glenohumeral joint d. Scapulothoracic articulation
c.
A client is referred to OT with the diagnosis of shoulder pain resulting from impingement syndrome. If the client wants to know what is wrong with her shoulder, the most appropriate response should be: a. "You should ask your doctor." b. "I'm sorry I am just an OTA and can't answer that question." c. "Your doctor diagnosed you with shoulder impingement, which means that there are inflamed soft tissues that are getting pinched when you move in a certain way." d. "Your doctor diagnosed you with shoulder pain as a result of impingement syndrome."
c.
A client was referred to the clinic for a dynamic orthosis 2 weeks after surgically repaired nerves which were damaged when he had sustained a gunshot injury to the arm. In this situation, a dynamic orthosis is used: a. For immobilization b. To gain stiffness c. To compensate for loss of motion and improve function d. To statically position joints
c.
A client with finger stiffness has been referred for an orthosis to increase the joint ROM in the proximal interphalangeal joint of the index finger. Which of the following statements regarding orthosis fabrication and fitting is true? a. Making a pattern is just a waste of time b. Having the proper tools will not assist with orthosis fabrication c. A client education handout should be given to the client for ease in following directions regarding orthosis use d. Orthotic fabrication is not an effective treatment intervention
c.
In addition to pendulum exercises, which of the following exercises are typically indicated for a client 10 days after ORIF of a proximal humerus fracture? a. Active shoulder flexion b. Elbow flexion and extension with 2lb weights c. Scapular shrugs and pinches d. Passive stretching in all planes of motion
c.
In the middle of the OT session, your client with fibromyalgia starts crying and says, "I can't stand this pain anymore. When I get home from work, I am so miserable and tired that sometimes I can't remember what I'm doing when I'm making dinner. I hope I don't burn the house down." What is your best response? a. "I know just how you feel. It's horrible to be so tired and in pain." b. "You think you have it bad? Mrs. Smith over there can't even dress herself." c. "It must be frustrating when you feel like this. Let's brainstorm some ideas to lighten your load." d. "Why are you still doing all the cooking? What about your husband or kids?"
c.
The client is a 52-year old female who lacerated her extensor tendon in the left middle finger and is three days after a tendon repair. What is her treatment likely to include? a. A dynamic orthosis for flexion b. ROM and strength testing c. A protective orthosis, suture care, and dressing changes d. Ergonomics and return-to-work training
c.
You are an OT pratitioner in an outpatient setting, treating a client who has suffered a CVA. This client presents with a flaccid wrist and hand. He was not fitted for an orthosis while in acute rehabilitation; however, he reports that his hand is getting more swollen and painful and this prevents him from trying to engage in functional activities. Which orthosis would you fabricate for this client? a. Finger orthosis for protection b. A dynamic shoulder orthosis for stretching the shoulder c. WHFO to position the wrist and hand to prevent contractures d. A static progressive hand orthosis to gain end range of motion
c.
Your client complains that pain and swelling in her hands is preventing her from doing her shoulder exercises. What recommendation would you give her for home? a. Take a warm shower before exercising b. Squeeze a stress ball 10 times before exercising c. Do shower exercises holding a cold water bottle in each hand d. Do not do any exercises until her hands feel better
c.
What is complex regional pain syndrome (CRPS)?
chronic pain syndrome that develops either in the upper or lower extremity and is characterized by swelling, stiffness, burning pain, hypersensitivity to cold, changes in skin color, hair growth, and nail growth, and a loss of functional use of extremity
What is fibromyalgia characterized by?
chronic widespread musculoskeletal pain instead of joint pain or destruction
What does the box and block test measure?
coordination, dexterity, UE function, gross motor movements
A client with a diagnosis of radial nerve palsy has been referred for a custom orthosis. He presents with inability to extend the wrist and fingers. This loss of motion makes it difficult for him to release objects from his hand after gripping. The goal of the orthosis would be to: a. Immobilize the wrist and hand b. Protect skin from exposure to heat and cold c. Gain end ROM in stiff joints d. Assist with function by providing wrist and finger extension while awaiting nerve return
d.
A client with traumatic transradial amputation of the dominant arm is participating in OT after receiving the prosthesis. The occupational therapist has incorporated a goal into the treatment plan to facilitate independence with feeding and meal preparation. Which of the following is the best procedure for the OTA to recommend the client to use when cutting meat? a. Hold a regular knife with a builtup handle in the terminal device, and hold the plate with the nondominant hand b. Hold a regular knife with the terminal device to cut the meat and a regular fork with the nondominant hand c. Use a rocker knife with the nondominant hand, and hold the plate with the terminal device d. Hold a regular knife with the nondominant hand, and hold a regular fork in the terminal device
d.
Mrs. Mullis is recovering from hand surgery, and comes to her outpatient OT appointment noting increased pain in her incision. The OTA uncovers the inceision and is immediately concerned about infection. Which of the following are the visual signs of infection in a wound? a. Tight, red, purple b. Open, blue, painful c. Black and dry d. Yellow and exuding pus
d.
Which orthotic would you recommend for a client with osteoarthritis of the thumb CMC joint? a. Functional position orthotic b. Forearm-based orthotic with wrist in slight extension and thumb in 45-degree abduction c. Figure-eight orthotic d. Hand-based orthotic with the thumb abducted in a position of comfort
d.
What is one of the most common fractures of the UE and what does it result from?
distal radius fracture resulting from FOOSH
What does the kapandji score measure?
end stage opposition (range from 0 to 10)
Swelling, or edema, is one of the cardinal signs of inflammation. How is edema managed with arthritic conditions?
light compression garments (gloves), light massage, application of modalities (cryotherapy)
What does the minnesota manual dexterity test measure?
simple hand-eye coordination and gross motor skills
What is the most frequently torn muscle of the rotator cuff?
supraspinatus
What does the 9 hole peg test measure?
tests dexterity and UE function, fine motor movements
What does the Jebsen hand function test measure?
tests overall UE function
What does the purdue pegboard test measure?
unimanual and bimanual finger and hand dexterity