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Hands and Upper Extremities Hand and Upper Extremity Worksheet By Stephanie Shane OTR/L "Pass the NBCOT" OT interventions e.g. Symptoms/Characteristics/OT ROM/Exercises/Edema Injury/Condition assessments control/Tendon gliding etc Potential Splints Contraindications Picture Restricted passive shoulder PROM, modalities, encourage range of motion; AKA frozen active use, pain management Adhesive tendonitis shoulder (modalities) People who cannot move the thumb away from the rest of the hand. It is an inability to abduct the thumb. High median nerve injury at the elbow or proximal forearm. Sensory loss in index, middle, and raidal side of finger; loss of pinch, thumb opposition, index finger MCP and PIP flexion; and Ape Hand decreased pronation. A form of joint disorder that With a resting splint address the involves inflammation of one natural aging process of skin and or more joints. Two types: adipose tissue. Use soft straps Functional split or safe splints, depending Arthritis OA and RA. and thick padding. on stage Tendon separates from the bone and its insertion and removes bone material with the tendon. (i.e.., mallet finger, boutonniere deformity, Avulsion injuries swan neck deformity) Orthotics are used for immobilization as needed. ROM is begun early, within 1 week if medically cleared. A sling is used for type 1 fractures or comfort if Fracture of the first the client has pain and is nervous Bennet's fracture metacarpal base. in public places. A type of injury to flesh or skin caused by heat, electricity, chemicals, friction, Superficial, partial thickness or radiation. Burns that affect burns: wound care and only the superficial skin are debridement, sterile whirlpool, known as superficial or first- dressing changes, gentle degree burns (i.e. sunburn). A/PROM to individual's tolerance, When damage penetrates edema control, splinting if into some of the underlying necessary, ADL's and role layers, it is a partial-thickness activities. Deep partical thickness or second-degree burn. In a burns: wound care and full-thickness or third-degree debridement, sterile whilpool, burn, the injury extends to all dressing changes, gentle layers of the skin. A fourth- A/PROM to individual tolerance, degree burn additionally edema control, splinting if involves injury to deeper necessary, ADL's and role tissues, such as muscle or activities, and strengthing (when Airplane splints. Heal in anatomical Burns bone. wounds are healed). position The metacarpophalangeal joints to be splinted in 70°–90° of flexion to prevent clawing of the fingers and shortening of the tendons and ligaments. This type of Passively range each digit and splint is also referred to as an joint one at a time. Ranging each antideformity splint, safe position splint, or joint separately decreases the intrinsic plus splint. Splinting the hand in chance of rupturing finger the safe position allows the graft to take Burns to the dorsum of the extensor tendons with dorsal and the wound to heal and prevents hands hand burns. deformities. Silver rings. PIP is splinted in extension PIP joint flexed, and the DIP Isolated DIP flexion exercises are and isolated DIP flexion exercises are Boutonniere deformity joint hyperextended. performed. performed. A boxer’s fracture is the result of a clenched fist hitting an object with enough force to break the metacarpophalangeal neck, Boxers Fracture (Proximal most commonly seen in the Fracture) fourth and fifth digits. Ulnar gutter splint A network of nerves that conducts signals from the spinal cord, which is housed in the spinal canal of the vertebral column (or spine), to the shoulder, arm and hand. These nerves originate Treatment includes in the fifth, sixth, seventh and orthosis/splinting, surgery, or it eighth cervical (C5-C8), and may heal without treatment. The first thoracic (T1) spinal ability to bend the elbow (biceps nerves, and innervate the function) is considered an muscles and skin of the indicator of probable recovery, chest, shoulder, arm and with additional upward movement Any motion hand. Brachial plexus of the wrist, as well as beyond 90° injuries, or lesions, are straightening of thumb and abduction may caused by damage to those fingers an even stronger indicator induce added nerves. Can occur as a result of excellent spontaneous Flail arm splint provides the needed stress to the of shoulder trauma, tumours, improvement. Gentle range of stability at both the shoulder and elbow for brachial plexus Brachial Plexus Injury or inflammation. motion exercises. functional positioning of the hand. and its roots. Movements possible: Shoulder, flexion, abduction, extension. Elbow flexion, supination. Scapular Wrist splint in a functional position with a C5 SCI adduction, abduction. slot to hold a typing stick Practice to allow the proximal Movements possible: C6: interphalangeal (PIP) joints to Scapular protraction (partial develop a contracture to facilitate horizontal adduction). functional grasp. Ranging the Forearm supination. Radial hand (wrist extension combined wrist extension. C7: Elbow with finger flexion and wrist extension flexion combined with finger Ulnar/wrist extension. Finger extension) of a client with a extensions. Thumb flexion, spinal cord injury preserves a extension & abduction functional tenodesis grasp while encouraging PIP flexion Tenodesis splint. c6 (wrist driven flexor C6-C7 SCI contractures. hinge splint during a prehension activity). Most commonly involved arthritic joint in the hand. More common in women, may exist in a localized form or may exists as a systemic form of arthritis, primary form is most common in post- menopausal women, systemic form may be due to CMC arthritis RA or gout A hand based thumb splint Fracture to the individual carpal bone. Most common injury to the wrist is the scaphoid. Lunate fractures are associated with Carpal Fracture Keinbock's disase. (Non surgical) wrist splint in neutral, median nerve gliding exercises, activity mod, ergonomics. - (surgical) edema control, AROM, nerve/tendon glides, sensory re-ed., strengthening, activity mod. Pillar Median nerve injury. pain is pain on either side of the Symptoms include palmar carpal tunnel release surgery numbness and numbness of site. The source of the pain is wrist splint wrist splint wrist splint first digit to half of the fourth unknown and may be positioned 0-15 positioned 0-15 positioned 0-15 digit, with generalized ligamentous or muscular in Wrist splint positioned 0-15 degees of degees of degees of degees of Carpal tunnel weakness and pain. origin. extension, volar splint with wrist in neutral extension Carpal tunnel extension Carpal tunnel extension Degenerative joint disease affecting the first carpometacarpal joint (CMC1).[1] This joint is formed by the trapezium bone of the wrist and the first metacarpal bone of the thumb. Occurs when the cushioning cartilage of the A thermoplastic splint osteoarthritis to joint surfaces wears away, support the CMC joint or a CMC neoprene resulting in damage of the wrap support to provide more movement CMC osteoarthritis joint. Splinting and activity modification but less support. Gentle, pain-free AROM for short periods, stress loading (i.e., scrubbing the floor, carrying a weighted bag). Pain control techniques TENS, splinting, continuous passive motion. Edema control techniques (i.e., PROM or painful Distal radius fracture is the elevation, massage AROM, treatment. Wearing primary reason. Pain contrast baths, compression). an arm sling will dispropriate to an injury that Desensitization techniques, increase stiffness is either sympathecially fluidotherapy, blocked exercises, and edema maintained or independent of tendon gliding, joint protection, because it places the sympathetic nervous energy conservation. Provide the extremity in a system. Symptoms often instruction in a stress loading Static then dynamic as tolerated. Volar in dependent and Complex Regional Pain include pain, swelling, program and incorporation of use extension, as tolerated static position for Syndrome (AKA: reflex stiffness, and sudomotor and of the upper extremity in Circumferential wrist might be used to long periods of sympathetic dystrophy) trophic changes. functional activities. avoid edema time. Orthotics are used for immobilization as needed. ROM is begun early, within 1 week if Complete fracture of the medically cleared. A sling is used distal radius with dorsal for type 1 fractures or comfort if displacement. Most common the client has pain and is nervous Colles Fracture type of wrist fracture. in public places. Ulnar nerve compression at elbow; numbness/tingling along ulnar aspect of - (non surgical) elbow pad to forearm/ hand, pain at elbow decrease compression of nerve, with extreme , weak power activity mod. (surgical) edema grip; elbow splint to prevent control, AROM, nerve glides, ; + tinel sign at elbow (pain strengthening, MCP splint if Cubital tunnel syndrome or sensation) clawing is noted (non surgical) elbow splint to prevent Acute phase: reduction of inflammation and pain through static splinting , ice, contrast baths, ultrasound, inferential stimulation. Subacture phase: slow stretching, myofascial release, progressive resistive exercises as tolerated, proper body mechanics, education on identifying triggers and returning to acute phase treatment. Return Trauma to soft tissue caused to work, functional capacity by repeated force. Patient evaluation, work hardening. has muscle fatigue, pain, Activity modification and proper chronic inflammation, body mechanics are essential for sensory impairment,
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