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 PROM, modalities, encourage range of motion; AKA frozen active use, pain management Adhesive tendonitis shoulder (modalities) People who cannot move the away from the rest of the hand. It is an inability to abduct the thumb. High injury at the or proximal . Sensory loss in index, middle, and raidal side of ; 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 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.., , , 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 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. 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 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 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 . 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. 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, long-term control of an Cumulative trauma disorder decreased ability to work. Ex. inflammatory cumulative trauma Static splint during activities that cause (CTD) playing piano 10 hours a day disorder. pain. Non operative treatment: Caused by cumulative computer ergonomics education microtrauma resulting in and strengthening exercises. tenosynovitis of the thumb, Operative Treatment: gentle Thumb Spica Splint including wrist. muscle tendon unit, abductor ROM, tendon gliding exercises, Forearm based thumb spica splint with Nonoperative pollic longus and extensor grip and pinch strengthening after wrist in neutral and thumb radially treatment: activity pollis brevis, and the tendons 2 weeks, scar management and abducted for 3 weeks. After 3 weeks, the modification and in the first dorsal desensitization techniques are client can progress to a soft splint and avoidence of pinch De Quervains Disease compartment of the wrist used. isometric exercises. are recomended. Initiation of controlled AROM can begin between 3 and 6 weeks Look at colles fracture and postinjury if the fixation of the Distal Radius fracture smith's fracture. fracture is adequate. Wrist extension splint. Occurs when a peripheral nerve is entrapped in more Non-operative treatment: treat than one location. according to each nerve injury or Symptoms: Intermittent syndrome. Nerve gliding Avoid movements diffuse arm pain and exercises, and exercises for or postures that paresthesias with specific scapular stability, posture, and aggreviate Double Crush postures. core trunk strengthening. symptoms. Wound Care: dressing changes. Whirlpool if infection is suspected. Edema Control: elevation above the heart. A/PROM and progress to Disease of the fascia of the strengtheing when wound are palm and digits. Results in healed. Scar management, flexion deformities of the functional tasks that emphasize involved digits (i.e., mostly flextion (griping) and extension Extension splint at all times except to Dupuytren's Disease ring finger) (release). remove for ROM and bathing Involvement of radial head may result in limited rotation Orthotics are used for immobilization as of forearm. Usually caused needed. A sling is used for Type 1 fracture by a forceful load through an ROM begins early, within in 1 (nondisplaced) or comfort if the client has Elbow fracture outstretched arm. week if medically cleared. pain and is nervous in public places. Paralysis of the arm caused by injury to the upper group of the arm's main nerves, specifically the severing of the upper trunk C5–C6 nerves. The arm hangs limp with teh shoulder rotated inward due to atrophy and paralysis in the biceps, deltoid, brachialis, and The paralysis can either resolve Elbow lock splint stabilizes the elbow to brachioradialis muscles. This on its own over a period of enable the individual to position the hand significantly limits functional months, necessitate rehabilitative clower to or away from his/her body for Erb's palsy movement. therapy, or require surgery funcational use. Exercises promote tendon excursions and prevent adhesions. Modalities include heat, to gradually prepare the tissue for motion, and NMES to promote tendon excusion and activation. Use of modalities begins once cleared by the prescribing physician. A clearly identified and planned home program is important to ensure the client's safety and progress toward goals. Tendon glides are used to promote excursions and Injury to the extensor prevent adhesions. ROM. digitorum communis, Strengtheing usually not initated extensor indicis proprius until the late phase of repair, Extensor Tendon Injury (EIP) usually 8-12 weeks after surgery. Lacking firmness, resilience, Flacidity or muscle tone resting hand splint Support the user's wrist in 10 to 20 degrees of extension to Lacking firmness, resilience, prevent contracture, but allows Flacid wrist or muscle tone in the wrist digits to function cock up splint flexor tendon protocol using controlled passive motion. Passive extension of the distal interphalangeal joint if the metacarpal and proximal phalangeal joints are flexed. The distal interphalangeal joint and proximal interphalangeal joint can be passively extended if the other joints of the digit are flexed to initiate tendon glide and prevent scarring of the tendon. Zone II of the flexor tendon system has A tendon repair is been called no man’s land typically at its A deep cut on the palm side because excessive scarring weakest 10–12 of your fingers, hand, wrist, makes it difficult to get good days postsurgery or forearm can damage your results from a repair. Zone IV during the flexor tendons, which are the consists of the transverse carpal fibroplasia phase, tissues that help control ligament, and the median nerve in which collagen movement in your hand. A runs under this ligament; Zone V Kleinert or Duran dorsal protection splint. is just beginning to flexor tendon injury can make is distal to this ligament and thus The dorsal blocking splint protects the be laid down to it impossible to bend your contains the median nerve surgery and guards against flexor tendon strengthen the Flexor tendon injury fingers or thumb. branch. rupture. repair. Focal hand dystonia Paralysed interossei (no abduction/adduction of the fingers) and no flexion in little Gentle active range-of-motion Initially, the arm should be splinted in 90° Fracture of Medial and ring finger reduced exercises may begin within 1 of elbow flexion. Protective splinting may Epicondyle causing Hand week after injury. be continued for 3 weeks if necessary. Froment’s sign occurs when the flexor pollicis longus compensates for a weak or paralyzed adductor pollicis and flexor pollicis brevis. When a client attempts to pinch, the interphalangeal joint of the thumb flexes more Froment’s sign than usual. - an ulnar nerve compression at the wrist; numbness/tingling in ulnar nerve distribution of hand; motor weakness of ulnar nerve innervated (non surgical) work activity mod. musculature; neutral wrist (surgical) edema control, AROM, splint; + tinel’s sign at guyon’ nerve glides, sensory re-ed., Guyon's canal s canal strengthening (non surgical) wrist splint in neutral, Most common fracture of the With a nondisplaced fracture of upper arm and may involve the humeral neck, support from a the articular surface, greater sling and supervised exercise or lesser tuberosity, or lead to the most desirable Humeral fracture surgical neck outcome. Injury to the index finger, (also referred to as forefinger, pointer finger, trigger finger, digitus secundus, digitus II, and many other terms), is the first strap incorporating the index and middle finger and the second digit of fingers provides passive rom to the index Index finger injury a human hand. finger CTD from degeneration of the tendon origin as a result of repetitive microtrauma; overuse of the wrist ice/deep friction massage, elbow wrap/wrist splint. The splint rests the extensors, especially the stretching, activity mod, muscle and tendon and protects against Lateral epicondylitis ECRB; AKA tennis elbow strengthening pain with activity. First splint the client’s DIP joint in full extension continuously for 6 weeks. The DIP terminal tendon is delicate and requires Avulsion of the terminal continuous splinting to prevent Mallet Finger tendon extensor lag of the tendon. Splinted for 6 weeks. same as lateral epicondylitis, but is overuse of wrist Medial epicondylitis flexors; AKA golfer’s elbow elbow wrap/wrist splint Causes ape . Symptoms: , sensory loss in Operative treatment: AROM and index, middle, and radial side PROM in splint for digits and of ringer finger; loss of pinch, thumb, tendon gliding exercises, Non-operative treatment: Static thenar thumb opposition, index scar massage, discontinue splint web spacer splint. Operative treatment: finger MCP and PIP flexion; at 6 weeks and begin dorsal wrist blocking splint worn for 4-6 Median Nerve Injury. and decreased pronation. strengthening exercises. weeks. - loss of thumb opposition, weak pinch; clawing of index/mid fingers for low level lesiono Ape hand- flattening of o Hand of bendiction- dorsal protection splint (30° wrist if low loss of of thumb, index, lesion, 90° elbow at elbow if high), C-Bar and middle fingers; high level A/PROM, scar management, splint to prevent thumb adduction Median nerve laceration lesion strengthening, sensory re-ed, contracture Injury to both the median and ulnar nerves results in an impairment of function. Can Figure of eight splint to prevent MP Median and Ulnar nerve be caused by car accidents hyperextension or dynamic MCP flexion injury and glass injuries. splint Metacarpal fracture Ulnar gutter splint Difficulty flexing the MCP's. The metacarpophalangeal joints (MCP) are of the condyloid kind, formed by the reception of the rounded heads of the metacarpal bones into shallow cavities on the proximal ends of the The correct angle of pull for a finger loop is first phalanges, with the 90°. This angle of pull distributes the exception of that of the pressure most evenly to the proximal MCP flexion limitation thumb, which is a hinge joint. phalanx. a median nerve compression between two heads of pronator teres; symptoms same as CTS, with also avoid repetitive aching pain in proximal volar forearm forearm elbow splint at 90° (forearm in neutral), pronation/supination Metacarpal fracture, such as a boxer's (4th and 5th finger) Proximal Fracture fracture A prefabricated dynamic PIP extension assist splint will improve PIP extension Proximal interphalangeal and takes less therapy time to fit than to (PIP) flexion contracture custom make this splint. Type 2 (displaced) treated nonoperatively with immobilization for 2-3 weeks and early motion with medical clearence. Type 3 (committed) Type 1 (nondisplaced) can be treated with 33% of elbow fractures. treated operatively, with a long arm sling. A Type III fracture of the Usually caused by a forceful immobilization and early motion radial head requires removal of the load through an outstretched within the first postoperative fragmented bone and a cast for 3–4 weeks Radial head fracture arm. week as medically prescribed. to ensure proper healing and support. inability to ⁄ digits to release objects; difficulty ROM, sensory re-ed, home laceration manipulating objects program, activity mod dynamic ⁄ splint, radial nerve compression; weakness/paralysis of extensors to wrist, MCPs, Thumb Extension Splint, duran dorsal thumb; ; AKA ROM, nerve gliding, protection splint, volar splint with wrist in Radial nerve palsy Saturday night palsy strengthening neutral, dynamic ⁄ splint Operative treatment: long arm splint, elbow flexed, forearm supinated, wrist neutral for 2 weeks, the wrist cock up for 2 Compression of the radial more weeks, passive and active Non-operative: Long arm splint, elbow nerve in the proximal forearm pronation and supination, hand flexed, forearm supinated, wrist neutral, resulting in a dull ache and strengthening exercise at 3 massage or TENS for pain management, Avoid foreceful burning sensation along the weeks, resistive exercise at 6 pain free ROM, nerve gliding, activity wrist extension lateral forearm. weeks. modification and supination. Under the broad category of pervasive developmental disorders, together with the autism spectrum disorders. Maintain the integrity of the skin Repetitive stereotyped hand such as dynamic elbow splints movements, such as that inhibit a hand to mouth wringing and/or repeatedly pattern by limiting full elbow Retts syndrome putting hands into the mouth. flexion. An autoimmune disease that results in a chronic, systemic inflammatory disorder that may affect many tissues and Volar in extension up to 30 degrees, based organs, but principally on the person's comfort level attacks flexible (synovial) • -Ulnar drift close to neutral during joints. early stages inflammation (irritation and activity mod, educate in sleeping swelling) of the tendons of posture (avoid arm overhead), Rotator cuff tendonitis the shoulder pain management, strengthening AROM and pinch strength at 6 Rupture of the ulnar collateral weeks. ADL's that require ligament of the MCP joint of opposition and pinch strength. Skier's Thumb the thumb. (i.e., skiing with PROM at 8 weeks and (Gamekeepers Thumb) the thumb held in a ski pole) strengtheing at 10 weeks Thumb splint for 4-6 weeks Orthotics are used for immobilization as needed. ROM is begun early, within 1 week if medically cleared. A sling is used Complete fracture of the for type 1 fractures or comfort if distal radius with palmar the client has pain and is nervous Smith's fracture displacement. in public places. Thumb splint Altered skeletal muscle performance in muscle tone involving hypertonia; it is also referred to as an unusual "tightness", stiffness, or "pull" Spasticity of muscles. Spasticity splint or cone splint Injury to the MCP, PIP, or DIP joints characterized by PIP hyperextension and DIP silver rings. PIP is splinted in slight flexion, Swan neck deformity flexion or buttonhole splint Treatment is largely conservative with rest, and gradual return to exercise is a common therapy. Ice, compression and elevation. Initial recovery is typically within 2 to 3 days and full recovery is within 4 to 6 weeks. Treatment of tendinitis helps reduce some of the risks of developing tendonosis, which takes longer to Duran dorsal protection splint, volar splint Tendinitis/tenosynovitis Inflammation of a tendon heal. with wrist in neutral excess pressure placed on a neurovascular bundle passing between the anterior scalene and middle scalene muscles To rest the tendon and prevent snapping as the tendon pulls through the finger pulleys, the MCP joint is blocked by splinting, CTD; tenosynovitis of the then gentle pull through with finger flexors; most common bending and straightening of the is A1 pulley. Trigger finger is distal and proximal a condition in which edema in interphalangeal joints is the tendon and synovium of recommended 20 times every 2 the digit results in lack of hours while the client is awake. hand based TF splint (MCP ⁄, IP jts free), smooth flexion or extension edema control, tendon gliding, a splint to support the Trigger finger of the finger. activity/work mod. metacarpophalangeal joint in extension Hand deformity in which the swelling of the metacarpophalangeal joints (the big knuckles at the base of the fingers) causes the fingers to become displaced, tending towards the little finger. The hand including the fingers move towards the ulna. Ulnar deviation is a disorder in which flexion by ulnar nerve innervated muscles is intact while flexion on the median nerve side is Ulnar Drift not. Ulnar deviation splint Results in ulnar claw Orthotics are used for Ulnar nerve injury splint, dynamic/static deformity and numbness of immobilization as needed. ROM splint to position MP's in flexion. MCP the ulnar side of the hand is begun early, within 1 week if block splint. If it is a low-levelulnar nerve and the fifth and half of the medically cleared. A sling is used fourth digits, with generalized for type 1 fractures or comfort if injury, then a splint that prevents weakness of the ulnar side of the client has pain and is nervous hyperextension of the MCP joints and Ulnar Nerve Injury the hand and pain. in public places. allows MCP flexion. Upper extremity weakness A deltoid sling. Occurs in phases that generally follow the process of inflammation, proliferation, Wound healing and remodeling Injury to the wrist. The wrist is variously defined as the carpus or carpal bones, the complex of eight bones forming the proximal skeletal segment of the hand; the wrist joint or radiocarpal joint, the joint between the radius and the carpus;and the anatomical region surrounding the carpus including the distal parts of the bones of the forearm and the proximal parts of the metacarpus or five metacarpal bones and the series of joints between these bones, thus referred to as wrist joints.This region also includes the carpal tunnel, the anatomical snuff box, the flexor retinaculum, and the extensor Maximum passive extension up duran dorsal protection splint, volar splint wrist fracture retinaculum. to 30 degrees. with wrist in neutral Dexamethasone is the most widely used medication by therapists using iontophoresis because of its anti-inflammatory Wrist tendenitis Inflammation of the wrist properties.