Diagnoses

scapular winging

• serratus anterior deficiency

• limited flexion and abduction, overhead activity

• shoulder pain

what is one possible treatment for scapular winging?

using the foam roller

• reach up with foam roller while pushing away from the wall

• round back while pushing to engage scapula

• therapist guides shoulder blades around armpits to engage serratus anterior

shoulder subluxation

• dislocation of glenohumeral joint

• caused by trauma, muscle weakness

shoulder impingement

• compressed soft tissue structures under acromion

• may lead to bursitis and/or rotator cuff rupture

• can be caused by repetitive stress or overhead injury

• symptoms: shoulder pain, weakness

what are some treatments for shoulder impingement?

massage

• use tennis ball and find shoulder region w increased pain

• place ball between body and wall

• pain should increase before relieving; apply variants of pressure to the same spot until pain decreases

• discontinue if pain increases

rotator cuff tear

• partial or complete rupture of tendon of SITS muscles

• caused by trauma, repetitive stress, overhead injury

• symptoms include shoulder pain, shoulder weakness

what is one possible treatment option for rotator cuff tears?

pendulum swings

• stand beside chair or table with unaffected side on table, feet slightly wider than shoulder width

• bend at hips and let affected arm hang down towards the floor

• shift weight forward and backward, letting arm swing from front to back passively

bicipital tendonitis

• inflammation of the long head of the biceps

• symptoms: anterior shoulder pain, pain with overhead activity, pain with elbow flexion

treatment for bicipital tendonitis is similar to treatment for what?

shoulder impingement; one option is massaging

thoracic outlet syndrome

• compression of structures under clavicle

• symptoms include pain, weakness, spasms

• can be neurogenic, vascular or both

what is one treatment for TOS?

posture and breathing education

• educate patient on proper posture

• education on proper breathing techniques

• adapting work environment to support proper posture

frozen shoulder

• fibrosis of joint capsule leading to significant ROM deficits

• causes can be related to injury, inflammatory conditions, or aging

what is a treatment for frozen shoulder?

hot pack to reduce pain and swelling

greenstick fracture

bone bends and cracks but does not break all the way through

buckle fracture

result from compression without cortical disruption

what is one treatment option for a buckle fracture?

casting or splinting for 3 weeks

boxer’s fracture

excessive force from hand impacting an object or person transfers to the metacarpal neck and results in a fracture; usually occurs from direct impact with a clenched fist

what is one treatment option for a boxer’s fracture?

MC orthosis to stabilize ring and little finger MCP, gentle AROM once fracture is stable

Colles fracture

DRF with dorsal angulation and displacement and radial shortening, caused by FOOSH

Smith fracture

distal radius fracture with volar displacement, often caused by FOOSH

what are common treatment options for Colles and Smith fractures?

splinting or orthotics to immobilize

flexor tendon repair or reconstruction

• caused by trauma such as MVA, knife injury or sports injury

• tendon frays from bone spurs

what is one treatment option for flexor tendon laceration?

• dorsal blocking orthosis; MCP joint at 70-90 degrees flexion, wrist in neutral, PIP/DIP in full extension

• pt allowed to move passively within confines of splint

ulnar collateral ligament injury of the thumb

Skier’s thumb: caused by radial deviation and hyperextension force applied to thumb MCP resulting in injury to UCL

Gamekeeper’s thumb: results from repetitive stress and chronic weakening of the ligament

what is one treatment option for UCL injury at the thumb?

thumb spica orthosis

De Quervain’s tenosynovitis

• overuse injury involving impaired gliding of APL and EPB

• caused by thickening of extensor retinaculum over 1st dorsal compartment

what is one treatment option for De Quervain’s tenosynovitis?

• eliminate repetitive movements

• thumb spica orthosis to rest

• ice for pain and inflammation

lateral epicondylitis

• tendonitis of forearm extensor muscles

• caused by overuse or force overload injury

what is one treatment option for lateral epicondylitis?

• pain management is ice

• wrist cock up orthosis

• iontophoresis

medial epicondylitis

• less common lateral epicondylitis

what is one treatment option for medial epicondylitis?

• stretches done in supination

• ice for pain management

• iontophoresis

carpal tunnel syndrome

• compression of median nerve at wrist level under transverse carpal ligament

• caused by chronic tenosynovitis of flexor tendons in carpal tunnel (repetitive forceful wrist movements), or trauma

what is one treatment option for carpal tunnel syndrome?

• wrist cock up orthosis: wrist in 0-15 degrees of extension

• surgical intervention

cubital tunnel syndrome

• compression of ulnar nerve as it passes through cubital tunnel along elbow

• caused by prolonged pressure of leaning elbow on a surface, repetitive or sustained elbow flexion

what is one treatment for cubital tunnel syndrome?

• elbow orthosis with elbow in 45-65 degrees of flexion, worn at night

• anti-claw orthosis

• surgical intervention

complex regional pain syndrome

• burning, throbbing, searing, shooting, aching sensations

• no identified peripheral nerve injury

what is one treatment option for complex regional pain syndrome?

• mirror therapy

• desensitization

• sensory bins

trigger finger

• inflammation for A1 pulley; most common in ring finger. reduces ability of tendon to glide through pulley making it difficult to flex or extend the finger

• caused by repeated gripping or use of tools such as drills or wrenches

what is one treatment option for trigger finger?

• custom orthotic to prevent MP flexion

• surgery

• steroid injections

• avoid repetitive gripping

mallet finger

• laceration or rupture of extensor tendon at zone 1

• inability to extend the DIP

• caused by sudden direct force applied to the tip of the finger

what is one treatment option for mallet finger

split DIP into extension or hyperextension; must be worn continuously for 6 weeks. if removed, time starts over again

Boutonniere deformity

• injury to dorsum of digit in zones III and IV that affect central slip

• absent or weak active extension of the PIP joint along with DIP joint hyperextension

• caused by forceful blow to the top of dorsal side of a bent middle joint of a finger, or by RA

what is one treatment option for Boutonniere deformities?

immobilize PIP joint at 0 degrees extension for 6 to 8 weeks; usually using a serial static orthosis

swan neck deformity

• hyperextension of PIP joint and flexion of DIP joint, can be fixed or flexible

• most common causes or RA or OA

what is one possible treatment option for swan neck deformities?

correct deformity with oval ring orthosis

what is one common treatment intervention for sprains, strains, or PIP fractures?

buddy strapping or taping to allow for some ROM, but doesn’t allow for isolation

bursitis

• inflammation of fluid filled bursa that cushion the joint

• can be caused by overuse of joint

what is one treatment option for bursitis?

hot packs can help alleviate pain