Upper Extremity- NBCOT

Static Splint

Immobilization, protection, positioning.

Keep non-issue joints functional

Serial Static Splint

Adjusted overtime to improve PROM

Static Progressive Splint

Adjustable in moment

Followed with active use

Pull on moving body part at 90 degree angle

Dynamic Splint

Dynamic and moveable at all times

Assists with movement and or gives resistance

General guidelines for splint fabrication

Avoid bony prominences

Flare edges

General guidelines for splint wear

Low and slow

increase total end range time before increasing force

Resting Hand Splint

PARROT

general comfort (i.e. post stroke)

Antideformity Splint

ANTIDEFORMITY ALLIGATOR

Used post trauma and edema

Thumb Spica Splint

UNICORN WITH HORN

Puts thumb in opposition

Long= De Quervain

Short= Arthritis of CMC and MP of thumb

Dorsal Blocking Splint

DOROTHY THE ELEPHANT

Flexor tendon repair

affected digit in increased flexion compared to rest

Wrist Cock-Up Splint

“RADICAL DUDE” COCKY SURFER SQUID

radial nerve/tunnel and carpal tunnel

Posterior elbow splint

90 degrees flexion

MCL/LCL injury/elbow fx

anterior elbow splint can also be used

mallet splint

CAP

6-8 weeks no flexion

oval 8

boutonniere (circle on top)

arthritis

swan neck (turned around)

Inflammation

In flames

red, painful, warm

Pitting edema

indent after pressure touch

Non-pitting edema

Hard touch, thick and discolored skin

Lymphedema

Lymph system not draining

How to measure Edema

Volumetry (not on open wounds)

Figure Eight

Stages of healing

Inflammation- avoid infection

Proliferation- Forming scar tissue

Maturation- Remodeling

How does Edema cause deformity in hand?

Swelling pulls skin and fingers

Ape hand and loss of metacarpal arch

We want antideformity position

Edema intervention Throughline

MASTECCT

MASTECCT

Manual Edema

AROM

Splint

Taping

Elevation

Compression

Cold

Think about contraindications

Contraindications for compression (edema)

DVT, cardio concerns, periph neuropathy, active TB

Contraindications for manual edema mobilization

stuff moving within the body

cancer, lymph issues, clots, ect.

Isometric exercise

Hold in place with resistance

Eccentric exercise

Muscle lengthening w/ resistance

Concentric exercise

Muscle shortening w/ resistance

Open-chain

End (distal point) has movement

Close-chain

End (distal point) does not move

Order of ROM

AROM → PROM → Resistance

Order of exercise

Eccentric → Concenntric

What do to if someone has compromised stability?

Use more caution

What to do if a Pt has compromised mobility?

Use more motion

Throughline for Upper extremity Eval

NEW SPORC

NEW SPORC

Nerves

Edema

Wounds

Strength

Pain

Occupation

ROM

Coordination

Important wound colors

Red is good

Yellow/black is not good

If AROM < PROM

Weakness

If AROM < or equal to PROM with wrist position does not affect

Joint stiffness

If AROM < or equal to PROM with wrist position does affect

Extrinsic Issues

if AROM=PROM and MP position affects

Intrinsic issues

Foundation of Shoulder

High mobility, low stability

Scapulohumeral Rhythm

90 humerus

after 90 the scapula rotates and elevates

Where Is Thoracic Outlet?

Under Clavicle by coracoid process

Frozen Shoulder is also called

Adhesive Capsulitis

What is frozen shoulder caused by

coracohumeral ligament adhering to joint

Three-phases of frozen shoulder

freezing

frozen

thawing

How long can frozen shoulder happen

less than or equal to 4 years.

How to heal frozen shoulder

do not overstretch

active pain free ROM

compensation techniques

Brachial Plexopathy is also called

Thoracic outlet syndrome

what makes Brachial Plexus worse

vascular problems

overhead movement

poor posture

How to help brachial plexus?

fix posture

strengthen scap elevations

nerve glides and stretching

sleep

diaphragm breathing

Common thing seen with Proximal Humeral Fracture

compensation with early scapular rotation

avoid this is possible

How to help proximal humerus fracture

Stabilize (sling): Move distal joints

PROM when cleared: pendulum swings and towel glides

AROM when cleaned: Open and closed chain and glenohumeral rhythm

Glenohumeral Instability comes from which two causes

AMBRI

TUBS

Cause for Glenohumeral Instability from AMBRI

“Already loose”

Slow onset/congenital

impingement with overhead motions

non-surgical

Cause for Glenohumeral Instability from TUBS

“Trauma”

SLAP lesion: superior labrum anterior and posterior

Surgical treatment

Treatment of Cause for Glenohumeral Instability

strength and proprioception of rotator and scapular muscles

start with isometrics

treatment for anterior Glenohumeral Instability

internal rotation and adduction

treatment for global Glenohumeral Instability

all muscles

Keyline for Arthritis

JAPO, really anything

What is OA?

Worn down cartilage

CMC and IP affected

Dorsal CMC sublux, boutonniere and mallet deformities

What is RA?

Autoimmune

metacarpals, MP, CMC

ulnar drift, boutonniere, swan neck deformities

Pnumonic for RA

RA= Right Angle, wRist Also, Really Anything

Proximal Stability Leads to distal Mobility as it relates to arthritis?

Address proximal deformities first and early

Mend Vs. Move as it relates to arthritis

Joint protection (Adapt and compensate)

Pain= Damage

JAPO (arhtritis)

Joint Protection

AROM

PAM

Orthosis

PAM for OA

Heat and Paraffin

PAM for RA

Really Anything

Orthosis for Arthritis

Custom splints for for deformed joints

thumb spica

oval 8

Keyline for wrist fractures

Wrists are routine

Distal Radius Fx is called what?

Colle’s

Distal Radius Fx is caused by?

FOOSH

One thing to note about Carpal Fx

Low blood supply so longer heal time

One thing to note about Ulnar fx

Non-surgical and usually not alone

What to prioritize when working with wrist fx

Stability vis orthosis

when should you mobilize a wrist fx?

as early as allowed

focused on other joints

Mobility progression

AROM

PROM

Resistance

Proliferation rate for bone

6-8 weeks

Keyline for hand fx

Splintrinsic Plus

Mend vs move for hand fx

Stability through orthotics

mobility as soon as cleared

General considerations for splinting hand fx

Intrinsic plus= antideformity alligator

only splint affected joints

buddy finger taping

MCP fracture calls for what kind of splint?

boxers fx

ulnar gutter

PIP fracture calls for what kind of splint?

oval 8

Keylines for Elbows

Egyptian Elbows

Lucille and Michael

valGUS is for Guns

Focus on what for elbow issues?

Stability via orthotics

Valgus/Varus instability comes from

stiffness or instability

LCL

Lateral collateral ligament

Lucille (bottom)

Varus

more common

stable with flexion and supination

MCL

Medical collateral ligament

Micheal (top)

Valgus (michael likes guns)

throwing athletes

Stable with flexion and pronation

How to splint an elbow?

sling/spint at 90 degrees flexion

AROM for elbow when healing

position of max stability

supine, shoulder 90 flexion

Egyptian elbows

What splint should be used if elbow progress plateaus

static progressive/serial static splint

Keyline for finger deformities

splint in antideformity and don’t move a finger

proliferation time for tendon healing

6-8 weeks

General splinting recommendations for fingers deformities

antideformity

day/night for 6 weeks

make sure no blanching

Mallet Splint

Dip extension

Cap splint

Boutonniere splint

pip flex and deip extend (position of def)

oval 8 with circle under

Swan neck splint

pip exten and dip flex (position of def)

Oval 8 circle on top

Keyline for peripheral nerves

DR. CUMA

parasthesia

numbness and tingling