UE (edema, exercise, eval, shoulder)

Edema

Excess fluid in tissues, has a cause, like MASTECCTomy, causes deformity

MASTECCTomy

Acronym for Edema Tx, manual edema mobilization, AROM, Splint, Taping, Elevation, Compression, Cold, Think

Pitting edema

Pressing a finger leaves an indentation that takes time to refill

Non-pitting edema

Hard to the touch, skin often thicker & discolored from proteins

Lymphedema

• Edema caused by poor lymphatic fxn

• Typically incurable but manageable

Volumetry

Dunking hand in water and seeing the measure change (best option but occasionally contraindicated)

Figure-of-eight & circumferential measurement

Wrapping flexible measuring tape (problems w/ consistency)

Manual edema mobilization (MEM)

• Light manual mobilization of skin over lymph nodes to promote lymph flow

• Contraindicated for damaged lymph system, infection, blood clots, CHF, kidney problems & cancer - basically if stuff moving around is a problem we avoid it

• Best for persistent edema from sx or trauma

• Advanced technique requiring special training

Antideformity position

Also called intrinsic plus, default position to avoid deformity of the hand

3 kinds of contraction

• Isometric

• Eccentric

• Concentric

Isometric

Hold a resistance (band or weight) in place

Eccentric

Holding a resistance and then lowering it, muscle is lengthening

Concentric

Muscle is shortening, working out, bicep curls

Open chain exercise

Lifting a weight, moving arm freely where air is exposed

Closed chain exercise

Like a push-up, the end of extremity is touching smth else

Standard ROM progression

Immobilization- AROM - PROM - Resistance

Sensation testing

• Semmes Weinstein monofilament

• 2 point discrimination

Wound color

• Red is good

• Black & yellow are bad “keep bees away from your wounds”

Strength testing

• Grip & pinch testing (dynamometer)

• MMT

Coordination testing

• 9 hole peg test

• Moberg pickup test - “picking up coins for one mo burger”

DASH

Common functional assessment for UE

Brachial plexus

Nerve injury or impingement at the BP, give it space & keep it mobile

Thoracic outlet syndrome

Compression of neurovascular structures in the thoracic outlet, leading to symptoms like pain, numbness, and weakness in UE

Brachial plexopathy/TOS

• Injury to the brachial plexus

• Usually comes from trauma to shoulder

• Sx’s worsen w/ overhead mvmt & poor posture

Tx for Brachial plexopathy/TOS

• Give it space but keep it mobile

• Improve posture, strengthen scapular elevators

• Nerve glides & stretching (ex: doorway stretch w/ shoulder shrug)

• Sleeping position (avoid compression of TOS)

• Diaphragmatic breathing

Erb’s palsy

Upper brachial plexus injury, affects the upper arm: shoulder on down. “That nerd Erb always raises his hand in class”

Klumpke’s palsy

Lower BP injury, affects lower arm: Hand on up. “Can’t hold your keys with Klumpke’s”

Proximal humeral fx tx

Stabilize until clear (sling), then PROM (pendulum swings, towel glides), AROM when cleared (open & closed chain, scapulohumeral rhythm, no subs)

Frozen shoulder

Pain-free AROM & compensation until it thaws naturally

3 phases of frozen shoulder

1. Freezing

2. Frozen

3. Thawing

Glenohumeral instability

Frequent impingement or dislocations, strengthen RC muscles to compensate

AMBRI/TUBS

Always been loose vs Torn loose

RC Tests

• Empty can test

• Hawkins Kennedy

• Neer’s impingement test