OTS 450 comp 2

Define Rotator Cuff Repair

a group of muscles and tendons that keep the shoulders stable and allows the arm to move. When you tear the rotator cuff it limits motion and causes weakness and pain. A rotator cuff repair is done by stitching the muscles in your shoulder back to the bone.

What are activity restrictions/ limitations for rotator cuff repair?

• wear shoulder immobilizer at all times (except when exercising)

• sleep in a recliner chair if possible

• no use of the affected arm (lifting, pushing, pulling)

what PAMs can be used for rotator cuff repair?

• cyrotherapy: can be used starting post-op day 3 and beyond. can be used throughout the day for 15 minutes each session

• ice massage: localized application of cold directly to skin

• cold packs: can be used throughout the day as needed. 15 mins each session

What is the orthosis for rotator cuff repair?

shoulder abduction immobilizer- purpose is to hold the shoulder in a neutral position to reduce tension on the rotator cuff repair and improve blood flow

What are assessments for the rotator cuff repair?

• activity and scar observation

• VAS

• QuickDASH

What are intervention exercises 3-5 days post op for rotator cuff repair?

education on shoulder sling (teach client how to don/doff shoulder sling and educate on wearing sling at all times except for exercises and showering)

light exercises (pendulum exercises, table slides)

What are pendulum exercises (for rotator cuff repair)

place one hand on a table and lean forward, letting the affected arm hang down. move your body forward and back, side to side, and in circular motions so that the arm swings with the movements

what are table slides (for rotator cuff repair)?

sit next to a table and lean forward on the table to stretch the arm

Define below the elbow ampuation:

removal of the forearm and hand. incision is made below the elbow joint. can occur as a result of infection, severe trauma, or complications from other conditions (diabetes)

What are activity restrictions/ limitations for below the elbow amputation?

• important to wear the postoperative dressing

• phantom limb pain can be present and limit occupational performance

• 5-7days after surgery: the postop dressing can be removed and replaced with a light, non-adherent dressing

• first week after surgery: take care of the incision site. keep it dry and clean.

• 14 days after surgery: sutures can be removed if the wound is healing properly, and an elastic bandage or stockinette can be used to protect the incision site and help shape the limb

What PAMs can be used with a below the elbow amputation?

• tens: used for pain management

• fluidotherapy: can be for desensitization used once the wound is fully healed

• cold packs: should only be used if the client can tolerate cold

• cryotherapy: can be used periodically throughout the day for 10-15 min. be sure the incision is kept dry and that excessive pressure is not being applied to the residual limb or incision.

What is the orthosis for below the elbow amputation?

figure 8 bandage wrap

What are possible assessments for below the elbow amputation?

• activity observation

• VAS

• manual ability measure (MAM-20)

• QuickDASH

• COPM

• Edema assessment

• ROM

• Functional Independence Measure

What are intervention exercises for below the elbow amputation 5-7 days postop?

evaluation of the client

education on pain management and mirror therapy

instruct client on figure-8 wrapping

ROM exercises

How to perform mirror therapy?

amputated limb is placed behind a mirror while the intact limb is placed in front of the mirror > client will perform simple movements with both limbs, while concentrating on the reflection > the OT will set up a mirror on a table in line with the client’s midline> client is instructed to place residual limb behind the mirror and place the intact limg in front of the mirror > OT will instruct client to focus their attention on the reflection of the intact arm > client is instructed to open and close the intact fist while keeping their focus on the reflection

What are intervention exercises for below the elbow amputation 14 days postop?

educare client on scar massage

educate client on desensitization

ROM exercises

What is reverse total shoulder arthroplasty (TSA)?

surgical procedure that replaces parts of the shoulder bones with metal and plastic devices. This particular surgery switches the positions of the ball and socket which allows the shoulder to have more stability and function for movement, without needed to rely on the rotator cuff muscles.

What are patient education activity restrictions/ limitations for reverse TSA?

• sleep in a recliner chair

• position the arm on pillows, keeping the arm in the shoulder sling in front of the body

• prevent the arm from extending beyond the midplane of the trunk

• wear button-down shirts, sleeveless shirts, or very loose fitting top

• avoid sleeping on the affected side

• do not push out of a chair or lean on the elbow of involved side

• no tucking in a shirt, reaching in back pocket, fastening a bra from the back, or reaching across the body

What are lifetime precautions and limitations for reverse TSA?

• no lifting more than 10 lbs with affected arm

• no lifting more than 15-25 lbs with BOTH arms

• no sudden jerking or pushing with the arm

• avoid compressive loads (pushups)

What PAMs can be used for reverse TSA?

cryotherapy: post exercises for approx. 5 mins and periodically throughout the day as needed

cold modalities: ice pack: apply 4-6 towels between the cold pack and skin for 10-20 min

ice massage

What orthosis is used for reverse TSA?

shoulder sling/ immobilizer

What assessments can be used for the reverse TSA?

patient specific functional scale

VAS

edema assessment (figure 8 measurement or volumeter)

quickDASH

dynamometer

pinch gauge test

ROM with goniometer

What are intervention exercises for reverse TSA 5-7 days postop?

education- teach client how to don/doff sling

pendulum exercises

seated ROM exercises

supine ROM exercises

define carpal tunnel syndrome:

occurs when the median nerve becomes compressed/squeezed in the carpal tunnel of the wrist ; can be caused by repetitive wrist movements, as well as hormonal changes

What are activity restrictions / limitations 0-6 weeks for carpal tunnel syndrome?

• wear your orthosis as instructed

• maintain the wrist in a neutral position during daily activities

• avoid a sustain pinch or grip, particularly with the wrist in flexed posture

• avoid repetitive overuse of the wrist and hand in daily activities

• avoid positioning the wrist in a flexed posture while sleeping, once the wrist orthosis is discontinued

What are PAMs for carpal tunnel syndrome?

contrast bath; ultrasound; kinesiotaping; cold therapy; heat

What is the orthosis for carpal tunnel syndrome?

cock-up splint - places the wrist in a neutral and slightly extended position to relieve pressure on the median nerve

What are assessments for carpal tunnel syndrome?

O’connor dexterity test

Jebsen hand test

purdue pegboard

phalen’s test

tinel’s test

VAS

pinch gauge test

sensation tests ( pain awareness)

figure 8 measurement of the hand

Define Lateral Epicondylitis:

condition that causes pain and inflammation on the outside of the elbow. it affects the extensor tendons that attach to the lateral epicondyle.

What are activity restrictions/ limitations 0-3 weeks for lateral epicondylitis?

avoid repetitive gripping, lifting, and wrist extension movements

do not lift objects with your palm facing down, lift with palm facing up

refrain from using your affected arm for forceful tasks

wear prescribed braces and orthoses as directed

limit arm use during daily activities

What are PAMs for lateral epicondylitis

cold pack and non-thermal ultrasound

What orthosis is used for lateral epicondylitis

tennis elbow brace or strap

What assessments can be use for lateral epicondylitis

cozen’s test

dynamometer

ROM stress test

VAS

What are intervention exercises for lateral epicondylitis 0-3 weeks

education - educate on purpose of wearing the braces

Define radial nerve repair:

surgical procedure to the radial nerve which involves reconnecting the damaged nerve ends back together. the goal of the surgery is to help restore as much movement and sensation as possible.

What are activity restrictions/limitations for radial nerve repair?

be aware of location of sensory loss and how to protect the area from temperature, pressure, and sharp objects (very important during the first 4 weeks post-op as the nerve is repairing)

be cautious during activities that involve temperature, pressure, and sharp objects bc you may not feel any changes in discomfort or pain

avoid activities that involve repetitive arm and wrist movements, heavy lifting, or gripping (during the first 4 weeks post-op)

What are PAMs for rotator cuff repair?

10-14 days post-op: scar massage and desensitiation techniques can be used 2-3x day, 5 mins.

PAMs/heat should be avoided IF client has excessive sensory loss in the back of the hand and forearm; can use heat if that is not the case

What is the orthosis for radial nerve repair?

wrist cock-up splint

What are assessments for radial nerve repair?

tinel’s test, dynamomoter, ROM w goniometer, MMT, grip and pinch strength, circumferential measurements, VAS, quickDASH

What are intervention exercises for radial nerve repair 5-7 days post-op?

edema management, orthosis support, early immobilization, pain and inflammation control

What are 10-14 days post-op intervention exercises for radial nerve repair?

scar management, sensory re-education, continued ROM exercises, thermal modalities

What are 3 weeks post-op intervention exercises for radial nerve repair?

progressive ROM exercises and continued sensory and scar management

What is CMC OA?

the cartilage at the base of the thumb wears away, causing symptoms of pain, stiffness, and potentially leading to reduced function. Signs of CMC OA include joint pain that increases with use, joint inflammation, restricted ROM, joint stiffness secondary to inactivity, and ligament laxity.

What are activity restrictions/limitations for rotator cuff repair?

avoid sustained or forceful pinching activities, avoid key/lateral pinch, avoid sleeping w hands compressed under the body or thumb adducted in any form, limit repetitive thumb movements against resistance, avoid tasks exacerbating MP joint hyperextension.

What are PAMs for CMC OA?

Paraffin wax, fluidotherapy, cold packs, ice massage, TENS, and iontophoresis

What is the orthosis for CMC OA?

Short opponens splint

What assessments are for CMC OA?

COPM, Michigan hand questionnaire, CMC grind test, pinch gauge test, dynamomoter, quickDASH, VAS, edema, capillary refill test, jebsen hand test, ROM

What are intervention exercises for CMC OA?

Pain control, orthotic education and application, AROM exercises and strengthening,

What is cubital tunnel syndrome?

a peripheral nerve compression syndrome in which there is irritation or injury of the ulnar nerve in the cubital tunnel of the elbow. can be caused by frequent bending of the elbow, prolonged elbow pressure, sleeping with bent elbows, direct trauma, and previous injuries.

What are activity restrictions/ limitations for cubital tunnel syndrome?

avoid prolonged elbow flexion, avoid resting your elbow on hard surfaces, limit repetitive elbow and wrist motions, avoid sleeping with elbow bent, modify activities that cause numbness, tingling, or weakness in the ring or pinky finger

What are PAMs for cubital tunnel syndrome?

moist heat, cold pack/ice massage, iontophroesis, TENS, ultrasound

What are orthosis for cubital tunnel syndrome?

cubital tunnel syndrome splint/elbow brace , protects ulnar nerve from direct contact; wear throughout the day, WILL NOT HAVE TO DEMONSTRATE BRACE DURING THE COMP

What are assessments for cubital tunnel syndrome?

COPM, Michigan hand questionnaire, VAS, elbow flexion test, glenohumeral IR test, tinel’s test

What are intervention exercises for cubital tunnel syndrome?

0-6 weeks: education and nerve gliding

What is carpal tunnel release?

surgical procedure used to treat carpal tunnel syndrome, which happens when the median nerve is compressed as it passes through the carpal tunnel in the wrist.

What are activity restrictions/limitations for carpal tunnel release?

avoid heavy lifting, repetitive motions, and vibrations for about 2-6 weeks to allow for proper healing

What PAMs are used for carpal tunnel release?

cold pack, ice massage, TENS

What orthosis is used for carpal tunnel release?

wrist cock up sling to reduce pressure on the median nerve by keeping the wrist in a neutral and slightly extended position

What assessments are used for carpal tunnel release?

Jebsen hand test, quickDASH, 9-hole peg, purdue pegboard, VAS, observe functional tasks, ROM measurements, edema- figure 8

assess sensations: semmes-weinstein, two point discrimination, touch localization, sharp/dull, vibration test

What are interventions for carpal tunnel release?

pain assessment (VAS, cold therapy, TENS), sensation assessment, scar mobilization, desensitization, ROM exercises, goals

What is a distal radius fracture?

fracture/break near the wrist end of the radius bone. most common type of forearm fracture.

What are activity restrictions/limitations for distal radius fracture?

5-6 weeks post-op: do not bear weight or perform forceful activities on the wrist and avoid walking around w/o orthoses if you have balance concerns.

7 weeks post-op: avoid strengthening if there is persistent swelling or pain

What are PAMs for distal radius fracture?

contrast bath and hot pack

What orthosis to use for distal radius fracture?

wrist immobilization orthosis

What are assessments for distal radius fracture?

jebsen hand test, quickDASH, 9-hole peg, purdue pegboard, ROM, MMT, dynamometer, pinch gauge test, edema

What are intervention assessments for distal radius fracture?

ROM exercises, strengthening,

What is De Quervain’s

painful condition that affects the tendons on the thumb side of the wrist

what are activity restrictions/limitations for de quervain’s

0-3 weeks : avoid cradling the baby with the wrist flexed or supporting the baby;s head with one hand, avoid repetitive pinching or pulling motions with your thumb, avoid sustained wrist flexion/ulnar deviation

What are PAMs for de quervain’s

cyrotherapy, contrast bath, and non-thermal ultrasound

what is the orthosis for de quervain’s

forearm-based thumb spica orthosis

What are hand burns- post grafting

burn that caused damage to multiple layers of the skin.