Orthopedics OT

non-weight bearing

0%

sit to perform ADLs

touchdown weight bearing

10-15%

Sit to perform ADL’s

Partial weight bearing

50%

full weight bearing

75%

Possible movement restrictions after hip surgery

No hip flexion beyond 90: including movement of the trunk over thighs

No hip rotation

No crossing operative leg over inoperative leg

No adduction of operated leg

Adaptive devices for hip precautions

Reacher or dressing stick to don and doff pants

sock aid to don and doff socks

Extended handled shoehorn

Elastic laces

Orthotic splints

reduce local inflammation

reduce soft-tissue and joint pain

correctly position joint

improve joint stability

improve hand function

Static resting splint

reduce localized pain and inflammation by providing support in an anatomically correct position at rest

ergonomics

addressing human performance in relation to occupational tasks and applying the most efficient use of equipment, tools, and the environment to promote health and safety

Tissue healing phases

inflammation

fibroplasia

maturation or remodeling

tendinopathy

tendonitis/tendinosis

Lateral epicondylitis

tennis elbow

extensor carpi radialis brevis

most common in activities involving resisted wrist extension

medial epicondylitis

golfers elbow

flexor carpi radialis

pain worsens with resisted flexion and pronation

De Quervain Tenosynovitis

tendinitis involving

abductor pollicis longus and extensor pollicis brevis at the first dorsal compartment of the wrist

golfers, knitters, new mothers, racquet sports

thumb posture sustained in hyperabduction like at the computer space bar

Finkelstein test

tests for de Quervain disease

positive test: extensive pain with passive wrist ulnar deviation while flexing the thumb

Trigger finger

development of nodule at the flexor tendon sheath and stenosis at A-1pulley

when bending finger, the swollen area causes a catching or triggering sensation

If left untreated the nodule may become too swollen to pass through the pulley and the finger will get stuck in a bent position

carpal tunnel

compression of the median nerve w/in the carpal tunnel

tunnel acts as a pulley for the nine long finger flexors during gripping

hand numbness at night or when driving

medical: cortisone injections, OTC wrist orthosis and surgery

Cubital Tunnel Syndrome

ulnar nerve compressed at medial epicondyle and olecranon

proximal and medial forearm pain (aching and sharp), decreased sensation of the palmar and dorsal surfaces of the small finger and the ulnar half of the ring finger, weakness of the interossei, adductor pollicis, flexor carpi ulnaris and flexor digitorum profundus of the ring and small finger

grip and pinch strength decreased

complaints of dropping things

Posterior Interosseous Nerve Syndrome

motor condition

paralysis of all muscles innervated by posterior interosseous nerve

inability to extend the MP joints of the thumb, index, long, ring and small fingers

therapeutic intervention: PROM and orthotic selection to prevent deformity

nerve laceration

complete or partial

median nerve laceration

low median nerve palsy

denervation of the opponens policis and abductor pollicis brevis of thumb

loss of sensation of radial side of hand

absence of thumb abduction and opposition

loss of manipulation and sensibility of the thumb, index and long fingers: “ape hand”

therapeutic intervention: prepare patient for tendon transfers by preventing deformity with orthotics

maintain PROM of pronation and digital MP’s in flexion, digital IP’s in extension and thumb CMC abduction

ulnar nerve lesions

laceration at wrist

loss of hand intrinsics

ring and small finger: claw hand

Distal radius fracture

most common: fall on extended hand

low radial nerve injury

posterior interosseous palsy

strong radial deviation with wrist extension

MP extension is affected

sensation of dorsal hand is affected

high radial nerve injury

occur from a humerus fracture

wrist drop: absent wrist and digital extensors

sensory loss on dorsal-radial hand

loss of supinator and all wrist and finger extensors

skier’s thumb

ulnar collateral ligament of thumb MCP joint occurs with acute radial deviation

analysis of occupational performance

OTPD

looks specifically at client factors, skills, performance patterns that are barriers to identified areas of occupation

Edema control

elevation, active exercise, and movement of the extremity and compression

scar management

compression and mechanical forces of vibration used to promote scar softening and maturation

Neer Impingement Sign

Forced shoulder flexion through patient’s full range of motion with internal rotation. If patient expresses pain, the sign is positive, indicating compression and/or inflammation of the supraspinatus and/or long head of biceps tendon.

Hawkin’s Test

Shoulder and elbow are flexed to 90 degrees, followed by forced internal rotation. If the patient expresses pain, the test is positive, indicating compression and/or inflammation of the supraspinatus and long head of biceps tendon.

Jobe’s Test/ Empty Can test

Shoulder elevation to 45 degrees and internal rotation with thumb facing down. Therapist applies resistance to abduction (downward force). Positive sign is weakness or pain, indicating possible tear of the supraspinatus tendon. Repeat the same test at 90 degrees, if pain is only experienced at 90 degrees position, suspect bursitis.

Speed’s Test

Shoulder flexed to 90 degrees, forearm supinated, and elbow extended. Resistance is applied to flexion (downward force using a long lever arm). Positive sign is pain over bicipital groove.

Drop Arm Test

Patient’s arm is positioned in 90 degrees of abduction. The patient slowly lowers their arm to the side. The test is positive if the patient drops the arm to the s ide, indicating a supraspinatus tear.

Finkelstein Test

Provocative testing of extensor pollicis brevis and abductor pollicis longus muscles. The therapist then asks the patient to make a fist around a thumb and to perform a ulnar deviation.

Wartenberg Sign

Abduction of the 5th digit due to ulnar nerve palsy, client is unable to adduct the small finger with hand palm down on the table.

Froment Sign

Tests the strength of adductor pollicis; the thumb elicits IP flexion during forceful lateral pinch in response to the therapist attempting to tug piece of paper from client’s grip.

Phalen’s Test

Provocative testing of median nerve, implicated in carpal tunnel syndrome, positive sign includes pain/numbness/tingling radiating into radial aspect of hand.

Tinel’s Test

Provocative testing including tapping along median nerve distribution at the transverse carpal ligament with positive sign indicating nerve pain radiating into radial aspect of hand.

Which of the following joint protection strategies would be the most appropriate to recommend for supporting occupational performance and independence in someone with arthritis in the upper extremity? 

Using built-up utensils for easier, ergonomic grip during eating.

Which of the following statements regarding physical agent modality use in arthritis is not true?

Cold applications are preferred over thermotherapy in active joints where intra-articular heat increase is contraindicated, such as during an exacerbation of rheumatoid arthritis symptoms. 

Medial epicondylitis

Sometimes referred to as golfer elbow; extrinsic flexor muscle involvement, especially flexor carpi radialis, with pain frequently at the flexor wad, activities involving resisted wrist flexion and pronation often produce greatest pain.

Lateral Epicondylitis

Sometimes referred to as tennis elbow; extrinsic extensor muscle involvement, especially extensor carpi radialis brevis, with pain frequently at the extensor wad, activities involving resisted wrist extension often produce greatest pain.

De Quervain Tenosynovitis

First dorsal compartment of wrist involvement, especially abductor pollicis longus and extensor pollicis brevis; thumb posture in sustained hyperabduction can cause condition, with pain most pronounced with wrist ulnar deviation with thumb flexion.

Trigger finger

Often from development of a nodule on the flexor tendon sheath and stenosis at the A-1 pulley, with pain over A-1 pulley of digit flexor; characterized by resisted grip and catching or locking of the finger in composite flexion with MCP and PIP extension.

Skier’s thumb

Disruption of the ulnar collateral ligament of the thumb MP joint; Hand-based thumb MP orthosis may be used to immobilize grade I or II injuries

Cubital Tunnel Syndrome

Ulnar nerve entrapment between the medial epicondyle and olecranon; most often proximal and medial forearm pain; decreased sensation of dorsal and palmar surfaces of the small finger and ulnar half of ring finger, weakness of interossei.

Carpal Tunnel Syndrome

Compression of the median nerve within the carpal tunnel in the wrist at the transverse carpal ligament; characterized by hand numbness, particularly at night; pain and paresthesia over median nerve distribution (thumb through radial aspect of ring finger).

Radial Tunnel syndrome

Compressive neuropathy of the posterior interosseus nerve (PIN) in the radial tunnel; repetitive prono-supination with elbow at 0-45 degrees of flexion is common injury mechanism

Colles Fracture

Distal radius fracture, often caused by a fall on an outstretched (extended) hand (FOOSH injury); causes dinner fork deformity from dorsal displacement

Smith Fracture

Distal radius fracture with volar displacement (often from fall on flexed wrist) causing garden spade deformity.

scaphoid fracture

Marked by atrophy over the anatomic snuffbox.

Boutonniere Deformity

Flexion of the PIP joint, hyperextension at the DIP joint.

Swan-Neck deformity

Hyperextension of the PIP joint and flexion at the DIP joint.

Mallet finger deformity:

Damage to extensor tendon of the DIP joint, resulting in DIP hyperflexion.

Characteristic rheumatoid arthritis thumb deformity:

Excessive hyperextension of the IP joint and flexion of the MCP joint of the thumb.

Characteristic osteoarthritis deformity:

Thumb CMC joint adduction, MCP hyperextension, IP joint flexion.

Claw deformity:

Finger position of MP hyperextension and PIP flexion associated with muscle imbalance in ulnar innervated structures.

Dupuytren’s contracture:

Abnormal thickening of the tissues in the palm of the hand causing MP flexion of involved digit(s).