Rehabilitation Exam Review

Activity Analysis

• Activity analysis should be based on what is provided, identifying triggers for conditions like lateral epicondylitis (e.g., typing, overhead motion, grasping with supination and pronation).
• Understanding the muscles involved in an activity starts with anatomy and leads to understanding function.

Splinting

• Initiate splinting immediately after injury to mitigate contractures.

Scar Management Techniques

• Never weight bear directly onto a scar.
• Scar management techniques include desensitization, resensitization, soft tissue mobilization, and the use of autoform or gel scar pads.
• Autoform is a putty-like substance applied over the scar site to help with management. Gel scar pads also provide benefit.

Soft Tissue Mobilization

Reasons for beneficial intervention:

• Pain
• Edema
• Soft tissue issues

Colles Fracture

• Six weeks post-op, promote bilateral integration with non-resistive tasks.
• Avoid resistive exercises at this stage.

Edema Assessment

• For unilateral edema post-Colles fracture, use a circumferential tape measure for assessment.

Humeral Fracture and Nerve Damage

• Nerve damage after a mid-shaft humeral fracture may manifest as wrist drop due to radial nerve involvement.

Standardized Assessments

• The assessment with seven subsets is the Jebsen Hand Function Test.
• The Minnesota Test is a gross motor control test.

Pain Management and Grip Strength

• If a client reports high pain (e.g., 9/10) during grip strength assessment with a JMAR dynamometer, find a functional task to assess grip strength instead.

Jepson Test

• The Jepson Hand Function Test involves various subsets using random items (e.g., cans, empty and full) to assess hand function.

Mini Mental Assessment

• Perform a mini-mental assessment before CT scans to check for lingering effects of anesthesia or medication that could affect orientation.
• Ensures the client is oriented, reducing fall risk.
• Required in hospital settings.

Humeral Fracture Assessment

• Assessments for humeral fractures include evaluating pain, cognition, biomechanical factors, range of motion, and MMT on the strong arm.
• Also assess self-care abilities and fall risk.

Provocative Tests for Shoulder Tendinitis

• Neer’s Test: Shoulder flexion with internal rotation.
• Empty Can Test: Arm abduction to 90 degrees with internal rotation.
• Hawkins-Kennedy Test: Arm flexion with internal rotation.

Provocative Tests

• Phalen’s Test: For carpal tunnel syndrome.
• Reverse Phalen’s Test: For carpal tunnel syndrome.
• Tinel’s Test: For nerve compression.
• Grind Test: For the CMC joint.
• Finklestein’s Test: For De Quervain's tenosynovitis.

Allen's Test

• The Allen’s test assesses vascular integrity.
• Procedure: Occlude radial and ulnar arteries, have the client pump their hand, and then release one artery to observe color return.

Capillary Refill Test

• Press on the nail bed and observe the time taken for color to return; assesses vascular integrity.

Intrinsic Plus Position

• Wrist at 20 degrees of extension, MPs at 70-90 degrees flexion, IPs fully extended, thumb in palmar abduction.
• Important for preserving fine motor and functional abilities.

Allen’s Test

• Assesses vascular integrity, particularly in hand settings.

Virtual Reality (VR) in OT

• VR can be used to practice functional tasks, change emotion, promote mindfulness, visual imagery and reduce pain and anxiety for burn patients.

Range of Motion

• For a client in a coma, perform passive range of motion.

Carpal Tunnel Syndrome (CTS)

• Do NOT do strengthening exercises pre-op for CTS.
• Phalen’s test is a provocative test for CTS.

Trigger Finger Splint

• The splint used for trigger finger is an MP blocking splint.

Sarmiento Brace

• Provides circumferential compression around the humerus for stabilization.
• Used when a client is at risk for nonunion with bone healing; considers factors like smoking or diabetes.

Scar Formation

• Scar formation does not occur immediately; it takes a couple of weeks.
• Scar management is not indicated if the client is less than two weeks post-op.

Cumulative Trauma Injuries

• Main intervention categories: activity modification, splinting, stress and pain management.

Lateral Epicondylitis

• Strengthening other muscle groups can prevent overuse of the affected muscle.
• Fine motor control is generally not directly impacted by lateral epicondylitis.
• The primary issue is impaired grasp due to wrist extensor involvement (ECRB).
• OT interventions should focus on pain management and compensation strategies rather than fine motor control.

Sensation Test

• The gold standard sensation test is the Semmes Weinstein monofilament test.

Ergonomic Strategies

• 90-90-90 positioning (hips, knees, ankles at 90 degrees) is a recommendation from the Duretti textbook, though not the gold standard. Adjusting the height of the keyboard, monitor, reducing strain, reducing prolonged patterns, sustained positioning, are all examples of ergonomic strategies.

Carpal Tunnel Syndrome Scenario

• If a client's sister asks for help with moving during a carpal tunnel syndrome scenario, firmly say no.

Carpal Tunnel Structures

• The structures within the carpal tunnel: flexor digitorum profundus, flexor digitorum superficialis, flexor pollicis longus, median nerve.

Edema Control

• The best manual intervention for edema control is retrograde massage.

Cubital Tunnel Syndrome

• Involves the ulnar nerve.
• Know the distribution for radial, median, and ulnar nerves to match with conditions.

Boutonniere Deformity

• Extensor tendon injury at the PIP joint, often caused by rheumatoid arthritis.

Neuropraxia

• A reversible nerve compression injury.
• Example: Saturday night palsy, caused by compression of the radial nerve.
• Resolves over time.

Tendon Glides

• Tendon glide exercises include: Straight, hook, fist, table top, full fist with neutral in between.

Flexor Tendon Injuries

• Zone 2 flexor tendon injuries have poor rates of healing.