Purpose of thumb immobilization splint
immobilize and stabilize
A thumb immobilization splint is used to treat what conditions?
CMC arthritis
OA of D1
Dequervains
What are the arches of the hand?
proximal transverse arch,
distal transverse arch (distal palmar crease)
longitudinal arch
What is the function of the TFCC ligaments?
main stabilizer from ulnar to radial side
How many interossei are there in the hand? What is their function?
4 dorsal 4 volar. AB/AD
What is the most important crease of the hand?
distal palmar crease
most mobile digits
D4/D5
least mobile digits
D2/D3
Name an example of thicken fascia.
dypuytren's contracture
What is a carpal metacarpal boss?
a node on top of MP
What is a node at the base of a digit?
Buchards
What are the 4 components of pressure and stress on tissue?
degree, duration, repetition, direction
How is venous and lymphatic edema different?
venous: acute and in 1 area
lymphatic: over the entire limb, chronic and bilateral
What types of fractures complicate tufts fracture?
spiral or oblique
What brace is the best at distributing force to decrease stress/pressure?
sarmiento brace
The intrinsic plus position = ________ position
safe position
What is the intrinsic plus position?
wrist ext, MP flex, thumb AD
In the intrinsic plus position the extrinsics are on _______ and the intrinsics are on ______.
extrinsics on stretch, intrinsics on slack
What is an example of a condition that results from an imbalance of the intrinsics and extrinsics?
swan neck and claw hand
Mallet Finger
terminal T of DIP = 6wk of uninterrupted splinting
Swan Neck
sinking PIP
DIP goes up because of lateral bands
Boutonnierre
opposite of swan neck
Ape hand
No opposition, complication of Median N
Claw hand
Radial N is taking over with intrinsics. Ulnar N and extrinsics are weak.
Crazy 8 splinting is used for what condition?
Claw hand
What are the 3 linear forces utilized for a majority of splints?
the troff is 1 linear F and the 2 straps are the other 2 Fs
What are the benefits of lever systems and splinting:
1) splints serving as levers use a proximal input of Fs
2) two moment arms
3) axis or fulcrum to move a distal output forces
what are the 4 Cs of an ideal prosthesis?
A. Capacity, clear, correct, clean?
B. Careful, character, clunky, crooked?
C. Crafty, creative, civilized, cute?
D. Control, cosmesis, comfort, and cost
D. Control, cosmesis, comfort, and cost
The most proximal level of amputation surgery in the upper limb is referred to as...??
Forequarter
Above elbow (AE) amputation is now commonly referred to as...?
transhumeral amputation
A terminal device (TD) that is shaped to enable participation in activities that require catching, manipulating, or throwing balls is called....?
flexible mitt
Who works with the client and is allowed to fit a prosthetic??
Prosthetist
What is another name for a forequarter amputation??
Interscapularthoracic amputation?
The congenital or partial absence of a limb at birth is called...?
amelia
What is a temporary prosthesis used initially to reduce edema, pain and swelling, and protect the site??
Immediate Post-Operative Prosthesis?
What is a type of surgical amputation after birth as a result of trauma or disease??
acquired amputation
A type of prosthetic that combines several options in a single prosthesis??
hybrid prosthesis
What is the term that describes the combination of bone tissue with titanium??
Osseointegration?
What is the procedure that keeps the terminal device open until tension is applied to the control cable for grasp??
voluntary closing mechanism
The higher the _______ number, the thicker the sock."?
ply
What can move a prosthetic device/ terminal device without an external power source and cables??
body power
What is the type of harness system used to keep on UE prosthetics?
Figure 8
What is the purpose of prepositioning that an OT can educate a pt with a prosthesis on?
rotating the prosthetic to put it in the best possible position to complete a task to decrease poor body mechanics.
What part of an UE prosthetic enables the hook to grasp objects by flexion of the shoulder?
bowed cable
What type of device is more cosmetic?
terminal devices
What type of device is more functional?
mechanical devices
1 rubber band = _____ lb of pinch force
0.5lbs of pinch force
Splints places on extremities function as levers and are considered what type of lever?
1st class lever
In a cock-up splint, the strap placed over the wrist signified the axis or ______.
1st pressure point
a splint in "trough" placed on the forearm should encompass how much if the forearm?
2/3
What are two classifications of splints named in the article?
dynamic and static
What is the purpose of static splints?
joint integrity and alignment, prevents contractures, support for joint laxity, maintain PROM, and improves function of more than one joint
What comes first for fabrication a dynamic or static progressive?
static progressive
is the claw hand a high or low nerve injury?
low
What structures in claw hand are unopposed?
D4/5
What is the name of the splint which is used to counteract opposing forces for claw hand?
figure 8 splint or intrinsic -
What structures are involved in ape hand?
median N
thenar muslces
opponens pollicis mm
Why does ape hand occur?
lesion of median n at wrist or elbow
What splint helps conteract ape hand?
C bar split
What are alternative names to the static immobilization splint?
� Short/long Opponens
� Radial gutter thumb splint
� Resting Thumb splint
� CMC stabilization splint
What performance area do you expect to be limited as a result of someone needing a thumb immobilization splint?
Grip, pinch, opposition, FMC
Describe dynamic splinting?
Consists of elastics, rubber bands, and springs that produce motion & is used during the healing phase, day 3-5 (flexor T. repairs)
What is gapping?
� Associated with increased adhesion formation, poor gliding function, and poor clinical results.
� Occurs when suture gaps and tendon pulls apart and fills with scarring
How much excursion is needed to avoid gapping?
3 mm
What are the 3 rehabilitation protocol after T repair?
� Immobilization
� Early Passive Motion
� Early controlled motion
What is the main precaution after T repair?
avoid active digital flexion
How soon can pinch/grip be tested after T repair?
12 weeks
When are T repairs most likely to rupture?
0-12 days
Who designed and organized splinting within the US army hospitals?
Dr. Sterling Brunnel
Name 4 types of splints
� Static
� Dynamic
� Serial Static
� Static Progressive
What type of splint uses low load, long duration stretch?
serial static
ex. bar/serial cast
What is it referred to when the tissues are stretched and held at a constant length and the stretching forces relax over time?
stress relaxation
Define creep
a constant load is applied for several hours per day over a period of time (weeks or months)
What is Dr. Brands Theory
Keeping the tissues at a physical state that demonstrates the need for change will stimulate the cells to multiply and make changes in response to need. The more time in the splint, the more quickly the tissues will respond.
What is it referred to when a patient feels that distal portions of the phantom limb have moved closer to the site of amputation ?
telescoping
What are some tx for phantom limb pain?
limb percussion, US and TENS
How often should a clean bandage be applied?
every 2 days
What is 1 pro and 1 con of electrical power prosthetics?
con: heavier
pro: greater pinch force
What should be done during the 1st therapy session with a pt with a prosthesis?
1) don/doff: limb sock/liner, harness, coat method and pull over method
2) wearing schedule: 15-30 min sessions over the day inc by 30 min intervals
3) hygiene of residual limb
What should be covered in therapy during the intermediate stage of a prosthesis?
1. Prosthetics control training:
Transradial: humeral flexion and scap abduction (protraction).
Transhumeral: scap depression and humeral extension and abduction
Electrical: shoulder = pectoralis/ infraspinatus, transhumeral = biceps/triceps
2. Functional
What is the area of space in which the patient can operate the upper limb prosthesis which includes: overhead, table top, floor level referred to?
functional envelope
What should be covered in therapy during the final stage of prosthesis?
IADL training