OT NBCOT Exam Prep - Upper Extremity Disorders

Introduction

• Presenter: Jeff, OT Dude
• Focus: Upper extremity disorders and injuries (hands, fractures, etc.)
• Resources: Free course, study guides, interactive games, quizzes
• Important tool: Splints matching game for upper extremity conditions

General OT Interventions for Fractures

• Weight-bearing precautions:
  • Non-weight bearing
  • Touchdown weight bearing
  • Partial weight bearing (up to 50%)
  • Weight bearing as tolerated
  • Full weight bearing
• Complications: Polytrauma, multiple fractures with different weight-bearing precautions
• Healing Phases:
  • Callous formation: 2-3 weeks
  • Bone union: 4-6 weeks
• Fracture characteristics & management:
  • Unstable/stable, displaced/non-displaced, open/closed, communited, spiral
  • Surgical: ORIF, Ex-fix
  • Conservative: Cast, protection
  • Immobilization techniques: Casting, bracing, splinting
• Encouraged activities: AROM, strengthening surrounding structures
• Evidence: Early mobilization beneficial, avoid blood thinners recently administered
• Intervention areas:
  • Patient & caregiver education
  • Pain and wound management, edema management
  • Psychosocial (e.g. fear of falls, anxiety)
  • ADL promotion, adaptive strategies, home exercise program (HEP)

Fracture Characterization - Upper Extremities

• Procedure during evaluation: Use monofilament, two-point discrimination, grip strength, MMT, ROM
• Precaution: Contraindications e.g., weight-bearing for MMT

Humerus Fracture

• Common locations: Surgical neck, mid-shaft
• Symptoms: Radial nerve involvement → Wrist drop
• Management: Brace, shoulder sling, Sarmiento brace

Elbow Fracture

• Common location: Olecranon
• Complications: High dislocation risk, Volkmann's contracture
• Management: Casting, posterior elbow splint, progressive ROM & strengthening

Forearm Fracture

• Classification: Type 1 (non-displaced), Type 2 (displaced), Type 3 (communited)
• Management: Long arm sling for non-displaced

Distal Radius Fracture

• Types:
  • Colles' (dorsal displacement): Volar wrist splint
  • Smith's (volar displacement)
• Complication: Median nerve compression

Metacarpal Fracture

• Common types:
  • Bennett’s fracture (base of thumb): Thumb spica splint
  • Boxer's fracture (4th/5th metacarpal): Ulnar gutter splint

Nerve Complications with Wrist Fracture

• Affected nerves:
  • Median Nerve → Similar to Carpal Tunnel Syndrome
  • Ulnar Nerve

Carpal Fracture

• Mnemonic: So Long To Pinky Here Comes The Thumb
• Common fracture: Scaphoid (use thumb spica splint)
• Complication: Kienbock’s disease (lunate osteonecrosis)

Phalanx Fracture

• Common: Proximal phalanx
• Complications: Loss of PIP motion

Upper Extremity Syndromes and Traumas

Complex Regional Pain Syndrome (CRPS)

• Definition: Vasomotor dysfunction with disproportionate pain
• Types: Type 1 (noxious event), Type 2 (nerve injury)
• Stages: Traumatic, Dystrophic, Atrophic
• Symptoms: Pain, swelling, contractures, skin discoloration, temperature changes
• Treatment: No PROM, use TENS, CPM, active ROM, desensitization, and avoid passive interventions

Cumulative Trauma Disorder (CTD)

• Definition: Repetitive strain injury
• Symptoms: Pain, inflammation, muscle fatigue, sensory impairment
• OT strategy: Modify activities, environment, and encourage movement

Tendon Injuries

• Flexor & Extensor Tendons:
  • Zones start from finger tips to wrist
  • Complications: Pain, edema, loss of function
  • Protocols: Duran and Kleinert
• Tendon Glides: Promote early mobilization, combine with modalities and ROM
• Protocols:
  • Duran: Passive ROM
  • Kleinert: Active extension, passive flexion

Nerve Injuries

• Major nerves: Median, Ulnar, Radial
• Recording hand signs is helpful for visualization
• Tests:
  • Tinel's Sign: Indication of carpal tunnel, Guyon's canal, cubital tunnel
  • Fromment's Sign: Ulnar nerve palsy
  • Jeanne's, Wartenberg's, Finkelstein's tests
  • Phalen's Test: Carpal tunnel
• Nerve Injury Signs:
  • Median Nerve: Hand of Benediction, static thenar splint
  • Ulnar Nerve: Claw Hand, anti-claw splint
  • Radial Nerve: Wrist Drop, dorsal splint

Shoulder Conditions

• Rotator Cuff Tendinitis & Tear:
  • Shoulder joint inflammation or tear
  • Management: Pain management, strengthening, progressive tendon forces
• Adhesive Capsulitis (Frozen Shoulder):
  • Symptoms: Decreased shoulder ROM
  • Treatment: Stretches, caution with PAMS
• Subacromial Impingement Syndrome:
  • Symptoms: Shoulder pain at 90 degrees flexion
  • Treatment: PAMS, elastic taping

Elbow Conditions

• Epicondylitis:
  • Lateral (tennis elbow): Wrist extensor overuse
  • Medial (golfer's elbow): Wrist flexor overuse
  • Treatments: Elbow & wrist splints, stretching, strengthening

Nerve Compression Syndromes

• Median Nerve Compression: Pronator Teres Syndrome
  • Symptoms: Same as carpal tunnel, managed with elbow splint
• Ulnar Nerve Compression: Cubital Tunnel Syndrome
  • Symptoms: Pain at elbow, managed with elbow splint
• Radial Nerve Compression: Radial Tunnel Syndrome
  • Symptoms: Pain at lateral forearm, managed with long arm splint
• Carpal Tunnel Syndrome: Median Nerve Compression at wrist
  • Symptoms: Tinels & Phalen's positive, managed with wrist splint
• Guyon’s Canal Syndrome: Ulnar Nerve Compression at wrist
  • Symptoms: Addressed similarly to carpal tunnel

Thumb & Finger Conditions

• Game Keeper’s/Skiers Thumb:
  • Symptoms: Ulnar collateral ligament rupture
  • Managed with thumb spica splint
• De Quervain's Tenosynovitis: Inflammation of thumb tendon
  • Symptoms: Pain & tenderness, positive Finkelstein's test, managed with thumb spica splint
• Dupuytren's Contracture: Palmar fascia thickening
  • Symptoms: Flexion deformity
• Finger Deformities:
  • Boutonniere's: PIP flexion, DIP hyperextension
  • Swan Neck: PIP hyperextension, DIP flexion
  • Mallet Finger: Lack of DIP extension
  • Trigger Finger: Stenosing tenosynovitis, managed with splint preventing MCP flex