AOTA NBCOT Exam Prep - Hand and Upper Extremity

General Considerations for Hand and Upper Extremity Intervention

Anatomy

• Forearm and Upper Arm Bones: Radius, Ulna, Humerus
• Wrist Bones: Distal radius, Ulna, Eight carpal bones, Joint capsule, Ligaments

Muscles

• Deltoid, Triceps, Anconeus, Biceps brachii, Brachialis, Brachioradialis

Blood Supply

• Right Arm: Brachiocephalic artery -> Subclavian artery -> Axillary, Brachial, Radial, Ulnar arteries
• Left Arm: Subclavian artery -> Axillary, Brachial, Radial, Ulnar arteries

Hand Anatomy

• Carpal Bones: Distal (hamate, capitate, trapezoid, trapezium), Proximal (pisiform, lunate, triquetrum, scaphoid)
• Muscles from Lateral Epicondyle: Anconeus, Supinator, ECRL, ECRB, ECU, ED, EDM
• Muscles from Medial Epicondyle: Pronator teres, FCR, FCU, PL, FDS
• Blood Supply: Radial and Ulnar arteries
• Sensory Receptors: Pacinian corpuscles, Ruffini end organs, Merkel cells

Evaluation of Hand and Upper Extremity

• Client History: Current injury, previous interventions
• Occupational Profile: Rapport, psychosocial status
• Cognition Assessment: Adherence to home program
• Observation: Nonverbal communication, posture, scars
• Pain and Wound Assessment: Pain scales, wound and scar assessment
• Specific Testing: ROM, edema, sensation, strength, coordination

Common Shoulder Diagnoses

Thoracic Outlet Syndrome/Brachial Plexopathy

• Regions: Sternocostovertebral space, Scalene triangle, Costoclavicular space, Pectoralis minor space
• Brachial Plexus: Supplying scapula, hand intrinsic muscles, elbow, wrist flexors/extensors
• Treatment: Education, breathing, posture, exercises, operative decompression

Frozen Shoulder/Adhesive Capsulitis

• Phases: Freezing, Frozen, Thawing
• Treatment: Avoid overstretching, ADL modifications, surgical release

Rotator Cuff Disease

• Involvement: Rotator cuff muscles, long head of biceps, subdeltoid bursa
• Treatment: Rest, anti-inflammatory modalities, ROM and strengthening exercises, surgical repair if needed

Fractures

Hand Fractures

• Types: Metacarpal, Thumb (e.g., Bennett's, Skier's thumb), Avulsion injuries (e.g., Mallet finger, Boutonniere deformity)
• Management: Bone regeneration, healing phases, ORIF, rehab with orthoses, home programs

Wrist Fractures

• Types: Distal radius (Colles, Smith's), Distal ulna, Carpal (Scaphoid, Lunate)
• Nerve Injuries: Median and ulnar nerve injuries
• Management and Rehab: Immobilization, edema and pain management, ROM exercises, strengthening

Forearm Fractures

• Types: Radial head, Olecranon, Distal humeral
• Management: Nonoperative for stable fractures, ORIF for displaced fractures, early ROM

Upper Arm Fractures

• Types: Proximal humeral fractures
• Management: Immobilization, ORIF, early ROM and strength training

Tendons

Extensor Tendons

• Anatomy and Zones: EDC, EIP, EDM, EPL, EPB, APL, surgical repair rehabilitation phases

Flexor Tendons

• Anatomy and Zones: FDS, FDP, FPL, pulley system
• Rehabilitation Approaches: Immobilization, passive flexion, active flexion

Nerve Injuries and Syndromes

Radial Nerve Injury

• Symptoms: Wrist drop
• Treatment: Splinting, ROM, strengthening

Median Nerve Injury

• Symptoms: Ape hand deformity
• Treatment: Splinting, tendon gliding, strengthening

Ulnar Nerve Injury

• Symptoms: Claw deformity
• Treatment: Splinting, education, nerve gliding

Sensory Function and Reeducation

• Assessments: Monofilament, two-point discrimination
• Reeducation: Protective and discriminative reeducation, desensitization

Pain and Trauma Considerations

Complex Regional Pain Syndrome (CRPS)

• Types: Type I and II
• Symptoms and Treatment: Neuropathic pain, edema, rehabilitation approaches

Cumulative Trauma Disorder (CTD)

• Symptoms and Treatment: Muscle fatigue, pain, OT interventions

Splinting

Types and Applications

• Static and Dynamic Splints: Resting hand, thumb spica, wrist cock-up, MP anti-ulnar deviation
• Special Considerations: Pediatric and geriatric adaptations

This summary encompasses key elements relevant to the anatomy, pathology, evaluation, and management of hand and upper extremity conditions as outlined in the AOTA NBCOT Exam Prep material.