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Used to assess sensation secondary to nerve compression
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The home program for a humeral fracture can include....A sling for comfort and sleeping for the first 6 weeks as neededDevelops after a noxious eventCRPS Type IDevelops after a nerve injuryCRPS Type IISensation misinterpreted as painAllodyniaIncreased response to painful stimuliHyperalgiaPain that continues after the stimuli is removedHyperpathia- Gentle pain-free AROM - Stress loading - Pain control (TENS or splinting) - Edema control (elevation, massage, AROM, contrast baths, and compression) - Desensitization (fluidotherapy) - Blocked exercise (tendon gliding) - Joint protection and energy conservationCRPS treatmentPain after activity, resolves quicklyGrade IPain during activity, resolves when activity stopsGrade IIPain persists after activity, affects work productivity, objective weakness and sensory lossGrade IIIUse of extremity results in pain up to 75% of time, work is limitedGrade IVUnrelenting pain, unable to workGrade VReduction of inflammation and pain through static splinting, ice, contrast baths, ultrasound phonophoresis, iontophoresis, high-voltage electric and interferential stimulationAcute phase of treatment of CTDSlow stretching, myofascial release, progressive resistive exercise as tolerated, proper body mechanics, education on ID of triggers and returning to acute phase treatment with flare ups, static splint during activity that causes painSubacute phase of treatment of CTDAssessment of job site, tools used, and body positioning. Therapy using work simulator, weight well, elastic bands, putty, functional activities, and strengthening activitiesReturn to work phase of treatment of CTD- Acute - Subacute - Return to work - FCE - Work hardeningTreatment progression for CTDIP joint of thumb DIP joints of digitsExtensor Zone IProximal phalanx of thumb Middle phalanx of digitsExtensor Zone IIMCP joint of thumb PIP joint of digitsExtensor Zone IIIFirst metacarpal Proximal phalanx of digitsExtensor Zone IVWrist at the base of the thumbExtensor Zone VMCP joints of the digitsExtensor Zone VMCP bones of the digitsExtensor Zone VICarpal bones and wristExtensor Zone VII- Exercises to promote tendon excursion and prevent adhesions - Modalities (heat and NMES) - Home exercise program - Tendon gliding to promote excursion and prevent adhesions - ROM - Strengthening 8-12 weeks post surgeryProgression of treatment for flexor and extensor tendon repairsFrom fingertips to the center portion of the middle phalanxFlexor Zone IFrom center position of middle phalanx to the distal palmar creaseFlexor Zone II (no man's land)From the distal palmar crease to the transfers carpal ligamentFlexor Zone IIIOverlies the transverse carpal ligamentFlexor Zone IVBeyond the level of the wristFlexor Zone VEarly passive ROM protocol for flexor injuriesDuranInvolves active extension of the digits with passive flexion via traction using a rubber bandKleinertProtocol that begins within days of surgery to prevent adhesions and promote tendon gliding and excursionEarly Active Motion ProtocolWhen is an immobilization protocol advisable after a flexor tendon repair?For patients who are unable to care for themselves or who do not have the cognitive capacity to ensure safety (protected position for 6 weeks)When is a repaired tendon at its weakest?10-12 days post surgeryWrist cock-up splint with or without dynamic finger and thumb extension assist. passive and active ROM, isotonic exercises upon muscle re-inervationRadial nerve injury conservative treatmentStatic wrist extension splint 30', after 4 weeks adjust to 10-20' extensionRadial nerve injury post-op treatmentBurning pain in lateral forearm (radial head to supinator muscles)Radial tunnel syndromeLong arm splint, elbow flexed, forearm supinated, wrist neutral Massage or TENS, pain free ROM, nerve glides, activity modification to avoid forceful wrist extension and supinationRadial tunnel syndrome conservative treatmentLong arm splint, elbow flexed forearm supinated, wrist in neutral (2 weeks) Wrist cock up splint (2 more weeks) Passive and active pronation and supination and hand strengthening exercises (at 3 weeks) Resistive exercises (6 weeks)Radial tunnel syndrome post-op treatmentDeep pain in the proximal forearm with activityPronator syndromeDistal ulnar nerve compression or lesion at the wrist will cause...Claw deformityHyperextension of the thumb MCPJeanne's signEducates clients to visually compensate for sensory loss and to avoid working with machinery and temperatures below 60'Protective reeducationUses motivation and repetition in a vision-tactile matching process in which clients identify objects with and without visionDiscriminative reeducationA process of applying different textures and tactile stimulation to reeducate the nervous system so clients can tolerate sensation during functional use of the upper extremityDesensitizationWound is closed with suturesPrimaryWound is left open and allowed to close on its ownSecondaryWound is cleaned, derided, and observed 4-5 days before suturing it closedDelayed primary