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Hand Therapy Test #1
Terms in this set (41)
Typical sequence of treatment
1. Moist heat
2. Soft Tissue Mobilization
3. HEP for stretching
4. Strengthening exercises
What do you do if ice increases pain or muscle tightness?
Try electrical stimulation
Soft Tissue Mobilization is used for...
many different diagnoses in the upper extremity to significantly decrease pain and increase function
What are 4 benefits of Soft Tissue Mobilization?
1. Increase blood flow and fluid circulation
2. Diminish trigger points
3. Decrease muscle tightness
4. Decrease pain
What do you palpate for prior to treating a patient with soft tissue mobilization?
1. Changes in skin temperature
2. Muscle tone/tension
3. Trigger points
What are 4 steps to take prior to treating a patient with soft tissue mobilization techniques?
1. Look for muscle guarding
3. Make sure patient is relaxed and the arm is well supported
4. Evaluate your own posture/positioning
Should soft tissue mobilization be painful?
What is a trigger point?
A tight band in a muscle that is hyper-irritable and causes pain in other areas of the body when firm pressure is applied
What is referred pain?
Pain that is felt in an area of the body that is adjacent to the source of pain
What are three steps to release a trigger point?
1. Identify the hyper-irritable are in the muscle
2. Apply firm pressure with your thumb or index/middle fingers
3. Maintain pressure for 30-60 seconds
What are 4 ways to follow a trigger point release?
1. Soft tissue mobilization
3. Electrical stimulation
4. Ice pack
What are two things to identify during the initial evaluation?
1. Primary location of pain
2. Identify the type of pain
3. Determine whether a soft tissue restriction is contributing to pain patterns
How long should the patient be able to maintain a position?
At least 20 minutes
How should the patient positioned when working on their shoulder?
Supine, prone, or sidelying
How should the patient positioned when working on their elbow?
How should the patient positioned when working on their forearm, wrist, or hand?
Supported with their arm on a towel or pillow
Explain the sidelying shoulder technique
1. Place pillow between you and patient with patient positioned facing you and lying on their unaffected shoulder
2. Start by gently protracting and retracting the scapula
3. Elevate and depress the scapula and shoulder girdle
What muscles can be kneaded in the sidelying shoulder position?
Upper traps, deltoids, and medical scapular border
What shoulder structures should be treated in supine?
1. Anterior insertion of the upper trap on the clavicle
2. Anterior deltoid
3. RC insertions
4. Pectoralis muscles
Explain the supine elbow/forearm technique
1. Bend elbow at 90d to use kneading and muscle bending techniques
2. Lay arm flat on a table to knead and trigger point release
What are mini massages for?
They are designed for scar massage but are very effective for reducing joint stiffness and muscle tightness - good for home use
What is joint mobilization?
Manual manipulation of a joint following an injury or period of immobilization
What is the purpose of joint mobilization? (3)
1. Improves ROM
2. Decreases pain
3. Decreases adhesions
What are the 4 benefits of joint mobilization?
1. Increase flow of lubricating fluids (stimulates synovial fluid production)
2. Decreases joint stiffness
3. Increases joint nutrition (improved blood flow and fluid circulation)
4. Increases proprioceptive input
What are 5 contraindications of joint mobilization?
1. Unhealed fractures
2. Acute arthritic flare-up
4. Bone disease or malignancy
5. Tendon repair
What is the convex-concave rule? (mobilizing convex)
If you are mobilizing a convex bone on a concave stationary bone, the direction of mobilization should be the opposite direction that the bone is moving
What is the convex-concave rule? (fixed convex)
When the convex surface is fixed and the concave surface is moving, the joint surface glides in the same direction that the bone is moving
Grade I Joint Mobilization
Small amplitude of motion at the beginning of the available ROM
Grade II Joint Mobilization
Large amplitude movement, but not reaching the end of the available ROM
Grade III Joint Mobilization
Large amplitude movement that is performed up to the limit or end of the range ***
Grade IV Joint Mobilization
Small amplitude movement, performed at the limit of the movement ***
What are Grades I and II for?
Pain reduction and to increases flow of lubricating fluids
What are Grades III and IV for?
Improving joint movement
In which position should joint mobilizations be performed?
Loose pack position
What is loose pack position?
The position in which the joint and joint capsule are the most relaxed and the greatest amount of joint motion is possible
What is closed pack position?
The least amount of movement is available in this position
What is the closed pack position for the glenohumeral joint?
Full shoulder abduction
What is the loose pack position for the glenohumeral joint?
55d of ABD, 30d horizontal ADD
How do you mobilize the humerus?
Fixed concave glenoid, moving convex humeral head
What is the purpose of GH distraction and oscillation?
Facilitates relaxation and decreases pain
How to complete GH distraction
1. Position patient in supine
2. Grasp the humerus with both hands positioned distally just above the elbow
3. Mobilize and pull the humerus toward you gently
4. "Arm pull"
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