Give me a hand [Autosaved] - Utah Occupational Therapy ...

9/20/2018

GIVE ME A HAND!

Learning to assess common upper extremity injuries and disorders that effect occupational performance

Andrew Bracken MOT, OTR/L, CHT

OBJECTIVES

?Identify and assess specific upper extremity injuries and disorders through clinical exam. ?Learn how to utilize functional outcome measures like the Canadian Occupational Performance Measure (COPM), Disability of the Arm, Shoulder, and Hand (DASH), and health-related quality of life Short Form-36 to determine the impact of an upper extremity injury on a person's occupational performance.

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IMPACT OF UPPER EXTREMITY INJURIES ON LIVES

?Report inability to perform everyday tasks. ?Consult with physicians more frequently. ?Use prescription medication more often. ?Report a decreased quality of life.

?Walker-Bone K, Palmer K, Reading I, Coggon K, Cooper S. Prevalence and impact of musculoskeletal disorders of the upper limb in the general population. Arthritis and Rheumatism, 51, 642-651. (2004) ?Moon DK, Park YJ, Song SY, Kim MJ, Park JS, Nam DC, Kim DH, NA, JB, Lee SI, Hwang SC, Park KS. Common Upper Extremity Disorders and Function Affect Upper Extremity-Related Quality of Life: A Community-Based Sample from Rural Areas. Yonsei Medical Journal, 5, 669-676. (2018)

OCCUPATIONAL THERAPY'S ROLE

?"Occupational therapy practitioners have a holistic perspective." ?"Individualized evaluation, during which the client/family and occupational therapist determine the person's goals." ?"Customized intervention to improve the person's ability to perform daily activities and reach the goals." ?"Outcomes evaluation to ensure that the goals are being met."

? retrieved 8/29/18.

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NERVE INJURIES AND ENTRAPMENTS PERIPHERAL NERVE SENSORY DISTRIBUTION

MEDIAL CUTANEOUS NERVE OF THE FOREARM

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RADIAL NERVE PALSY & PIN INJURY

?Radial nerve palsy- Inability to extend the wrist, digits, and thumb and weakness with supination due to loss of the supinator, ECRL, ECRB, ECU, EDC, APL, EPL, and EPB. ?Posterior Interosseous Nerve (PIN)- Inability to extend the digit and thumb due to loss of the EDC, APL, EPL, and EPB. Weakness with wrist extension due to loss of the ECU.

?Cooper, S. Fundamentals of hand therapy: Clinical reasoning and treatment guidelines of common diagnosis of the upper extremity, Edition 2. (2014)

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RADIAL TUNNEL SYNDROME

?Dull or achy pain in the lateral elbow and forearm. ?Does not produce tingling or numbness. ?Pain with resisted supination with the elbow extended. ?Pain with resisted middle finger extension with the elbow extended ("Middle Finger Extension Test").

?Cooper, S. Fundamentals of hand therapy: Clinical reasoning and treatment guidelines of common diagnosis of the upper extremity, Edition 2. (2014)

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ULNAR NERVE INJURY

Jeanne sign & Froment sign Wartenberg sign

?Presence of a "claw hand" due to loss of the 3rd and 4th lumbricals. ?Atrophy of the 1st dorsal interossei and hypothenar muscles. ?Presence of a Froment sign and Jeanne sign. ?Presence of a Wartenberg sign.

?Cooper, S. Fundamentals of hand therapy: Clinical reasoning and treatment guidelines of common diagnosis of the upper extremity, Edition 2. (2014)

CUBITAL TUNNEL SYNDROME

?Pain, tingling, and numbness in the ulnar aspect of the hand. ?Pain and sensory impairment when the elbow is held in full flexion for 3-5 minutes (Elbow Flexion Test). ?Pain and sensory impairment with a Tinel's Sign in the medial elbow.

?Cooper, S. Fundamentals of hand therapy: Clinical reasoning and treatment guidelines of common diagnosis of the upper extremity, Edition 2. (2014)

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