Rehabilitation Techniques for CRPS and Fractures

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Questions and Answers

What is a characteristic symptom of complex regional pain syndrome type 1 (CRPS 1)?

Intense prolonged pain (correct)

Numbness in extremities

Rapid weight loss

Difficulty breathing

Which treatment is primarily focused on controlling pain and edema in patients with CRPS?

Surgery to repair nerve damage

Long-term medication therapy

Dietary modifications

Physical therapy (correct)

What mechanism is believed to contribute to the pathophysiology of CRPS?

Only peripheral mechanisms

Changes in blood pressure

Both peripheral and central mechanisms (correct)

Strictly central mechanisms

What is the primary focus of early rehabilitation for wrist and hand fractures?

Limiting the amount of edema and pain Signup and view all the answers

Which physical therapy technique employs the use of mirrors for visual feedback?

Mirror therapy Signup and view all the answers

For a fracture with mild angulation, what treatment method may be necessary?

Closed reduction Signup and view all the answers

What type of cast is applied in the treatment of an undisplaced fracture?

Colles cast Signup and view all the answers

Which statement is true about the symptoms of CRPS 1?

Symptoms can occur without a known precipitating event. Signup and view all the answers

What is the primary goal of early active range of motion (ROM) following a simple elbow dislocation?

To prevent post-traumatic stiffness Signup and view all the answers

Which technique is used for the reduction of a posterior elbow dislocation?

Palm-palm technique Signup and view all the answers

What should be avoided during the first two weeks after an elbow dislocation?

Strengthening exercises Signup and view all the answers

What common incident typically leads to a radial head fracture?

Fall on an outstretched arm Signup and view all the answers

Which of the following is a common feature associated with a radial head fracture?

Maximal tenderness over the radial head Signup and view all the answers

What is the recommended range of motion progression in a hinged elbow brace after an elbow dislocation?

10 to 15 degrees per week Signup and view all the answers

Which shoulder movement should be avoided in the early rehabilitation phase following an elbow dislocation?

Valgus stress to the elbow Signup and view all the answers

What is the expected timeline for regaining full elbow flexion after a dislocation?

6 to 12 weeks Signup and view all the answers

What percentage of all elbow injuries do dislocations constitute?

10% to 25% Signup and view all the answers

Which of the following is NOT a characteristic of simple elbow dislocations?

They always include associated fractures. Signup and view all the answers

What is the usual direction of dislocation in posterior elbow dislocations?

Posteriorly Signup and view all the answers

Which of the following is part of the 'terrible triad' in elbow dislocation?

Radial head injury Signup and view all the answers

What is the recommended treatment for a simple posterior elbow dislocation?

Closed reduction and fixation in a cast Signup and view all the answers

What commonly causes posterior elbow dislocations in children under 10 years?

A fall on an outstretched hand Signup and view all the answers

Which condition may accompany complex elbow dislocations?

Nerveovascular injury Signup and view all the answers

What type of elbow dislocation is defined as having associated fractures?

Complex dislocation Signup and view all the answers

What is the healing time for proximal pole scaphoid fractures?

8 to 12 weeks Signup and view all the answers

What is the recommended treatment for an undisplaced scaphoid fracture?

Cast immobilization Signup and view all the answers

What complication is associated with both scaphoid fractures and lunate fractures?

Avascular necrosis Signup and view all the answers

Which of the following observations may indicate a lunate fracture?

Tenderness in the lunate fossa Signup and view all the answers

What is the usual treatment for a displaced metacarpal fracture?

Surgical fixation Signup and view all the answers

What type of cast is recommended for a proximal pole scaphoid fracture?

Above elbow thumb spica cast Signup and view all the answers

What is typically observed when assessing for tenderness associated with a lunate fracture?

Tenderness distal to the center of the distal radius Signup and view all the answers

What is the significance of immobilization for a scaphoid fracture treatment?

It minimizes movement to facilitate union Signup and view all the answers

What is the typical timeline for regaining maximum range of motion (ROM) after surgical treatment of a wrist fracture?

6 to 8 weeks post-op Signup and view all the answers

Which type of wrist fracture results from a fall on a palmer flexed wrist?

Smith fracture Signup and view all the answers

What is the primary focus during the rehabilitation phase of a surgically treated wrist fracture?

Increasing ROM and beginning strengthening exercises Signup and view all the answers

What is a common symptom of a scaphoid fracture?

Deep, dull ache in the radial part of the wrist Signup and view all the answers

Which of the following statements about Barton’s fracture is correct?

It features dorsal displacement, similar to Colles’ fracture. Signup and view all the answers

Which of the following stretches is commonly used to increase wrist range of motion during rehabilitation?

Wrist extension and flexion stretches Signup and view all the answers

Radial styloid fractures are also known as which type of injury?

Chauffeur fracture Signup and view all the answers

What is the primary blood supply to the scaphoid bone?

Radial artery Signup and view all the answers

What is the typical management for a stable Rolando's fracture?

Thumb spic splint Signup and view all the answers

Which of the following describes a Boxer’s fracture?

Occurs at the metacarpal neck of the 4th or 5th finger Signup and view all the answers

Which principle is NOT part of Greer’s principles of splinting (REDUCE)?

Avoid any immobilization after 1 week Signup and view all the answers

What is the recommended joint position to avoid extension contractures in metacarpal fractures?

Flexion Signup and view all the answers

What condition may result if the thumb is excessively hyperextended during immobilization?

Stiff thumb Signup and view all the answers

When surgical intervention is recommended for Boxer’s fractures, which scenario is likely?

Significant angulation or displacement Signup and view all the answers

Which component of Greer’s principles emphasizes the importance of joint positioning?

Eliminate contractures through proper positioning Signup and view all the answers

What type of fracture is characterized by a T or Y shape and limited to the thumb area?

Rolando's fracture Signup and view all the answers

Study Notes

Fractures & Dislocations of the Upper Limb

Upper limb injuries include fractures and dislocations.
Elbow dislocations constitute 10% to 25% of all elbow injuries in adults.
Shoulder dislocations are the most frequent injury in the upper limb.
Elbow dislocations can be simple (ligamentous) or complex (involving associated fractures).

Elbow Dislocation

Simple dislocations are ligamentous injuries without associated fractures.
Posterior dislocation is the most common type.
Posterior dislocations are further categorized based on the direction of the ulna's displacement (e.g., posterior, posteromedial, posterolateral, direct lateral).
X-rays and clinical appearance help assess elbow dislocation.

Complex Elbow Dislocations

These dislocations are accompanied by associated fractures like radial head, coronoid process of ulna, and olecranon.
The 'terrible triad' is a common complex elbow dislocation involving injuries to the coronoid process, radial head, and posterior-lateral dislocation of the elbow joint.
Nerve and blood vessel injuries (e.g., ulnar/median neuropraxia, brachial artery injury) can sometimes occur with complex dislocations.
Ulnar collateral ligament tear is sometimes associated with elbow dislocation.

Mechanism of Injury

In children under 10, posterior dislocations are frequent, often due to falls.
Posterior dislocations often follow axial compression, valgus stress, arm abduction, and forearm supination.
Anterior dislocations mostly stem from direct force on the posterior forearm with a flexed elbow.

Treatment

Simple posterior dislocations often involve closed reduction under sedation, followed by plaster cast or posterior splint for 2-3 weeks with the elbow at 90 degrees.
Active range of motion exercises should begin early.
Complex or unstable elbow dislocations, severe soft tissue or bony injuries need open reduction with internal fixation and possibly ulnar collateral ligament repair.

Reduction of Posterior Elbow Dislocation

The 'palm-palm technique' is a common method.
Examiner's palm grasps the patient's hand with fingers interlocked.
Examiner's elbow is placed at the patient's antecubital fossa.
By pushing downward on the patient's distal humerus, a distal humeral distraction is done.
Posteriorly dislocated elbow is pulled back into the appropriate anatomical position.

Rehabilitation Considerations

Extended casting and immobilization should be avoided as they can lead to post-traumatic stiffness for elbow injuries.
Active range of motion (ROM) exercises are key to regaining flexibility.
Elbow splinting for 5-7 days is often followed by a hinged elbow brace (30-90 degrees) to improve soft tissue rest.
Active ROM should start early and involves muscle activation and compression across the elbow joint.
Exercises involve increasing the ROM in hinged elbow brace by 10-15 degrees per week.
Up to 2 weeks after injury, avoid passive ROM (as it increases swelling and inflammation), valgus stress, external rotation, and abduction.
No strengthening or resistive exercises should be performed to avoid placing undue tension on healing ligaments.
Strengthening usually starts at 6-8 weeks, with elbow flexion usually regaining first, followed by extension which can take 3-5 months to fully heal.

Radial Head Fracture

Radial head fractures usually result from falls, often onto an extended arm.
A fall on an outstretched arm with minimal or moderate elbow flexion is often causative.
A direct blow to the elbow is less often causative.
The fracture commonly causes swelling at the lateral aspect of the elbow, limited ROM, and maximal tenderness over the radial head.
The typical deformity range is 10° to 15° limitation of normal ROM.

Types of Radial Head Fractures

The Mason classification categorizes this type of fracture according to whether the fracture involves bone displacement, and its severity.

Treatment of Radial Head Fracture

Treatment depends on the severity and the displacement.
Simple, minimally displaced fractures (Type I) can be managed by immobilization in a cast for about 3 weeks.
Moderately displaced fractures (Type II) are often treated with open reduction and internal fixation (ORIF) or immobilization with a cast for about 2 weeks.
More severely comminuted fractures (Type III) are treated with ORIF, or resection of the radial head; followed by immobilization for two weeks.
Dislocations associated with fractures (Type IV) need ORIF or replacement of the radial head.

Forearm Bone Shaft Fracture

Monteggia and Galeazzi fractures are common types.
Monteggia fracture is a proximal ulnar fracture with superior radio-ulnar dislocation.
Galeazzi fracture is distal radius fracture with dislocation of the inferior radioulnar joint.
Both require ORIF (Open Reduction and Internal Fixation) to treat fractures.

Both Bone Forearm Fracture Rehabilitation

Phase I(0-2 weeks): Patients are immobilized with surgical incisions protected in a splint.
Phase II(2-6 weeks): Active and active-assisted ROM of elbow, forearm, and wrist, avoiding repetitive twisting.
Phase III(6 weeks onwards): Lifting and twisting restrictions are released according to surgeon preference.
Proper communication with the treating surgeon is crucial.

Distal Radial Fractures

These include Colles', Smith, Barton’s, and chauffeur's (radial styloid) fractures.
Colles' fracture is a transverse fracture of distal radius, and it affects primarily the elderly and is often due to a fall on an extended wrist.
Typical deformity when a Colles’ fracture happens is called a dinner fork deformity.
Smith fracture is frequently from a fall on a flexed wrist, with the opposite (palmar) deformity of a Colles' fracture, called a garden spade deformity.
Barton’s Fracture is an intra-articular type of distal radius fracture, often requiring open reduction and internal fixation (ORIF).

Carpal Bone Fractures

Scapholunate fractures constitute up to 50-80% of carpal bone fractures.
Due to a fall on an outstretched hand with a radially deviated wrist, that results in dorsiflexion.
The symptoms involve a deep dull ache in the radial portion of the wrist, and the pain might be worse when pinching and gripping.
The radial side of the wrist may also be slightly swollen or bruised.
Treatment for scaphoid injuries depends on the severity and displacement of the injury.

Lunate Fracture

Occurs via a fall on outstretched hand.
The proximal fracture fragment is at risk of avascular necrosis.
Clinically, this is suspected when axial compression on the 3rd metacarpal elicits tenderness.
Pain in the anatomical snuff box is common when a lunate fracture is present.
Treatment usually follows a short arm thumb splint and cast, followed by up to 7-10 days of observation.

Metacarpal Fractures

Bennett's fracture: Intra-articular fracture at the base of the first metacarpal, commonly associated with dislocation of the carpometacarpal joint.
Management typically involves ORIF (open reduction and internal fixation) for unstable cases, and a thumb spica splint for stable ones.
Boxer's fracture: Fracture of the 4th or 5th metacarpal neck, typically caused by forceful striking.
Treatment includes immobilization, often with buddy taping, with closed reduction if possible. ORIF if highly displaced.

Treatment summary

Treatment often involves immobilization of the affected joint to promote healing.
Splints, casts, or taping techniques (buddy taping) are commonly used.
Surgery (open reduction and internal fixation) may be necessary for severely displaced, unstable, or misaligned fractures.

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Description

This quiz covers critical concepts related to complex regional pain syndrome type 1 (CRPS 1) and essential rehabilitation techniques for wrist and hand fractures. It explores symptoms, treatment methods, and physical therapy techniques like mirror therapy. Test your knowledge on early rehabilitation strategies and fracture management approaches.