OCCTH 583 Forearm & U/E Applications PDF

OCCTH 583 FOREARM & U/E APPLICATIONS Jennifer Krysa, MSc, OT Reg (AB), OTR  Bones: ulna & radius Forearm Joints (all synovial): Humeroradial joint: trochlea of humerus sits in trochlear Supination & notch of ulna  hinge Proximal radiouln...

OCCTH 583 FOREARM & U/E APPLICATIONS Jennifer Krysa, MSc, OT Reg (AB), OTR  Bones: ulna & radius Forearm Joints (all synovial): Humeroradial joint: trochlea of humerus sits in trochlear Supination & notch of ulna  hinge Proximal radioulnar joint: head of radius sits in radial notch Pronation of ulna  pivot Distal radioulnar joint: head of ulna sits in ulnar notch of radius An interosseous membrane runs the length of the two bones  Action is on the radius with respect to the ulna Shape of ulna and its articulation with humerus means it cannot rotate Humerus is uninvolved In pronation the interosseous membrane is slack It comes under tension in supination Limits amount of supination Forearm - Muscles of Supination Biceps brachii O: coracoid of scapula (short) & supraglenoid tubercle of scapula (long) I: radial tuberosity (& fascia) Supinator: O: lateral epicondyle of humerus & coronoid process of ulna I: distal radius, lateral & middle surface N: radial nerve Forearm - Muscles of Pronation Pronator teres O: medial epicondyle of humerus & coronoid process of ulna I: radius, proximal shaft Pronator quadratus – deep muscle O: distal ulna I: distal radius Both innervated by median nerve Shoulder Treatment Considerations Shoulder difficult joint to treat What is the underlying problem Acute vs chronic condition Pain Body mechanics Compensatory movements Red Flags to Rule Out Diseases of digestive system can refer to shoulder Fracture proximal humerus Injury to blood vessels upper arm or avascular necrosis Neoplasm Osteoporosis with pathological fracture Cardiovascular Exercise Grading Considerations PROM AAROM AROM  resistance Gravity itself is resistance Use positioning to change difficulty Correction vs compensation Treatment – Pendular Exercises Good in early stages Gravity provides distraction Goal: joint mobility Decrease pain & stiffness Movement of synovial fluid Blood flow in limb Safe limited range Patient in control Easy at home exercise Treatment - AAROM Active Assisted Range of Motion One body part assists another to complete the movement Until able to move against gravity (??) Treatment - AROM Can perform against gravity or in G.E. Closed-chain or open-chain Positioning (external stability) Adding resistance: bands vs DBs Learning vs Performance Need motor learning if want to effect a permanent change Easier to change performance  temporary change in capability to respond Harder to get learning but then  relatively permanent changes Learning over time can translate to new environments Modifying Learning New movement strategy: goal-directed Repeated practice + feedback Results in relatively permanent change in movement Feedback Any kind of sensory information resulting from the movement Inherent (intrinsic) feedback: Sight Hearing Tactile Kinesthetic Augmented feedback: Always extrinsic Information in addition to performing task E.g. directions/corrections, tactile cues, mirror  Extrinsic feedback  rapid learning; Pt reliance; poor generalization to other environments Intrinsic feedback  slower to learn; better transfer of skill/motor pattern Learner deduces performance independently based on therapist instructions e.g. keeping joints aligned a certain way while performing and exercise Functions of the Upper Limb Reach Lift Pull Push Carry Also: placement of hands to interact with environment counterbalance, walking speed, protective reactions