SIM LAB #1 OT 7450 Prep cases

Case #1

23-year-old, right dominant female, works as an adaptive ski instructor and slipped and fall on ice while
transporting equipment into storage shed at mountain. Patient sustained a right scaphoid fracture for
which she underwent bone grafting and open reduction internal fixation (ORIF) with a screw 4 weeks
again. She returned for her post-operative appointment with the surgeon and feels she is ready to
transition out of a cast. Physician will see patient back in 4 weeks (at 8 weeks) after which time he would
like her to begin gentle progressive strengthening of the hand and wrist. Patient indicated her employer
is willing to have her work part time to manage reservations for programming and work on marketing,
but need a physician’s note.

DOI: 9/9/23
DOS: 9/11/23

OT referral: Fabrication of a protective splint, Pt education on edema management, ADLs, adaptive

equipment, and very gentle AROM exercises to the wrist.
Precautions: No resistance, weight bearing or heavy gripping. No PROM

Case #2

35-year-old, right dominant, self-employed male plumber who had his left hand crushed by equipment
when loading his truck. Patient sustained a left, non-displaced D5 metacarpal fracture, which did not
require surgery 4 weeks. He was seen by the PA in orthopedics and feels he is ready to transition out of a
cast and work on AROM. The provider will see patient back in 3 weeks (at 7 weeks) after which time she
would like him to begin gentle progressive strengthening of the hand and wrist. He has health insurance
through his wife’s work, but outpatient OT visits are limited to 10 per year with a $40 co-pay, which he
said he can’t afford.

DOI: 9/9/23
OT referral: Fabrication of a hand-based protective splint, Pt education on edema management, ADLs,
adaptive equipment, and AROM exercises to the wrist and fingers.
Precautions: No weight bearing or heavy gripping.

Case #3

30-year-old, right dominant male who cleans homes and landscapes for a living. Patient sustained a left,
non-displaced olecranon fracture, which did not require surgery 4 weeks. He was seen by the PA in
orthopedics and feels he is ready to transition out of a long arm cast (LAC) and work on AROM. The
provider will see patient back in 3 weeks (at 7 weeks) after which time she would like him to begin
AAROM and PROM progressive strengthening of the hand and wrist. Patient reported he has been able
to drive and do some home management, cleaning of home with his right hand, but is very anxious
about losing contracts. Pt does not have health insurance and is having a hard time dealing with his
anxiety resulting in increased drinking of alcohol.

DOI: 9/9/23
OT referral: Fabrication of a protective splint, Pt education on edema management, ADLs, adaptive
equipment, and AROM exercises to the LUE.
Precautions: No weight bearing or heavy gripping.

Case #4

A left dominant, 27-year-old professional female basketball player sustained a left, proximal humeral
fracture during a scrimmage. This did surgery 3 weeks ago. She had ORIF with a plate and screws placed
and has been wearing a coaptation splint since surgery and using a sling for comfort. The provider and
patient agree with initiation of “protected AROM” to get her back to basketball before the season
officially begins in 4 months. The provider will see patient back in 2 weeks (at 5 weeks) at which time
she would like the patient to begin AAROM and progressive strengthening of the hand and wrist, but
would like her to hold off on PROM of her shoulder for the next 2 weeks. Patient reported she has had a
really hard time completing bathing and dressing as well as cooking given it is her dominant arm. Pt does
not feel comfortable driving and is not certain how she will get to her appointments. She also was told
she might have to move out due to not being able to pay rent and hospital bills.

DOI: 9/9/23
DOS: 9/11/23

OT referral: Pt education on precautions, AROM, scar management, ADLs, adaptive equipment

Precautions: No weight bearing or heavy lifting, No PROM of left shoulder for another 2 weeks.

Case #5

A right dominant 22-year-old administrative assistant sustained a boney mallet deformity of her right
index finger while playing volleyball with friends. She was seen in the emergency room by orthopedics
who recommended conservative management (closed reduction) with splint fabrication by OT. Pt to be
seen in orthopedics in 6 weeks unless needed sooner. Pt is very anxious about not being able to type and
use her mouse during work.

DOI: 9/9/23

OT referral: Splint fabrication, pt education on precautions, AROM of uninvolved joints, edema

management, ADLs, and adaptive equipment as needed.
Precautions: No weight bearing or heavy lifting, No PROM of left shoulder for another 2 weeks.