Elbow, Wrist and Hand Flashcards
How is the radial head splinted?
90 degrees of flexion
Rehab rules
- Dependent on extent of soft tissue injury
- Know which ligaments/tendons were repaired
- use low load resistance exercises
- do not apply valgus/varus stretches in terminal extension/flexion
LCL repair limitation
limit supination to 20 degrees during early rehab
Linked TEA
articulated-semi constrained
Unlinked TEA
non articulated, two separate, articulated implants
PROM to AAROM for linked TEA
usually initiated 2-3 days after surgery
PROM to AAROM for unlinked TEA
5-7 days after surgery
TEA triceps involved
limit assisted flexion to 90-200 degrees for 3 to 4 weeks
Exercises for TEA in protective
pain free, no resistance, while patient is in splint
-low intensity isometrics
TEA weight limit
1lb for 3 months
2 lbs for next 3 months
5lbs for long term repetitive lifting
10-15 lbs max for single lift
What patients are the candidates for TEA?
RA patients
Functional implications after TEA
- AVOID moving or carrying object for 6 weeks
- AVOID pushing mechanisms if triceps mechanism was detached and repaired
- Do not lift object with the elbow extended to avoid shear forces on the ligament repair
- limit repetitive limited
- no golf or tennis…forever
Wrist arthroplasty
immobilized for days to 2 weeks in short arm volar wrist splint
10-15 degrees of extension
What do you avoid in TEA maximum phase?
end range flexion/extension
TEA exercises of ROM in moderate to minimum protection phases:
low intensity manual stretching
low load dynamic splinting
TEA exercises of strength in moderate to protective phases:
- resisted multi-angle isometrics @ 5 weeks
- light ADLs: avoid pushing motion
- low load closed-chain activities: wall push ups after 6 weeks or later
What motion to concentration on in wrist arthroplasty?
extension more than flexion
Zone I of hand:
DIP joint region
Zone II of hand:
middle phalanx
Zone III of hand
PIP joint region
Zone IV of hand
proximal phalanx
Zone V of hand
apex of the MCP joint region
Zone VI of hand
dorsum of hand
Zone VII of hand
wrist region/dorsal retinaculum
Zone VIII and IX of hand
distal and middle forearm
Zone T-I
IP joint region of thumb
Zone T-II
proximal phalanx of thumb
Zone T-III
MCP joint region of thumb
Zone T-IV
metacarpal of thumb
Zone T-V
CMC joint region of thum
Zones of hand I-V
flexor
Zones I-IX of hand
extensor
Zones T-I to T-III of thumb
flexor
Zone T-1 to T-V of thumb
extensor
What is the rationale for early controlled motion after tendon repair?
- decreased post op edema
- maintains tendon gliding ability
- increases synovial fluid diffusion
- repair site loses strength during the first 2 weeks after surgery
Who is appropriate for prolonged immobilization and delayed motion after flexor tendon repair?
children under 7-10 years of age
-patients with cognitive function impairment
What are functional considerations for hand surgery?
- teaching precautions
- protection of the hand repair
- splint use
- modifying life activities
- cleanliness to avoid infection
- emphasizing avoidable ROM to avoid adhesions/contractures
