Elbow, Wrist and Hand

Question 1

How is the radial head splinted?

Answer 1

90 degrees of flexion

Question 2

Rehab rules

Answer 2

1. Dependent on extent of soft tissue injury
2. Know which ligaments/tendons were repaired
3. use low load resistance exercises
4. do not apply valgus/varus stretches in terminal extension/flexion

Question 3

LCL repair limitation

Answer 3

limit supination to 20 degrees during early rehab

Question 4

Linked TEA

Answer 4

articulated-semi constrained

Question 5

Unlinked TEA

Answer 5

non articulated, two separate, articulated implants

Question 6

PROM to AAROM for linked TEA

Answer 6

usually initiated 2-3 days after surgery

Question 7

PROM to AAROM for unlinked TEA

Answer 7

5-7 days after surgery

Question 8

TEA triceps involved

Answer 8

limit assisted flexion to 90-200 degrees for 3 to 4 weeks

Question 9

Exercises for TEA in protective

Answer 9

pain free, no resistance, while patient is in splint

-low intensity isometrics

Question 10

TEA weight limit

Answer 10

1lb for 3 months
2 lbs for next 3 months
5lbs for long term repetitive lifting
10-15 lbs max for single lift

Question 11

What patients are the candidates for TEA?

Answer 11

RA patients

Question 12

Functional implications after TEA

Answer 12

1. AVOID moving or carrying object for 6 weeks
2. AVOID pushing mechanisms if triceps mechanism was detached and repaired
3. Do not lift object with the elbow extended to avoid shear forces on the ligament repair
4. limit repetitive limited
5. no golf or tennis…forever

Question 13

Wrist arthroplasty

Answer 13

immobilized for days to 2 weeks in short arm volar wrist splint
10-15 degrees of extension

Question 14

What do you avoid in TEA maximum phase?

Answer 14

end range flexion/extension

Question 15

TEA exercises of ROM in moderate to minimum protection phases:

Answer 15

low intensity manual stretching

low load dynamic splinting

Question 16

TEA exercises of strength in moderate to protective phases:

Answer 16

• resisted multi-angle isometrics @ 5 weeks
• light ADLs: avoid pushing motion
• low load closed-chain activities: wall push ups after 6 weeks or later

Question 17

What motion to concentration on in wrist arthroplasty?

Answer 17

extension more than flexion

Question 18

Zone I of hand:

Answer 18

DIP joint region

Question 19

Zone II of hand:

Answer 19

middle phalanx

Question 20

Zone III of hand

Answer 20

PIP joint region

Question 21

Zone IV of hand

Answer 21

proximal phalanx

Question 22

Zone V of hand

Answer 22

apex of the MCP joint region

Question 23

Zone VI of hand

Answer 23

dorsum of hand

Question 24

Zone VII of hand

Answer 24

wrist region/dorsal retinaculum

Question 25

Zone VIII and IX of hand

Answer 25

distal and middle forearm

Question 26

Zone T-I

Answer 26

IP joint region of thumb

Question 27

Zone T-II

Answer 27

proximal phalanx of thumb

Question 28

Zone T-III

Answer 28

MCP joint region of thumb

Question 29

Zone T-IV

Answer 29

metacarpal of thumb

Question 30

Zone T-V

Answer 30

CMC joint region of thum

Question 31

Zones of hand I-V

Answer 31

flexor

Question 32

Zones I-IX of hand

Answer 32

extensor

Question 33

Zones T-I to T-III of thumb

Answer 33

flexor

Question 34

Zone T-1 to T-V of thumb

Answer 34

extensor

Question 35

What is the rationale for early controlled motion after tendon repair?

Answer 35

• decreased post op edema
• maintains tendon gliding ability
• increases synovial fluid diffusion
• repair site loses strength during the first 2 weeks after surgery

Question 36

Who is appropriate for prolonged immobilization and delayed motion after flexor tendon repair?

Answer 36

children under 7-10 years of age

-patients with cognitive function impairment

Question 37

What are functional considerations for hand surgery?

Answer 37

• teaching precautions
• protection of the hand repair
• splint use
• modifying life activities
• cleanliness to avoid infection
• emphasizing avoidable ROM to avoid adhesions/contractures