Fundamentals: Hand Therapy Concepts/Treatment Techniques

Question 1

Things to consider when treating hand/UE patients (3)

Answer 1

1. What structures are limited
2. How this limitation effects function
3. Target treatment to those particular areas

Question 2

multiarticulate

Answer 2

structures that cross multiple joints

Question 3

Phases of healing (3)

Answer 3

1. inflammation phase
2. fibroplasia phase
3. maturation (remodeling) phase

Question 4

Timeline: inflammation phase

Answer 4

immediately following injury and lasts a few days
vasoconstriction followed by vasodilation
migration of WBC to promote phagocytosis

Question 5

Timeline: fibroplasia phase

Answer 5

begins about 4 days after injury and lasts 2-6 weeks

fibroplasts begin formation of scar tissue

Question 6

Timeline: maturation (remodeling) phase

Answer 6

overlaps with fibroplasia and may last years

improved organization of collagen fibers and increase in tissue strength

Question 7

Deformity position from edema

Answer 7

wrist flexion
MP hyperextension
PIP/DIP flexion
thumb adduction

Question 8

Antideformity (intrinsic-plus) position

Answer 8

*recommended after injury unless contraindicated (ex. FTR)
wrist 30 deg extension
MP 90 deg flexion
IP 0 deg extension
MCP 80-90 deg
thumb ABduction with opposition

Question 9

joint tightness

Answer 9

PROM of joint does not change despite repositioning of proximal or distal joints

Question 10

musculotendinous tightness

Answer 10

PROM of joint changes with repositioning of adjacent joints that are crossed by that particular muscle-tendon unit

Question 11

intrinsic muscle tightness

Answer 11

passive PIP/DIP flexion is limited when the MP joint is passively extended or hyperextended

Question 12

extrinsic extensor muscle tightness

Answer 12

PIP/DIP flexion flexion is limited when MP joint is passively flexed

Question 13

composite motions

Answer 13

combined flexion motions of the wrist, MPs, and IPs

Question 14

extrinsic extensor tightness

Answer 14

passive flexion of the fingers (composite) is more limited with wrist flexion than wrist extension

Question 15

extrinsic flexor tightness

Answer 15

passive extension of the fingers (composite) is more limited with wrist extension than wrist flexion

Question 16

lag

Answer 16

the active limitation when PROM is greater than AROM at a joint
*caused by adhesions, disruption of musculotendinous unit, or weakness

Question 17

joint contracture

Answer 17

passive limitation of joint motion

*caused by collateral ligament tightness, adhesions, or mechanical block

Question 18

soft end-feel

Answer 18

joint has a spongy quality at the end-range

• favorable
• indicates a potential for remodeling
• othoses: static or low-load, long duration type

Question 19

hard end-feel

Answer 19

joint has unyielding quality at end-range

*may require serial casting or static progressive orthoses with longer periods of splint wear

Question 20

nociceptive pain

Answer 20

caused by structural dysfunction, such as an arthritic wrist

Question 21

neuropathic pain

Answer 21

caused by some form of peripheral nerve dysfunction and is typically a sensory pain

Question 22

preventing pain

Answer 22

tell clients to avoid pain when exercise

NO PAIN, NO GAIN IS WRONG!!!

Question 23

PROM precautions

Answer 23

PROM can injure swollen and inflamed joints and tissues

Question 24

aggressive therapy

Answer 24

progressive

take care of joints and fragile tissues but “aggressively” upgrade program and encourage maximum results

Question 25

dyscoordinate co-contraction

Answer 25

poor quality movement that can result from co-contraction of antagonist muscles

Question 26

adjunct treatments (5)

Answer 26

1. heat
2. cold
3. ultrasound
4. e-stim
5. iontophoresis

Question 27

fundamental scar management (3)

Answer 27

1. silicone gel pads
2. elastomer
3. massage

Question 28

static orthoses

Answer 28

used to immobilize tissues, prevent deformity, prevent contracture of soft tissue, and provide substitution for lost motor function

Question 29

serial static orthoses

Answer 29

position the tissue for lengthening and are remolded at intervals

Question 30

static progressive orthoses

Answer 30

apply mobilizing force using nonmoving parts such as monofilament, Velcro, or screws

Question 31

dynamic orthoses

Answer 31

use moving parts such as rubber bands or spring wires, to apply gentle force

Question 32

exercise principles (2)

Answer 32

1. look up the chain

2. look at the wrist when exercising the fingers

Question 33

blocking exercises

Answer 33

exercises in which proximal support is provided to promote isolated motion at a particular site

Question 34

tendon glides (5)

Answer 34

1. straight digits
2. hook fist
3. composite fist
4. tabletop
5. straight (FDS) fist

Question 35

place and hold exercises

Answer 35

gentling perform AAROM to position the finger then ask client to sustain position while releasing the assisting hand
*helpful when PROM is greater than AROM

Question 36

resistive exercises

Answer 36

used for strengthening and to improve excursion of adherent tissue

Question 37

functional activity

Answer 37

incorporating gains made from exercising into function UE use at home and at work