Hand Flashcards
What are the creases of the hand we are concerned about with splinting?
- distal palmar crease
- proximal palmar crease
- simian crease (not all)
- thenar crease
What is the distal palmar crease important for? (mvt)
MCP flexion
To facilitate MCP flexion, where should a splint stop?
proximal to the distal palmar crease
To limit MCP flexion, where should the splint stop
distal to the distal palmar crease
Simian crease
- apes have this
- seen in Downs pts
- not seen with everyone
- must accommodate for MCP flexion
Thenar crease is important for: (mvt)
opposition
Prevent opposition
cover up thenar crease
Allow opposition
leave thenar crease exposed
No man’s land is where these converge
finger flexors
Why is it called no-man’s land?
- finger flexors work together more here
- scar tissue here would cause a contracture
What is dual obliquity?
means there’s flexibility in two planes of the hand (arches)
What are the arches of the hand
- natural downward arch from 1st »4th phalanx (proximal transverse)
- longitudinal arch
What does dual obliquity give us?
- strength
- ability to manipulate objects better than other animals
Dual obliquity: remember this about rehab
- hand has curvature that is not spherical
- don’t give a pt a tennis ball to squeeze for strength
Skin on palmar surface of hand
- thick, tight
- lots of connective tissue
Thick, tight skin on palmar surface helps with
- grip
- shear forces
Function of muscles on palmar surfaces
Thenar and hypothenar eminences give cushioning
Why would a Z-plasty be done for hand surgery?
allows for greater pliability of tissue
Skin: dorsal surface of hand
- thinner, looser than palmar
- less connective tissue
Why is it important for the dorsal aspect of the hand to have thinner, looser skin than the palmar aspect?
- important for ROM
- if skin is too tight, can’t flex the wrist
Which is more sensitive: dorsal or palmar surface?
dorsal
Skin on dorsal surface of hand: impact on therapy
must work on tissue pliability as soon as possible
What are the Cleland and Grayson ligaments?
- tiny ligaments in the fingers
- hold skin of your fingers to the bones
What happens if the Cleland and Grayson ligaments aren’t intact?
skin can rotate around the finger
impact of degloving on skin
- finger skin doesn’t adhere all around the bone when it’s repaired
- loose
