Hand Therapy: Diagnosis and management Flashcards
List the hand therapy intervention strategies?
- Splinting
- Oedema control
- Wound and scar care
- Desensitisation
- Specific exercises
- Patient education
What are the arches you have to maintain when splinting?
- Dorsal arch (MC arch)
- Proximal transverse (carpal) arch
- Longitudinal arch - allows MCPJ, PIPJ and DIPJ flexion
Which hand creases to note when splinting?
- Distal Palmar Crease
- Proximal Palmar Crease
- Thenar Crease
What are some construction principles of splinting?
- Increase area of force application
- Roll edges
- Conforming fit
- Round internal and external corners
What are positions of safe immobilisation for each joint
Wrist: 20-39 ext
MCP J: 70-90 flex
IP J: 0-10 Relative extension
Thumb: CMC J palmar abduction
What are ways to control oedema?
Coban, neoprene, compression
What to do to manage a wound?
Silcon gel sheet, self massage
What is the purpose of desensitisation?
Reintroduction of different textures and sensations to familiarise sensation
What are the time frames for tissue healing?
- Inflammation 4-6 days
- Proliferation 4-24 days
- Remodelling 21 days- 2 years
What are the clinical presentations for Carpal tunnel syndrome?
- Pain, P&N/ numbness in median nerve distribution
- Worse at night
- Common in pregnancy
- Reduce grip and pinch strength
- Loss of sensation median nerve
- APB wasting
- Sensory changes before motor loss
Describe the management of Carpal Tunnel Syndrome?
- Provocation test: Tinnels, Phalens, Durkans
- Differential Diagnosis: C/sp radiculopathy
- Splint at night, median nerve glides, postural advice, ergonomic assessment
When do you refer to hand surgeon for CTS?
APB wasting, constant numbness, Failure to improve after 6/52 conservative management
What is DeQuervains syndrome?
- Denegerative Tenosynovitis
- APL and EPB
What is the clinical presentation of DeQuervains syndrome?
- Pain and swelling radial aspect of wrist +/- crepitus
- Positive finkelsteins test
- Pain on active thumb extension
What is the clinical presentation of DeQuervains syndrome?
- Pain and swelling radial aspect of wrist +/- crepitus
- Positive finkelsteins test
- Pain on active thumb extension
What is the management program for DeQuervains Syndrome?
- Patient edu to avoid agg activities - adduction of thumb with wrist deviation
- Long opponens splint to support thumb
- Soft-neoprene splint
- KTape
- Radial nerve glides
What is trigger finger and its clinical presentation?
- Flexor tendon gets caught at thickened A1 pulley
- Finger clicks or locks in flexion after making a fist
- Snapping sensation when trying to straighten finger or thumb
- Worse in morning
- Painful lump in palm at DPC
What is the management of trigger finger?
- Splinting to prevent full flexion
- Passive ex to maintain ROM
- Avoid agg activities
- Hand surgeon when failure of conservative management
Describe mallet finger and its presentation
- Forced DIP flexion while extensor tendon is contracting
- Soft tissue mallet or avulsion fracture of distal phalanx
CP: extension lag, inability to fully extend DIP joint
What is the management of mallet finger?
- Splint with DIP in extension (8weeks for tendon, 6 weeks for avulsion)
- Skin care
- Allow PIP ROM
- SLOW careful weaning
- Gradual strengthening and return to ADL
When to refer mallet finger to hand surgeon?
- Delayed presentation
- Open fracture
- Large mallet fracture fragment > 30 % articular surface
- Joint sublluxation
Describe PIP dislocations and their clinical presentation
- Dorsal 85%, Volar: central slip rupture, Lateral
Clinical presentation:
- Painful swollen digit following hyperextension injury
- Possible associated volar plate avulsion frature of base of middle phalanx
- Often relocated at time of injury or ED
What is the management of PIPJ dislocation?
- Closed reduction and splinting (3-4 weeks if stable after reduction)
- Dorsal blocking splint in neutral (or slight flexion) for dorsal dislation
- AROM IPJ flexion/ext exercises in splint
When to refer to hand surgeon for PIPJ dislocation
- Avulsion fragment > 50% of articular surface
- Joint remains subluxed and unstable
