Hand/UE Disorders & Injuries 2 Flashcards
OT tx goals with tendon repairs
Increase tendon excursion, improve strength at repair site, increase joint ROM, prevent adhesions, facilitate resumption of occs
Kleinert Protocol
Tendon Repair; Flexion using rubber band traction & active extension to the hood of splint
Kleinert Protocol Early Phase
Dorsal block splint - wrist 20-30 flex, MCP 50-60 flex and IP extended; Passive flex/Active exten w/in limits of splints
Kleinert Protocol Intermediate Phase
Cont dorsal block splint w adjustments: wrist to neutral. Place/hold exercises and differential flexor tendon gliding exercises
Kleinert Protocol Later Phases
6-8wk: AROM, diff tendon gliding, light purpose act, D/C splint
8-12wk: Strengthening/work/leisure acts
Duran Protocol
Passive flexion/extension of digit
Duran Protocol Early Phase
Dorsal blocking splint - exercises in splint include passive flex of PIP/DIP and to DPC - 10 reps every hour
Duran Protocol Intermediate Phase
Active flex/exten w/in limitis of spint
Duran Protocol Later Phases
6-8wks: Tendon gliding/diff tend gliding, scar mngt, light occ based
8012wks: Strengthening/work acts
Extensor Tendons Zone I & II
Mallet finger deformity; 0-6wk DIP extensoin splint
Extensor Tendons Zone III & IV
Boutonniere deformity: 0-4wks PIP exten splint (DIP free) AROM of DIP while splinted; 4-6wks begin AROM of DIP/Flex of digits to DPC
Extensor Tendons Zone V, VI & VII
0-2wks: volar wrist splint w wrist in 20-30 exten, MCP in 0-10 flex and IP in full exten - 2-3wk: shorten splint to allow flex and exten of IP joints - 4wk: remove splint to begin active MCP flex/eten - 5wk: begin active wrist ROM & wear splint between exercises - 6wk D/C slpint
Carpal Tunnel Syndrome (CTS)
Median nerve compression; Numb/ting of thumb/index/mid/radial half of ring fingers, parasthesis at night, c/o dropping things, positive tinels at wrist, advanced stages can result in atrophy of thenar eminance
Conservative Tx of CTS
Wrist splint in neutral worn at night/during day if performing rep activities; Median nerve gliding ex/diff tendon gliding ex, activity mod, avoid extrem wrist flex & ergonomics
Op: CT release - Post Op Tx for CTS
Edema control thru elevation, retrograde, comp glove and/or contrast bath, AROM, nerve/tendon gliding, sensory re-edu, strengthening of thenar muscles (6wk post op)
Pronator Teres Syndrome - prox volar forearm
Median nerve compression between 2 heads of pro teres. Numb/ting of thumb/index/mid/radial half of ring fingers, c/o dropping things, positive tinels at forearm, aching pain in prox forearm - no night symptoms; advanced stages can result in atrophy of thenar eminance
Op: Decompression - Post Op Tx for Pro Teres Synd
AROM, Nerve gliding, strengthening at 2wks, sensory re-edu, work/act mod