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
Conservative Tx of Pro Teres Synd
Elbow splint at 90 w forearm in neutral & avoid activities w rep forearm pro/sup
Guyons Canal
Ulnar Nerve Compression at wrist. Numb/ting &motor weakness at ulnar distribution, Positive tinels at guyon canal, advanced stages can result in atrophy of ulnar-nerve innervated musculature
Conservative Tx of Guyons Canal
Wrist splint in neutral & work/act mod
Op: Decompression - Post Op Tx for Guyons Canal
Edema control, AROM, Nerve gliding, strengthening at 2-4wks w focus on power grip, sensory re-edu
Cubital Tunnel Syndrome
Ulnar nerve compression at elbow, 2nd most common compression; numb/ting along ulnar aspect of forearm/hand, pain at elbow w extreme flex, weak of power grip, positive tinels at elbow, advanced stages can lead to atrophy of FUC, FDP to digits 4/5 and ulnar nerve innervated intrinsic muscles
Conservative Tx of Cubital Tunnel Synd
Elbow splint to prevent position of extreme flex esp at night, elbow pad to decrease compression, act/work mod
Op: Decompression/Transpoition - Post Op Tx for Cubital Tunnel Synd
Edema control, scar mngt, AROM/nerve gliding, strengthening (4wk post op), MCP flex splint if clawing noted
Radial Nerve Palsy
Radial nerve compression; can result from humeral shaft fx, saturday night palsy - awkward sleeping position that affects radial nerve. Weakness/paralysis of wrist extensors, MCPs, thumb - wrist drop
Conservative Tx for Radial Nerve Palsy
Dynamic exten splint, work/act mod, strengthening wrist/finger exten when motor function returns
Op: Decompression - Post Op Tx for Radial Nerve Palsy
ROM, nerve gliding, strengthening at 6-8wks, ADL/occ acts
Median Nerve Laceration Sensory Loss
central palm- thumb to radial 1/2 of ring, palmar surface of thumb to radial 1/2 of ring, dorsal surface of index/mid/radial 1/2 of ring (mid/distal phalanges
Median Nerve Laceration Motor Loss
Lumbricals I & II - MCP flex of digits 2/3, opposition w opponens pollicus, aBduction with abductor pollicus brevis, flex of thumb MCP w flex pollicus brevis
Motor Loss for High Lesion at/Prox to Elbow - Median Never Laceration
Lumbricals I & II - MCP flex of digits 2/3, opposition w opponens pollicus, aBduction with abductor pollicus brevis, flex of thumb MCP w flex pollicus brevis, FDP to index.mid fingers and FPL for flex of tip of index/mid/thumb & FCR for flex radial aspect of wrist
Median Nerve Laceration Defomity
Flattening of thenar eminance or “ape hand”, clawing of index/mid for low lesion, benediction sing for high lesion
Fx’al Loss with Median Nerve Laceration
loss of thumb opp/pinch weakness
Tx for Median Nerve Laceration
Dorsal protect splint w wrist at 30 flex if low - include elbow at 90 if high. Begin A/PROM of digits w wrist in flex at 2wk post op. Scar mngt. AROM of wrist at 4wk - and elbow if high. Strengthening at 9wks; sensory re-edu if shows diminished level of protective sens (4.31) on Sem-W.
*Consider c-bar to prevent thumb adduction contracture
Ulnar Nerve Laceration Sensory Loss
Ulnar Aspect of palmar/dorsal surfaces. Ulnar 1/2 of ring/lil finger on palmar/dorsal surfaces.
Ulnar Nerve Laceration Motor Loss - low at wrist
Palmar/doral interossei for adduction/aBduction of MCP. Lumbricals III/IV for MCP flex of digits 4/5. FPB/Adducttor pollicus for flex/adduction for thumb & ADM/ODM/FDM for aBduction/opp/flex of 5th digit
Ulnar Nerve Laceration Motor Loss - high wrist/above
Palmar/doral interossei for adduction/aBduction of MCP. Lumbricals III/IV for MCP flex of digits 4/5. FPB/Adducttor pollicus for flex/adduction for thumb. ADM/ODM/FDM for aBduction/opp/flex of 5th digit. FCU for flex toward ulnar wrist & FDP IV/V for flex of DIPs of ring/lil finger
Ulnar Nerve Laceration Deformity
Claw hand, Flattened MC arch, + Froments sigh (paper pinch)
Ulnar Nerve Laceration Fx’al Loss
Loss of power grip/decreased pinch strength
Tx for Ulnar Nerve Laceration
Sensory re-edu, MCP flex block spint, Dorsal protect splint w wrist at 30 flex if low - include elbow at 90 if high. Begin A/PROM of digits w wrist in flex at 2wk post op. Scar mngt. AROM of wrist at 4wk - and elbow if high. Strengthening at 9wks
Radial Nerve Laceration Sensory Loss - High at humerus
medial aspect of dorsal forearm, radial aspect of dorsal palm, thumb, index, mid and radial 1/2 of pinky phalanges
Radial Nerve Laceration Motor Loss - Low at Forearm
Loss of wrist exten d/t impaired ECU innervation, MCP/ thumb exten
Radial Nerve Laceration Motor Loss - High at humerus
Loss of wrist exten d/t impaired ECU innervation, MCP/ thumb exten, ECRB, ECRL, brachioradialis - if at axilla level, loss of triceps for elbow exten
Radial Nerve Laceration Fx’al loss & Defomity
Inability to extend digits to release objects/diff manipulating objects.
Deformity = wrist drop
Tx for Radial Nerve Laceration
Dynamic exten spint, ROM, sens re-edu if needed, home program, act mod
