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PHTY3120 > L28-29: Clinical reasoning in management of the Wrist and Hand (Surgery) > Flashcards

L28-29: Clinical reasoning in management of the Wrist and Hand (Surgery) Flashcards

1
Q

What is a hand therapist?

A
  • Registered OT and physiotherapists who, through further education, clinical experience and independent study have become proficient in the treatment of upper limb conditions.
  • The Australian Hand Therapy Association Inc. (AHTA) is Australia’s only professional association representing practitioners of hand therapy.
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2
Q

What are 4 features in the AHTA 4 Levels of Membership?

A
  1. Accredited hand therapist (AHT) as awarded by the AHTA
    • Clinician
    • Educator
    • Honorary and life member
  2. Associate
  3. Affiliate
  4. Newsletter subscribe
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3
Q

What are 4 features of an Accredited Hand Therapist?

A
  1. Minimum 3 years equivalent full time post-graduate experience
  2. Minimum 3600 hours clinical hand therapy experience
  3. Complete the 4 AHTA courses
    • Orthotics Mobilisation
    • Fundamentals of Hand Therapy
    • Advanced Trauma: Open
    • Advanced Trauma: Closed
  4. Complete 2 additional elective modules
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4
Q

What are diagnosticians in hand surgery?

A

Accurate assessment and appropriate investigations

  • Subjective, objective assessement
  • Investigations: X-rays, CT, MRI, US
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5
Q

What are 4 priorities in traumatic cases for hand surgery?

A
  1. Bony and joint stabilisation
  2. Soft tissue coverage: e.g. Skin, flap
  3. Nerve
  4. Tendon
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6
Q

What are 4 hand surgery processes?

A
  1. Surgery game plan developed
  2. Patient preparation: Skin care, hair removal, draping
  3. Tourniquet on upper arm to minimise blood flow
  4. Appropriate surgical approach
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7
Q

What are 3 types of hand surgery?

A
  1. Distal Radius Intra-Articular Multi-Fragment Fracture
  2. Distal Radius Extra-Articular Fracture
  3. Carpal Tunnel Surgery
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8
Q

What are 7 features of Distal Radius Intra-Articular Multi-Fragment Fracture in hand surgery?

A
  1. Open surgery
  2. Longitudinal incision on skin and pronator quadratus, and pulled away
  3. Do not damage nerves
  4. Put plate in to stabilise the fragments
  5. May also put bone graft in plate too
  6. Screws to hold everything together
  7. Move wrist up and down to check stability
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9
Q

What are 2 features of Distal Radius Extra-Articular Fracture in hand surgery?

A
  1. Kirschner wire put through bone to stabilise the proximal and distal fragment. The hooks are above or just under the skin.
  2. Pull out wires at 6-8 weeks.
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10
Q

What are 2 types of Carpal Tunnel Syndrome in hand surgery?

A
  1. Endoscopic surgery
  2. Open surgery
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11
Q

What are 5 features of Endoscopic Carpal Tunnel Surgery in hand surgery?

A
  1. 1-2 incisions
  2. Put scope in with camera
  3. Cut transverse carpal ligament to release pressure
  4. More complications due to nerve damage
  5. Minimal invasions allow better rehab & functional outcomes
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12
Q

What are 3 features of Open Carpal Tunnel Surgery in hand surgery?

A
  1. Skin incision, cut transverse carpal ligament
  2. Bigger scar, more pain, more problems with healing
  3. Longer rehab
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13
Q

What are 5 assessments in the pre-op for hand surgery?

A
  1. Allergies to antibiotics, anaesthetics
  2. Bleeding disorders, previous problems with blood clots
  3. Recent or long term illnesses
  4. Psychological or psychiatric illnesses
  5. Keyloid scars or poor healing
    • Keoloid scars are thick raised scars that can lead to contractures
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14
Q

What are te 2 potential risks and complications of the hand surgery?

A
  1. General health
    • Anaesthetic complications
    • Blood clots, respiratory and cardiac complications
    • Smokers, diabetics, obese pts have higher risks
  2. Common complications to wrist and hand surgery
    • Infection
    • Scar formation
    • Poor wound healing
    • Nerve injury: Frequently altered sensation in small patch around scar
    • Joint stiffness
    • Allergies to drugs, dressings etc.
    • Abnormal pain response
    • Circulatory problems
    • Specific risks related to the surgery: e.g. Poor healing, tendon breaks, ligament fails
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15
Q

What are 3 general health complications of hand surgery?

A
  1. Anaesthetic complications
  2. Blood clots, respiratory and cardiac complications
  3. Smokers, diabetics, obese pts have higher risks
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16
Q

What are 9 common complications of wrist and hand surgery?

A
  1. Infection
  2. Scar formation
  3. Poor wound healing
  4. Nerve injury: Frequently altered sensation in small patch around scar
  5. Joint stiffness
  6. Allergies to drugs, dressings etc.
  7. Abnormal pain response
  8. Circulatory problems
  9. Specific risks related to the surgery: e.g. Poor healing, tendon breaks, ligament fails
17
Q

What are 3 features in the post-op for hand surgery?

A
  1. Minimise post-op swelling
  2. Relieve pain & anxiety
  3. Limit immobilisation
18
Q

What are 9 treatment principles in the post-op for hand surgery?

A
  1. Healing timeframes
  2. Wound management
    • Green, oozy, bleeding wound is not good
    • If the dressing is broken or dirty, then change the dressing
  3. Oedema control: Rest, elevation, heat, gloves, tubigrip, coban
    • Ice is usually uncomfortable in hand
  4. Therapeutic exercise: Wrist & fingers active exercise - reduce swelling.
    • e.g. For carpal tunnel surgery, no lifting with wrist F + finger F because tendons may bulge into the incision.
  5. Manual therapy: Effleurage reduces swelling.
  6. Splintage: Splint pre-op to minimise pressure on nerves. Generally no splint post-op.
  7. Scar management
    • At 3 weeks post-op, scar mobilisation 3-4x per day.
    • Silicone product hydrates and pressures the scar.
  8. Sensory reeducation
  9. Functional integration
19
Q

What are 2 “wound management” treatment principles in the post-op for hand surgery?

A
  1. Green, oozy, bleeding wound is not good
  2. If the dressing is broken or dirty, then change the dressing
20
Q

What is “oedema control” treatment principles in the post-op for hand surgery?

A

Rest, elevation, heat, gloves, tubigrip, coban

  • Ice is usually uncomfortable in hand
21
Q

What is “therapeutic exercise” treatment principles in the post-op for hand surgery?

A

Wrist & fingers active exercise - reduce swelling.

  • e.g. For carpal tunnel surgery, no lifting with wrist F + finger F because tendons may bulge into the incision.
22
Q

What is “manual therapy” treatment principles in the post-op for hand surgery?

A

Effleurage reduces swelling.

23
Q

What is “splintage” treatment principles in the post-op for hand surgery?

A

Splint pre-op to minimise pressure on nerves. Generally no splint post-op.

24
Q

What are 2 “scar management” treatment principles in the post-op for hand surgery?

A
  1. At 3 weeks post-op, scar mobilisation 3-4x per day.
  2. Silicone product hydrates and pressures the scar.

PHTY3120 (29 decks)

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