Therapy Interventions Flashcards
Dupuytren’s Disease (post-op)
Wound care
Edema control
Splinting
Scar Management
AROM/PROM (day 1 or 2)
Strengthening after wound closure (3-4 weeks)
Boutonniere Deformity
Splint PIP in extension with DIP and MP free (6 weeks)
Gentle flexion of the PIP at 6 weeks
Splint for addiitonal 2-4 weeks
Swan-Neck Deformity
Dependent upon surgical technique
Rheumatoid Arthritis
Dependent upon stage
- Patient education
- Appropriate splinting
- Gentle ROM
- Modalities
- Grip and pinch exercises
- Joint protection
Mallet Finger
(without fracture)
Closed injury without fracture
- Immoblization of the DIP joint in slight hyperextension for 6 weeks with a volar gutter splint
- Active motion of the PIP joint
- Active motion of the DIP after 6 weeks
- Continued splinting at night for an additional 4 weeks
Mallet Finger
(with fracture)
Closed injury with distal tendon avulsion fracture
- Percutaneous pinning for 6-8 weeks
- Splint in colar hetter splint at one week with immediate AROM of PIP and all proximal joints
- Begin AROM of DIP once pin is removed
Trigger Finger
Goal is to restore normal tendon gliding without compromising the overall function of the tendon system
Operative:
- Immediate AROM of the finger
- AROM, AAROM, PROM at 1 week
- return to regular activities at 3 weeks
Tendon Lacerations
(general)
Create favorable adhesions
Prevent gap formation
Promote tendon glide
Control edema
Protect tendon healing
Enhance tensile strength at repair site
Restore ROM
Restore strength
Restore function
Tendon Lacerations
(3-5 days post-op)
Wound care
Scar management
Edema control
Dorsal blocking splint
PASSIVE finger flexion
ACTIVE finger extension
Splinting 24/7
No active flexion for 4-6 weeks
TFCC
(non-operative)
Long-arm cast or splint with elbow at 90 degrees and forearm/wrist in neutral for 4-6 weeks
At 6 weeks begin AROM, AAROM, wrist splint for comfort and protection
At 8 weeks (provided asymptomatic) progressive strengthening (avoiding rotation initially) and gradual return to activites
Fracture Therapy Management
(Immoblization Phase)
Pain management
Reduce and control edema
Maintain ROM and strength in ninvolved
Maintain CV endurance
Patient education:
- fracture healing, edema control, pin site maintenance, and external fixators
Fracture Therapy Management
(Mobilization Phase)
Modalities:
-Pain and edema control
AROM, AAROM, PROM
Joint modilization
Dynamic/Static/Static Progressive Splinting
Scar Management
Progressive Strengthening
Gradual return to function
DeQuervain’s Tenosynovitis
(non-surgical)
Thumb spica splint
Anti-inflammatory (ice, iontophoresis)
Thumb ROM
Tendon gliding
Modilization with movement
Eccentric exercises
DeQuervain’s Tenosynovitis
(post-surgical)
Edema control
AROM/PROM
Scar Management
Desensitization
Begin strengthening when authorized by physician (3-4 weeks)
Progressive return to activities in 6-8 weeks
Intersection Syndrome
Immobilizatinon of the wrist and thumb in 15-20 degrees of extension
Anti-inflammatory measures (ice, iontophoresis)
CFM
Stretching
Gradual Return to strengthening
Patient education:
- avoid repetitive wrist flexion/extension combined with power grip
Ganglion Cyst
Anti-inflammatory measures
Compression
Splinting
ROM
Skier’s Thumb
(post-surgical)
Splinting
Edema control
Scar Management
AROM
Strengthening at 8 weeks
Skier’s Thumb
(non-surgical)
Anti-inflammatory measures
Grade I:
- immoblization or tape for 3 weeks followed by AROM and strengthening
Grade II:
- thumb spica splint or cast for 3 weeks followed by another 6 weeks of protection before beginning AROM or strengthening
Ulnar Nerve Entrapments at Guyon’s Canal
(non-surgical)
Modalities
Ulnar gutter splint in intrinsic plus position
Nerve gliding
Patient education and activity modification
Ulnar Nerve Entrapments at Guyon’s Canal
(post-surgical)
Pain management
Edema control
Scar management
Desensitization
ROM
Nerve gliding
Patient education
Strengthening at approx 4 weeks
Wartenberg’s Syndrome
Modalities
Resting splint in position of comfort (neutral wrist and hand)
Desensitization
Patient education
Carpal Tunnel Syndrome
(non-surgical)
Splinting at night in neutral wrist position
Modalities (ionto, contrast baths)
Tendon gliding
Nerve gliding
Avoid repetitive strengthening activities for the hand/wrist
Proximal stabilization
Patient education
Carpal Tunnel Syndrome
(post-surgical)
3 days: Change dressings and begin tendon gliding
1 week: Begin gentle AROM and PROM of the wrist
2-3 weeks: Begin strengthening
3 weeks: Begin nerve gliding
4 weeks: Begin functional activities
Proximal stabilization
Patient education
Activity modification
Complex Regional Pain Syndrome
Minimize pain (modalities)
Edema control
Desensitization
Gentle AROM/PROM
Tendon gliding exercises
Mirror therapy
Patient education
Do Not Immoblize
Olecranon Bursitis
(Acute Phase)
Ice, compression, iontophoresis
Splinting/Padding
Patient education
Olecranon Bursitis
(Subacute Phase)
Heat modalities, contrast baths
Range of motion
Sub-maximal isometrics
Olecranon Bursitis
(Chronic Phase)
Rehabilitation of any residual problems and prevention of recurrence/reinjury
Strengthening
Functional training
Protective padding
Bicipital Tendinopathy
Modalities
Transverse friction massage
Correction of muscle imbalances
Soft tissue mobilization
Patient education
Distal Biceps Tendon Rupture
(post-op)
Modalities
ROM
Gentle strengthening
Patient education:
-return to unrestricted activity generally not allowed for up to 6 months post-op
Lateral Epicondylalgia
Pain control (rest)
Modalities (HVGS and ice massage)
STM
Mobilization with movement
Lateral gapping
Radial head distraction
Cervical or thoracic mobs
Stretching
Eccentrics
Proximal Stabilization
Medial Epicondylalgia
Modalities
Rest
ROM/stretching
Strengthening
Patient education
Elbow Sprains
Modalities
ROM
Sub-max isometrics to isotonic
Proximal!
Throwing and conditioning programs
Taping/Bracing for sports
Elbow Dislocations
(Immobilization Phase)
AROM of the shoulder, wrist, and hand
Sub-max isometics
Modalities (for pain and edema control)
Elbow Dislocations
(post-immobilization phase)
Active stretching and ROM
Restricted strengthening (avoiding full extension) working into full rage as tolerated by tissue
Functional training
Nursemaid’s Elbow
Often not necessary
Patental education
Little Leagure’s Elbow
Patient Education
Parent/Coach Education
Modalities for pain and inflammation
ROM
Correction of muscle imbalances
Gradual return to functional activities
Cubital Tunnel Syndrome
(non-surgical)
Modalities for pain and inflammation management (HVGS)
Night splinting at 40-60 degrees
Anti-claw splint
Elbow pads
Ulnar nerve glides
Strengthening
Patient education (activity modification and sleeping positions)
Cubital Tunnel Syndrome
(post-op: 2 weeks)
Modalities for pain and inflammation (HVGS)
Splinting/Elbow pads
Scar management
ROM
Strengthening
Desensitization
Ulnar nerve glides
Patient education
Radial Nerve Compression
Dynamic splinting with finger extension assist, allowing full finger flexion
Static night splint in wrist and finger extension
Soft tissue mobilization
Thermal modalities
Radial nerve gliding
Stretching
Patient educaiton
Median Nerve Entrapment
Thermal modalities
Splinting in neurtal position (4-6 weeks)
Soft tissue mobilization
Stretching
Median nerve glides
Correction of muscle imbalances
Patient education
