Ul Flashcards
Safe immobilisation position (10)
Wrist at 20-30degrees extension
-to balance the long flexors and extensors
Mcp at 80-90flexion
-to maintain the collateral ligaments at the maximum length
Ips completely straight
-to prevent contracture of the volar plates
Thumb in opposition
-ie abduction and extension preventing web space contracture
Neutral ulnar/radial deviation
Neutral pro/supination
Position of function (11)
Wrist at 20-30degrees extension -for stability and provides more powerful grip Mcp at 45degrees -balanced stable position where the collateral ligaments are tightened Ips at 5degrees -muscle balance is achieved Thumb in opposition -to facilitate opposition Web space maintained Neutral ulnar/radial deviation Neutral pro/supination
Position of rest/comfort (8)
Wrist in neutral flexion/extension
-as the wrist extends the carpal bones pack together
Mcps and ips in slight flexion
Thumb in comfortable mid position of opposition
Neutral or slight ulnar deviation
-to prevent zig zag deformity
Neutral pro/supination
All of these positions will be modified to achieve a pain free hand
Dupuytrens contracture (7)
Progressive contracture of the palmar aponeurosis
Leading to flexion contractures of the finger joints
Genetic
Triggered by trauma, alcoholism and anti-epilepst drugs
Surgery releases contracture but contracture reoccurance often seen
Orthosis after surgery for 6 weeks
Stock dynamic pip extension orthosis
3 who positions (3)
Safe immobilisation to prevent contractures
Function for useful hand positioning
Rest/comfort for relief of pain
Flexor tendon repairs (9)
Least amount of tension should be applied to the repaired tendons to protect repair
Flex surrounding joints
6-8weeks rehab period
Dorsal surface orthosis
Wrist flexed up to 30degrees
Mcpj flex up to 90 degrees
Ips extended
Kleinert regime:elastic added to fingernails and to prox palmar strap
Belfast regime: similar without elastics, therapist passively flexes pts figers in orthosis, less chance of volar plate contractures
Extensor tendon repairs (4)
Treated in a similar manner to flexor tendon repairs
Surrounding joints extended
Palmar who applied
Splint wrist in 30-40degrees extension, mcpjs 10-20 degrees flexion and ips in neutrl
Gamekeepers thumb (5)
Rupture of ulnar collateral ligament of mcp joint of thumb
Valgus movement over the thumb mcpj causing rupture of the ucl
Pain and weakened pinch grasp
Complete lesion then surgery, partial lesion splinting alone may be adequate
Thumb spicas
Tenosynovitis (5)
Inflammation of tendons and synovial sheath
May last a few days or weeks and months and is generally caused by overuse through heavy or repetitive physical activity
-commonly ul and can often be cured by rest
Static orthosis which prevents tendon moving but condition can occur if pt repeats activity
Surgeon may inject an antiinflammatory agent such as steroids into tendon sheath
Ulnar nerve lesion (5)
At or about wrist leads to paralysis of small muscles of the hand(except thenar eminence and 1st 2 lumbricals)
Pt is unable to adduct/abduct fingers and because of loss of lumbricals of little and ring fingers they claw
Clawing is hyperextension of mcpjs and secondary flexions of ipjs
If untreated clawing leads to little an ring volar plates contracting leading to permanent flexion contractures
Orthoses after surgery include knuckle duster to flex mcpjs
Median nerve lesion (6)
Muscles of thenar eminence paralysed
Causes a flat hand where thumb lies in the plane of the hand
Thumb is laterally rotated and adducted and pt cannot oppose with thumb
First 2 lumbicals paralysed which can lead to clawing (mcps hyperextend, ips secondary flexion)
Orthotic treatment positions thumb in oppositiob until repaired nerve reinervated the thenar muscles
Known as opponens orthosis or basic opponens orthosis
Carpal tunnel syndrome (6)
Formed by concave anterior surface of carpals at wrist and covered by flexor retinaculum
Contains flexor tendons blood vessels and median nerve
When nerve is compressed within tunnel pain and tingling will be experienced along the distribution of the median nerve in the hand which is the radial fingers and weakness of thenar eminence
Pressure cqn be caused by swelling of any of the structures within the canal, posture, pregnancy, ra or odema
Surgically the flexor retinaculum cqn be divided but often a simple who in the position of rest or function can relieve symptoms
Fabric stock who
Radial nerve damage (6)
No motor innervation to hand
Supplies extensor muscles of forearm
May be damaged when humerus broken as it passes close to bone at spiral groove
Pt looses wrist extension and wrist goes into flexion
Static who or dynamic who with dynamic finger extension
Orthosis should be worn tilll motor power of wrist extensors regained
Ra (10)
Resting orthosis to immoblise in a neutral position prevents joint movement and maintains bones in least packed position
Orthoses to slow down joint destruction or enable pt to use hand longer
Distal carpals slide ulnar direction
Radial deviation at wrist
Flexor and extensor tendons deviated radially so pull in an ulnar direction on fingers at mcpj
Zig zag deformity so radial deviation at wrist, ulnar deviation of fingers
Orthosis must correct wrist before mcpjs
Acute stage: pain relief immbolising affected joints
Late stage: stabilising affected joint
Splints afte surgery: who with dynamic finger extensors and static who at night
Dorsal burn (5)
Skin is thin and loosly attached to deeper tissues enabling its mobility
Little protection to extensor tends esp over pipj so can lead to boutinniere deformities
Mcpjs pulled into hyperextension as skin tightens, thumb adducts and wrist often flexes
Splinted in safe immobilisation: wrist 20degree extension, mcpjs flexed 90degrees and ipjs fully straightened
Thumb abducted and in slight extension
