Wrist And Hand - Manual Therapy Flashcards
Nerve healing acute injury
12-48 hours wallergian degeneration
48-72 hours axons break into twisted fragments - macrophages and Schwann cells present
2 weeks - all traces of axons are lost
Nerve healing atonal degeneration phase 1
6-18 mo
Neuro recovers
Atonal growth commences
Axon reaches injured zone
Nerve healing axonal regeneration phase 2
6-18 mo
Scar delay
Axon transverse scar tissue at site of injury
Nerve healing axonal regeneration phase 3
6-18 mo
Axons propagate beyond site of injury to reach peripheral target
Nerve healing axonal regeneration phase 4
6-18 mo
Restoration of normal patterns of conduction
DASH
Disabilities of the Arm, Shoulder, and Hand Outcome measure -30 item self report -minimum 27 items must be answered Higher score is more disabled
DASH MDC
12.7
More for research use
DASH MCID
15
Clinical significance
Symptom severity scale
Specifically for CTS
Higher score means more severe
Not as commonly used
Clearing Cspine for all UQ
Spurlings
Neck distraction
ULTTA
Cervical rotation <60 deg
Normal scapholunate angle
30-60 deg
Scapholunate dorsiflexion instability
> 70 deg
Scapolunate Lig injured
Scapholunate palmarflexion instability
<30 deg
CTS exam
Neuroscreen Cspine - cerv radic Tinnel Rule out TOS ULND Phalan’s test Reverse phalans
CTS tax
Splint Avoid forceful grip Reduce entrapment Nerve mobility Associated impairments
Splinting vs sx for CTS
Splinting better at 1 mo
Sx better long term
—-
Splint while waiting for sx
Sliding vs tensioning
Sliding has more longitudinal excursion
Sliding less aggressive - uncoupling learnt expectations of pain
Sliding more appropriate for
Acute injuries Post op management Situations leading to nerve irritation and entrapment \: bleeding and inflammation around nerve Prevention of chronic pain
Tensioning
Reduce intraneural swelling
Reduce circulatory compromise
Milking effect - alternating intraneural pressure
Movement based vs immobilization in cubital tunnel
Movement based management may be beneficial
CTS and manual therapy vs neuro mobe
Pt can benefit from manual treatment
Carpal mobe no better than nueral mobe
Manual therapy better than no therapy
Post immobilization for collies fx
Grade III oscillations earlier in intervention = more range and less pain
Sustained stretches later in intervention = more range
