Wrist and hand surgies Flashcards
What are bursae
Flattened sacs of synovial membrane supported by dense irrgular connective tissue
Where do bursae occur
etween tissue planes:
Subcutaneous - b/t skin and bone
Submuscular (b/t muscle planes - e.g between the glute tendons
Are bursae involved in tendinopathies
Commonly involved with glute tendinopathy nad rotator cuff diseases
Whate occurs in the acute pathology of bursa
they become inflamed and infected
WHat occurs in the chronic pathology of bursae
Pathology is also in the supporting tissue
Hav cytokines, SP and IL-1 evident
increase synovial hypertrophy
increase in vascularisation, increase in inter adipose septa
List the common areas that commonly get bursitis’
Trochanteric knee Iliopsoas Ischium ankle subachromial cubital olecranon radio humeral
How do you treat an acute bursitis
Infected - with antiobiotis
Non infected with: NSAIDS, corticosteroids, Ice, Rest, treat underlying problem, behavious modification
How do you treat chronic busitis’
Bursectomies or Synovectomies
What does rehab need to address in the wrist, hand and lebow
Pre op history and impairments
Surgical procedure and technique
surgeons assessment of tissue on finalisation of surgery
WHat are some common restrictions post wrist hand and elbow surgery
AROM and PROM
ROM limits
SLing to be worn for comfort
True or false: THere is evidence that increase immoilisation period increase risk of flexion contracture in the elbow and adhesions in the hand
True
Are you likely to see Hand post op patinets
No, hey are not in the ward for bery long and may not even be admitted
Orthopaedic management is required for
Education:
Odema management, prevention of adhesions, maintance of other joint
WHat occurs during flexor tendon repair surgery
tendon ends are located, threaded back through a window between the pulleys
Maintain anatomical relationship of profundus and superficials
To allow early AROM flexion the repair must
Secure nots, a mooth junction of tendon ends, suture nots should be place to minimise impingement as flex tendon moves through pull system, preventing grapping, maintain vascularity
How long does it take for a flexor tendon to regain enough of it’s tensile strength to avoid rupture
12 week.s here it can withstand normal strong use of the hand
What are consideration for flexor tendon repair rehab
Type of injury - degenerative and acute trauma
status of tendond sheath and vessels at the time of repiar, Age, sex, long term steroid use, co morbidities
How long does it take for tendons to heal according to sue witchalls
3 weeks for early healing - movement without stress and 6-12 weeks for consolidated healing - can take full stress
WHat is important in early hand rehab
Odema control
Adhesion control - occurs super quickly
What are the indications for immobilisation
Young children: for first 3-4 weeks but should be evaluated depening on maturty
Cognitive limitations
Cast may be needed instead of remoable splint in first 4-6 weeks
Fracture of significant loss of skin requiring a graft
What are some immobilisation guidelines
Page 1 - 0-4 weeks
When do they apply a dorsal blocking splint?
3-4 days after repair surgery
WHy would you attach an elastic band to a dorsal splint
This is for extensor resistance
What are the common principles for post op hands?
EDucate, immolise, restrictions on joint ROM permitted, restrictions on AROm permitted, oedema, adhesions, other joints, protect and maintain
