Wrist and hand surgies

Question 1

What are bursae

Answer 1

Flattened sacs of synovial membrane supported by dense irrgular connective tissue

Question 2

Where do bursae occur

Answer 2

etween tissue planes:
Subcutaneous - b/t skin and bone
Submuscular (b/t muscle planes - e.g between the glute tendons

Question 3

Are bursae involved in tendinopathies

Answer 3

Commonly involved with glute tendinopathy nad rotator cuff diseases

Question 4

Whate occurs in the acute pathology of bursa

Answer 4

they become inflamed and infected

Question 5

WHat occurs in the chronic pathology of bursae

Answer 5

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

Question 6

List the common areas that commonly get bursitis’

Answer 6

Trochanteric
knee
Iliopsoas
Ischium
ankle
subachromial
cubital
olecranon
radio humeral

Question 7

How do you treat an acute bursitis

Answer 7

Infected - with antiobiotis

Non infected with: NSAIDS, corticosteroids, Ice, Rest, treat underlying problem, behavious modification

Question 8

How do you treat chronic busitis’

Answer 8

Bursectomies or Synovectomies

Question 9

What does rehab need to address in the wrist, hand and lebow

Answer 9

Pre op history and impairments
Surgical procedure and technique
surgeons assessment of tissue on finalisation of surgery

Question 10

WHat are some common restrictions post wrist hand and elbow surgery

Answer 10

AROM and PROM
ROM limits
SLing to be worn for comfort

Question 11

True or false: THere is evidence that increase immoilisation period increase risk of flexion contracture in the elbow and adhesions in the hand

Answer 11

True

Question 12

Are you likely to see Hand post op patinets

Answer 12

No, hey are not in the ward for bery long and may not even be admitted

Question 13

Orthopaedic management is required for

Answer 13

Education:

Odema management, prevention of adhesions, maintance of other joint

Question 14

WHat occurs during flexor tendon repair surgery

Answer 14

tendon ends are located, threaded back through a window between the pulleys
Maintain anatomical relationship of profundus and superficials

Question 15

To allow early AROM flexion the repair must

Answer 15

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

Question 16

How long does it take for a flexor tendon to regain enough of it’s tensile strength to avoid rupture

Answer 16

12 week.s here it can withstand normal strong use of the hand

Question 17

What are consideration for flexor tendon repair rehab

Answer 17

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

Question 18

How long does it take for tendons to heal according to sue witchalls

Answer 18

3 weeks for early healing - movement without stress and 6-12 weeks for consolidated healing - can take full stress

Question 19

WHat is important in early hand rehab

Answer 19

Odema control

Adhesion control - occurs super quickly

Question 20

What are the indications for immobilisation

Answer 20

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

Question 21

What are some immobilisation guidelines

Answer 21

Page 1 - 0-4 weeks

Question 22

When do they apply a dorsal blocking splint?

Answer 22

3-4 days after repair surgery

Question 23

WHy would you attach an elastic band to a dorsal splint

Answer 23

This is for extensor resistance

Question 24

What are the common principles for post op hands?

Answer 24

EDucate, immolise, restrictions on joint ROM permitted, restrictions on AROm permitted, oedema, adhesions, other joints, protect and maintain