Chapter 24: The Forearm, Wrist, Hand and Finger - PowerPoint PPT Presentation

Loading...

PPT – Chapter 24: The Forearm, Wrist, Hand and Finger PowerPoint presentation | free to view - id: 23e630-MjZiM



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Chapter 24: The Forearm, Wrist, Hand and Finger

Description:

Pain, swelling, and difficulty executing wrist and finger flexion ... Unable to extend distal end of finger (carrying at 30 degree angle) ... – PowerPoint PPT presentation

Number of Views:179
Avg rating:3.0/5.0
Slides: 73
Provided by: usm
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Chapter 24: The Forearm, Wrist, Hand and Finger


1
Chapter 24 The Forearm, Wrist, Hand and Finger
2
Anatomy of the Forearm
3
(No Transcript)
4
(No Transcript)
5
(No Transcript)
6
Blood and Nerve Supply
  • Most of the flexors are supplied by the median
    nerve
  • Most of the extensor are controlled by the radial
    nerve
  • Blood is supplied by the radial and ulnar arteries

7
Assessment of the Forearm
  • History
  • What was the cause?
  • What were the symptoms at the time of injury, did
    they occur later, were they localized or diffuse?
  • Was there swelling an discoloration?
  • What treatment was given and how does it feel now?

8
  • Observation
  • Visually inspect for deformities, swelling and
    skin defects
  • Range of motion
  • Pain w/ motion
  • Palpation
  • Palpated at distant sites and at point of injury
  • Can reveal tenderness, edema, fracture,
    deformity, changes in skin temperature, a false
    joint, bone fragments or lack of bone continuity

9
Palpation Bony and Soft Tissue
  • Proximal head of radius
  • Olecranon process
  • Radial shaft
  • Ulnar shaft
  • Distal radius and ulna
  • Radial styloid
  • Ulnar head
  • Ulnar styloid
  • Distal radioulnar joint
  • Radiocarpal joint
  • Extensor retinaculum
  • Flexor retinaculum
  • Extensor carpi radialis longus and brevis
  • Extensor carpi ulnaris
  • Brachioradialis
  • Extensor pollicis longus and brevis

10
Palpation (continued)
  • Abductor pollicis longus
  • Extensor indicus supinator
  • Flexor carpi radialis
  • Palmaris longus
  • Flexor digitorum superficialis
  • Flexor digitorum profundus
  • Flexor pollicis longus
  • Pronator quadratus
  • Pronator teres

11
Recognition and Management of Injuries to the
Forearm
  • Contusion
  • Etiology
  • Ulnar side receives majority of blows due to arm
    blocks
  • Can be acute or chronic
  • Result of direct contact or blow
  • Signs and Symptoms
  • Pain, swelling and hematoma
  • If repeated blows occur, heavy fibrosis and
    possibly bony callus could form w/in hematoma

12
  • Contusion (continued)
  • Management
  • Proper care in acute stage involves RICE for at
    least one hour and followed up w/ additional
    cryotherapy
  • Protection is critical - full-length sponge
    rubber pad can be used to provide protective
    covering

13
  • Forearm Splints
  • Etiology
  • Forearm strain - most come from severe static
    contraction
  • Cause of splints - repeated static contractions
  • Difficult to manage
  • Signs and Symptoms
  • Dull ache between extensors which cross posterior
    aspect of forearm
  • Weakness and pain w/ contraction
  • Point tenderness in interosseus membrane
  • Management
  • Treat symptomatically
  • If occurs early in season, strengthen forearm
    when it occurs late in season treat w/
    cryotherapy, wraps, or heat
  • Can develop compartment syndrome in forearm as
    well and should be treated like lower extremity

14
  • Forearm Fractures
  • Etiology
  • Common in youth due to falls and direct blows
  • Ulna and radius generally fracture individually
  • Fracture in upper third may result in abduction
    deformity due pull of pronator teres
  • Fracture in lower portion will remain relatively
    neutral
  • Older athlete may experience greater soft tissue
    damage and greater chance of paralysis due to
    Volkmans contracture
  • Signs and Symptoms
  • Audible pop or crack followed by moderate to
    severe pain, swelling, and disability
  • Edema, ecchymosis w/ possible crepitus

15
  • Management
  • Initially RICE followed by splinting until
    definitive care is available
  • Long term casting followed by rehab plan

16
  • Colles Fracture
  • Etiology
  • Occurs in lower end of radius or ulna
  • MOI is fall on outstretched hand, forcing radius
    and ulna into hyperextension
  • Less common is the reverse Colles fracture

17
  • Signs and Symptoms
  • Forward displacement of radius causing visible
    deformity (silver fork deformity)
  • When no deformity is present, injury can be
    passed off as bad sprain
  • Extensive bleeding and swelling
  • Tendons may be torn/avulsed and there may be
    median nerve damage
  • Management
  • Cold compress, splint wrist and refer to
    physician
  • X-ray and immobilization
  • Severe sprains should be treated as fractures
  • Without complications a Colles fracture will
    keep an athlete out for 1-2 months
  • In children, injury may cause lower epiphyseal
    separation

18
Anatomy of the Wrist, Hand and Fingers
19
(No Transcript)
20
(No Transcript)
21
(No Transcript)
22
(No Transcript)
23
(No Transcript)
24
(No Transcript)
25
Blood and Nerve Supply
  • Three major nerves
  • Ulnar, median and radial
  • Ulnar and radial arteries supply the hand
  • Two arterial arches (superficial and deep palmar
    arches)

26
Assessment of the Wrist, Hand and Fingers
  • History
  • Past history
  • Mechanism of injury
  • When does it hurt?
  • Type of, quality of, duration of, pain?
  • Sounds or feelings?
  • How long were you disabled?
  • Swelling?
  • Previous treatments?

27
  • Observation
  • Postural deviations
  • Is the part held still, stiff or protected?
  • Wrist or hand swollen or discolored?
  • General attitude
  • What movements can be performed fully and
    rhythmically?
  • Thumb to finger touching
  • Color of nailbeds

28
Palpation Bony
  • Scaphoid
  • Trapezoid
  • Trapezium
  • Lunate
  • Capitate
  • Triquetral
  • Pisiform
  • Hamate (hook)
  • Metacarpals 1-5
  • Proximal, middle and distal phalanges of the
    fingers
  • Proximal and distal phalanges of the thumb

29
Palpation Soft Tissue
  • Triangular fibrocartilage
  • Ligaments of the carpals
  • Carpometacarpal joints and ligaments
  • Metacarpophylangeal joints and ligaments
  • Proximal and distal interphylangeal joints and
    ligaments
  • Flexor carpi radialis
  • Flexor carpi ulnaris
  • Lumbricale muscles
  • Flexor digitorum superficialis and profundus
  • Palmer interossi
  • Flexor pollicis longus and brevis
  • Abductor pollicis brevis
  • Opponens pollicis
  • Opponens digiti minimi

30
Palpation Soft Tissue
  • Extensor carpi radialis longus and brevis
  • Extensor carpi ulnaris
  • Extensor digitorum
  • Extensor indicis
  • Extensor digiti minimi
  • Dorsal interossi
  • Extensor pollicis brevis and longusAbductor
    pollicis longus

31
  • Special Tests
  • Finklesteins Test
  • Test for de Quervains syndrome
  • Athlete makes a fist w/ thumb tucked inside
  • Wrist is ulnar deviated
  • Positive sign is pain indicating stenosising
    tenosynovitis
  • Pain over carpal tunnel could indicate carpal
    tunnel syndrome
  • Tinels Sign
  • Produced by tapping over transverse carpal
    ligament
  • Tingling, paresthesia over sensory distribution
    of the median nerve indicates presence of carpal
    tunnel syndrome

32
  • Phalens Test
  • Test for carpal tunnel syndrome
  • Position is held for approximately one minute
  • If test is positive, pain will be produced I
    region of carpal tunnel

33
  • Valgus/Varus and Glide Stress Tests
  • Tests used to assess ligamentous integrity of
    joints in hands and fingers
  • Valgus and varus tests are used to test
    collateral ligaments
  • Anterior and posterior glides are used to assess
    the joint capsule

34
  • Lunotriquetral Ballotment Test
  • Stabilize lunate while sliding the triquetral
    anteriorly and posteriorly
  • Assessing laxity, pain and crepitus
  • Positive test indicates instability that often
    results in dislocation of the lunate

35
  • Circulatory and Neurological Evaluation
  • Hands should be felt for temperature
  • Cold hands indicate decreased circulation
  • Pinching fingernails can also help detect
    circulatory problems (capillary refill)
  • Allens test can also be used
  • Athlete instructed to clench fist 3-4 times,
    holding it on the final time
  • Pressure applied to ulnar and radial arteries
  • Athlete then opens hand (palm should be blanched)
  • One artery is released and should fill
    immediately (both should be checked)
  • Hands neurological functioning should also be
    tested (sensation and motor functioning)

36
  • Functional Evaluation
  • Range of motion in all movements of wrist and
    fingers should be assessed
  • Active, resistive and passive motions should be
    assessed and compared bilaterally
  • Wrist - flexion, extension, radial and ulnar
    deviation
  • MCP joint - flexion and extension
  • PIP and DIP joints - flexion and extension
  • Fingers - abduction and adduction
  • MCP, PIP and DIP of thumb - flexion and extension
  • Thumb - abduction, adduction and opposition
  • 5th finger - opposition

37
Recognition and Management of Injuries to the
Wrist, Hand and Fingers
  • Wrist Sprains
  • Etiology
  • Most common wrist injury
  • Arises from any abnormal, forced movement
  • Falling on hyperextended wrist, violent flexion
    or torsion
  • Multiple incidents may disrupt blood supply
  • Signs and Symptoms
  • Pain, swelling and difficulty w/ movement

38
  • Management
  • Refer to physician for X-ray if severe
  • RICE, splint and analgesics
  • Have athlete begin strengthening soon after
    injury
  • Tape for support can benefit healing and prevent
    further injury

39
  • Triangular Fibrocartilage Complex (TFCC) Injury
  • Etiology
  • Occurs through forced hyperextension, falling on
    outstretched hand
  • Often associated w/ sprain of UCL
  • Signs and Symptoms
  • Pain along ulnar side of wrist, difficulty w/
    wrist extension
  • Swelling is possible, not much initially
  • Athlete may not report injury immediately
  • Management
  • Referred to physician for treatment

40
  • Tenosynovitis
  • Etiology
  • Cause of repetitive wrist accelerations and
    decelerations
  • Repetitive overuse of wrist tendons and sheaths
  • Signs and Symptoms
  • Pain w/ use or pain in passive stretching
  • Tenderness and swelling over tendon
  • Management
  • Acute pain and inflammation treated w/ ice
    massage 4x daily for first 48-72 hours, NSAIDs
    and rest
  • When swelling has subsided, ROM is promoted w/
    contrast bath
  • Ultrasound and phonphoresis can be used
  • PRE can be instituted once swelling and pain
    subsided

41
  • Tendinitis
  • Etiology
  • Repetitive pulling movements of (commonly) flexor
    carpi radialis and ulnaris repetitive pressure
    on palms (cycling) can cause irritation of flexor
    digitorum
  • Primary cause is overuse of the wrist
  • Signs and Symptoms
  • Pain on active use or passive stretching
  • Isometric resistance to involved tendon produces
    pain, weakness or both
  • Management
  • Acute pain and inflammation treated w/ ice
    massage 4x daily for first 48-72 hours, NSAIDs
    and rest
  • When swelling has subsided, ROM is promoted w/
    contrast bath
  • PRE can be instituted once swelling and pain
    subsided (high rep, low resistance)

42
  • Nerve Compression, Entrapment, Palsy
  • Etiology
  • Median and ulnar nerve compression most common
  • Direct trauma to nerves
  • Signs and Symptoms
  • Sharp or burning pain associated w/ skin
    sensitivity or paresthesia
  • May result in benediction/ bishops deformity
  • (damage to the ulnar nerve) or claw hand
    deformity (damage to both nerves)
  • Palsy of radial nerve produces drop wrist
    deformity caused by paralysis of extensor muscles
  • Palsy of median nerve can cause ape hand (thumb
    pulled back in line w/ other fingers)
  • Management
  • Chronic entrapment may cause irreversible damage
  • Surgical decompression may be necessary

43
  • Carpal Tunnel Syndrome
  • Etiology
  • Compression of median nerve due to inflammation
    of tendons and sheaths of carpal tunnel
  • Result of repeated wrist flexion or direct trauma
    to anterior aspect of wrist
  • Signs and Symptoms
  • Sensory and motor deficits (tingling, numbness
    and paresthesia) weakness in thumb
  • Management
  • Conservative treatment - rest, immobilization,
    NSAIDs
  • If symptoms persist, corticosteroid injection may
    be necessary or surgical decompression of
    transverse carpal ligament

44
  • de Quervains Disease (Hoffmans disease)
  • Etiology
  • Stenosing tenosynovitis in thumb (extensor
    pollicis brevis and abductor pollicis longus
  • Constant wrist movement can be a source of
    irritation
  • Signs and Symptoms
  • Aching pain, which may radiate into hand or
    forearm
  • Positive Finklesteins test
  • Point tenderness and weakness during thumb
    extension and abduction painful catching and
    snapping
  • Management
  • Immobilization, rest, cryotherapy and NSAIDs
  • Ultrasound and ice are also beneficial

45
  • Dislocation of Lunate Bone
  • Etiology
  • Forceful hyperextension or fall on outstretched
    hand
  • Signs and Symptoms
  • Pain, swelling, and difficulty executing wrist
    and finger flexion
  • Numbness/paralysis of flexor muscles due to
    pressure on median nerve
  • Management
  • Treat as acute, and sent to physician for
    reduction
  • If not recognized, bone deterioration could
    occur, requiring surgical removal
  • Usual recovery is 1-2 months

46
  • Scaphoid Fracture
  • Etiology
  • Caused by force on outstretched hand, compressing
    scaphoid between radius and second row of carpal
    bones
  • Often fails to heal due to poor blood supply
  • Signs and Symptoms
  • Swelling, severe pain in anatomical snuff box
  • Presents like wrist sprain
  • Pain w/ radial flexion
  • Management
  • Must be splinted and referred for X-ray prior to
    casting
  • Immobilization lasts 6 weeks and is followed by
    strengthening and protective tape
  • Wrist requires protection against impact loading
    for 3 additional months

47
  • Hamate Fracture
  • Etiology
  • Occurs as a result of a fall or more commonly
    from contact while athlete is holding an
    implement
  • Signs and Symptoms
  • Wrist pain and weakness, along w/ point
    tenderness
  • Pull of muscular attachment can cause non-union
  • Management
  • Casting wrist and thumb is treatment of choice
  • Hook of hamate can be protected w/ doughnut pad
    to take pressure off area

48
  • Wrist Ganglion
  • Etiology
  • Synovial cyst (herniation of joint capsule or
    synovial sheath of tendon)
  • Generally appears following wrist strain
  • Signs and Symptoms
  • Appear on back of wrist generally
  • Occasional pain w/ lump at site
  • Pain increases w/ use
  • May feel soft, rubbery or very hard
  • Management
  • Old method was to first break down the swelling
    through distal pressure and then apply pressure
    pad to encourage healing
  • New approach includes aspiration, chemical
    cauterization w/ subsequent pressure from pad
  • Ultrasound can be used to reduce size
  • Surgical removal is most effective way

49
  • Contusion and Pressure Injuries of Hand and
    Fingers
  • Etiology
  • Result of blow or compression of bones w/in hand
    and fingers
  • Signs and Symptoms
  • Pain and swelling of soft tissue
  • Management
  • Cold compression until hemorrhaging has ceased
  • Follow w/ gradual warming - soreness may still be
    present -- padding may also be necessary
  • Bruising of distal phalanx can result in
    subungual hematoma - extremely painful due to
    build-up of pressure under nail
  • Pressure must be released once hemorrhaging has
    ceased

50
  • Bowlers Thumb
  • Etiology
  • Perineural fibrosis of subcutaneous ulnar digital
    nerve of thumb
  • Pressure from bowling ball on thumb
  • Signs and Symptoms
  • Pain, tingling during pressure on irritated area
    and numbness
  • Management
  • Padding, decrease amount of bowling
  • If condition continues, surgery may be required

51
  • Trigger Finger or Thumb
  • Etiology
  • Repeated motion of fingers may cause irritation,
    producing tenosynovitis
  • Inflammation of tendon sheath (extensor tendons
    of wrist, fingers and thumb, abductor pollicis)
  • Thickening occurs w/in the sheath and, forming a
    nodule that does not slide easily
  • Signs and Symptoms
  • Resistance to re-extension, produces snapping
    that is palpable, audible and painful
  • Palpation produces pain and lump can be felt w/in
    tendon sheath
  • Management
  • Same treatment as de Quervains disease -- if
    unsuccessful, injection and splinting are last
    options

52
  • Mallet Finger (baseball or basketball finger)
  • Etiology
  • Caused by a blow that contacts tip of finger
    avulsing extensor tendon from insertion
  • Signs and Symptoms
  • Pain at DIP X-ray shows avulsed bone on dorsal
    proximal distal phalanx
  • Unable to extend distal end of finger (carrying
    at 30 degree angle)
  • Point tenderness at sight of injury
  • Management
  • RICE and splinting for 6-8 weeks

53
  • Boutonniere Deformity
  • Etiology
  • Rupture of extensor tendon dorsal to the middle
    phalanxForces DIP joint into extension and PIP
    into flexion
  • Signs and Symptoms
  • Severe pain, obvious deformity and inability to
    extend DIP joint
  • Swelling, point tenderness
  • Management
  • Cold application, followed by splinting
  • Splinting must be continued for 5-8 weeks
  • Athlete is encouraged to flex distal phalanx

54
  • Jersey Finger
  • Etiology
  • Rupture of flexor digitorum profundus tendon from
    insertion on distal phalanx
  • Often occurs w/ ring finger when athlete tries to
    grab a jersey
  • Signs and Symptoms
  • DIP can not be flexed, finger remains extended
  • Pain and point tenderness over distal phalanx
  • Management
  • Must be surgically repaired
  • Rehab requires 12 weeks and there is often poor
    gliding of tendon, w/ possibility of rerupture

55
  • Dupuytrens Contracture
  • Etiology
  • Nodules develop in palmer aponeurosis, limiting
    finger extension - ultimately causing flexion
    deformity
  • Signs and Symptoms
  • Often develops in 4th or 5th finger (flexion
    deformity)
  • Management
  • Tissue nodules must be removed as they can
    ultimately interfere w/ normal hand function

56
  • Sprains, Dislocations and Fractures of Phalanges
  • Etiology
  • Phalanges are prone to sprains caused by direct
    blows or twisting
  • MOI is also similar to that which causes
    fractures and dislocations
  • Signs and Symptoms
  • Recognition primarily occurs through history
  • Sprain symptoms - pain, sever swelling and
    hemorrhaging
  • Gamekeepers Thumb
  • Etiology
  • Sprain of UCL of MCP joint of the thumb
  • Mechanism is forceful abduction of proximal
    phalanx occasionally combined w/ hyperextension

57
  • Signs and Symptoms
  • Pain over UCL in addition to weak and painful
    pinch
  • Management
  • Immediate follow-up must occur
  • If instability exists, athlete should be referred
    to orthopedist
  • If stable, X-ray should be performed to rule out
    fracture
  • Thumb splint should be applied for protection for
    3 weeks or until pain free
  • Splint should extend from wrist to end of thumb
    in neutral position
  • Thumb spica should be used following splinting
    for support

58
  • Sprains of Interphalangeal Joints of Fingers
  • Etiology
  • Can include collateral ligament, volar plate,
    extensor slip tears
  • Occurs w/ axial loading or valgus/varus stresses
  • Signs and Symptoms
  • Pain, swelling, point tenderness, instability
  • Valgus and varus tests may be possible
  • Management
  • RICE, X-ray examination and possible splinting
  • Splint at 30-40 degrees of flexion for 10 days
  • If sprain is to the DIP, splinting for a few days
    in full extension may assist healing process
  • Taping can be used for support

59
  • Swan Neck Deformity and PsuedoBoutonniere
    Deformity
  • Etiology
  • Distal tear of volar plate may cause Swan Neck
    deformity proximal tear may cause
    PsuedoBoutonniere deformity
  • Signs and Symptoms
  • Pain, swelling w/ varying degrees of
    hyperextension
  • Tenderness over volar plate of PIP
  • Indication of volar plate tear passive
    hyperextension
  • Management
  • RICE and analgesics
  • Splint in 20-30 degrees of flexion for 3 weeks
    followed by buddy taping and then PRE

60
  • PIP Dorsal Dislocation
  • Etiology
  • Hyperextension that disrupts volar plate at
    middle phalanx
  • Signs and Symptoms
  • Pain and swelling over PIP
  • Obvious deformity, disability and possible
    avulsion
  • Management
  • Treated w/ RICE, splinting and analgesics
    followed by reduction
  • After reduction, finger is splinted at 20-30
    degrees of flexion for 3 weeks -- followed by
    buddy taping

61
  • PIP Palmar Dislocation
  • Etiology
  • Caused by twist while it is semiflexed
  • Signs and Symptoms
  • Pain and swelling over PIP point tenderness over
    dorsal side
  • Finger displays angular or rotational deformity
  • Management
  • Treat w/ RICE, splinting and analgesics followed
    by reduction
  • Splint in full extension for 4-5 weeks after
    which it is protected for 6-8 weeks during
    activity

62
  • MCP Dislocation
  • Etiology
  • Caused by twisting or shearing force
  • Signs and Symptoms
  • Pain, swelling and stiffness at MCP joint
  • Proximal phalanx is angulated at 60-90 degrees
  • Management
  • RICE, splinting following reduction
  • Buddy taping and given early ROM following
    splinting

63
  • Metacarpal Fracture
  • Etiology
  • Direct axial force or compressive force
  • Fractures of the 5th metacarpal are associated w/
    boxing or martial arts (boxers fracture)
  • Signs and Symptoms
  • Pain and swelling possible angular or rotational
    deformity
  • Management
  • RICE, analgesics are given followed by X-ray
    examinations
  • Deformity is reduced, followed by splinting - 4
    weeks of splinting after which ROM is carried out

64
  • Bennetts Fracture
  • Etiology
  • Occurs at carpometacarpal joint of the thumb as a
    result of an axial and abduction force to the
    thumb
  • Signs and Symptoms
  • CMC may appeared to be deformed - X-ray will
    indicate fracture
  • Athlete will complain of pain and swelling over
    the base of the thumb
  • Management
  • Structurally unstable and must be referred to an
    orthopedic surgeon

65
  • Distal Phalangeal Fracture
  • Etiology
  • Crushing force
  • Signs and Symptoms
  • Complaint of pain and swelling of distal phalanx
  • Subungual hematoma is often seen in this
    condition
  • Management
  • RICE and analgesics are given
  • Protective splint is applied as a means for pain
    relief
  • Subungual hematoma is drained

66
  • Middle Phalangeal Fracture
  • Etiology
  • Occurs from direct trauma or twist
  • Signs and Symptoms
  • Pain and swelling w/ tenderness over middle
    phalanx
  • Possible deformity X-ray will show bone
    displacement
  • Management
  • RICE and analgesics
  • No deformity - buddy tape w/ thermoplastic splint
    for activity
  • Deformity - immobilization for 3-4 weeks and a
    protective splint for an additional 9-10 weeks
    during activity

67
  • Proximal Phalangeal Fracture
  • Etiology
  • May be spiral or angular
  • Signs and Symptoms
  • Complaint of pain, swelling, deformity
  • Inspection reveals varying degrees of deformity
  • Management
  • RICE and analgesics are given as needed
  • Fracture stability is maintained by
    immobilization of the wrist in slight extension,
    MCP in 70 degrees of flexion and buddy taping

68
  • PIP Fractures and Dislocation
  • Etiology
  • Combination of fracture and dislocation is an
    axial load on a partially flexed finger
  • Signs and Symptoms
  • Condition causes pain and swelling in the region
    of the PIP joint
  • Localized tenderness over the PIP
  • Management
  • RICE, analgesics, followed by reduction of the
    fracture
  • If there is a small fragment, buddy taping is
    used
  • Large fragments - splint at 30-60 degrees of
    flexion

69
  • Fingernail Deformities
  • Changes in normal appearance of the fingernail
    can be indicative of a number of different
    diseases
  • Scaling or ridging psoriasis
  • Ridging and poor development hyperthyroidism
  • Clubbing and cyanosis congenital heart
    disorders or chronic respiratory disease
  • Spooning or depression chronic alcoholism or
    vitamin deficiency

70
Rehabilitation of Injuries to the Forearm, Wrist,
Hand and Fingers
  • General Body Conditioning
  • Must maintain pre-injury level of conditioning
  • Cardiorespiratory, strength, flexibility and
    neuromuscular control
  • Many exercise options (particularly lower
    extremity)
  • Joint Mobilizations
  • Wrist and hand respond to traction and
    mobilization techniques

71
  • Flexibility
  • Full pain free ROM is a major goal of
    rehabilitation
  • The program should include active assisted and
    active pain free stretching
  • Strength
  • Exercises should not aggravate condition or
    disrupt healing process
  • A variety of exercises are available for strength
    (wrist and hand)

72
  • Neuromuscular Control
  • Hand and fingers require restoration of dexterity
  • Pinching, fine motor activities (buttoning
    buttons, tying shoes, and picking up small
    objects)
  • Customized bracing, splints and taping techniques
    are available to protect the injured wrist and
    hand
  • Return to Activity
  • Grip strength must be equal bilaterally, full
    range of motion and dexterity
  • Thumb has unique strength requirements
  • Manual resistance can be instituted to strengthen
    major motions intrinsic muscles can be
    strengthened w/ rubber band
About PowerShow.com