OTA hand therapy setting: injuries/Disorders and appropriate treatments for them

For Distal radius fracture Of the Asian gentleman with the cast, what instructions did The OT give for tendon glides As part of the home exercise program?

10 repetitions of the sequence, 2 times a day, 1 to 2 times a day. She corrected him on the form, making sure his street fest was straight and hook fist had D.I. P joints that were As flexed as possible.

who is at risk for De Quervain's Tenosynovitis?

1: post partum females due to repetitive lifting of the infant. 2: positive Finkelstein maneuver. 3: local injection of long-acting steroids.

How long should patient do this self massage for, after you instruct them about the above?

5 minutes, twice a day. If patient is sore after the massage, patient should use ice as directed . Cryosphere by recoup fitness may be recommended

How are the majority of distal radius fractures treated medically?

70% of distal radius fractures are treated with conservative nonsurgical management. This involves immobilization through application of plaster or splint with or without closed reduction. Surgery is not needed for fractures that are not displaced and displaced fractures that are stable following reduction.

crush injury

A crush injury occurs when force or pressure is put on a body part. It often happens when a body part is squeezed between two heavy objects. related Damage to includes: Bleeding, Bruising, Compartment syndrome, Fracture, Laceration (open wound), Nerve injury, Secondary infection, Smashed fingers, Wounds.

What type of splint is appropriate for deQuervains?

A thumb spica splint because it immobilizes the wrist and thumb for healing.

Duputren's contracture

And abnormal thickening of tissue, a fibrous layer, underneath the skin of the Palm and fingers. It is the thickening of this issue that causes a finger or fingers to curl. It is more common in men than women.

How does a therapist diagnose Trigger finger?

Ask the patient to make a fist, then straighten the fingers. The affected finger or thumb may stay curled, then suddenly popped to a straight position, as if releasing the trigger of a gun.

What are the symptoms of Trigger finger?

Bent finger suddenly pops out and straightens, Finger movement creates a "popping" or "clicking" sound or sensation, Finger feels stiff and sore, Finger becomes bent with inability to straighten, Symptoms are worse in morning.

Brachial Plexus

C5 to T1, source of arm and hand nerves

What disorder is ranked as the most painful form of chronic pain today by the McGILL Pain Index?

CRPS

Tendons

Connect muscle to bone

What are the FOUR Main Symptoms of, or criteria for C.R.P.S?

Constant chronic burning pain, usually much greater than the original injury; affected area may feel cold, but patient it feels it on fire. allodynia. Spasms in blood vessels & muscles of extremities. Insomnia & Emotional Disturbance: short-term memory problems, concentration difficulties, sleep disturbances, confusion, etc.

What is a good H.E.P. for DeQuervains?

Exercise programs should be tailored to patients needs. Home exercise programs may include Putty, free weights and theraband

What causes DeQuervains syndrome?

Extensor carpi radialis and brevis Muscle or muscles got overused & the tendons got irritated.

Which tendons are affected in DeQuervains syndrome?

Extensor pollicis longus and extensor pollicis brevis

Which tendons are affected in DeQuervains syndrome?

Extensor pollicis longus and extensor pollicis brevis. Extensor pollicis brevis should have emphasis.

How do hand therapists treat trigger finger?

Fabricate a custom orthosis to rest the finger, & teach patient exercises to avoid during healing. Discuss ways to modify activity while finger is healing. Hand therapy following surgery improves range of motion & teaches patient how to regain hand function

What are interventions for the Distal radius fracture of the Asian gentleman with the cast?

Heat, OT practitioner manually Flexes each finger and thumb joint to its fullest extent, then, with the DIP and PIP joints flexed, bends MCPs back into extension.

What treatment does Kimberly recommend for Dequervains?

Heat, massage, vibration, use weights, mobilize joints & muscles, educate patient to keep joints around it mobile. Therapist and patient must work together to Keep tendon gliding back and forth in the tendon sheath; otherwise it becomes stiff.

What is the medical treatment for trigger finger?

If symptoms are mild, antiinflammatory medication. If the triggering is moderate to severe, Cortizone injection and a custom made orthosis designed to rest the finger. If resting or injections do not relieve the triggering, surgery recommended.

What is conservative medical treatment for Trigger finger?

Immobilize finger in extension with splint for 4 to 6 weeks to keep finger in a neutral position enabling the joint to rest. NSAID's may relieve pain & inflammation. Steroid injections in affected finger may reduce the inflammation.

Where do people with DeQuervains feel pain?

In their wrist, specifically, the first extensor compartment. Pain and swelling in the first extensor compartment. Pressure. Symptoms increase with certain types of movement

What are the risks of surgery for Dupuytrens contracture?

Injury to nerves and blood vessels & infection. Swelling & soreness are expected; severe problems are rare. Elevating the hand after surgery and gently moving the fingers helps minimize pain, swelling, & stiffness.

How to perform Finkelstein's test, interpret results

Instruct patient to make fist with their thumb inside & elbow extended. Stabilize forearm and *passively ulnar deviate* the wrist. Do test bilaterally. If patient has acute pain in anatomical snuff box region, which is 1st compartment, they have DeQuervain's disease.

What happens if a patients trigger finger keeps catching and releasing?

It continues to irritate the tendon more and more. If this condition persists for several months, the finger often becomes stiff

What are the symptoms of Duputrens contracture?

It occurs gradually, beginning as one or more small, tender lumps in the palm. Over time, the pain usually goes away. The nodules May tighten and contract. fans of tissue may form and cause one or more fingers to bend toward the palm.

What causes this contracture?

It runs in families, associated with Northern European or Scandinavian ancestry, smoking and drinking, & certain medical conditions, such as diabetes, thyroid problems, and seizures. more common in older people

What else does a hand Therapy practitioner do for trigger finger?

Massage over flexor Tendon sheath softens the pool area and increases circulation, leaving a loser, more mobile tendon. Massage with gentle but firm pressure over the whole Palmer surface of the involve finger, working directly down to the palm and wrist.

Innervation of hand muscles

Median, radial, and Ulnar

Can nerve injury be identified in all cases of RSD,CRPS?

No; in some cases, nerve injury cannot be immediately identified.

Where should I perform vibration in manual massage for DeQuervains?

On the pathway of the first compartment tendons, including the part of the tendon that goes up the dorsal forearm when the patient moves their thumb. To locate this, palpate dorsal forearm while they move their thumb, or my forearm while I move my thumb.

Where does a person with trigger finger feel pain?

Pain may occur in the palm of the hand or knuckles.

Where do DeQuervains patients feel pain?

Pain may radiate to the thumb or the forearm

What are the Symptoms of trigger finger?

Pain, a small nodule or bump in the palm of the hand, and tenderness or swelling at the base of the finger or thumb.

What are some exercises for DeQuervains?

Passive range of motion for wrist: ulnar, radial deviation with arm resting on ulna, may be on wedge. Do 10 reps, 1 or 2 sets if no pain. Stretches for extension on power web: . isometrically grip stress ball, tennis ball, or tomato paste can for 2 seconds, 20 times. Also see handout.

Name some Risk factors that can negatively affect adequate healing after surgery

Poor nutrition, Smoking, Alcoholism, Chronic illness, Steroid use, Age over 60

What causes trigger finger?

Repeated gripping or repeated use of tools place That places bones and muscles too far apart. Common in those with diabetes, arthritis, and palmar injuries

What types of activities cause trigger finger?

Repetitive Motion: Individuals who perform heavy, repetitive hand and wrist movements with prolonged gripping at work or play are believed to be at high risk for developing trigger finger.

What exercises does the textbook recommend for DeQuervains?

Resistive exercises may be isometric, isotonic, and isokinetic modes. start with brief, repetitive isometric hand & wrist exercises, 5 reps, 6 seconds each, once daily. When isometrics can be done at multiple joint angles, isotonic exercise can be added.

What is OT treatment for Trigger Finger?

Rest hand for 2 to 4+ weeks; avoid repetitive gripping &activities that bring on the symptoms. Strengthen and stretch finger with exercises. to reduce symptoms, Ice affected finger. Apply ice over a towel for 5-15 minutes, 3-4 x daily

What type of pain does a person with deQuervains Have?

Sharp pain that catches your breath

How did Kimberly tape Curtis, who has DeQuervains?

She taped his thumb and his dorsal forearm

What characterizes DeQuervain's disease?

Stenosing tenosynovitis of the abductor pollicis longus and extensor pollicis brevis, pain and swelling over radial styloid, and positive Finkelstein's test

What if conservative treatment options fail to resolve the condition, symptoms persist for 6 months or more and quality of life is adversely affected?

Surgeon may recommend a percutaneous trigger finger release surgical procedure to release the tendon. This surgery is usually performed in an operating room under local or regional anesthesia on an outpatient basis as day surgery. surgeon makes a 1 inch long incision to affected finger area and releases the tight portion of the flexor tendon sheath. The incision is then closed with sutures and a dressing.

What is the surgical treatment for Dupuytrens contracture ?

Surgery recommended when the inability to straighten fingers limits hand function. Surgery divides or removes thickened bands to restore finger motion. Sometimes the wound is left open and allowed to heal gradually. Skin grafting may be needed.

What are normal features, science, and symptoms of distal radius fracture?

Swelling, deformity, tenderness, and loss of wrist motion

What types of repercussions may result from TFCC injuries?

TFCC injury may have significant functional repercussions for our clients, including loss of grip strength and pain with loading of the wrist and/or distal forearm.

What types of activities often cause Trigger finger?

Tenosynovitis of the finger flexors is often caused by repetitive use of tools placed too far apart.

Trigger Finger

Tenosynovitis, Which is inflammation of 1 finger flexor tendon.

What does the central portion of the TFCC do, And Can the TFCC heal if it is torn?

The central portion is a disc that provides a smooth gliding surface for the ulnar carpus. It has no blood supply; therefore, it will not heal if torn.

What is DeQuervains diagnosis based on?

The diagnosis is generally based on symptoms and physical examination.

How did trigger finger get its name?

The name is due to the popping sound made by the affected finger when moved.

How does Kimberly rule out arthritis in a case of possible DeQuervains?

The patient has no reaction to palpation at the scaphoid or the trapezium, She can rule out arthritis

Which fingers are most commonly affected by this contracture?

The ring finger and small finger. As contractures increase, it is difficult to use the affected fingers to grasp objects!

What is the nonsurgical treatment for Dupuytrens contracture?

There is no way to stop or cure it, yet if a painful lump is present, and injection may help to diminish the pain.

Before rehab can begin, What is the treatment for distal radius fracture?

Treatment is casting for six weeks or surgery. Surgery indicated if the joint surface is broken and does not line up, the radius is overly short, or the joint surface of the radius is tilted more than 10% backwards. Among those who are casted, repeated X-rays are recommended within three weeks to verify that a good position is maintained

Sample treatment for deQuervains

Use rectanglar 2-pound sand weight for radialulnar deviation: twosets, 10 reps.Squeeze ball - 10 reps, three sets. Then 20 seconds each way.

What are some variations in immobilization techniques for distal radius fracture?

Variations in immobilization techniques involve the type of cast, position of immobilization, and the length of time required in the cast

When a person bears wait on their Wrist or grips an item, how much of the load is transferred to the radius and how much is transferred to the ulna? What structure transfers the load?

When bearing weight on the wrist, or gripping, about 80% ofthe load traveling through the carpal bones is transferred to the radius and 20% is transferred to the ulna via the TFCC

When can DeQuervains patients begin strenthening exercises?

When painful symtoms subside.

What Other exercises did Kimberly give the Asian gentleman with the cast?

Wrist exercises, including the first of three on the page.

Is estim used for DeQuervains?

Yes, 10 minutes, then cold pack.

Does Complex Regional Pain Syndrome spread to additional body parts?.

Yes, in over 70% of the victims it spreads to additional areas.

What is trigger finger?

a disorder characterized by catching or locking of the involved finger. Most commonly the index finger or thumb is affected.

reflex sympathetic dystrophy (RSD)

a fall, sprain, break or fracture (especially wrist), sharp force injury (such as a knife or bullet wound), heart problems, infections, surgery, spinal injuries/disorders, R.S.I.'s , C.T.S., Tarsal Tunnel Syndrome, injections, & partial paralysis injury cases.

Iontophoresis

a technique of introducing ionic medicinal compounds into the body through the skin by applying a local electric current. transdermal drug delivery via a voltage gradient on the skin. Molecules are transported across the stratum corneum by electrophoresis and electroosmosis. the electric field can also increase the permeability of the skin.

What are symptoms of carpal tunnel syndrome?

abnormal pressure on median nerve results in pain, numbness, tingling, weakness, stiffness, and pain in the fingers and hand. There is no known way to prevent carpal tunnel, but some exercises can lower chances of needing surgery.

Distal radius fracture

also known as wrist fracture, is a break of the part of the radius bone which is close to the wrist. Symptoms include pain, bruising, and rapid-onset swelling. The wrist may be deformed. The ulna bone

Iontophoresis Contraindications

areas with bruises, cuts, or otherwise broken skin. Also contraindicated in acute injuries and over sites of active hemorrhage. General contraindications for electrical stimulation apply. Iontophoresis should be very cautiously applied in areas of impaired sensation.

What are some treatments for this syndrome?

avoiding activities that bring on the symptoms, pain medications such as NSAIDs, and splinting the thumb. If this is not effective, steroid injections or surgery may be recommended.

How is carpal tunnel syndrome diagnosed, and what is the treatment for it?

diagnosis: electromyography. Treatment: suggested exercises,applying cold packs, taking frequent breaks, splinting wrist at night, & corticosteroid injections. For mild cases, patients recieve splint and anti-inflammatory. For severe cases, surgical decompression is needed

What is a Colle's fracture

distal radius fracture with dorsal angulation. Image: Fracture of the base of the ulnar styloid which indicates disruption of the trianglar fibrocartilage complex (T.F.C.C.).

What is a Smith's fracture?

distal radius fracture with palmar (apex dorsal) angulation. Also, Reverse deformity is seen in volar angulation (). MOI: fall on a flexed hand.

allodynia

extreme sensitivity to touch, sound, temperature, and vibration. Inflammation. It can affect appearance of skin, bruising, mottling, tiny red spots, shiny, purplish look and affect the skin temperature of the affected area, cause excessive sweating, etc. Part of C.R.P.S

Complex Regional Pain Syndrome, CRPS

formerly RSD. a progressive, Sympathetic Nervous System disease. pain is constant, intense, out of proportion to original injury, accompanied by swelling, skin changes, extreme sensitivity, & often debilitating. Usually affects arm or leg but can occur in any body part

Triangular Fibrocartilage Complex (TFCC)

hammock-like structure composed of cartilage and ligaments, suspends the ulnar carpus and acts as both a force distributor berween the ulna head and triquetrum, and a primary stabilizer for the distal radioulnar joint (D>R>U>J.)

What risk factors cause trigger finger?

hypothyroidism, rheumatoid arthritis, diabetes, and certain infections such as TB. Trigger finger is more common in females.

compartment syndrome

increased pressure in an arm or leg that causes serious muscle, nerve, blood vessel, and tissue damage

What is Trigger finger caused by?

inflammation of the tenosynovium, the substance that lines the protective sheath around the finger tendon. This substance enables the tendon to glide smoothly within the sheath when the finger is bent or straightened.

What is Dequervains syndrome?

inflammation of two tendons that control movement of the thumb and their tendon sheath. results in pain at the outside of the wrist. Pain is increased with gripping or rotating the wrist.The thumb may be difficult to move smoothly.

what happens when When this tenosynovium of the tendon becomes inflammed?

it can no longer glide smoothly in its sheath, which causes "catching" of the finger in a bent position, then suddenly releasing the finger straight

What are the peripheral parts of the TFCC made of, and can they bear weight?

ligaments. They can Bear tensile loads generated during gripping or weight bearing on the wrist. These portions have fair-to-excellent blood supply and accordingly have a fair-to-good capaciry to heal follow- ing injury.

What nerve is involved in DeQuervain's?

median nerve repetitive stress injury

Is surgery usually successful for this contracture?

motion in fingers usually improves after surgery, though surgery does not always cure contracture

What makes DeQuervains pain worse?

movement of the thumb and wrist. .

carpal tunnel syndrome

numbness/tingling at night or work; radial digits(3.5) of median nerve; location -wrist; maneuver-Phalen-wrist flexion & Tinel -tingling on percussion over median

carpal tunnel syndrome (CTS)

occurs when the tunnel becomes narrowed or when tissue surrounding the flexor tendons, called synovium, swells, putting pressure on the median nerve. synovium normally lubricates the tendons, making it easier to move fingers. When synovium swells, it takes up space in carpal tunnel & crowds nerve.

What are 2 symptoms of DeQuervain's?

pain and tingling along thumb .

What are the symptoms of this syndrome?

pain at the radial side of the wrist, spasms, tenderness, occasional burning sensation in the hand, and swelling over the thumb side of the wrist, and difficulty gripping with the affected side of the hand

postoperative guidelines for Trigger finger:

postoperative guidelines include: Keep incision clean and dry. Cover area with plastic wrap when bathing or showering. Ice packs may reduce pain and swelling. Once bandage is removed, full finger movement is encouraged.

What are the risk factors for DeQuervains syndrome?

repetitive movements, pregnancy, trauma, and rheumatic diseases.

What are some techniques used to control pain?

rest, immobilization, physical agent modalities, elevation, soft tissue massageJ active range of motion (AROM), functional accivicies, joint protection education, adaptive equip- ment, and education.

Where do 65% of CRPS and RSDS cases come from?

soft tissue injuries, such as burns, sprains, strains, tears, bursitis, arthritis, & tendonitis

what are 2 other names for trigger finger?

stenosing tenosynovitis & flexor tendonitis

What does a positive Finkelstein's test indicate?

stenosing tenosynovitis of abductor pollicis longus and/or extensor pollicis brevis = De Quervain's disease

The bracial plexus gives rise to which nerves that innervate the arm and hand?

the radial nerve, the median nerve, the ulnar nerve

What type of splint is appropriate for DeQuervain's?

thumb splint including wrist with IP joint free

splint for DeQuervain's

thumb splint, includes wrist, IP joint free

Finkelstein's test

when the wrist is bent in ulnar deviation while a person is grabbing their thumb within a fist. This stretches and lengthens the thumb tendon to assess the possibility of de Quervain's disease, which is tenosynovitis of the thumb tendon.