quiz #2 � hand therapy


what are requirements to become a certified hand therapist?


five years of practice as a PT or OT4000 hours direct practice experience in hand therapy


what are the requirements to become recertified as a certified hand therapist


take exam or have 80 hours ceu, 36 of which must be hand/upper extremity relatedhave 2000 hours clinical experience in hand therapy


the certificate to become a hand therapists comes from


hand certified therapy commission


what are the bones that articulate with the radius


scaphoidlunatedistal ulna


what does FOOSH stand for


fallonoutstretchedhand
this occurs more frequently in the wintertime because of ice and snow


true or false � joints with pre-existing but asymptomatic osteoarthritis are very susceptible to stiffness even if not involved in the trauma
True False


true


true or false � a fall on the outstretched hand may also injure the proximal joints
True False


true� elbow and shoulderif the patient has a fractured wrist don't forget to check these joints


what are the three common types of distal radius fractures


Colles FractureSmith's FractureBarton's displacement


which distal radius fracture is the most common type of fracture


Colles fracture


what is the mechanism of injury for a Colles Fracture


fall with the wrist extended


dinner for deformity is associated with what kind of distal radius fracture


CollesDorsal Angulation


what is a reverse colles fracture?


a Smith's fracture � volar angulationfall with the wrist flexed


what is the mechanism of injury for a Barton's fracture


fall on extended wrist and pronated forearmusually falling backwards


what is a Bartons fracture


displaced, unstable fracturecarpal displacement with the fragment of radius distinguishes this from Colle's and Smith's


what does this picture represent and what kind of fracture is it associated with


dinner for deformityColle's fracturewhat is seen in the emergency room � we don't see this very much


distal radius fractures objective findings should include


observations� atrophy, swelling, deformity, scars, colorlimited range of motion� wrist, forearm, hand, shoulderweakness� finger extensors strongersensory status� check for median nerve compromise, complaints of numbness and tingling


what is the treatment for distal radial fractures


immobilization � cast or splint itclose reduction and castORIF - open reduction internal fixationexternal fixator


what are some observations to consider when looking at distal radius fractures � objective findings


atrophyswellingdeformityscarscolor


what is one observation we can make this picture


right-hand has a mild amount swelling because there are less wrinkles in the hand


what is being measured in this picture


volume� this is part of objective findings


what are some limitations to be concerned about when looking at distal radius fractures � objective findings


range of motion of wrist, forearm, hand, shoulderpatients have usually been in a cast and therefore have not used their extensors or flexors


what are some weaknesses that are observed in distal radius fractures� objective findings


finger extensors are usually stronger than wrist extensorsbecause the patient has been in cast and has been able to move fingers but not wrist


what are some sensory concerns you should have when considering distal radius fractures � objective findings


check median nerve because it is very close to the bones of the forearm, compact space, very common to have swelling and compression in that area.Perform Semmes Weinstein Test


what does this picture represents


Semmes Weinsten monofilament testtest sensation of the handused to track the sensation of the handhas the nerve recovers from injury


distal radius fracture management � what is the main goal


main goal is to have functional range of motion


true or false � it is very rare for a patient to return to full range of motion
True False


trueif they do they are probably 15 or very young


what are the functional ranges of motion for the wrist


extension � 40�flexion � 40�ulnar and radial deviation � total of 40�supination � 45�pronation � 45�


how long does it take to gain full grip strength


months � very slow to return


what is the general treatment for distal radius fractures


modalities � moist heat or paraffin bathactive range of motion of all involved jointsjoint mobilization techniqueshome exercise program � active range of motion addressing all involved joints


treatment continued

true or false � Most treatments for the hand are started with a hot pack, paraffin bath, fluidotherapy, or some kind of
True False


true


treatment continued

True or false � for the hand it is preferred that you do active range of motion rather than passive range of motion
True False


truewhen we see the patient the fracture is not strong enough for the hand to withstand passive stretching


treatment continued

what are the three exercises used for active range of motion in the treatment of distal radius fracture


intrinsic stretchingtendon glidingisolate wrist extensors


the first picture demonstrates a tight intrinsic muscleFlexing the IP joint and the MP joint� they have full range of motion
The second picture shows the finger being brought into extensionThe IP flexion is tight = tight intrinsic muscles
This is not the same as joint tightness which would mean that the MP joint was tied in flexion and extension


what is tended gliding


mobilization of the nerves in the upper extremity


Explain this Tendon Glide


flexor digitorum superficialis maximum excursion occurs in straight fist positionMP and PIP joints maximally flexed and DIP straight


explain this to glide


FDPMaximum excursion of FDP occurs in fist position

explain this tendon glide


maximum excursion between FDS and FDP occurs in hook positionMP extended withPIP and DIP flexed


why are tendon glides so important


prevents formation of adhesions after trauma or surgeryForces each digital joint through full potential rangeAides tendon and cartilage nutritionvaluable in treating inflammatory tendon disorders


true or false � patients with distal radial fractures are often splinted to help reduce median nerve pain
True False


true


when can you start using weights in the treatment of distal radial fractures


after about six weeks � low weightselbow curlssupination/pronationwrist curlsputty, gripper- must be careful with this because they can overdo it real easy


which motion is most often restricted in the wrist


supination � joint mobilizationsplints are often used to help facilitate supination


carpal tunnel syndrome


what are the anatomical structures associated with carpal tunnel syndrome


transverse carpal ligamentCarpalsFDPFDSFPLMedain nerve


what are the causes of carpal tunnel syndrome


repetitive motiontrauma � fooshbony deformityCongenital disordersLifestyle � obesity, sedentaryIt is important to remember that many things cause carpal tunnel syndrome and it's not just from one thing, must look at full picture


what is the etiology of carpal tunnel syndrome


compression of the median nerve in the carpal tunnel


what are the signs and symptoms of carpal tunnel


pain in paresthesia, usually worse at nightWeakness � dropping thingsIn advance cases atrophy of the thenar area to reach recurrent motor branch of median nerve involvementsometimes, edema and/or radiating pain

What does this picture demonstrate


atrophy in the thenar eminence� right side


true or false � when assessing carpal tunnel syndrome you should always do a full upper quarter screen
True False


true � to help you gain a better understanding of condition


what is tinel sign


tapping on the nerve


what test is this


phalen's� hold for 30 to 60 secondsPositive � reproduces parathesias


what is a way to make the median nerve glide


put hand in supination with passive wrist and finger extension followed by active composite fist, this may be an effective procedure to produce median nerve excursion


what are the goals of carpal tunnel syndrome


decrease painDecrease parathesiasIndependence in self management - education


how often should tendon gliding performed during the dayin the treatment of carpal tunnel syndrome


three or four times a day


what are some things that need to be addressed while treating a patient with carpal tunnel syndrome


exercised correct postureExercise to improve neural glidingexercise to improve tendon glidingEducation positions/activities to avoidNight splint, especially if a phalen's, reverse Phalens are positive


what is the benefit of splinting


promotes the wrist to be in neutral position, which allows for more space and decreases compression


what kind of treatment is this


ASYTMaugmented soft tissue mobilizationthis is good for patient that wants to get better but doesn't want surgery


other than ASYTM what are some other conservative measures for the treatment of carpal tunnel syndrome


NSAIDSsteroid injectionsvitamin B6


if all conservative treatments fell for the treatment of carpal tunnel syndrome what is the last resort


carpal tunnel syndrome surgical interventionrelease the transverse carpal ligamenttenosynovectomyneurolysis


what is the "safest" type of carpal tunnel release which is performed by a surgeon


full carpal tunnel release � with ligament reconstruction, without ligament reconstruction, or without a licenseincisions are smallsurgeons are able to see what they are doing


what kind of surgery was performed in this picture


scars may be hypersensitivemay have edemadecreased range of motion and tendon excursion of fingers


what is the management for carpal tunnel syndrome


moist heat, active range of motion, tendon gliding exercisescontinue night splintdesensitize � Rice, towel rubbing, scar massageprogress to grip and wrist strengthening at 4 to 6 weeks post surgery


Flexor Tendon Injuries


where is no man's land


zone IImost common flexor tendon laceration that we seeusually caused by a knife while patient is cutting an orange or Applewant to treat these patients as soon as possible� usually get these patients within one week post�op


what are the goals for flexor tendon injuries


prevent ruptureprevent tendon adherence, scar adherencemaintain range of motion uninvolved jointspromote tendon glidingfunctional range of motion and strength


why is a dorsal blocking splint so important after flexor tendon repair


the splint helps promote flexion of the wrist which decreases stress on the flexor tendons


what are some of the characteristics of poor soul talking splint


20 to 30� wrist flexionMCP 70 to 80�rubber band traction with Palmer pulleystart active extension in split with MPs Blockedpassive flexion of all finger jointsEdema control � elevation, Coban


what kind of splint is this


dorsal blocking splintrubber band provides passive flexion of the singerpatient is instructed to actively extent finger"never ever ever take this splint off"needs 4 to 5 cm of excursion


what happens three weeks post-op


start scar tissue massage� hypersensitive


what happens 3 to 4 weeks postop


start gentle place/hold


what happens 4 to 5 weeks postop


started active range of motionavoid forceful extension, simultaneously your and wrist extension


what happened 6 weeks post op


start gentle joint blockingstart straightening without stress to repair proximal muscles without dripping


what happens 10 weeks postop


start light grip stengthening


what happens 12 weeks postop


no restrictions


this picture represents a scar in what's zone


zone II


when isTenolysis indicated


if there is not adequate range of motion and tendon excursion


when is tenolysis done


when this car softens, around 4 to 6 months post injury


what is an important component for the success of tenolysis


good passive range of motion program


try to recall the zones of the hand on your own hand


what zone is the scar in on the left hand?


zone IIIthese are easier to treat because there is more room


extensor tendon injuries


true or false � on the extensor side of the hand there are more zones than on the flexor side
True False


true


try to imagine the zones of the hand on your own hand


complex because of the extensor intrinsic muscles of the hand


what is the etiology of extensor tendon injuries


char projectscrushrupturetendon adherence common


true or false � most tendon injuries can be treated conservatively


truth


name the three extensor tendon laceration we covered in class


mallet fingerboutonniereSwan neck deformity


what is a mallet finger


rupture/laceration of terminal tendon as it inserts into the distal phalanxmost likely a basketball injuryoften avulvion fracture -should receive the x-raythe patient will not be able to expand DIP


true or false � mallet finger is always treated surgically
True False


false � mallet finger has a very conservative treatment and is hardly ever operated on surgically


true or false � this x-ray is an x-ray of a mallet finger


what is the treatment for mallet finger


splints 6 to 8 weeksgradually decrease use of splint and watch for extensor lagshould not flex the GIP jointtherapeutically we can't do much for this they just need to wear the splint


typical mallet finger splint


what kind of injuries this


boutonniere deformityrupture/laceration of central slip over the PIP joint


what is the management of nonsurgical boutonniere deformities


active range of motionsplinting
caution � don't do passive forceful flexion on a mallet finger or boutonniere tendon are thin and fragile


explain how you would splint a boutonniere deformity


what is a swan neck deformity


hyperextension of the PIP flexion of the PIPthis is very common in rheumatoid arthritic patients


Inflammatory Conditions


what are two inflammatory conditions


DeQuervain's TenosynovitisStenosing Tenosynovitis -trigger finger


what to muscles does DeQuervain's tenosynovitis affect


extensor pollicus brevisabductor pollicus longus


common causes of DeQuervain's Tenosynovitis


traumarepetitive motiontight cast, poorly fitting splint
This is also common in new mothers � they are the easiest to treat


what are some objective findings for DEQuervain's tenosynovitis


tenderness of the first dorsal compartmentpositive Finkelstein's


what kind of test is this


active finkestein testthis test is normally done passively with the assistance of the therapist


what is the management for DeQuervain's Tenosynovitis


splints limiting wrist and thumb range of motion� with the thumb up (thumbs up sign)stretchingASTYM � outcomes studies show 80% success rate with average of eight visits


what is another name for stenosing tenosynovitis


trigger finger


what is trigger finger


flexor tendon catching on pulley system, usually at A1


what is trigger finger usually caused by


trauma directly over the pulleyrepetitive gripping-using a screwdriver causes pressure directly over the pulleyusually seen in 60 to 80's years age groupoften in diabetic patients or rheumatoid arthritis


what are some of the signs and symptoms of trigger finger


painful locking of involve finger� often the ring fingertenderness of pulley, noduleoccasionally secondary joint stiffness