Wrist&hand

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Wrist&hand

  1. 1. THE WRIST AND HAND MANAGEMENT OF WRIST AND HAND DISORDERS AND SURGERIES
  2. 2. JOINT HYPOMOBILITY:NON OPERATIVE MANAGEMENT
  3. 3. PATHOPHYSIOLOGY REPETITIVE JOINT FRACTURE , POTENTIAL JOINT TRAUMA DEFORMITIES AND SURGERY DEGENERATIVE IMMOBILIZATIONCARTILAGINOUS AND BONY CHANGES JOINT CAPSULE WEAKENING, CARTILAGE DESTRUCTION, TENDON RUPTURE, IMPAIRED JOINT, TENDON AND MUCLE MOBILITY, TISSUE PROLIFERATION JOINT HYPOMOBILITY
  4. 4. Common Joint Pathology and Associated Impairments• Rheumatoid Arthritis • Joint Deformities• Osteoarthritis
  5. 5. SIGNS AND SYMPTOMS (RA)• ACUTE STAGE • PAIN • SWELLING • LIMITED MOTION FROM SYNOVITIS • PROGRESSIVE MUSCLE WEAKNESS
  6. 6. • ADVANCED STAGES • JOINT INSTABILITY • SYBLUXATIONS • DEFORMITIES • Swan Neck Deformity • Boutonniere Deformity • Zigzag Deformity • Ulnar Drift
  7. 7. Swan Neck Deformity• Hyperextension of PIP and flexion of DIP
  8. 8. Boutonniere Deformity • PIP flexion and DIP extension
  9. 9. Ulnar Drift  Stretching or rupture of the collateral ligaments at the MCP jts and bowstringing effec from the extrinsic extensionZigzag Deformity  Metacarpal dislocation of thumb
  10. 10. Volar subluxation of the triquetrum on the articular disk and ulna • The extensor carpi ulnaris tendon displaces volarly and causes a flexor force at the wrist joint.Ulnar subluxation of the carpals • This causes radial deviation of the wrist.
  11. 11. SIGNS AND SYMPTOMS (OA)• ACUTE STAGE • ACHINESS • FEELING OF STIFFNESS • SWELLING • WARMTH • RESTRICTED AND PAINFUL MOTION
  12. 12. • ADVANCED STAGES • WITH DEGENERATION THERE IS LAXITY RESULTING IN HYPERMOBILITY AND INSTABILITY • WITH PROGRESSION CONTRACTURES AND LIMITED MOTION DEVELOP
  13. 13. • GENERAL MUSCLE WEAKNESS• WEAK GRIP STRENGTH• POOR MUSCULAR ENDURANCE• PAIN (LOM FOR PINCHING AND GRIPPING)
  14. 14. JOINT SURGERY ANDPOSTOPERATIVE MANAGEMENT
  15. 15. • GOALS: 1. relief of pain 2. restoration of normal/sufficient function of the wrist and hand 3. correction of instability and deformity 4. restoration of ROM 5. improve strength of wrist and fingers
  16. 16. WRIST ARTHROPLASTY• Usually for arthritis and impaired mobility of other joints in the extremity• INDICATIONS: 1. severe pain (destruction of articular surfaces) 2. deformity and marked limitation of wrist that causes mm-tendon imbalance
  17. 17. 3. sublaxation of dislocation of radiocarpal joint4. appropriate for: • low-demand UE functional needs • pt with bilateral wrist involvement • pt with significant stiffness of the ipsilateral shoulder, elbow or wrist and finger joints.
  18. 18. OVERUSE SYNDROMES
  19. 19. • Disorders from cumulative/repetitive trauma in the wrist & hand lead to significant loss of hand function & lost work time.• Resulting inflammation can affect muscle, tendon, synovial sheaths & nerves
  20. 20. Carpal Tunnel Syndrome• Confined space between the carpal bones dorsally and flexor retinaculum volarly.• The extrinsic flexor tendons & median nerve course through the tunnel.• CTS is described by the sensory loss and motor weakness that occur when the median nerve is compromised in the carpal tunnel.
  21. 21.  Synovial thickness & scarring in the tendon sheathes or irritation, inflammation & swelling as a repetitive wrist flexion, extension or gripping activities. Swelling of the wrist joint from trauma to the carpals, a fracture to the carpals, pregnancy, RA, OA could decrease carpal tunnel space. Increase pain in the hand with repetitive use.
  22. 22. • Atrophy in the thenar muscles & 1st 2 lumbricals (ape hand deformity)• Tightness in the adductor pollicis & extrinsic extensors of the thumb and digits 2 & 3.• Sensory loss in the median nerve distribution.• Phalen’s Test
  23. 23. Compression of Tunnel of Guyon• Injury/irritation of the ulnar nerve in the tunnel between the hook of hamate & pisiform occurs from sustained pressure such as prolonged hand writing.
  24. 24. • Pain and paresthesia along the ulnar side of the palm of the hand & digits in the distribution of the ulnar nerve.• Weakness/atrophy in the hypothenar, lumbricals, adductor pollicis, deep head of the flexor pollicis brevis muscle (bishop’s hand deformity)• Tightness in the extrinsic finger flexor & extensor muscles.• Possible restricted mobility of the pisiform.
  25. 25. Tenosynovitis/Tendinitis• Inflammation occurs from the repetitive use of involved muscle from the stress overload to the contracting muscle or roughening of the surface of the tendon.• Pain whenever the related muscle contracts.• Warmth & tenderness with palpation in the region of inflammation
  26. 26. TRAUMATIC LESIONS IN THE WRIST AND HAND
  27. 27. Simple Strain• A blow or fall, excessive stretch force may strain the supporting ligamentous tissue.• There may be related fractured, subluxation or dislocation.• Pain at the involved site whenever a stretch force is placed in the ligament.• Possible hypermobility.

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