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  • Table 19.2 summarizes Wrist and Hand Pathologies/Surgical Procedures and Preferred Practice Patterns.
  • Box 19.2 summarizes Joint Protection in the Wrist and Hand.
  • Traumatic Lesions in the Wrist and Hand
  • Ch19

    1. 1. Copyright © 2013. F.A. Davis CompanyPart IV: Exercise Interventions by BodyRegionChapter 19The Wrist and Hand
    2. 2. Copyright © 2013. F.A. Davis Company Nerve Disorders in the Wrist– Median nerve-Carpal Tunnel– Ulnar nerve-Guyon’s Tunnel Referred Pain and Sensory Patterns– Terminal point for C6, C7, and C8 (median, radialand ulnar nerves)Major Nerves Subject to Pressureand Trauma at the Wrist and Hand
    4. 4. Copyright © 2013. F.A. Davis Company Common Joint Pathologies/Impairments– Rheumatoid arthritis• covered previously, lets review together! How aboutthe Swan-neck and Boutonniere deformity– Osteoarthritis and post-traumatic arthrosis• Covered previously, lets review together!– Postimmobilization hypomobility• Dec’d ROM and jt play, firm end feel, tendonadhesions, dec’d muscle performanceJoint Hypomobility:Nonoperative Management
    5. 5. Copyright © 2013. F.A. Davis Company
    6. 6. Copyright © 2013. F.A. Davis CompanyJoint Hypomobility:Nonoperative Management Common Activity Limitations and ParticipationRestrictions– Acute-prehension activities are painful• Dressing, eating, grooming, toileting• Any functional activity that requires pinching, grippingand fine finger dexterity including writing and typing• Depending upon joint involvement, functional loss maybe minor or significant
    7. 7. Copyright © 2013. F.A. Davis Company Management: Protection Phase– Control pain and protect joints• Patient education• Pain management• Splinting• Activity modification– Maintain joint and tendon mobility and muscle integrity• Passive, assistive, or active ROM• Tendon-gliding exercises• Multiple-angle muscle setting exercisesJoint Hypomobility:Nonoperative Management (contd)
    8. 8. Copyright © 2013. F.A. Davis Company Management: Controlled Motion and Returnto Function Phases– Increase joint play and accessory motions• Joint mobilization techniques• Unlocking a subluxated ulnomeniscal-triquetral joint– Improve joint tracking and pain-free motion• MWM of the wrist• MWM of the MCP and IP joints of the digitsJoint Hypomobility:Nonoperative Management (contd)
    9. 9. Copyright © 2013. F.A. Davis Company Management: Controlled Motion and Returnto Function Phases (cont’d)– Improve mobility, strength, and function• Neuromuscular control and strength• Functional activities• Conditioning exercises-aquatics or cycling• Joint protection-Box 19.2Joint Hypomobility:Nonoperative Management (contd)
    10. 10. Copyright © 2013. F.A. Davis CompanyRepetitive Trauma Syndromes/Overuse Syndromes Disorders lead to significant loss of handfunction and lost work time Repeated movements over an extendedperiod of time Carpal Tunnel Syndrome Trigger finger De Quervain disease Tendinopathy (tendonitis/tenosynovitis)
    11. 11. Copyright © 2013. F.A. Davis Company Tendinopathy– Etiology of symptoms• Pathological breakdown from repetitive use, RA, andstress overload– Common structural and functional impairments• Pain with muscle contraction and tendon gliding insheath, warmth and tenderness with palpation,synovial proliferation and swelling in affected tendonsheaths (RA), muscle imbalance and poor enduranceRepetitive Trauma Syndromes/Overuse Syndromes
    12. 12. Copyright © 2013. F.A. Davis CompanyRepetitive Trauma Syndromes/Overuse Syndromes– Common activity limitations and participationrestrictions• Inability to perform repetitive or sustained work,recreational, or leisure gripping activities or handmotions that require contraction of the muscle– Management• Protection phase– Pt ed, rest, tendon mobility, muscle integrity• Controlled motion and return to function phases– Exercise progression, biomechanical assessment, prevention
    13. 13. Copyright © 2013. F.A. Davis Company First dorsal extensor compartment Repeated tension with abd and ext of thumb and/ormedial and lateral deviation of the wrist andextension of the wrist-creates friction that leads toswelling and thickening of the connective tissue andnarrowing of the tunnel Termed as tendinitis, tenosynovitis or tendinosisDeQuervain Disease
    14. 14. Copyright © 2013. F.A. Davis Company Presentation: pain on radial side of wrist-aggravated with use of the thumb Swelling and possible nodules Finkelstein test Management: activity modification,immobilization, ice, e-stim (HVPGS),iontophoresis (questionable benefit), PROMprogress to AROM and strengtheningDe’Quervain Disease
    15. 15. Copyright © 2013. F.A. Davis Company Limits movement of the finger, with extensionmovement, the finger will lock or catch beforepopping out straight Irritation to tendon as it slides through thetendon sheath tunnel, with irritation thetendon may thicken and form nodulesTrigger Finger
    16. 16. Copyright © 2013. F.A. Davis Company
    17. 17. Copyright © 2013. F.A. Davis CompanyDupuytren Disease Nodules just below the skin of the palm Longitudinal contraction of the underlyingfascia Tissue becomes very thick and forms cordsthat become firm and tendon-like (affecteddigits lose extension) Incidence: white males of northern Europeandescent
    18. 18. Copyright © 2013. F.A. Davis Company Steroid injections to soften nodules and break downcollagen Surgery: fasciotomy Management: usually CHT Splinting: dorsal blocking splint that allows activeflexion but limits full extension at the MP joints- 2 to3 weeks then progressed to volar splint to hold theMP and IP in full available extension-worn for 3monthsDupuytren Disease
    19. 19. Copyright © 2013. F.A. Davis Company
    20. 20. Copyright © 2013. F.A. Davis Company Nonoperative Management– Common functional and structural impairments• Pain at involved site with stretch force on ligament• Hypermobility or instability in the joint if ligament torn– Common activity limitations and participationrestrictions• Pain with functional use when jt is stressed, instabilitywith significant tears (subluxation/dislocation)– Management-Chapter 10Simple Sprain
    21. 21. Copyright © 2013. F.A. Davis CompanyQuestions?