Upload
keaton-davenport
View
62
Download
6
Embed Size (px)
DESCRIPTION
The Wrist and Hand. Chapter 19. Structure and Function of the wrist and hand. Joints of the Wrist. Characteristics and Arthrokinematics Radiocarpal joint Midcarpal joint. Joints of the Hand. Characteristics and Arthrokinematics Carpometacarpal joints of digits 2 through 5 - PowerPoint PPT Presentation
Citation preview
Copyright © 2013. F.A. Davis Company
Part IV: Exercise Interventions by Body Region
Chapter 19
The Wrist and Hand
Copyright © 2013. F.A. Davis Company
Characteristics and Arthrokinematics– Radiocarpal joint– Midcarpal joint
Joints of the Wrist
Copyright © 2013. F.A. Davis Company
Characteristics and Arthrokinematics– Carpometacarpal joints of digits 2 through 5– Carpometacarpal joint of the thumb (digit 1)– Metacarpophalangeal joints of digits 2 through 5– Interphalangeal joints and MCP joint of the
thumb
Joints of the Hand
Copyright © 2013. F.A. Davis Company
Muscles of the Wrist and Hand– Length-tension relationships– Extensor mechanism– Control of the unloaded (free) hand
Grips and Prehension Patterns– Power grips– Precision patterns– Combined grips
Hand Function
Copyright © 2013. F.A. Davis Company
Nerve Disorders in the Wrist– Median nerve– Ulnar nerve
Referred Pain and Sensory Patterns
Major Nerves Subject to Pressure and Trauma at the Wrist and Hand
Copyright © 2013. F.A. Davis Company
Common Joint Pathologies and Associated Impairments– Rheumatoid arthritis– Osteoarthritis and post-traumatic arthrosis– Postimmobilization hypomobility
Common Activity Limitations and Participation Restrictions
Joint Hypomobility: Nonoperative Management
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 exercises
Joint Hypomobility: Nonoperative Management (cont'd)
Copyright © 2013. F.A. Davis Company
Management: Controlled Motion and Return to 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 digits
Joint Hypomobility: Nonoperative Management (cont'd)
Copyright © 2013. F.A. Davis Company
Management: Controlled Motion and Return to Function Phases (cont’d)– Improve mobility, strength, and function• Neuromuscular control and strength• Functional activities• Conditioning exercises• Joint protection
Joint Hypomobility: Nonoperative Management (cont'd)
Copyright © 2013. F.A. Davis Company
Indications for Surgery Procedures– Implant designs, materials, and fixation– Operative overview
Wrist Arthroplasty
Copyright © 2013. F.A. Davis Company
Postoperative Management – Immobilization– Exercise• Maximum and moderate protection phases• Minimum protection/return to functionphase
Outcomes– Pain relief– Wrist and forearm ROM, strength, and function– Complications
Wrist Arthroplasty (cont'd)
Copyright © 2013. F.A. Davis Company
Indications for Surgery Procedures– Implant design, materials, and fixation– Operative overview
Metacarpophalangeal Implant Arthroplasty
Copyright © 2013. F.A. Davis Company
Postoperative Management – Immobilization– Exercise• Maximum protection phase• Moderate and minimum protection phases
Outcomes– Pain relief and patient satisfaction– ROM and hand function– Complications
Metacarpophalangeal Implant Arthroplasty (cont'd)
Copyright © 2013. F.A. Davis Company
Indications for Surgery Procedure– Implant design, materials, and fixation– Operative overview
Proximal Interphalangeal Implant Arthroplasty
Copyright © 2013. F.A. Davis Company
Postoperative Management– Immobilization– Exercise• Maximum and moderate protection phases
– Boutonnière deformity– Swan-neck deformity
• Minimum protection/return to function phase
Outcomes– Complications
Proximal Interphalangeal Implant Arthroplasty (cont'd)
Copyright © 2013. F.A. Davis Company
Indications for Surgery Procedure– Background and surgical options– Operative overview• Tendon interpositional arthroplasty• Surface replacement arthroplasty
Carpometacarpal Arthroplasty of the Thumb
Copyright © 2013. F.A. Davis Company
Postoperative Management– Immobilization– Exercise• Maximum protection phase• Moderate and minimum protection phases
Outcomes– Pain relief and patient satisfaction– ROM and hand function– Complications
Carpometacarpal Arthroplasty of the Thumb (cont'd)
Copyright © 2013. F.A. Davis Company
Background and Indications for Surgery Procedures– Tendon transfer– Tendon graft reconstruction– Tendon anastomosis (side-to-side tenorrhaphy)– Direct end-to-end repair
Tendon Rupture Associated With RA
Copyright © 2013. F.A. Davis Company
Postoperative management– Immobilization– Exercise• Maximum protection phase• Moderate and minimum protection phases
Outcomes
Tendon Rupture Associated With RA (cont'd)
Copyright © 2013. F.A. Davis Company
Tendinopathy– Etiology of symptoms– Common structural and functional impairments– Common activity limitations and participation
restrictions– Management• Protection phase• Controlled motion and return to function phases
Repetitive Trauma Syndromes/ Overuse Syndromes
Copyright © 2013. F.A. Davis Company
Nonoperative Management– Common functional and structural impairments– Common activity limitations and participation
restrictions– Management
Simple Sprain
Copyright © 2013. F.A. Davis Company
Background and Indications for Surgery Procedures– Types and timing of operative procedures• Immediate primary repair• Delayed primary repair• Secondary repair• Late reconstruction• Staged repair
Lacerated Flexor Tendons of the Hand
Copyright © 2013. F.A. Davis Company
Procedures (cont’d)– Operative overview• Surgical approach• Suturing technique• Closure
Lacerated Flexor Tendons of the Hand (cont'd)
Copyright © 2013. F.A. Davis Company
Postoperative Management– General considerations– Approaches to postoperative management– Immobilization• Duration• Type or method• Position
Lacerated Flexor Tendons of the Hand (cont'd)
Copyright © 2013. F.A. Davis Company
Postoperative Management (cont’d)– Exercise• Early controlled motion approaches
– Passive motion– Active motion
• Maximum protection phase• Moderate protection phase• Minimum protection/return to function phase• Delayed motion approach
Outcomes
Lacerated Flexor Tendons of the Hand (cont'd)
Copyright © 2013. F.A. Davis Company
Background and Indications for Surgery Procedures– Types of repair and reconstruction– Operative overview• Zone III/IV primary repair
Lacerated Extensor Tendons of the Hand
Copyright © 2013. F.A. Davis Company
Postoperative Management– Immobilization• Duration• Types
– Exercise • Early controlled active motion approach
– Use of customized static volar splints
• Delayed mobilization approach
Outcomes
Lacerated Extensor Tendons of the Hand (cont'd)
Copyright © 2013. F.A. Davis Company
Place-and-Hold Exercises Flexor Tendon-Gliding Exercises– Hook (claw) fist position– Full fist– Straight fist (sublimis fist)– Thumb flexion
Tendon-Gliding and Tendon-Blocking Exercises
Copyright © 2013. F.A. Davis Company
Flexor Tendon-Blocking Exercises– Isolated MCP flexion (lumbricales and palmar
interossei)– PIP flexion (flexor digitorum superficialis)– DIP flexion (flexor digitorum profundus)– Full fist
Tendon-Gliding and Tendon-Blocking Exercises (cont'd)
Copyright © 2013. F.A. Davis Company
Exercises to Reduce Extensor Lag– Isolated MCP extension– Isolated PIP and DIP extension– Terminal range extension of IP joints
Extensor Tendon-Gliding Exercises
Tendon-Gliding and Tendon-Blocking Exercises (cont'd)
Copyright © 2013. F.A. Davis Company
To Mobilize the Long Finger Flexor Tendons To Mobilize the Extensor Tendons and the
Extensor Mechanism
Scar Tissue Mobilization for Tendon Adhesions
Copyright © 2013. F.A. Davis Company
General Stretching Techniques– To increase wrist extension– To increase wrist flexion– To increase flexion or extension of individual joints
of the fingers or thumb
Exercise Techniques to Increase Flexibility and Range of Motion
Copyright © 2013. F.A. Davis Company
Stretching Techniques for the Intrinsic and Multijoint Muscles– Self-stretching the lumbricales and interossei muscles– Self-stretching the interossei muscles– Self-stretching the adductor pollicis– Manual stretching of the extrinsic muscles– Self-stretching the flexor digitorum profundus and
superficialis– Self-stretching the extensor digitorum communis
Exercise Techniques to Increase Flexibility and Range of Motion (cont'd)
Copyright © 2013. F.A. Davis Company
Techniques to Strengthen Muscles of the Wrist and Hand– To strengthen wrist musculature– To strengthen weak intrinsic musculature– To strengthen weak extrinsic musculature– Mechanical resistance techniques for combined
intrinsic and extrinsic muscle function
Exercise to Develop and Improve Muscle Performance, Neuromuscular Control, and Coordinated Movement
Copyright © 2013. F.A. Davis Company
Dexterity and Functional Activities– Fine finger dexterity– Functional activities
Exercise to Develop and Improve Muscle Performance, Neuromuscular Control, and Coordinated Movement (cont'd)