Disease of the fascia of the palm and digits

Surgical release required

Intervention:

1. wound care - dressing changes. whirlpool if infection is suspected

2. edema control - elevation above the heart

3. extension splint - initially at all times except for ROM and bathing

4. A/PROM - and progress to strengthening when wounds are healed

5. Scar management - massage, scar pad, and compression garment

6. Functional tasks that emphasize flexion (gripping) and extension (release)

Skier's Thumb (Gamekeeper's Thumb)

Intervention:

1. Thumb splint (4-6 wks)

2. AROM (6 wks)

3. PROM (8 wks)

4. strengthening (10 weeks)

- focus on ADL that require opposition and pinch strength

Complex Regional Pain Syndrome (CRPS)

Intervention:

-Modalities to decrease pain

-AROM to involved joints

-ADL to encourage pain-free active use

-WB and joint distraction ax

-Splinting to prevent contractures

AVOID: PROM, joint mobilization, dynamic splinting/casting

Intervention:

1. Always use AROM unless it's a humerus fracture (PROM/AAROM)

2. edema control: elevation, retrograde massage, compression garments

3. light ADL and role activities

Humerus Fx:

1. light functional ax

2. pain management: positioning and PAMs

3. Strengthening begins with isometrics

DeQuervain's

Treatment (post-op):

- Thumb spica splint (IP joint free): 0-2 wks

- Strengthening, ADL, role ax: 2-6 wks

- unrestricted ax: 6 weeks

Intervention:

- Ice massage over radial wrist

- gentle AROM of wrist/thumb to prevent stiffness

- actvity/work modification

Lateral/Medial Epicondylitis

Treatment:

- Elbow strap/wrist splint

- ice and deep friction massage

- stretching

- ax/work modification

- dec pain = inc strengthening

Trigger Finger

Treatment:

- hand based trigger finger splint (MCP extended, IP joints free)

- scar massage

- edema control

- tendon gliding

-ax/work modivifications

AVOID: repetitive gripping or use of tools with handles too far apart

Kleinart Protocol:

0-4 wks: dorsal block splint. passive flex and ax ext within limits of splint

4-6 wks: place/hold exercise. scar mgt

6-8 wks: AROM. tendon gliding. light ADL. d/c splint

8-12 wks: strengthening and work ax

early mobilization program for flexor tendons involving passive flexion and extension of digit

0-4 wks: dorsal blocking splint. exercise in splint include passive flex of PIP joint, DIP joint and DPC. 10 reps ever hr.

4-6 wks: active flex/ext within splint limits

6-8 wks: tendon gliding, scar mgt., light ADL ax

8-12 wks: strengthening and work ax

Etiology:

repetition, awkward postures, vibration, and pregnancy

Symptoms:

- numbness and tingling of the thumb, index, middle, and radial half of the ring fingers due to compression of the median n.

- c/o dropping things

- positive Tinel's sign at wrist.

- Positive Phalen's sign.

Treatment:

- wrist splint in neutral (night and during ax)

- edema control

- AROM

- nerve/tendon gliding exercises

- strengthening of thenar mm.

- sensory reeducation

Etiology:

repetitive pronation and supination and excessive pressure on volar forearm

Symptoms:

- same as CTS with aching pain in prox. forearm

- Positive Tinel's sign at the forearm

- No night symptoms

Treatment:

- elbow splint at 90 degree wit forearm in neutral.

- avoid ax that include pronation/supination

post-op treatment:

- AROM

- nerve gliding

- strengthening (2 wks)

- sensory re-ed

- work/ax modification

Etiology:

Repetition, pressure, and fascial thickening causing ulner nerve compression at the wrist

Symptoms:

- numbness/tingling in the ulnar n. distribution of hand

- motor weakness

- positive tinel's sign at Guyon's canal

Treatment:

- edema control

-AROM

- nerve gliding

- strengthening (2-4 wks) power grip

- sensory re-ed

Etiology:

pressure at elbow and extreme elbow flexion d/t ulnar n. compression at elbow

Symptoms:

- numbness/tingling along ulnar aspect of forearm/hand

- weakness of power grip

- positive tinel's sign at elbow

Treatment:

- elbow splint to prevent extreme flexion (night)

- elbow pad to dec. compression when leaning on elbows

- edema control

- scar mgt.

- AROM and nerve gliding (2 wks)

- strengthening (4 wks)

- MCP flex splint if clawing noted

Etiology, Symptoms, and Treatment

Radial Nerve Palsy

Etiology:

sleeping in a position that places stress on the radial nerve. also compression d/t humeral shaft fracture

Symptoms:

- weakness/paralysis of extensors to the wrisst, MCPs, and thumb.

- wrist drop

Treatment:

- dynamic extension splint

- strengthening wrist and finger extensors when motor function returns

- ROM

- n. gliding

- strengthening (6-8 wks)

- ADL ax

Median Nerve Laceration