Tip to tip
fingernail to fingernail
pad to pad
pad of finger to pad of finger
tripod
D123 touch- use this for writing
Lateral pinch
pad of D1 touches middle phalanx of D2- used for using a key
Name all of the grasps:
Cylindrical
Spherical
Hook
Bilateral palmer grasp
Division of the hand
- Radial side- manipulation
- Ulnar side- strength and stability
Flexor tendon injuries:
- frequently caused by lacerations or crush/fracture injuries
- Zone 2- “no man’s land” most challenging)- unrepairable, tendon would get stuck- Zone 2
TX for FTI’s:
- TX: -Early Active motion- NO AROM in flexion
- or
- -Controlled passive
- or
- Immobilization
- Extensor tendon injuries
- caused by laceration or crush/fracture injury
- 8 zones- different zones dictate different surgery and treatment approach
TX for ETI’s
- focus is to prevent adhesions which cause extensor lag
- Treatment generally occurs splinting/immobilization followed by AROM and finally resisted exercise.
What is extensor lag?
during active movement- where tendon is cut it gets stuck
Neurapraxia
contusion or bruising of the nerve. Full recovery in days or weeks
- Axontmesis:
nerve fibres distal to the injury degenerate, but nerve is still in continuity. No surgery required. Recovery usually good. Length of time depends upon location of injury.
- Neurotmesis:
complete laceration of the nerve. Usually repaired micro surgically. Recovery is unpredictable.
Radial nerve injury:
- most commonly injured in upper arm.
- Results in wrist drop and MP joint extension
- Rx with a wrist extension splint and ROM exercises.
Median Nerve Injury
- Median nerve often called the eyes of the hand (provides sensation to much of the palmar hand surface)
- distal injuries- loss of thumb ABD and OPP. Wasting of thenar eminence.
- Rx- thumb opposition splint.
Ulnar Nerve Injury
- Injury in the forearm results in hyperextension of the MCPJs of the ring and small finger (clawing).
- Rx- MCP extension block splint for D4 and D5.
- Educate client about risk of burns and injury.
Cumulative Trauma Disorder
- AKA repetitive stress or strain, overuse syndromes.
- Common examples are tennis elbow, DeQuervain’s tenosynovitis, and carpal tunnel syndrome.
Carpal Tunnel syndrome
- compression of the median nerve travelling through the carpal tunnel.
- Causes pain, paresthesias and sometimes weakness in the median nerve distribution.
Causes of The stiff hand
- Immobilization
- Disease
- Injury
- Trauma
- Burn
- Crush
- Laceration
- Post Surgery
Characteristics of stiff hand:
EDEMA
Immobility
Pain
Position of deformity
Decrease stiff hand
- Proper positioning- splinting. Hand and thumb,
- Assure client involvement and understanding
- Increase mobility- PROM, stretch, progressive splinting, AROM, activity
- Control edema
