Hand & Upper Extremeity Disorders & Injuries

  1. Image Upload 1 What is this and define.What splint is used? What is intervention?
    • Dupytren's Contractures = Disease of the fascia of the palm & digits.
    • Rusults in flexion deformities of digits involved. May have web space contractures.
    • Surgical release is required(Z-plasty or skin graft. May be left open this called open palm technique).
    • Intervention = Wound care: dressing changes. Whirlpool is infection is suspected.
    • Edema control: elevation above the heart.
    • Extension splint- Resting hand splint Doctors prefer the dorsal forearm-based static extension splint to reduce pressure over  surgical site.
    • * Wear splint at all time except for ROM & hygiene.
    • *A/PROM & progress to strengthening when wounds are healed.
    • *Scar management(massage, scar pad, & compression garment).
    • *Functional tasks that emphasize flexion(gripping) & extension(release).
  2. What is Skier's Thumb(gamekeeper's Thumb) & what splint is used?
    What is intervention?
    • Rupture of the ulnar collateral ligament of the MCP joint of the thumb.
    • The volar or a dorsal thumb immobilization splint is used for 2-3  remove for hygiene.
    • Intervention -AROM & pinch strengthening (At 6 weeks)
    • *Post-operative splint 6 wks followed by AROM. PROM can begin at 8 wks.

    * Focus on ADL that require opposition & pinch strength.
  3. What is swan neck deformities? What causes the deformity and what splint is used?
    • It is the PIP hyperextended & DIP flexed.
    • Deformity caused by rheumatoid arthritis.
    • A dorsal  gutter splint with the PIP in slight flexion of 20 degrees are used or the Hyperextension blocking splint.
  4. What is Boutonniere deformity and what splint is used? What is the deformity from?
    • It is caused from rheumatoid arthritis. It is the PIP flexion & the DIP's hyerextended.
    • Serial cast, A dynamic 3 point extension splint might be used or a static splint can be adjusted serially with the goal of achieving full passive PIP extension.
  5. What is a Peripheral nerve lesion and where does it occur?
    How many & name the surgical repair procedures used?
    A peripheral nerve lesion occur to the median, radial, & ulnar nerves. The location of the lesion determines the impairment of sudomotor, vasomotor, muscular, sensory, & functional involvement.

    There are four procedures used to surgically repair nerves.

    • 1. decompression- most common - carpal tunnel release- decompressing the median nerve.
    • 2. repair
    • 3. neurolysis
    • 4. grafting

    The purpose for splinting an extremity that has nerve injury are to protect, prevent contractures (short oppenens splint) of the tyhumb web space after a median nerve injury.& assistance with function.

    Clawhand deformity results from a ulnar nerve injury. The splint used for this is a mobilizing ulnar gutter splint to remodel the soft tissues to increase passive extension of the ring & little fingers.

    Wrist drop & radial tunnel syndrome are caused from radial nerve injury. Splint intervention would be the Long-arm elbow & wrist splint elbow flexion of 90 degrees and slight wrist extension 20-30 degrees in flexion.
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Hand & Upper Extremeity Disorders & Injuries
Hand & Upper Extremeity Disorders & Injuries