Splinting, Nerve Repair, & Tendon Transfers

Thumb abduction tendon transfer

PL to APL

thumb adduction tendon transfer

FDS of RF to Adductor insertion

thumb extension tendon transfer

PL, EIP, or FDS middle to EPL

types of nerve repair

Direct Nerve Repair

Nerve Grafting (autografts, allografts)

Conduits

Biological (veins, arteries)

Synthetic (collagen, polyglycolic acid, caprolactone)

Rehab after Nerve Repair includes Motor & Sensory training: Biofeedback, Neural Reeducation (sensory motor imagery); also Sensory Motor Imagery:

mirror therapy, active exercises included pinching, active touch of a single fiber texture, & active touching of everyday objects (sandpaper, tools, cutlery)

Volar Wrist Splint used to immobilize after fracture & night splinting for

CTS or lateral epicondylitis

Volar Wrist Splint fabrication includes clear way of DPC, thenar crease. Pop-out for prominent ulnar styloid. Wrist is in

neutral or slight ext (10-15°) for functioning

Extends to mid forearm

Tracing

Landmarks: DPC at IF & thenar crease, DPC at SF, Base of CMC

Hand Based Thumb Spica splint used for thumb CMC OA, UCL tear/repair, MP joint instability, trigger thumb. Goals are to provide protection to

CMC & MCP while clearing wrist crease, leave IP free

Forearm Based Thumb Spica splint is used for DeQuervain’s & thumb/scaphoid/trapezium/radial styloid fracture. Goals are to stabilize

thumb and wrist, leave IP free

Mallet Splint goal is to achieve hyperextension or ext of

DIP joint

To blanche or not to blanche (consider BF)

Clear PIP joint

Kept on at all times for 6-8 wks

Can use a strap or coban to keep on

Follow up splint check is key

Relative Motion Splint (Pencil trick) has various uses such as

Boutonniere

Flexor or extensor lag

MCP flexion for PIP ext; need at least 30° of passive ext for it to be successful

MCP extension for IP flexion

Extensor repair in addition w/ cock up splint

Relative Motion Splint Better w/ thinner material- aquaplast or orficast; easily removed. Pt can still perform

grasping activities while wearing

Make sure there is no rubbing on adjacent digits

Named based on affected finger MCP position relative to adjacent digits

relative motion flexion splint for RF to achieve IP extension

Two main types of fixation are

open internal fixation (primary healing) & closed reduction (2ndary healing)

Distal Radius fractures can be seen in PT as early as

2 weeks from internal fixation

What is the most common type of carpal fracture; slower healing time?

scaphoid fracture

Metacarpal and phalanx fractures differ in protocol based on

type/location of fracture & type of fixation

P2 fractures are often associated with

PIP jt dislocation

Distal phalanx fractures are best protected with

cap splint which can also help w/ common hypersensitivity

What is the most common site for degeneration in the hand & is fairly unstable?

Thumb CMC joint

Early mobilization has been shown to have

no negative affects on CMC arthroplasty techniques

Wrist instability can be both w/in the

same carpal row & between carpal rows

S-L ligament injury can lead to

DISI deformity; L-T injury can lead to VISI deformity

TFCC central repair has a quicker recovery than

perihperal repair

Ulnar positive variance can affect the quality of the

TFCC, possibly thinner

Thumb MCP UCL repair is warranted when there is more than

30° of laxity w/ valgus stress

Goal of DeQuervain’s release is full pain free motion of

APL & EPB of 1st dorsal compartment

What disease is most common w/ those of genetic hx, Viking or Celtic descent, history of diabetes, smoking, alcoholism, & vascular disorders?

Dupuytren’s

Goals of Dupuytren’s release is to improve

function/ROM, ↓ deformity, & delay progression of the disease

What txs are becoming more common as less invasive procedures to help treat chronic lateral epicondylitis?

PRP and TENEX

Median nerve glides have been shown to significantly improve symptoms after

carpal tunnel release

When ulnar nerve chronically subluxes, an ulnar nerve transposition is preferred over

cubital tunnel release

What is the most common site for flexor tendon repair?

zone 2

Early active motion is considered for what sutures?

4-core suture strand or greater

How are extensor injuries in zone 1-3 generally treated?

conservatively

Extensor repairs are becoming less conservative moving from a dynamic extensor orthosis to a

volar wrist orthosis & relative motion orthosis

Sagittal band ruptures are common with those who have deformities from

rheumatoid arthritis

Mirror therapy may hypothetically activate neurons within the

somatosensory cortex