hand and UE disorders/injuries

dupuytrens disease

• disease of fascia of palms and digits

  • flexion deformity

• surgery has not been successful

OT interventions for dupuytrens

• wound care

• edema control: above heart

• AROM/PROM

  • progress to strengthening

• scar management

• purposeful and occupation based tasks

orthosis for dupuytrens

hand based extension orthosis

• removed for ROM and bathing

• can be dorsal or volar

• ideal is full extension

skiers thumb (gamekeepers thumb)

rupture of ulnar collateral ligament of MCP joint

OT intervention for skiers thumb

• being AROM

• when approved, progress to AAROM

• lateral pinch strengthening

• ADL activities that require opposition and pinch strength

• edema management

orthosis for skiers thumb

thumb orthosis (hand or forearm based)

complex regional pain syndrome

• vasomotor dysfunction as a result of an abnormal reflex

• severe pain, edema, discoloration, osteoporosis, sudomotor changes, blotchy/shiny skin, temp changes, trophic changes, vasomotor instability

OT intervention for complex regional pain syndrome

• modalities (desensitization, warm fluidotherapy, hot packs, TENS)

• edema management

• AROM to involved joints

• ADLs

• stress loading: weight bearing & joint distraction

• orthotics to prevent contractures

• self-management

colles fractures

fracture of the distal radius with dorsal displacement

smiths fracture

fracture of distal radius with volar displacement

boxers fracture

5th metacarpal fracture

• ulnar gutter orthosis

OT eval for fractures

• profile

• history (mechanism of injury and fracture managemetn)

• special test results

• edema

• pain

• AROM

  • do not assess PROM or strength until order by physician

• sensation

• engagement

OT intervention for fractures (immobilization phase)

• stabilization and healing are goals

• AROM of joints above/below stabilized part

• edema control (elevation, MEM, retrograde massage, compression garments)

• light ADL/role activities with no resistance

OT intervention for fractures (mobilization phase)

• consolidation is the goal

• edema control (elevation, MEM, retrograde massage, contrast baths, compression garments)

• some require orthosis

• AROM

  • progress to AA/PROM when approved by physician

• light purposeful occupation activities

• pain management

• strengthening (when approved)

cumulative trauma disorders (CTD)

repetitive strain injuries (RSIs)

• most common types

  • deQervain’s

  • lateral epicondylitis

  • trigger finger

de Quervain’s

• stenosing tenosynovitis of the abductor pollicis longus and extensor pollicis brevis (thumb)

• pain and swelling over radial styloid

• positive finkelsteins test

conservative treatment for de Quervain’s

• thumb spica orthosis

• acivity/work mods

• ice massage

• gentle AROM

lateral epicondylitis

• degenerative changes of the tendon’s origin as a result of repetitive microtrauma

  • also called tennis elbow

  • overuse of wrist extensors

conservative treatment for lateral epicondylitis

• elbow strap, wrist orthosis

• ice and deep friction massage

• stretching

• activity/work mods

• add strengthening once pain decreases

  • proximal stretching

  • eccentric exercises for wrist

trigger finger

• tenosynoviits of the finger flexors: most commonly is A1 pulley

  • caused by repetition and the use of tools that are placed too far apart

conservative treatment for trigger finger

• hand or finger based trigger finger orthosis

  • MCP extended, IP joints free

• scar massage

• edema control

• tendon gliding

• activity/work mods

OT goals for tendon repairs

• increase tendon excursion

• improve strength

• increase joint ROM

• prevent adhesions

• facilitate resumption of meaningful roles/occupations/activities

early active mobilization for flexor tendonds

• minimum of 4 strands or more used in surgical procedure

• close communication with surgeon

• dorsal blocking orthosis

early mobilization programs for extensor tendons; zone I and II

• mallet finger deformity

  • 0-8 weeks: DIP extension orthosis

  • 6-8 weeks: gentle AROM

  • orthotic worn at night and in between exercises

early mobilization programs for extensor tendons; zones III and IV

• boutonniere deformity

  • 0-6 weeks: PIP extension orthosis (DIP free)

early mobilization programs for extensor tendons; zones V, VI, and VII

• types of orthosis and protocols vary

  • as per physician, orthosis adjusted to allow for IP AROM, then progresses to freeing MCPs to allow for AROM

  • progression continues to full flexion of DPC with wrist in extension

OT conservative treatment for rotator cuff tendonitis

• activity mod: avoid above shoulder level activities

• educate in sleeping posture

  • avoid sleeping with arm overhead or combined adduction and internal rotation

• decrease pain

• ROM

• strengthening: below shoulder

• occupation/role specific training

OT post op treatment for rotator cuff tendonitis

• being with PROM; progress to AAROM/AROM

  • sling or abduction orthosis to be worn between exercises

• decrease pain: start with ice, progress to heat

• strengthening: being isometric, progress to isotonic

• activity mods

• leisure and work activities

adhesive capsulitis (frozen shoulder) stages

• freezing

  • shoulder becomes painful at end range

• frozen

  • less pain, loss of motion; develops capsular pattern

• thawing

  • pain subsides, ROM gradually returns

capsular pattern

greatest limitation is external rotation, then abduction, internal rotation, and flexion

OT conservative treatments for freezing stage

• ice packs, E-stim, positioning

• gentle/pain free A/PROM

  • try to maintain functional movements such as reaching to small of back or behind head

• educate in home exercise programs

OT conservative treatment for frozen stage

• hot packs to begin session, conclude with ice

• continue A/PROM and begin pain free stretching

• continue home exercise program

OT conservative treatment for thawing stage

• continue as frozen stage with more ephasis on stretching

• restoring ROM and function

post op treatments

• PROM immediately after surgerty

• pain relief (modalities)

• encourage use of extremity for all ADL and role activities