HANDS EXAM

Functions of an orthoses

Immobilization = stopping a joint from moving

Mobilization = either to increase PROM of a joint or apply a passive force to a joint where there is a damaged structure eg tendon repair

Restriction = some of the joints can move in some direction but their P & AROM is restricted in some way

Purpose of orthoses

Support a painful joint, Immobilise for healing, Restrict unwanted motion, Prevent contractures, Substitute for weak or absent muscles Restore mobility, Protect tissues, Provide stability

Inflammation phase orthoses

Use splints to rest, immobilise or protect healing tissues.

Use positions that prevent shortening of tissues e.g. position of safe immobilisation

Position of safe immobilisation

ligaments all in lengthened position

Fibroplasia phase - orthoses

Use splints to rest and protect healing tissues.

May begin to use them for mobilisation to help facilitate the organisation of scar tissue.

use a split that is applying little force on the repaired structure. gets remodelled over time to achieve full ROM.

Maturation / remodelling phase - orthoses

Use splints to apply forces to encourage tissue to lengthen and to modify adhesions and separate tissues.

Purpose is to increase the ROM in a particular joint

Immobilise for healing

immobilise the joint above and below

prevent contractures

used a lot following burns. stretch.

mobilising splint core prinicple

gentle stretch of tissues for a long period of time. tissues lengthen and grow in response

patient factors

Understanding of splinting regime.

Ability to apply and remove splint.

Motivation for wearing of splint.

Compliance - offer choice, clarify benefits, provide handouts, observe application and removal of splint, immobilise only joints being treated, follow up appointment

Orthotic precautions

impaired skin integrity, Pain, Swelling, Stiffness, Sensory Disturbances, Increased stress on unsplinted joints, Functional limitations, splinting material may stick to nail polish or nails, splints melt if left in car

Oedema assessments

screening: observation, palpation, location

circumferential measurement: useful for individual joint, tape measure

Volumeter: useful for whole hand or multiple digits, record quantity of displaced water. contraindication = wounds/dressings

Oedema treatments

rest/protect: limit painful movements and support healing structures

elevate: just above heart. contraindicated with some heart conditions

compress: pressure glove, coban wrap

movement: AROM exercises to “pump” fluid out of tissues. must be appropraite to stage of healing.

educate

Pain assessments

interview: duration, location, type, frequency, sleep, triggers?

Observations: facial expression, fear of being touched

Level of pain: verbal rating, numeric scale

Pain treatments

Heat – paraffin wax bath, heat pack

Cold – cold pack

Electro modalities – tens machine – can’t use if pregnant, cant put pads on neck, blood vessels, heart

Scar assessments

interview: Hx of injury, length of time to achieve wound closure, previous scars

observation: colour, size, flat/raised, adhesions.

Scar treatments

Compression (second skin garments)

silicone gel products - otoform (use it in creases and hold in place)

Mositurisers

massage and vibration

ROM assessments

Screening: functional active motion scan

Comprehensive: goniometer

Function assessments

patient reported outcome measures - DASH

Performance tests - nine hole peg, rate of manipulation test

Strength assessments

manual muscle testing, grip strength, pinch strength (lateral, 2-point, 3-point)

ROM, function, strength treatments

tendon gliding, blocking exercises, resistive exercises, splinting, heat to relax muscles, putty