common diagnoses in the clinic

Dupuytren’s contracture

• Fibrosing disorder that causes thickening and shortening of fascia

• develops over time effect ring and little fingers

• More common in males than females, age >50, family history, northern European ancestry

• risk factors include smoking, diabetes, alcoholism, chronic pulmonary disease

• Presents with: Plamar nodules, thickened cords, diff placing hand flat (Pos table top test)

• Functional impact on: handshakes, wearing gloves, grasping large objects, hygiene & dressing tasks

• Treatment

  • No OT treatment without surgery

  • 3-5 days post op

    • wound care

    • orthosis

    • AROM/AAROM

    • Xompostive flexion and extension

  • Week 1-2

    • Compustite flexion wraps

  • Week 2

    • scar management

    • scar padding

    • E stim to promote active flextion of digits

    • edema management

  • weeks 3-6

  • Weeks 6-8

Trigger finger

• Inflamation & thicking of tendon sheaths & flexor tendons at the A1 pulley site, finger often stays flexed at the MCP and “Pops” with extension. Pain & small nodule/bump noted proximal MCP joint, tenderness volar aspect of MCP joint

• Causes (theory): repative forceful use of digit & gripping, diabetes, arthritis, prevous trama/surgery to hand, most common 5th & 6th

• Test-flexion of MCP, flex & extend IP joint, no triggering occures b/c thickened area do not pass through A1 pully

• Consertive treatment:

  • Orthosis with MCP in full extension-joint blacked to prevent flexion

    • worn 6 weeks

  • Active hook-fist tendon gliding excerises 2-3 times a day for 15 reps, holding long end strech for 15-30 secs

  • Soft tissue massage to palm

  • Pt edu & activity mods avoding prepative grasping of activies & tools to avoid triggering

  • Phonoporiesis or Iontopheresis (if no injuection)

  • Kinesiotaping

• Post surgical trigger finger

  • Surgen relases A1 pully

  • ROM to ragain function of hand

  • week 2-scar magnegement

  • Pt edu & activity mods

  • limit repative activity

  • tendon gluiding

  • Montiotor for PIP contracture

CMC artritis

• Wear and tear of joint causing loss of joint, causing loss of joint space (cartliage) between trapizum and 1st metacarpal

• Changes due to degerative, tramatic or systemic disease

• pain with pinching, gripping activies such as opening jars, turrning keys, holding a plate/tray

• Often presensts with crepitus and a shoulder sign

• Diffwetianal dignosises: Differential diagnoses: DeQuervain’s Tenosynovitis, Scaphoid Fracture, Scaphotrapeziotrapezoid Arthritis

  • CMC grind test

    • Acesses CMC thumb joint

    • Pt seated with hand on table

    • Exameriner: grasps Pt metacarpal of thumb and moves back & forth

    • Pos test: typically has a sundden dhar pain at CMC joint

• Consertive treatment

  • Pt edu activity mods & joint protection

  • Orthosis: hand based or forearm based tumb spica orthosis

  • Splint: prefabricated thumb splint/brace

  • physcian may perscibe anti-infalamtory

• Education recomenation things to do

  • tripod/3 jaw chuck pincher grasp for picking up items

  • rubber grip pads for opening jars

  • use siccisors for opening bags to avoid pinching and pulling

  • built up handels

• Education recomenation things to AVOID

  • sustained key & lateral pinching, pushing/pulling of thumb on items

  • sleep with hand comoressed

  • excessive repation

  • hyperextension of thumb

• Post OP treatment of CMC athritis

  • Proticol dependent

  • Senation (desnetion and/or pain control)

  • Pain, edema & Scar mangement (PAMS, silcone scar padm Isotoner glove)

  • AROM/AAROM thumb IP, didgits 2-5, and wrist, week 4 AROM thumb and PPROM (MP & IPJ only week 5

  • Isometorc stregthining

  • may need dynamic splinting for increased ROM of thumb and MCP and IP @ week 6

Joint Protection Princables

• Respect Pain

• Where possible, use larger, stonger joints

• Reduce effort and force

• find balance between rest and activity

• execrise in a pain free range

• avoid pos of defomity durring day to day activies

Bennett’s Fracture

• thumb joint dislocation at base of 1st metatcarpal of thumb

Boxers farcture

• fracture of 5th metacarpal

• From force of hand punchinh something in 1st pos or crush injury

• Pain/swelling in hypothenar eminance of hand & didgit

• pain & swelling in hypoethernar emnemce hand & didgit

• splinted with ulnar gutter splint

• Affects grip stregth

• Edema and pain control

• AROM at weeks 3-4

• AAROM/PROM 5-6 weeks

• discontuine splint weeks 7-8 begin strengthening hand

• 10-12 weeks return to normal function

Swan Neck deformity

• sublaxation of lateral bands

• hyperextension PIP joint and hyperflexion DIP joint

• Splint: oval 8 splint, sliver ring

Boutonneire Defomity

• injury of the central slip of the extensor tendon at the PIP joint

• PIP flexion DIP hyperextension

• Mechanism of injury

  • jammed finger

  • dislaction of PIP joint (volar)

  • lacertation of extenor tendon

  • can develop gradulaly in inflamory conditions

• Pathophysiology

  • Disruption of central slip, lateral bands migrate volarly & become PIP flexor

• Clinical signs

  • I

Mallet fingers

• Injury to the terminal extensor at the DIP joint resulting in ablity to actievely extend the fingertip

• May occur without and avoulsion fracture of disal phalaix

• common in sports

• Clinal presenation:

  • drooping fingertip at the DIP joing

  • Inablity to extend DIP join