Transcript REHABILITATION FOR THE ELBOW AND WRIST

REHABILITATION FOR
THE ELBOW AND WRIST
CONNIE GEIGER PT/CHT
Director of Hand Therapy
Sport and Spine Clinic
CARPAL TUNNEL SYNDROME
Evaluation Process






Detailed history of symptoms
Assess causative factors (what do they
think is causing this???)
Grip and pinch strength testing
Manual muscle testing-thenar/intrinsics.
Check for balance.
Proximal factors
Special tests (Phalen’s, Tinels’s, tendon
and nerve gliding
TREATMENT STRATEGIES




Modalities
Splints
Exercise Programs
Patient Education- do they REALLY
know what CTS is and isn’t? Take a
critical look at everything
MODALITES





Ultrasound
Electrical Stimulation
Iontophoresis
Heat/Cold/Contrast Therapy
Soft tissue mobilization total armcompare sides
SPLINTING FOR CARPAL
TUNNEL



Help maintain neutral position 0-15
degrees.
Proper fit important.
Night vs. daytime splint scheduledoes their job allow for splint?
EXERCISE PROGRAMS





Improve posture, flexibility and strength
of upper quadrant.
Designed to include entire UE includes
pectorals, neck musculature, shoulder
capsule.
Strengthening-entire limb stabilization
Improve tendon and nerve gliding
occupying thru CT to decrease
compressive forces.
Do “CHECKS”
PATIENT EDUCATION




Understand what CT really is
Proactive approach-self
management, compliance,
motivation to improve
Critically analyze all daily tasks
General health considerations-stress,
smoking, nutrition, exercise
GRIP STENGTH AND WRIST
ANGLES

Think NEUTRAL in
all you do.
CRITERIA FOR IMPROVEMENT







Decreased pain-local and referred
Decreased paresthesias
Deceased use of meds
Faster recovery after exacerbation
episodes
Decreased need for splints
Decreased fatigue with routine job tasks
Return to previous functional level with
modifications as needed
CMC OA OF THE THUMB
Evaluation Considerations




Detailed History of Symptoms
Grip and Pinch (3 point and key)
Assess balance of 9 muscles that
have an action at the thumb
Assess deformity and altered
mechanics (basilar prominence? web
space contracture? MP
hyperextension/IP flexion?)
TREATMENT APPROACH
4 PARTS





Symptom management strategies
Splinting options
Appropriate exercises for
ROM/Strengthening
Joint Protection and ergonomic
concepts
Treat the Patient not the Radiograph
SYMPTOM MANAGEMENT





Iontophoresis
Ultrasound
Cold Packs/ Ice massage
Fluidotherapy/Home heat /paraffin
Soft tissue mobilization/contracture
release
SPLINTING OPTIONS



Hand based neoprene soft splint with
molded abduction inset for lighter
activity
Custom thermoplastic hand based
thumb spica splint with thumb IP
supported in 30 degrees flexion for
heavier demand
Will the patient actually WEAR it???
EXERCISE FOR CMC OA




Thenar isometrics in position of
function
Extensor pollicus brevis “lifts”
Resisted index finger abduction
Wrist stabilization exercises in
neutral
JOINT PROTECTION CONCEPTS




Use the proper tool/utensil for the job
Modify grip and pinch technique (minimize
forcible pinching as this is a HUGE force
multiplier at the base joint of thumb
Avoid “hooking” items on thumb
Avoid forcible turning/twisting actions
DEQUERVAINS SYNDROME
1ST DORSAL COMPARTMENT
TENOSYNOVITIS





Splint in FOREARM BASED thumb
spica splint about 6 weeks
Ice
Rest
AROM- gentle stretching in
Finkelstein’s position
TIME

THANK YOU!!!