Download
the wrist and hand n.
Skip this Video
Loading SlideShow in 5 Seconds..
The Wrist and Hand PowerPoint Presentation
Download Presentation
The Wrist and Hand

The Wrist and Hand

314 Vues Download Presentation
Télécharger la présentation

The Wrist and Hand

- - - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

  1. The Wrist and Hand Chapter 19

  2. Structure and Function of the wrist and hand

  3. Joints of the Wrist • Characteristics and Arthrokinematics • Radiocarpal joint • Midcarpal joint

  4. Joints of the Hand • Characteristics and Arthrokinematics • Carpometacarpal joints of digits 2 through 5 • Carpometacarpal joint of the thumb (digit 1) • Metacarpophalangeal joints of digits 2 through 5 • Interphalangeal joints and MCP joint of the thumb

  5. Hand Function • Muscles of the Wrist and Hand • Length-tension relationships • Extensor mechanism • Control of the unloaded (free) hand • Grips and Prehension Patterns • Power grips • Precision patterns • Combined grips

  6. Major Nerves Subject to Pressure and Trauma at the Wrist and Hand • Nerve Disorders in the Wrist • Median nerve • Ulnar nerve • Referred Pain and Sensory Patterns

  7. management of wrist and hand disorders and surgeries

  8. Joint Hypomobility: Nonoperative Management • Common Joint Pathologies and Associated Impairments • Rheumatoid arthritis • Osteoarthritis and post-traumatic arthrosis • Postimmobilization hypomobility • Common Activity Limitations and Participation Restrictions

  9. Joint Hypomobility: Nonoperative Management (cont'd) • Management: Protection Phase • Control pain and protect joints • Patient education • Pain management • Splinting • Activity modification • Maintain joint and tendon mobility and muscle integrity • Passive, assistive, or active ROM • Tendon-gliding exercises • Multiple-angle muscle setting exercises

  10. Joint Hypomobility: Nonoperative Management (cont'd) • Management: Controlled Motion and Return to Function Phases • Increase joint play and accessory motions • Joint mobilization techniques • Unlocking a subluxated ulnomeniscal-triquetral joint • Improve joint tracking and pain-free motion • MWM of the wrist • MWM of the MCP and IP joints of the digits

  11. Joint Hypomobility: Nonoperative Management (cont'd) • Management: Controlled Motion and Return to Function Phases (cont’d) • Improve mobility, strength, and function • Neuromuscular control and strength • Functional activities • Conditioning exercises • Joint protection

  12. Wrist Arthroplasty • Indications for Surgery • Procedures • Implant designs, materials, and fixation • Operative overview

  13. Wrist Arthroplasty (cont'd) • Postoperative Management • Immobilization • Exercise • Maximum and moderate protection phases • Minimum protection/return to functionphase • Outcomes • Pain relief • Wrist and forearm ROM, strength, and function • Complications

  14. Metacarpophalangeal Implant Arthroplasty • Indications for Surgery • Procedures • Implant design, materials, and fixation • Operative overview

  15. Metacarpophalangeal Implant Arthroplasty (cont'd) • Postoperative Management • Immobilization • Exercise • Maximum protection phase • Moderate and minimum protection phases • Outcomes • Pain relief and patient satisfaction • ROM and hand function • Complications

  16. Proximal Interphalangeal Implant Arthroplasty • Indications for Surgery • Procedure • Implant design, materials, and fixation • Operative overview

  17. Proximal Interphalangeal Implant Arthroplasty (cont'd) • Postoperative Management • Immobilization • Exercise • Maximum and moderate protection phases • Boutonnière deformity • Swan-neck deformity • Minimum protection/return to function phase • Outcomes • Complications

  18. Carpometacarpal Arthroplasty of the Thumb • Indications for Surgery • Procedure • Background and surgical options • Operative overview • Tendon interpositional arthroplasty • Surface replacement arthroplasty

  19. Carpometacarpal Arthroplasty of the Thumb (cont'd) • Postoperative Management • Immobilization • Exercise • Maximum protection phase • Moderate and minimum protection phases • Outcomes • Pain relief and patient satisfaction • ROM and hand function • Complications

  20. Tendon Rupture Associated With RA • Background and Indications for Surgery • Procedures • Tendon transfer • Tendon graft reconstruction • Tendon anastomosis (side-to-side tenorrhaphy) • Direct end-to-end repair

  21. Tendon Rupture Associated With RA (cont'd) • Postoperative management • Immobilization • Exercise • Maximum protection phase • Moderate and minimum protection phases • Outcomes

  22. Repetitive Trauma Syndromes/ Overuse Syndromes • Tendinopathy • Etiology of symptoms • Common structural and functional impairments • Common activity limitations and participation restrictions • Management • Protection phase • Controlled motion and return to function phases

  23. Simple Sprain • Nonoperative Management • Common functional and structural impairments • Common activity limitations and participation restrictions • Management

  24. Lacerated Flexor Tendons of the Hand • Background and Indications for Surgery • Procedures • Types and timing of operative procedures • Immediate primary repair • Delayed primary repair • Secondary repair • Late reconstruction • Staged repair

  25. Lacerated Flexor Tendons of the Hand (cont'd) • Procedures (cont’d) • Operative overview • Surgical approach • Suturing technique • Closure

  26. Lacerated Flexor Tendons of the Hand (cont'd) • Postoperative Management • General considerations • Approaches to postoperative management • Immobilization • Duration • Type or method • Position

  27. Lacerated Flexor Tendons of the Hand (cont'd) • Postoperative Management (cont’d) • Exercise • Early controlled motion approaches • Passive motion • Active motion • Maximum protection phase • Moderate protection phase • Minimum protection/return to function phase • Delayed motion approach • Outcomes

  28. Lacerated Extensor Tendons of the Hand • Background and Indications for Surgery • Procedures • Types of repair and reconstruction • Operative overview • Zone III/IV primary repair

  29. Lacerated Extensor Tendons of the Hand (cont'd) • Postoperative Management • Immobilization • Duration • Types • Exercise • Early controlled active motion approach • Use of customized static volar splints • Delayed mobilization approach • Outcomes

  30. Exercise interventions for the wrist and hand

  31. Tendon-Gliding and Tendon-Blocking Exercises • Place-and-Hold Exercises • Flexor Tendon-Gliding Exercises • Hook (claw) fist position • Full fist • Straight fist (sublimis fist) • Thumb flexion

  32. Tendon-Gliding and Tendon-Blocking Exercises (cont'd) • Flexor Tendon-Blocking Exercises • Isolated MCP flexion (lumbricales and palmar interossei) • PIP flexion (flexor digitorum superficialis) • DIP flexion (flexor digitorum profundus) • Full fist

  33. Tendon-Gliding and Tendon-Blocking Exercises (cont'd) • Exercises to Reduce Extensor Lag • Isolated MCP extension • Isolated PIP and DIP extension • Terminal range extension of IP joints • Extensor Tendon-Gliding Exercises

  34. Scar Tissue Mobilization for Tendon Adhesions • To Mobilize the Long Finger Flexor Tendons • To Mobilize the Extensor Tendons and the Extensor Mechanism

  35. Exercise Techniques to Increase Flexibility and Range of Motion • General Stretching Techniques • To increase wrist extension • To increase wrist flexion • To increase flexion or extension of individual joints of the fingers or thumb

  36. Exercise Techniques to Increase Flexibility and Range of Motion (cont'd) • Stretching Techniques for the Intrinsic and Multijoint Muscles • Self-stretching the lumbricales and interossei muscles • Self-stretching the interossei muscles • Self-stretching the adductor pollicis • Manual stretching of the extrinsic muscles • Self-stretching the flexor digitorum profundus and superficialis • Self-stretching the extensor digitorum communis

  37. Exercise to Develop and Improve Muscle Performance, Neuromuscular Control, and Coordinated Movement • Techniques to Strengthen Muscles of the Wrist and Hand • To strengthen wrist musculature • To strengthen weak intrinsic musculature • To strengthen weak extrinsic musculature • Mechanical resistance techniques for combined intrinsic and extrinsic muscle function

  38. Exercise to Develop and Improve Muscle Performance, Neuromuscular Control, and Coordinated Movement (cont'd) • Dexterity and Functional Activities • Fine finger dexterity • Functional activities

  39. Independent Learning Activities • Critical Thinking and Discussion • Laboratory Practice • Case Studies