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The Wrist and Hand

The Wrist and Hand. Chapter 19. Structure and Function of the wrist and hand. Joints of the Wrist. Characteristics and Arthrokinematics Radiocarpal joint Midcarpal joint. Joints of the Hand. Characteristics and Arthrokinematics Carpometacarpal joints of digits 2 through 5

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The Wrist and Hand

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  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

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