Hand therapy notes:

Acreddited for hand theraypy guaranteed measured certain standard

Special skills, casting splints, debriding wounds, scar management and oedema care.

Zone 1- D IP
Zone 3 P IP
Zone 5 MCP

When distal bone Is no longer above phalanx

Swan neck extensor tear or laceration between joints.

Ring splints.

Boutionniere . tenderness on the center at PIP joint, central slip, stays extended first but as
time goes on the proximal PIP joint starts to flex .
Tender on the back of finger just splint it straight until pain and swelling has gone down.

Proximal phalanx fracture – whats the right amount of immobilisation. Leyton hewwit
position to avoid contractures. Splint PIP in extension, get web out, MCP in flexion.
Splint minimal time 3 weeks full time

Need to get x-ray for dislocation, lots of soft tissue damage for dislocations. Splinted and
given time to heal and tigheten up. Can use a hand splint.
MCP in 90 degrees and IP fully extended.

PIP joint don’t let it get stiff, make sure to exercise. Your grip strength plummets if you cant
close you first around an object.

Volar plate- painful at the front has been pulled back. Splinted in flexion traditionally so they
can scar up and heal properly. Flexion exercises straight away. Have a look at swelling and
ROM to determine level or strain, splint if grade 2 or 3. Buddy tape if not as bad.

Metacarpal neck fracture – palpable lump in volar surface of palm, caused by punching
something usually, most managed conservatively. Usually head of metacarpal. Can push into
place and K-wire it with 1-2 wires. Splint is opene at DIPs to keep extension.

Trigger finger, finger gets locked. Fingers trigger and catch. With ages tendons or pulleys
thicken. Change the position of tendion and pulley using a little split. 50% patients get
better. Diabetics tendon and hand problems.

Imaging – often only x-ray. Skiers thumb damage to lateral collateral ligament of thumb,
basketball. UCL injury. Careful with any adduction exercises.
OA of the thumb. Hand therapy is really good. Dynamic stabilisation protocol. Caring for the
painful thumb – book. Shouldn’t allow for the metacarpal to move. Splint for OA, helps
them do more during the day.

Tendinopathy, research doesn’t apply to the upper limb, thickening of retinaculum. Pain to
move and restrictive movement.

Wrist hyperflexion and test against thumb extension. Splint usually 1-2 weeks. Make sure to
refere at the appropriate time. Dequervain’s screening tool, use it if you don’t see if very
often.

Ergonomic, use hand as a scoop and stop the pinching of fingers.

Moulded neoprene. Boil it water place it at DIP joint, to the joint. Then mould it around base
of the thumb, so that it looks like it’s the thumb. Make sure its dry. For workers stop
sideways movements of the thumb. Move elbows only and no radial deviation.

Tendinopathy.

Distal radius fracture, carpal instability, soft tissue injuries do get missed. 5/10 pain after
week 46% chance of getting CRPS. 35/50 PRWHE. Chronic pain and CRPS biggest problem.

Cinderalla injury soft tissue injury. Might be something that could lead to a collapsed wrist.
Think about MOI: twisting,wrenching more force than pt’s body can lead to ligament issue.
Excellent palpation and surface anotomy. Splint for 6 weeks. Acute wrist pain, give it a wrist
and let it heal up. Scapholunate injury splinting easy way to be safe. Mobes increase
instability.

Scaphoid fracture you don’t have to include the thumb. Get CT scan for a displaced scaphoid
fracture displacement

Carpal tunn

Hook – flat fist – full fist

Hand OA, splinting

New wrist replacements are good.

Bisset 2015, patient rated tennis elbow. Lots of treatment early for bad LE. Give wrist
extensors a break.

FDP ruptures look up.