Transcript
THE WRIST AND HAND
MANAGEMENT OF WRIST AND
HAND DISORDERS AND
SURGERIES
JOINT HYPOMOBILITY:
NON OPERATIVE MANAGEMENT
PATHOPHYSIOLOGY
FRACTURE , POTENTIAL JOINT
DEFORMITIES AND SURGERY
JOINT CAPSULE WEAKENING, CARTILAGE
DESTRUCTION, TENDON RUPTURE, IMPAIRED JOINT,
TENDON AND MUCLE MOBILITY, TISSUE
PROLIFERATION
IMMOBILIZATION
JOINT HYPOMOBILITY
REPETITIVE JOINT
TRAUMA
DEGENERATIVE
CARTILAGINOUS AND BONY
CHANGES
Common Joint Pathology and
Associated Impairments
• Rheumatoid Arthritis
• Joint Deformities
• Osteoarthritis
SIGNS AND SYMPTOMS (RA)
• ACUTE STAGE
• PAIN
• SWELLING
• LIMITED MOTION FROM SYNOVITIS
• PROGRESSIVE MUSCLE WEAKNESS
• ADVANCED STAGES
• JOINT INSTABILITY
• SYBLUXATIONS
• DEFORMITIES
• Swan Neck Deformity
• Boutonniere Deformity
• Zigzag Deformity
• Ulnar Drift
Swan Neck Deformity
• Hyperextension of PIP and flexion of DIP
Boutonniere Deformity
• PIP flexion and DIP extension
Ulnar Drift
Stretching or rupture of the
collateral ligaments at the MCP jts
and bowstringing effec from the
extrinsic extension
Zigzag Deformity
Metacarpal dislocation of thumb
Volar subluxation of the triquetrum on
the articular disk and ulna
• The extensor carpi ulnaris tendon
displaces volarly and causes a flexor
force at the wrist joint.
Ulnar subluxation of the carpals
• This causes radial deviation of the wrist.
• ACUTE STAGE
• ACHINESS
• FEELING OF STIFFNESS
• SWELLING
• WARMTH
• RESTRICTED AND PAINFUL
MOTION
SIGNS AND SYMPTOMS (OA)
• ADVANCED STAGES
• WITH DEGENERATION THERE IS
LAXITY RESULTING IN
HYPERMOBILITY AND
INSTABILITY
• WITH PROGRESSION
CONTRACTURES AND LIMITED
MOTION DEVELOP
• GENERAL MUSCLE
WEAKNESS
• WEAK GRIP STRENGTH
• POOR MUSCULAR
ENDURANCE
• PAIN (LOM FOR PINCHING
AND GRIPPING)
JOINT SURGERY AND
POSTOPERATIVE MANAGEMENT
• GOALS:
1. relief of pain
2. restoration of normal/sufficient
function of the wrist and hand
3. correction of instability and
deformity
4. restoration of ROM
5. improve strength of wrist and
fingers
WRIST ARTHROPLASTY
• Usually for arthritis and impaired
mobility of other joints in the extremity
• INDICATIONS:
1. severe pain (destruction of
articular surfaces)
2. deformity and marked limitation
of wrist that causes mm-tendon
imbalance
3. sublaxation of dislocation of
radiocarpal joint
4. appropriate for:
• low-demand UE functional
needs
• pt with bilateral wrist
involvement
• pt with significant stiffness of the
ipsilateral shoulder, elbow or
wrist and finger joints.
OVERUSE SYNDROMES
• Disorders from cumulative/repetitive
trauma in the wrist & hand lead to
significant loss of hand function &
lost work time.
• Resulting inflammation can affect
muscle, tendon, synovial sheaths &
nerves
Carpal Tunnel Syndrome
• Confined space between the carpal
bones dorsally and flexor retinaculum
volarly.
• The extrinsic flexor tendons & median
nerve course through the tunnel.
• CTS is described by the sensory loss
and motor weakness that occur when
the median nerve is compromised in the
carpal tunnel.
Synovial thickness & scarring in the
tendon sheathes or irritation,
inflammation & swelling as a repetitive
wrist flexion, extension or gripping
activities.
Swelling of the wrist joint from trauma to
the carpals, a fracture to the carpals,
pregnancy, RA, OA could decrease
carpal tunnel space.
Increase pain in the hand with repetitive
use.
• Atrophy in the thenar muscles & 1st 2
lumbricals (ape hand deformity)
• Tightness in the adductor pollicis &
extrinsic extensors of the thumb and
digits 2 & 3.
• Sensory loss in the median nerve
distribution.
• Phalen’s Test
Compression of Tunnel of
Guyon
• Injury/irritation of the ulnar nerve in the
tunnel between the hook of hamate &
pisiform occurs from sustained
pressure such as prolonged hand
writing.
• Pain and paresthesia along the ulnar side
of the palm of the hand & digits in the
distribution of the ulnar nerve.
• Weakness/atrophy in the hypothenar,
lumbricals, adductor pollicis, deep head of
the flexor pollicis brevis muscle (bishop’s
hand deformity)
• Tightness in the extrinsic finger flexor &
extensor muscles.
• Possible restricted mobility of the pisiform.
Tenosynovitis/Tendinitis
• Inflammation occurs from the
repetitive use of involved muscle from
the stress overload to the contracting
muscle or roughening of the surface of
the tendon.
• Pain whenever the related muscle
contracts.
• Warmth & tenderness with palpation in
the region of inflammation
TRAUMATIC LESIONS IN THE WRIST
AND HAND
Simple Strain
• A blow or fall, excessive stretch force
may strain the supporting ligamentous
tissue.
• There may be related fractured,
subluxation or dislocation.
• Pain at the involved site whenever a
stretch force is placed in the ligament.
• Possible hypermobility.
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