7/26/2017 1 Regaining Function After Common Hand Injuries Lisa Choe OTR/L, CHT, MHA Florida Orthopaedic Institute Mallet Boutonniere Distal Radius Fractures Elbow Fractures Terminal Tendon rupture ◦ With or without fracture Conservative Treatment ◦ Immobilization of DIPj only for 6-8 weeks ◦ DIP in full extension to slight hyperextension ◦ PIPj should be free to allow for full ROM ◦ Many splint options OT: 5-8 visits typical ◦ Pt Ed ◦ Splint Management
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7/26/2017
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Regaining Function After Common Hand InjuriesLisa Choe OTR/L, CHT, MHAFlorida Orthopaedic Institute
Conservative Treatment◦ Immobilization of DIPj only for 6-8 weeks◦ DIP in full extension to slight hyperextension◦ PIPj should be free to allow for full ROM◦ Many splint options
OT: 5-8 visits typical◦ Pt Ed◦ Splint Management
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Rupture of the central slip Conservative Treatment◦ Immobilization of the PIPj only◦ PIPj should be in full extension◦ DIPj to be free to allow for blocking exercises◦ Many splints to choose from
Watch out for RED FLAGS◦ CTS◦ RSD/CRPS◦ Fracture disease –acute pain and persistent edema
leading to stiffness tendon adhesion capsular and ligamentous contracture◦ Intrinsic tightness – hook fist HEP
Radial Head Fractures (Conservative Mgmt)◦ Immobilize in early stages for pain management◦ Sling for 7-10 days◦ Gentle finger ROM for edema management and
avoiding stiff fingers◦ Start therapy 7-10 days for early ROM to prevent
long term stiffness Proximal Ulna/Distal Humeral Fractures◦ Simple vs. Complex Fractures
OT: 6-18 visits depending on severity
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ORIF vs. Conservative Management◦ When to start and how? ◦ Closed chain◦ Active vs. PROM◦ Strengthening concerns
◦ Orthoses – ≈60 degrees flexion◦ Protection from compression/contusion◦ Activity modification/Ergonomics No resting on elbows No flexion greater than 90 Postural awareness Core strengthening