Application of Hand Anatomy

Carolyn Podolski M.A. OTR/L

Repetitive Strain Injuries

Types
Carpal tunnel syndrome (CTS) Tendonitis

Purposes of splints
Support and immobilization Promote function

What is Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome

Conservative protocol
Modalities
Heat Ice

Rest Activity modification/education

Functional adaptation

Protective wrist splint

Wrist in neutral

Nerve and tendon gliding exercises

Prevent adhesions

Splint for Carpal Tunnel Syndrome

Splint can be volar or dorsal

(Clark, 1998)

Tendon and Nerve Gliding Exercises

CTS: Surgical Protocol

Protective splint
Scar massage Nerve and Tendon gliding exercises

Active range of motion

What is tendonitis?

Tendonitis

Protocol
Modalities Rest Activity modification/education Protective splint Strengthening

Splints for Tendonitis

Thumb Immobilization Splint

(Coppard, 2001)

Tennis Elbow Band

Wrist Immobilization Splint

(Coppard, 2001)

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Repetitive Strains (continued)

Precautions
Over-aggressive treatment Under-aggressive treatment

Tendon Repair

Types
Flexor tendons Extensor tendons

Flexor Tendon Zones

Zone 1
Zone 2 Zone 3 Zone 4 Zone 5

Purpose of Splinting after Tendon Surgery

Purposes of splint
Positioning Support and protect Therapeutic purposes

Tendon Repair (continued)

General Information
Duration varies dependent on medical treatments Compliance

Tendon Repair (continued)

Flexor protocol (early mobilization)

Splint
Dynamic Kleinert splint Protect 3-4 weeks

Passive range of motion (PROM)

Prevent adhesions and contractures Protected ROM 0-3 weeks Encourage tenodesis

Tendon Repair (continued)

Flexor protocol (continued)

Place and hold
Isometrics Status-post 3 weeks

Active range of motion (AROM)

4-6 weeks Gentle range

Resistance
Light resistance at 6-8 weeks Strengthening at 10 weeks

Kleinert Splint

Kleinert Splint

(Clark, 1998)

Tendon Repair (continued)

Precautions
Over-aggressive treatment
Tendon rupture

Under-aggressive treatment
adhesions poor tendon gliding

Median, Radial, and Ulnar Nerves

Types
Compression Laceration

Purposes of splints
Protection

Prevent deformity
Promote function

Degree of Nerve injury

Neuropraxia

Neuropraxia
Mildest form of nerve injury Acute insult to nerve resulting in interruption of impulse transmission May have motor and sensory involvement Full recovery with conservative treatment with in 21 days

Axontomesis

Axontomesis
Individual axons severed Nerve remains intact Degeneration to axon distal to site of injury Prognosis depends on degree of lesion and lesion location

Neurotomesis
Transection of nerve trunk Most severe damage Requires surgical intervention

Neuropraxia

Axontomesis

Neurotomesis

Surgical procedures

Suturing of epineurium

Nerve Cuff and Nerve Graft

Funicular Repair

Median, Radial, and Ulnar Nerves (continued)

Common goals
Maintain a balance between muscle structures Prevent
Over-stretching Joint stiffness Contractures

Median, Radial, and Ulnar Nerves (continued)

Common goals (continued)

Maximize functional use of extremity Decrease pain and parasthesias Protect surgical repair Protect sensation deprived areas

Median Nerve Injuries

Median Nerve Injury

Symptoms present (what we look for)

Loss of thumb opposition
Opponens pollicis

Weak abduction
APB

Apehand
(note thenar atrophy)
(Coppard, 2001)

Median Nerve (continued)

Protocol (what we do)

Maintain webspace
Prevent contracture

C-Bar Splint

(Coppard, 2001)

Median Nerve (continued)

Symptoms present (what we look for)

Loss IP thumb flexion
FPL

Weak MP thumb flexion

Superficial FPB

Median Nerve (continued)

Protocol (what we do)

ROM Flexion-assist splint

(Tenney, 1986)

Median Nerve (continued)

Additional symptoms (what we look for)

Weak wrist flexion Weak finger flexion
FDS & FDP (radial side)

Protocol (what we do)

Treat the symptom Maximize function Protect if repaired surgically

Radial Nerve Injuries

Radial Nerve (continued)

Symptoms present (what we look for)

Loss of wrist extension
ECU, ECRL & ECRB

Loss of finger and thumb extension

EDC, EDM, EPB, EPL, & EI

Wrist Drop
(Coppard, 2001)

Radial Nerve (continued)

Protocol (what we do)

PROM Prevent over-stretching of extensors Maximize functional use of the hand Splint
Static Dynamic
(Coppard, 2001)

Ulnar Nerve Injuries

Ulnar Nerve (continued)

Symptoms present (what we look for)

Loss of MP flexion and IP extension of 4th and 5th fingers
Lumbricals

Loss of Finger Ab/Adduction

PADS and DABS

Claw Hand
(Coppard, 2001)

Ulnar Nerve (continued)

Protocol (what we do)

PROM Splint

Lumbrical Bar Splints

(Coppard, 2001) (Tenney, 1986)

Ulnar Nerve (continued)

Additional symptoms (what we look for)

Weak wrist flexion

Weak finger flexors

Loss of thumb adduction Loss of hypothenar musculature

Ulnar Nerve (continued)

Protocol (what we do)

Treat symptom Maximize function

Protect if repaired surgically

Nerve Surgical Repair

Allow 7-9 weeks for surgical components to heal

Consult with physician

Protect side of nerve repair when splinting Scar massage

Median, Radial, and Ulnar Nerves (continued)

Precautions
Over-aggressive
Increase symptoms Rupture

Under-aggressive
Contractures