The Wrist and Hand

Copyright © 2013. F.A. Davis Company

Part IV: Exercise Interventions by Body Region

Chapter 19

The Wrist and Hand


STRUCTURE AND FUNCTION OF THE WRIST AND HAND


Characteristics and Arthrokinematics– Radiocarpal joint– Midcarpal joint

Joints of the Wrist


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

Joints of the Hand


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

Hand Function


Nerve Disorders in the Wrist– Median nerve– Ulnar nerve

Referred Pain and Sensory Patterns

Major Nerves Subject to Pressure and Trauma at the Wrist and Hand


MANAGEMENT OF WRIST AND HAND DISORDERS AND SURGERIES


Common Joint Pathologies and Associated Impairments– Rheumatoid arthritis– Osteoarthritis and post-traumatic arthrosis– Postimmobilization hypomobility

Common Activity Limitations and Participation Restrictions

Joint Hypomobility: Nonoperative Management


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

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



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



Indications for Surgery Procedures– Implant designs, materials, and fixation– Operative overview

Wrist Arthroplasty


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

Wrist Arthroplasty (cont'd)


Indications for Surgery Procedures– Implant design, materials, and fixation– Operative overview

Metacarpophalangeal Implant Arthroplasty


Postoperative Management – Immobilization– Exercise• Maximum protection phase• Moderate and minimum protection phases

Outcomes– Pain relief and patient satisfaction– ROM and hand function– Complications

Metacarpophalangeal Implant Arthroplasty (cont'd)


Indications for Surgery Procedure– Implant design, materials, and fixation– Operative overview

Proximal Interphalangeal Implant Arthroplasty


Postoperative Management– Immobilization– Exercise• Maximum and moderate protection phases

– Boutonnière deformity– Swan-neck deformity

• Minimum protection/return to function phase

Outcomes– Complications

Proximal Interphalangeal Implant Arthroplasty (cont'd)


Indications for Surgery Procedure– Background and surgical options– Operative overview• Tendon interpositional arthroplasty• Surface replacement arthroplasty

Carpometacarpal Arthroplasty of the Thumb


Postoperative Management– Immobilization– Exercise• Maximum protection phase• Moderate and minimum protection phases

Outcomes– Pain relief and patient satisfaction– ROM and hand function– Complications

Carpometacarpal Arthroplasty of the Thumb (cont'd)


Background and Indications for Surgery Procedures– Tendon transfer– Tendon graft reconstruction– Tendon anastomosis (side-to-side tenorrhaphy)– Direct end-to-end repair

Tendon Rupture Associated With RA


Postoperative management– Immobilization– Exercise• Maximum protection phase• Moderate and minimum protection phases

Outcomes

Tendon Rupture Associated With RA (cont'd)


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

Repetitive Trauma Syndromes/ Overuse Syndromes


Nonoperative Management– Common functional and structural impairments– Common activity limitations and participation

restrictions– Management

Simple Sprain


Background and Indications for Surgery Procedures– Types and timing of operative procedures• Immediate primary repair• Delayed primary repair• Secondary repair• Late reconstruction• Staged repair

Lacerated Flexor Tendons of the Hand


Procedures (cont’d)– Operative overview• Surgical approach• Suturing technique• Closure

Lacerated Flexor Tendons of the Hand (cont'd)


Postoperative Management– General considerations– Approaches to postoperative management– Immobilization• Duration• Type or method• Position



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



Background and Indications for Surgery Procedures– Types of repair and reconstruction– Operative overview• Zone III/IV primary repair

Lacerated Extensor Tendons of the Hand


Postoperative Management– Immobilization• Duration• Types

– Exercise • Early controlled active motion approach

– Use of customized static volar splints

• Delayed mobilization approach

Outcomes

Lacerated Extensor Tendons of the Hand (cont'd)


EXERCISE INTERVENTIONS FOR THE WRIST AND HAND


Place-and-Hold Exercises Flexor Tendon-Gliding Exercises– Hook (claw) fist position– Full fist– Straight fist (sublimis fist)– Thumb flexion

Tendon-Gliding and Tendon-Blocking Exercises


Flexor Tendon-Blocking Exercises– Isolated MCP flexion (lumbricales and palmar

interossei)– PIP flexion (flexor digitorum superficialis)– DIP flexion (flexor digitorum profundus)– Full fist

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

Tendon-Gliding and Tendon-Blocking Exercises (cont'd)


To Mobilize the Long Finger Flexor Tendons To Mobilize the Extensor Tendons and the

Extensor Mechanism

Scar Tissue Mobilization for Tendon Adhesions


General Stretching Techniques– To increase wrist extension– To increase wrist flexion– To increase flexion or extension of individual joints

of the fingers or thumb

Exercise Techniques to Increase Flexibility and Range of Motion


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

Exercise Techniques to Increase Flexibility and Range of Motion (cont'd)


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

Exercise to Develop and Improve Muscle Performance, Neuromuscular Control, and Coordinated Movement


Dexterity and Functional Activities– Fine finger dexterity– Functional activities

Exercise to Develop and Improve Muscle Performance, Neuromuscular Control, and Coordinated Movement (cont'd)


Critical Thinking and Discussion Laboratory Practice Case Studies

Independent Learning Activities

The Wrist and Hand

Documents

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