Download - Splinting Lecture 2
-
8/4/2019 Splinting Lecture 2
1/49
Application of Hand Anatomy
Carolyn Podolski M.A. OTR/L
-
8/4/2019 Splinting Lecture 2
2/49
Repetitive Strain Injuries
Types
Carpal tunnel syndrome (CTS)
Tendonitis
Purposes of splints
Support and immobilization
Promote function
-
8/4/2019 Splinting Lecture 2
3/49
What is Carpal TunnelSyndrome?
-
8/4/2019 Splinting Lecture 2
4/49
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
-
8/4/2019 Splinting Lecture 2
5/49
Splint for Carpal Tunnel
Syndrome
Splint can be volar or dorsal(Clark, 1998)
-
8/4/2019 Splinting Lecture 2
6/49
Tendon and Nerve Gliding
Exercises
-
8/4/2019 Splinting Lecture 2
7/49
CTS: Surgical Protocol
Protective splint
Scar massage
Nerve and Tendon gliding exercises
Active range of motion
-
8/4/2019 Splinting Lecture 2
8/49
What is tendonitis?
-
8/4/2019 Splinting Lecture 2
9/49
Tendonitis
Protocol
Modalities
Rest
Activity modification/education
Protective splint
Strengthening
-
8/4/2019 Splinting Lecture 2
10/49
Splints for Tendonitis
Tennis ElbowBand
Wrist
Immobilization
Splint
Thumb
Immobilization
Splint
(Coppard, 2001)(Coppard, 2001)
http://www.safetyproductsunlimited.com/tenniselbow.html
-
8/4/2019 Splinting Lecture 2
11/49
Repetitive Strains (continued)
Precautions
Over-aggressive treatment
Under-aggressive treatment
-
8/4/2019 Splinting Lecture 2
12/49
Tendon Repair
Types
Flexor tendons
Extensor tendons
-
8/4/2019 Splinting Lecture 2
13/49
Flexor Tendon Zones
Zone 1
Zone 2
Zone 3
Zone 4
Zone 5
-
8/4/2019 Splinting Lecture 2
14/49
Purpose of Splinting after Tendon
Surgery Purposes of splint
Positioning
Support and protect
Therapeutic purposes
-
8/4/2019 Splinting Lecture 2
15/49
Tendon Repair (continued)
General Information
Duration varies dependent on medicaltreatments
Compliance
-
8/4/2019 Splinting Lecture 2
16/49
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
-
8/4/2019 Splinting Lecture 2
17/49
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
-
8/4/2019 Splinting Lecture 2
18/49
Kleinert Splint
-
8/4/2019 Splinting Lecture 2
19/49
Kleinert Splint
(Clark, 1998)
-
8/4/2019 Splinting Lecture 2
20/49
Tendon Repair (continued)
Precautions
Over-aggressive treatment
Tendon rupture
Under-aggressive
treatment
adhesions poor tendon gliding
-
8/4/2019 Splinting Lecture 2
21/49
Median, Radial, and Ulnar
Nerves Types
Compression
Laceration
Purposes of splints Protection
Prevent deformity
Promote function
-
8/4/2019 Splinting Lecture 2
22/49
Degree of Nerve injury
-
8/4/2019 Splinting Lecture 2
23/49
Neuropraxia
Neuropraxia
Mildest form of nerve injury
Acute insult to nerve resulting ininterruption of impulse transmission
May have motor and sensory involvement
Full recovery with conservative treatmentwith in 21 days
-
8/4/2019 Splinting Lecture 2
24/49
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
-
8/4/2019 Splinting Lecture 2
25/49
Neurotomesis
Transection of nerve trunk
Most severe damage
Requires surgical intervention
-
8/4/2019 Splinting Lecture 2
26/49
Neuropraxia
-
8/4/2019 Splinting Lecture 2
27/49
Axontomesis
-
8/4/2019 Splinting Lecture 2
28/49
Neurotomesis
-
8/4/2019 Splinting Lecture 2
29/49
Surgical procedures
Suturing of epineurium
-
8/4/2019 Splinting Lecture 2
30/49
Nerve Cuff and Nerve Graft
-
8/4/2019 Splinting Lecture 2
31/49
Funicular Repair
-
8/4/2019 Splinting Lecture 2
32/49
Median, Radial, and Ulnar
Nerves (continued) Common goals
Maintain a balance between musclestructures
Prevent Over-stretching
Joint stiffness
Contractures
-
8/4/2019 Splinting Lecture 2
33/49
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
-
8/4/2019 Splinting Lecture 2
34/49
Median Nerve Injuries
-
8/4/2019 Splinting Lecture 2
35/49
Median Nerve Injury
Symptoms present (what we look for)
Loss of thumb opposition
Opponens pollicis
Weak abduction APB
Apehand(note thenar atrophy)
(Coppard, 2001)
-
8/4/2019 Splinting Lecture 2
36/49
Median Nerve (continued)
Protocol (what we do)
Maintain webspace
Prevent contracture
C-Bar Splint
(Coppard, 2001)
-
8/4/2019 Splinting Lecture 2
37/49
Median Nerve (continued)
Symptoms present (what we look for)
Loss IP thumb flexion FPL
Weak MP thumb flexion Superficial FPB
-
8/4/2019 Splinting Lecture 2
38/49
Median Nerve (continued)
Protocol (what we do)
ROM
Flexion-assist splint
(Tenney, 1986)
-
8/4/2019 Splinting Lecture 2
39/49
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
-
8/4/2019 Splinting Lecture 2
40/49
Radial Nerve Injuries
-
8/4/2019 Splinting Lecture 2
41/49
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)
-
8/4/2019 Splinting Lecture 2
42/49
Radial Nerve (continued)
Protocol (what we do)
PROM
Prevent over-stretching of extensors Maximize functional use of the hand
Splint Static
Dynamic
(Coppard, 2001)
-
8/4/2019 Splinting Lecture 2
43/49
Ulnar Nerve Injuries
-
8/4/2019 Splinting Lecture 2
44/49
Ulnar Nerve (continued)
Symptoms present (what we look for)
Loss of MP flexion and IP extension of 4thand 5th fingers
Lumbricals
Loss of Finger Ab/Adduction PADS and DABS
Claw Hand(Coppard, 2001)
-
8/4/2019 Splinting Lecture 2
45/49
Ulnar Nerve (continued)
Protocol (what we do)
PROM
Splint
Lumbrical
BarSplints
(Coppard, 2001) (Tenney, 1986)
-
8/4/2019 Splinting Lecture 2
46/49
Ulnar Nerve (continued)
Additional symptoms (what we look for)
Weak wrist flexion
Weak finger flexors
Loss of thumb adduction
Loss of hypothenar musculature
-
8/4/2019 Splinting Lecture 2
47/49
Ulnar Nerve (continued)
Protocol (what we do)
Treat symptom
Maximize function
Protect if repaired surgically
-
8/4/2019 Splinting Lecture 2
48/49
Nerve Surgical Repair
Allow 7-9 weeks for surgicalcomponents to heal
Consult with physician
Protect side of nerve repair when
splinting
Scar massage
-
8/4/2019 Splinting Lecture 2
49/49
Median, Radial, and Ulnar
Nerves (continued) Precautions
Over-aggressive Increase symptoms
Rupture
Under-aggressive
Contractures