Early motion after hand and wrist reconstruction

There is substantial evidence to support the fact that early motion is beneficial for bones, joints, ligaments, tendons, and muscles. An Early Mobilization Program was designed to provide early motion for all these structures after hand and wrist reconstruction.

Early motion after flexor tendon surgery

Flexor tendon rehabilitation means control of the tendon healing process. It is therefore important to appreciate the physiological and biomechanical nuances of flexor tendon healing.

Continuous passive motion use in hand therapy

This paper discusses the indications and contraindications of continuous passive motion (CPM) in hand therapy. The pros and cons of portable and stationary CPMs available for the hand, wrist, forearm, elbow, and shoulders are reviewed.

Early motion after wrist surgery

This article reviews general considerations for therapists when initiating early motion after wrist surgery. Various early range of motion techniques and splinting are discussed in detail for the radiocarpal joint and distal radioulnar joint.

Early motion protocols in hand and wrist rehabilitation

Early motion programs establish gliding, decrease unwanted adhesions, and enhance the healing process and return to normal function of injuries. This article elaborates on how to best incorporate early motion programs into the rehabilitation process.

Early motion in the treatment of fractures and dislocations in the hand and wrist

The concept of early motion is valuable in the treatment of fractures of the hand and wrist. It is a means to an end, however, and should be employed principally when the benefits outweigh the risks. The goal is a hand that functions as near to normally as possible, considering the injury. All treatments need to be tailored to the individual patient.

Silicone rubber splinting for athletic hand and wrist injuries

The use of a silicone rubber protective playing splint facilitates an athlete's continued or earlier return to sport participation following injury. The purposes of this paper are to review the literature and to describe the properties, fabrication procedures, and indications for use of the silicone rubber compound materials used to splint athletic hand and wrist injuries. In general, the use of silicone rubber protective splints for stable orthopedic hand and wrist injuries has been shown to be effective.

[Isolated dislocation of the os triquetrum--a rare wrist injury]

The isolated traumatic dislocation of the triquetrum is an extremely rare injury. The clinical signs are unspecific. Roentgenograms of the wrist in posteroanterior and lateral views, possibly complemented by oblique views, will help to provide the diagnosis. The best therapy appears to be the open reduction and fixation with Kirschner wires. With the presented case report, the difficulties in using the classification carpal injuries are discussed. Finally, corresponding to the carpus ring theory, the plausibility of additional injuries to carpal ligaments in such trauma is pointed out.

Rehabilitation and splinting of common upper extremity injuries in athletes

Treatment of athletes and the injuries they sustain can be both challenging and rewarding. Each individual case requires a careful examination of the physical symptoms and the process leading up to the injury. From this, one attempts to determine the appropriate course of treatment aimed at minimizing lost time from sports and to develop preventive strategies to promote healing and prevent future injury. Open communication between the athlete and his or her physician, therapist, trainer, and coach facilitates the most innovative and effective treatment strategies, enabling the best possible result following an athletic injury to the upper extremity.

[Analysis of strength values of the wrist muscles and its clinical relevance]

A lot of injuries in profession and sports concern the hand. Therefore first principles should be elaborated which make it possible to assess such an injury and to define the therapy progress. Concerning this 50 probationers underwent an isokinetic test of the wrist extensors and of the wrist flexors. A close correlation could be determined between torque and work. The highest torque were achieved with the lowest velocity. Dependences could be found out concerning, age and dominant hand, so that these factors have to be considered with an assessment of an injury.

Ejection of the proximal scaphoid in a trans-scaphoid perilunate fracture dislocation. A case report

Trans-scaphoid perilunate fracture dislocations are difficult injuries to treat. Described herein is the unusual case of a trans-scaphoid perilunate fracture dislocation in which the proximal scaphoid fragment was ejected into the volar aspect of the distal forearm. The significant displacement of the proximal fragment represented complete devascularization of this piece. This unique fracture raised difficult management issues in the treatment of this injury. A primary proximal row carpectomy was performed, with a successful clinical result.

Reliability of passive wrist flexion and extension goniometric measurements: a multicenter study

BACKGROUND AND PURPOSE

The purpose of this study was twofold: (1) to determine whether passive wrist flexion and extension goniometric measurements using ulnar alignment, radial alignment, and volar/dorsal alignment were similar or dissimilar and (2) to examine which of these three techniques had the greatest intratester and intertester reliability.

SUBJECTS

One hundred forty patients (141 wrists) were measured. The testers were 32 therapists from eight different hand/upper-extremity clinical sites around the United States.

METHODS

Randomly paired testers measured passive wrist flexion and extension. The intraclass correlation coefficient (ICC) was used as an estimate of agreement for both intratherapist (model 3.1) and intertherapist (model 2.1) reliability.

RESULTS

Six of the eight clinics showed significant differences among the various goniometric techniques. Flexion intratherapist mean ICCs for the radial, ulnar, and dorsal alignment techniques were .86, .87, and .92, respectively. Extension intratherapist mean ICCs were .80, .80, and .84 for the three techniques. Intertherapist flexion mean ICCs were .88, .89, and .93 for the radial, ulnar, and volar alignment techniques, respectively. Extension intertherapist mean ICCs were .80, .80, and .84 for the three techniques. The standard error of measurement was also used to quantify reliability, with the volar/dorsal alignment technique consistently producing less error than the ulnar and radial alignment techniques. The generalizability theory statistical model was utilized to identify the sources of error. The patient contributed to variance the most, although inherent error within the study, diagnostic category, therapeutic approach, and goniometric technique also contributed.

CONCLUSION AND DISCUSSION

The overall results indicated there were differences among the three goniometric techniques. The volar/dorsal alignment technique is the goniometric technique of choice, as it consistently had the greatest reliability.

[Markedly varying physiotherapeutic treatment following carpal injuries]

OBJECTIVE

To inventory long-term symptomatic and physiotherapeutic results in patients treated conservatively for a carpal injury.

DESIGN

Follow-up investigation and case control study.

SETTING

University Medical Centre, Amsterdam.

METHOD

A follow-up investigation was conducted in a group of 100 patients with carpal injury. In this group clinical parameters of patients treated conservatively and with physiotherapy (PT) (n = 16) were compared with 16 case controls without PT, selected for age, sex, diagnosis and duration of immobilisation.

RESULTS

After removal of the plaster cast, 16 patients had been referred to a physiotherapist because pain was a major complaint. PT was given 2-3 times a week for an average of 11 days after a period of immobilisation of about 9.5 weeks. Treatment varied strongly among the physiotherapists. Follow-up took place 13-50 months after injury. Patients treated with PT had significantly more complaints concerning the traumatised hand than patients without PT. In the long run only 2 patients benefited from PT.

CONCLUSION

Physiotherapy after carpal injury lacks method. Applications were arbitrary added or omitted. Patients with carpal injury who were treated with physiotherapy after immobilisation had more complaints in the long run. This difference may be due to selectivity in the policy of referring for physiotherapy.

The effect of upper extremity trauma on handedness

The effect of severe trauma on handedness was studied through patient responses from 146 questionnaires that were correlated with individual chart review. Subjects were asked to designate their hand use preference, before and after injury, when performing 16 activities. The incidence of change in hand use was determined within four diagnostic types and five designated anatomical levels of injury. Results indicated a significant difference in the way subjects in different diagnostic types and anatomical levels of injury performed. Simple, short activities that did not require sustained fine motor coordination were reported as being performed more easily with a different hand after injury than complex, continuous activities that required sustained fine motor coordination. Significant differences in job duties and place of employment were found for the anatomical level of an injury but not for diagnostic type. Findings suggest that the diagnostic type, the anatomical level of an injury, and the complexity of a task should be considered before changes in hand use are recommended.

Sports medicine. 2. Upper extremity injuries

This self-directed learning module highlights recent advances in this topic area. It is part of the chapter on sports medicine in the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and rehabilitation. In this article, shoulder and elbow problems of the throwing athlete are emphasized. Common injuries involving the wrist and hand are also covered.

Radio-ulnar dissociation. A review of twenty cases

The results of treatment were reviewed for twenty patients who had sustained concomitant injuries of the lateral compartment of the radiohumeral joint and the ipsilateral distal radio-ulnar joint. The ages of the patients ranged from eight to seventy-four years (average, thirty-five years) and the duration of follow-up ranged from four months to twenty-seven years (average, 113 months). In fifteen patients, the injury of the wrist was diagnosed after a mean delay of seven years and eleven months (range, one month to twenty-six years). In all fifteen, the radial head injury was treated by excision, either initially or after some delay. After excision of the radial head, all fifteen patients complained of severe pain at the distal radio-ulnar joint. The results, on the basis of elbow and wrist scores of fair or better without complications, were satisfactory in only three patients. In the remaining five patients, in whom the injuries of both the elbow and the wrist had been identified at the initial evaluation, the radial head was either preserved or replaced. The results, on the basis of elbow and wrist scores of fair or better, were graded as satisfactory in four of these patients. Our data show that any injury to the lateral side of the elbow should prompt a careful evaluation of the ipsilateral distal radio-ulnar joint for associated instability.

Rehabilitation techniques for ligament injuries of the wrist

The goal of treatment after any wrist injury is a pain-free, stable joint with sufficient strength and mobility to carry out the daily recreational, and occupational tasks required by the individual. Treatment varies considerably depending on the age of the patient, the severity of the initial injury, the operative procedure performed, and the specific guidelines requested by the referring physician.

Long-term results after Russe bone-grafting: the effect of malunion of the scaphoid

Twenty-five patients had Russe anterior corticocancellous bone-grafting between 1973 and 1984 for twenty-six symptomatic established non-unions of the scaphoid. The mean duration of follow-up was eleven years (range, seven to eighteen years). Twenty-one (81 per cent) of the twenty-six scaphoid bones united. We developed two rating scales to evaluate the results of the operation. One scale, based on objective findings, included the radiographic appearance of the wrist, the range of motion, and strength; the other scale, based on subjective findings, comprised function, pain, perception of a decrease in performance because of limitation of motion or strength, and satisfaction. These scales were used to compare the objective and subjective results in patients who had a malunion of the scaphoid in which the lateral intrascaphoid angle was more than 45 degrees convex dorsally between the proximal and distal poles (a so-called flexion or humpback deformity, which results in extension of the proximal fragment of the scaphoid at the radiocarpal joint) with the results in patients who had no such deformity. The lateral intrascaphoid angle was more than 45 degrees in thirteen (50 per cent) of the twenty-six wrists. Although the difference in the objective results between the wrists that had a malunion and those that did not have a malunion was highly significant (p = 0.001), there was no significant difference in the subjective results between the two groups, including satisfaction of the patient (p = 0.39). Twenty-three patients (92 per cent) returned to full-time employment and twenty-two (88 per cent), to sports activities. Twenty-three patients (92 per cent) reported that they had pronounced relief of pain and that the procedure had improved their quality of life. The presence of this deformity of the scaphoid after bone-grafting for a symptomatic non-union was not predictive of a poor long-term subjective outcome.

Rehabilitative management of injuries to the hand

Athletic participation after injury may resume when cleared by a physician familiar with hand injuries. It is the role of the athletic trainer or therapist to implement appropriate rehabilitative measures and apply a protective device to lessen the chance of re-injury or delayed healing. The trainer must also educate coaches, athletes, and parents that hand and finger injuries are not inconsequential. Without proper diagnosis and treatment, there may be future pain, disability, and deformity.

Intraarticular fractures of the distal end of the radius in young adults. A 16 (2-26) year follow-up of 42 patients

Forty-two patients, aged 29 (17-42) years when they sustained an intraarticular fracture of the distal end of the radius, were reexamined after 16 (2-26) years. More than two thirds of the fractures were caused by high-energy trauma. Subjectively, 34 patients had excellent or good results, while only 8 had fair or poor results; 6 patients had changed their occupation owing to disability from the wrist. Almost half of the patients had residual deformity at the follow-up clinical examination. Slightly more than half of the patients had radiographic arthrosis. Subjective evaluation correlated with residual deformity and arthrosis, but not with radiographic displacement or intraarticular step off. Arthrosis correlated with residual deformity and intraarticular step off, but not with radiographic displacement. Clinical residual deformity included soft-tissue changes in contrast to radiographic displacement. More interest should be directed to soft-tissue changes following this type of fracture.

Ligamentotaxis for comminuted distal radial fractures modified by primary cancellous grafting and functional bracing: long-term results

Ligamentotaxis with the use of external fixator offers a sound method for treating comminuted distal radial fractures. In an effort to shorten the period of external fixation, primary cancellous bone grafting and functional bracing were used as an adjunct to ligamentotaxis. The external fixator was left in place for 3 weeks, followed by functional bracing for another 3 weeks. This paper presents the results of 54 patients with an average follow-up of 31.5 months. Results showed that 80% of the patients regained full range of motion in their hands, wrists, and forearms. More than 80% of the patients regained strong and pain-free wrist functions. Radiologically, there was no loss of reduction or shortening. Nine percent of patients suffered mild arthritic changes in the radiocarpal joints. Final assessment showed that 90% of patients had excellent or good results. Late complications were minimal, apart from the problems of the distal radio-ulnar joints.