Ortho Final-OT

pain management
ROM, stregth
adaptive coping

adaptive equipment
joint protection techniques
energy conservation techniques

Reflex Sympathetic Dystrophy (RSD)

post tramatic pain accompanied by inappropriate activity and impaired UE function...but NOT fake

CRPS w/out an identifiable peripheral nerve injury

CRPS with an identifiable peripheral nerve injury (typically characterized by severe, unrelenting pain/hypersensitivity, which is atypical for injury)

*multidisciplinary effort
*pain scale
*AROM, PROM (if tolerated)
*Edema, sensitivity
*Sleep, psych reaction
*functional loss and/or compensations

Acute stage (1-3 weeks)
characterized by:
*soft, puffy edema
*intractable pain
*jhypersensitive
*limited ROM, mm spasm
*hyperthermia

*STATIC/RESTING SPLINT
*edema/pain control; fluidotherapy
*AROM w/in tolerance
*Adapted ADL
*weightbearing and stress loading/carrying program 6-8x a day for 2-3 min each

3-6 weeks
*hair and nail growth changes
*sweating
*cold, clammy, cynotic (3 C's)
*Osteoporosis

*same as early stage I but w/ more heat modalities
*progress to DYNAMIC splint, more stretching
*progressive joint mobilization
*weightbearing and stress loading programs cont.

Dystrophic stage (2-6 mos)
*decrease in pain
*brawny edema
*taut, shiny skin
*sweating, hypersensitivity, cold
*joint stiffness
*fat pad atrophy

*PROGRESSIVE splinting
*exercise
*ADL adaptation
*desensitization and pain control
*psych support
*progressive weightbearing and stress loading

atrophic stage (6-9 mos)
*rare pain
*muscle/bone atrophy
*thickening of fascia
*joint ankylosis
*atrophic, cool, glossy and taut skin w/ less cyanosis

*splint to improve fx/prevent deformity
*home unit of e-stim to prevent mm wasting
*extensive home maintenance programs for stretching and exercise

Smith's fracture
Colles' fracture

flexion fracture of the radius

extension fracture of the radius

closed reduction (cast)
internal/external fixation
-external fixators yield best results

*angulation of radius/ulna
*arthritis
*hand contracture and intrinsic tightness
*complex regional pain syndrome (CRPS)
*carpal tunnel syndrome

edema control
finger AROM and gentle PROM
light functional activity
exercise uninvolved joints

scaphoid

fall on outstretch hand

prone to avasculat necrosis
point tenderness in snuff box

long arm thumb spica cast, then short arm cast for 4-6wks

splint IS the closed reduction for fracture
-used for "hairline" fracture of ulna
*maximize hand use while protecting fracture
*minimize pain and edema

incr fx use of hand
protect wrist due to muscle weakness
improve wrist ROM

fracture: static
post wrist fracture:
*serial static
*static progressive (flex, ext, sup, pro)
*dynamic wrist flex/ext

first 2 wks: wrist cock up splint
then: progressive dynamic splints may be needed to provide low-load prolonged stress

AROM/PROM
modalities
occupational adaptation

between carpals, carpals/proximal metacarpals, carpals/radio-ulnar joint

dislocations, fracture, lig tear, tendonitis

2-3wks

immobilization w/ removable wrist cock up splint for edema and pain management

systemic disease that causes synovial proliferation of joints which thickens and destroys articular surfaces & soft tissue supports
**may affect shoulder, elbow, wrist, and finger joints

splints used during periods of acute inflammation to reduce pain by decreasing joint and lig stress and mm spasms
*may or may not prevent additional deformity
*splint straps should be easy to remove

resting hand splint (may seperate fingers to decrease ulnar deviation of MPs)
wear:
day and night during flare up
*remove for exervise every 1-2 hours

lig weaken around carpals causing proximal row to move radially and distal row to move ulnarly. Therefore causing MPs to drift ulnarly

DO NOT correct deformity, just prevent
*help improve fx pinch
*resting pan splint w/ finger dividers to decrease pain, inflammation and ulnar drift
*does not routinely need splinting

splinting
avoid strong grip/pinch
angle wrists in ulnar direction and pull MPs in radial dir.
finger walk to radial side
maintain passive MP ext and PIP/DIP flex

splint used to help promote healing of tissues and prevent deformity caused by tissue shortening and joint contracture

resting hand splint (made wide to fint hand/wrist when bandaged)
**use antideformity position to prevent collateral lig, volar plate and wrist capsule contracture

*allow room for bandages or scar management system in splint
*use material that cen be "re-used" to adjust for changes in edema and serial changes to promote more fx position
*position should NOT cause ischemia

thickening of palmer fascia; firm nodule under skin--non-painful but limits fx
**usually Ring and little finger flexed at MP and PIP, DIP ext

surgically

*do NOT put in full ext during inflammatory healing stage
2 weeks: dorsal blocking splint; 24/7 (gentle flexion w/in splint every 2 hours)
7-10 days post: add volar ext splints MP-DIP within the DBS
2.5-3wks post: D/C the DBS, replace with hand based volar extension splint for MP-DIP at night (Tendon gliding and full fist)

acute: instruct on edema ande pain management. splinting 24/7 and remove splint hourly for tendon glide ex. and modalities
Post acute: ROM. once wound healed: grip stregth exercises; modalities to minimize scar formation