Hand Flashcards
Trigger finger background
- Thickening of flexor tendon sheath at A1 pulley
- Commonly affect R/F & M/F
Cause:
- Overuse
- Idiopathic
- Diabetes
- Rheumatoid arthritis
Trigger finger S/S
- Palpable painful nodule at volar MCPJ (A1pulley)
- Catching, popping, or locking sensation when moving finger (esp. extension)
- Pain with finger flexion or attempted extension
- Stiffness/locking: worst after inactivity (morning stiffness)
Trigger finger non PT Rx
Splinting:
- Keep in extension
Corticosteroid:
- usually 2 shot max
After injection
*avoid returning to vigorous hand activities
*AROM with no resistance x 2 weeks–>gradually increase resistance
Surgical release:
- 2-4 wks rehab
** NO Splinting**
- pain-free AROM–>gradual strengthening
Trigger finger PT Rx
- PRICE
- US/Laser
- Activity modification
- Splinting in extension
** Gentle PROM 5x/day of splinted joints–>avoid stiffness
Mallet Finger Background
- Rupture or avulsion of extensor tendon at its insertion into distal phalanx
Cause:
- trauma that forces distal phalanx into flexion
Mallet Finger S/S
- unable to actively extend DIPJ
- DP remains in flexion
Mallet Finger Splinting VS Surgery
Sugery if…
- Large bone fragment
- Joint subluxation
- Open injury
Mostly volar/dorsal splinting
- keep DIPJ in slight hyperExt
Time frame:
6-8 wks: full time
8-12 wks: night
up to 3 mo: risky activities
Remove the splint with extreme caution–>keep DIPJ Ext
- Acceptable to have 5-10 deg extensor lag –> 6 more wks of full time splint
Mallet Finger PT Rx
ROM
- PIP/MCPJ A/PROM
- DIPJ: 6-8 wks–>AROM
No passive stretching
Strength:
- Light ADL when weaning from the splint
- Gradual DIPJ Ext strengthening
Flexor Tendon Repair Immobilisation
common splinting position:
- Wrist, MCP: flexion
- PIP & DIP: extension
Flexor Tendon Repair
ROM exercise
Phase 1:
AROM shoulder/elbow/
uninvolved finger
Phase 2:
- Gentle AROM–>PROM of wrist, MCP, IPJ
Start with wrist & MCPJ in flexion
- Tendon gliding exercise
- Blocking exercise
Flexor Tendon Repair Strengthening
Place & hold (isometric):
- Place passively into different flexed positions
Low load resistance:
~8 wks: gripping against
mild resistance
Functional activities:
- light functional activites (5-10 lb max)
- sustaining grip (endurance)
Full functional use of hand~ 12 weeks
Extensor Tendon Repair Immobilization
Volar splint
- Position of immobilization varies greatly based on the zone of injury
**Extensor tendons are weaker–> need to balance protection and adhesion
Extensor Tendon Repair ROM exericse
AROM shoulder, elbow
–>Gentle AROM->PROM of wrist, MCP, IP joints
–>Gentle AROM->PROM composite fist
Extensor Tendon Repair reduce extensor lag
- isolate joint
MCPJ:
full fist–>hook fist
IPJ:
full fist–>tabletop
CTS release Post op wk 1-2
Precaution (first 10 days):
- No active wrist F past neutral
- No combine active finger F+wrist F
Splint:
- in neutral/slight extension
EPT:
Ultrasound after wound fully healed
Exercises:
ROM exercise
- AROM of finger and thumb (wrist neutral)
- AROM of wrist Ext, PROM of wrist flexion
- AROM of all uninvolved joints
*Tendon glides
*Median nerve glides
*Dexterity exercises