Hand

Question 1

Trigger finger background

Answer 1

• Thickening of flexor tendon sheath at A1 pulley
• Commonly affect R/F & M/F

Cause:
- Overuse
- Idiopathic
- Diabetes
- Rheumatoid arthritis

Question 2

Trigger finger S/S

Answer 2

• 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)

Question 3

Trigger finger non PT Rx

Answer 3

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

Question 4

Trigger finger PT Rx

Answer 4

• PRICE
• US/Laser
• Activity modification
• Splinting in extension
  ** Gentle PROM 5x/day of splinted joints–>avoid stiffness

Question 5

Mallet Finger Background

Answer 5

• Rupture or avulsion of extensor tendon at its insertion into distal phalanx

Cause:
- trauma that forces distal phalanx into flexion

Question 6

Mallet Finger S/S

Answer 6

• unable to actively extend DIPJ
• DP remains in flexion

Question 7

Mallet Finger Splinting VS Surgery

Answer 7

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

Question 8

Mallet Finger PT Rx

Answer 8

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

Question 9

Flexor Tendon Repair Immobilisation

Answer 9

common splinting position:
- Wrist, MCP: flexion
- PIP & DIP: extension

Question 10

Flexor Tendon Repair
ROM exercise

Answer 10

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

Question 11

Flexor Tendon Repair Strengthening

Answer 11

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

Question 12

Extensor Tendon Repair Immobilization

Answer 12

Volar splint
- Position of immobilization varies greatly based on the zone of injury
**Extensor tendons are weaker–> need to balance protection and adhesion

Question 13

Extensor Tendon Repair ROM exericse

Answer 13

AROM shoulder, elbow

–>Gentle AROM->PROM of wrist, MCP, IP joints

–>Gentle AROM->PROM composite fist

Question 14

Extensor Tendon Repair reduce extensor lag

Answer 14

• isolate joint
  MCPJ:
  full fist–>hook fist
  IPJ:
  full fist–>tabletop

Question 15

CTS release Post op wk 1-2

Answer 15

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

Question 16

CTS release Post op wk 2-6

Answer 16

Exercises:
ROM Ex
- Pain-free AROM wrist F/Ext

Strengthening Ex
- Start at 4 weeks & isometric first
- Grip & pinch Ex at 6 weeks

Question 17

CTS release Post op wk 6-12

Answer 17

Return to work:
- sedentary–>8 wks
- physical labor job–>10-12 wks