Hand Injuries

Question 1

what portion of UE injuries do hand injuries make up?

Answer 1

1/3

sports related, farm injuries, industrial

Question 2

what are the problems caused by hand injuries?

Answer 2

difficulty in movement
lack of strength
tiring
lack of coordination 
pain or numbness
swelling

Question 3

what defines a hand injury?

Answer 3

any impairment to function or cosmesis of the hand including the skin, nails, tendon, bone, nerve or blood supply

Question 4

what are the qualifications of a certified hand therapist?

Answer 4

OT or PT with 5 years of experience
4,000 hours of documented direct patient care
Pass exam

Question 5

what are examples of hand injury diseases?

Answer 5

RA
Tenosynovitis
Dupuytren’s

Question 6

what causes occupation hand injury?

Answer 6

Repetitive stress

accidental injuries

Question 7

what should be evaluated after hand injury?

Answer 7

Medical history
Social & employment history
Surface anatomy
Observation & inspection
ROM/Muscle strength 
Grip & pinch strength 
Dexterity
Edema
Sensibility 
ADLs

Question 8

what is important to remember when txing hand injury patients?

Answer 8

they arent sick and have an active role in tx

Question 9

what are the methods used in hand rehab?

Answer 9

Patient education
Positioning
Edema control (wraps)
Splinting
Functional activities (exercise)

Question 10

what are the risk factors that prevent healing?

Answer 10

Infection
Physical location
Size
Appearance
Stage of wound healing

Question 11

what is wound healing initiated by?

Answer 11

tissue & platelet disruption

Question 12

what is would healing regulated by?

Answer 12

biomechanical exchange producing
• Phagocytosis
• Neovascularization
• Biosynthesis of collagen

Question 13

what are the wound healing phases?

Answer 13

1st: Inflammatory Phase
• Macrophage clearing, 6-48 hours

2nd: Fibroblastic (Repairative)
• Collagen synthesis begins 2-5 days

3rd: Proliferation
• Maturation and remodeling

Question 14

what are the surgical concerns for fingertip injuries?

Answer 14

Wound coverage
Adequate sensation, joint ROM
Maximum length
Appearance

Question 15

what are the therapeutic concerns of fingertip injuries?

Answer 15

Sensation—too much? Too
little?
Fine motor

Question 16

what are the skin coverage options for hand injury?

Answer 16

Advancement flap 
Local flap
Myocutaneous flap 
Pedicle flap
Rotational flap

Question 17

when is a full thickness graft used?

Answer 17

when a tumor is being removed and a large area needs to be covered

Question 18

what is a degloving injury and how is it txed?

Answer 18

skin taken off like glove.

treated with pedicle skin graft

Question 19

how is surgery for a flexor tendon injury determined?

Answer 19

depends on location of injury

Tendons divided into “zones” 1-5

Question 20

whih tendons of the hand are most important for pulley system?

Answer 20

proximal phalange

metacarpal

Question 21

when does a flxeor tendon repair have to occur?

Answer 21

12-24 hours after laceration

Question 22

what is the importance of the flexor tendon pulley system?

Answer 22

Holds tendon close to bone to improve mechanical advantage for ROM

Question 23

what does therapeutic management of flexor tendons depend on?

Answer 23

surgeons training, nature of injury, patient, type of surgery

Question 24

what are the tx protocols for flexor tendon injury?

Answer 24

Immobilization, 3 weeks
Early passive motion
Early motion (modified Duran)
Early Active motion (Indiana Protocol)

Question 25

when is immobilization after surgery of flexor tendon best?

Answer 25

when dealing with children or people with cognitive issues

Question 26

how should a pt initiate early active rehab?

Answer 26

active extension, with passive flexion. using rubber bands, elastic to pull on tendon

Question 27

what is the staged tendon repair surgery?

Answer 27

“Hunter Rod” procedure • Used when primary repair fails or never initially repaired. • Rod holds place for tendon, sheath forms around rod, tendon pulled thru when rod remove

Question 28

what is a zone 1 extensor injury?

Answer 28

``` Mallet finger • Hyper flexion injury (rupture of ext tendon) • Inability to extend DIP • Splint for 12 weeks • DIP extension, PIP free ```

Question 29

what is a zone 2 extensor injury?

Answer 29

Boutonniere deformity • Rupture central slip with volar migration of lateral bands • PIP flexion with DIP extension • Closed injury: splint, PIP extension, DIP free • Open injury: surgical repair of tendon, may need ORIF of PIP joint

Question 30

what is a zone 3 extensor injury?

Answer 30

Swan neck deformity • PIP hyperextension with DIP flexion • Caused by RA, old mallet finger, intrinsic muscle contracture

Question 31

what is a zone 4 extensor injury?

Answer 31

Flexion deformity of MCP joints • Therapeutic management • Early motion • immobilization

Question 32

what is a zone 5 deformity?

Answer 32

Flexion deformity of MCP joints

Question 33

what are special surgical considerations for hand fractures?

Answer 33

Prevent angulation or rotation of fingers | • Proper positioning during immobilization period preserves eventual motion of hand is “protective position”

Question 34

what is the burns position?

Answer 34

PROTECTS LENGTH OF COLLATERAL LIGAMENT FOR MPS AND MCPS MP flexion (65-70) degrees, IP’s full extension

Question 35

what are repetitive stress injuries?

Answer 35

Usually not just from work activities | • Takes weeks, months, years to develop and to “cure”

Question 36

what are examples of repetitive stress diseases?

Answer 36

Carpal Tunnel Syndrome, DeQuervain’s Disease

Question 37

what is dupuytrens disease?

Answer 37

disease of the palmer fascia resulting in thickening & shortening of fibrous bands on palmer surface of hand & fingers resulting in flexion deformity of the 4th and 5th fingers

Question 38

what are the implications for a hand/finger replant?

Answer 38

``` General health & age of patient Mechanism of injury Associated injuries Ischemia time Availability of skilled team Desire of patient ```

Question 39

what are the ethical considerations for transplant from another body?

Answer 39

``` Scientific background of innovation Skill & experience of team Ethical climate of institution Open display Public evaluation Public & professional discussion ```