Hand Anatomy and Rehabilitation

• Module 9 focuses on therapeutic rehabilitation of orthopedic injuries in the wrist, hand, fingers, and thumb

Anatomical Considerations of the Hand

• Bones, tendons, muscles, ligaments, fascia, and neural innervation contribute to its complexity
• Tendons and muscles are categorized into extrinsic and intrinsic groups

Biomechanical Considerations of the Hand

• Grips, functions, sensory and proprioceptive functions, and the range of motion contribute to its complexity

Skin of the Hand

• Characteristics of the volar/palmar and dorsal hand differ
• Dorsal hand skin is elastic, mobile, and easily separated from underlying fascia and can stretch 1 inch during tight grasping

Edema of the Hand

• Prolonged edema can cause fibrous tissue formation
• This can reduce hand mobility and function
• Edema tends to collect in the dorsal region, flattening the hand's arches

Use of the Hand

• The trimuscular system relies on a balance of extrinsic flexors, extrinsic extensor and intrinsic muscles for optimal function
• Different grips types dictate the hand's function
• Power grips help force transmission in gross-motor activities
• Prehensile grips help dexterity in fine-motor activities

Hand Splints and Orthoses

• They immobilize, protect, mobilize, and prevent deformity
• Static splints restrict or increase motion and provide support and protection
• Dynamic splints increase motion, facilitate hand use and allow restricted hand motion

Techniques

• Soft-tissue mobilization addresses common trigger points and myofascial release
• Joint mobilization is for joint accessory movements and they are needed for full finger motion

Flexibility Exercises

• Stretching should apply force to the distal joint first
• Stretch one joint at a time, progressing from distal to proximal joint
• When stretching a single joint, other joints should be kept in neutral

Tendon Gliding Exercises

• Hook exercise targets the flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP)
• Fist exercise targets the FDP tendons
• Modified fist exercise targets the FDS tendons
• MCP extension with IP flexion is for intrinsics, MCP flex-ext in IP flexion is for extensors, IP flex-ext in MCP flexion is for extensor

Strengthening Exercises

• Help in maintaining motion and early strengthening, with place and hold exercises
• Weights, putty, and rubber bands are used to increase strength gains

Complications Following Hand Injuries: Edema

• Successful treatment requires early and appropriate care
• Unresolved edema can lead to scar tissue, restricting hand mobility and function
• Treatment for edema includes elevation, compression, massage, and active range of motion (AROM) if possible
• Increased skin resistance to movements may occur

Complications Following Hand Injuries: Stiffness

• Loss of finger mobility leads to reduced hand function
• DIP or PIP joint stiffness can be a cause, as well as Intrinsic or extrinsic muscle restriction
• Treatment involves identifying and correcting the cause and maintaining mobility in other structures

Conditions: Hand Injuries

• Fractures
• Triangular Fibrocartilage Complex Lesion (TFCC)
• Carpal Tunnel Syndrome
• De Quervain’s Syndrome
• Long Tendon injuries
• UCL thumb injury

Fractures

• Finger alignment should be checked
• Surgery may be required for unstable fractures
• They are either intra-articular or extra-articular
• Immobilization is needed for up to 4 weeks

Fractures continued

• Rehabilitation duration is determined by injury severity
• Joint and soft-tissue mobilization may be necessary
• Inflexibility may require prolonged stretching

Fractures continued again

• Finger alignment with MCP and PIP flexion should be aligned

Triangular Fibrocartilage Complex Lesion (TFCC)

• It is caused by repetitive axial or rotational loads on the wrist
• TFCC is treated conservatively unless DRUJ instability is present

Carpal Tunnel Syndrome

• Median nerve is compressed as it passes through the carpal tunnel under the transverse carpal ligament
• Also known as compression syndrome

De Quervain’s Syndrome

• It affects the first dorsal compartment of the wrist
• Involves the abductor pollicis longus and extensor pollicis brevis
• Treated with corticosteroid injections, rest and thumb immobilization

Long Tendon Injuries

• Special tendon considerations
• Long flexor and long extensor hand tendons have different characteristics

Ulnar Collateral Ligament of 1st MCP

• Valgus stress to the 1st MCP joint can cause this injury
• Ball off the tip or landing onto the thumb
• Complication can be a lesion
• May require surgical intervention and stabilization