Wrist Joint PDF

12/2/2023 Wrist joint Carpal Tunnel Syndrome :  The most common peripheral neuropathy  Women are twice more affected than men  Occurs in middle and advanced age (>40 years) 1 ...

12/2/2023 Wrist joint Carpal Tunnel Syndrome :  The most common peripheral neuropathy  Women are twice more affected than men  Occurs in middle and advanced age (>40 years) 1  12/2/2023 Causes:  Prolonged flexion or extension of the wrists under the patient’s head or pillow during sleep  Conditions that alter fluid balance in the body e.g. pregnancy, hemodialysis  Trauma e.g. distal radial fracture  Wrist arthritis  Vibratory machinery 2  12/2/2023  Paresthesia, pain, numbness or tingling in the distribution of the median nerve  Nocturnal pain is common  ADL aggravate pain (such as driving a car, holding a cup)  Pain usually relieved by massaging or shaking the hand Special Test:  Phalen maneuver  Compression test  Tinel Sign 3  12/2/2023 Differential diagnosis:  Tinel test at pronator teres muscle/ pinch ands grip test to rule out pronator teres syndrome  Assess the cervical spine + myotomes, dermatomes and reflexes  Thoracic outlet syndrome Degrees of CTS:  Dynamic: the patient is asymptomatic + no detectable physical findings  Mild: intermittent symptoms, decreased light-touch sensibility, compression test usually positive whereas Tinel sign and Phalen manoeuvre may or may not be present 4  12/2/2023  Moderate: frequent symptoms, +ve Phalen maneuver, compression test, and Tinel sign, decreased vibratory perception in the median nerve distribution, increased 2- point discrimination, weakness of the thenar muscles.  Severe: symptoms are persistent, increased or absent 2- point discrimination, atrophy of the thenar muscles Conservative management:  Activity modification  Resting wrist splint (neutral): more effective with patients with less severe symptoms  Stretching ??  Tendon gliding exercises 5  12/2/2023 Surgical management Indications: Goals of surgery: Thenar eminence atrophy or Decompress the nerve weakness Sensation loss Improve nerve excursion Symptoms that persists for more than Prevent progressive nerve damage a year despite conservative management 6  12/2/2023  Carpal bones mobilization  Ultrasound  NSAIDs  Cortisone injection where? (not into the median nerve)  Systemic diseases should be controlled e.g. diabetes, RA  Involves complete division of the flexor retinaculum  Open carpal tunnel release is preferable to endoscopic release less complications e.g.: Increased frequency of digital nerve laceration Increased incidence of incomplete release 7  12/2/2023 Complications after CT release:  Pillar pain (25%): it resolves in 3 months in most patients  Incomplete release of the flexor retinaculum with persistent CTS (common after endoscopy)  CTS recurs in 7%- 20% of patients 8  12/2/2023 Rehabilitation after open release of CTS  Encourage gentle ROM exercises from day 1 in the postsurgical dressing Wrist splint could be used  After dressing removal (after around 2 weeks), permit the patient to use the hand in ADL as pain allows  After suture removal begin ROM and strengthening exercises as tolerated  Scar management ?? Gradual Return to Activities (Weeks to Months): Work and Daily Activities: Depending on the nature of your work, you may need to modify tasks to avoid strain on the healing hand. Your healthcare provider can guide you on when it is safe to return to work and daily activities. Gradual Resumption of Activities: Gradually reintroduce activities that involve hand use, taking care to avoid overuse and strain. 9  12/2/2023 De quervain’s tenosynovitis The condition involves inflammation of the tendons that run along the thumb side of the wrist. The affected tendons include the abductor pollicis longus and the extensor pollicis brevis. Symptoms: ❖ Pain and swelling near the base of the thumb. ❖ Difficulty moving the thumb and wrist, especially during activities that involve grasping or pinching. ❖ Localized swelling over the radial styoid 10 12/2/2023 11 12/2/2023 12 12/2/2023 13 12/2/2023 14  12/2/2023 The treatment protocol for a wrist sprain typically involves the following steps: ❖ Rest: Avoid activities that worsen the pain or strain the wrist. ❖ Ice: Apply ice to the affected area for 15-20 minutes every 2-3 hours during the initial 48 hours to reduce swelling. ❖ Compression: Use a compression bandage to help control swelling. Ensure it's not too tight, as it may impede blood circulation. ❖ Elevation: Keep the wrist elevated, especially when resting or sleeping, to minimize swelling. 15  12/2/2023 ❖ Immobilization: Splinting or bracing the wrist helps prevent further injury and supports the healing process. ❖ Pain Medication: Over-the-counter pain relievers like acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation. ❖ Physical Therapy: Once pain and swelling subside, physical therapy exercises can be introduced to improve strength, flexibility, and range of motion ❖ Follow-up: Regular check-ups with a healthcare professional to monitor progress and adjust the treatment plan if necessary. 16 12/2/2023 17 12/2/2023 18  12/2/2023 Acute Phase:  Rest and Immobilization: Protect the injured finger with splinting  Ice and Compression: Manage swelling and pain through ice application and compression. Subacute Phase:  Gentle Range of Motion (ROM) Exercises: Gradual introduction of finger movement exercises to prevent stiffness.  Strengthening Exercises: Begin strengthening exercises for the affected finger and hand. Rehabilitation Phase:  Progressive Strengthening: Gradually increase resistance and intensity of strengthening exercises.  Functional Activities: Integrate activities relevant to daily life and sports, focusing on proper finger use.  Sport-Specific Training Gradual Return to Sports: Implement a structured plan for returning to baseball- related activities.  Home Exercise Program: Provide a set of exercises for ongoing maintenance and injury prevention.  Education: Educate the individual on proper warm-up, techniques, and strategies to reduce the risk of recurrence. 19 12/2/2023 20