Kategoriarkiv: Hand

treatment-article

Fracture of forearm bones in the wrist

SportNetDoc

Do Colles’ fracture patients benefit from routine referral to physiotherapy following cast removal?

Watt CF, Taylor NF, Baskus K. Arch Orthop Trauma Surg 2000;120(7-8):413-5.

Colies’ fracture patients who received physiotherapy immediately following cast removal were compared with patients who received no active therapy following cast removal in a prospective randomised study. Patients who attended physiotherapy achieved significantly greater increases in wrist extension and grip strength after 6 weeks compared to patients who received no active therapy.

complication-article

Fracture of carpal bone in the wrist

SportNetDoc

Fractures of the scaphoid.

Mansat M. Ann Chir Main 1982;1(4):361-74.

Scaphoid fractures are the most common carpal injury. The diagnosis is often difficult and the treatment often controversial. Late complications are frequent and include nonunion, avascular necrosis and arthrosis. Carpal pathomechanics, the scaphoid’s blood supply and fracture healing are basic concepts leading to a better understanding of the injury. This paper discusses the scaphoid in relation to the pathomechanics of the wrist, the relationship of the blood supply of the scaphoid to the injury and the diagnosis, classification and treatment of these fractures.

treatment-article

Fracture of carpal bone in the wrist

SportNetDoc

Scaphoid fracture. Review of diagnostic tests and treatment.

Schubert HE. Can Fam Physician 2000 Sep;46:1825-32.

OBJECTIVE.
To help make diagnosis and treatment of scaphoid fracture more precise by review of published evidence.

QUALITY OF EVIDENCE.
MEDLINE was searched using the terms “scaphoid,” “carpal navicular,” “fracture,” “computed tomography,” “bone scan,” and “scintigraphy.” Most papers were case-series observational reports. Papers were cited if the case series was large or if there was a high degree of agreement among several observers. The main recommendation for change in treatment of scaphoid fracture is based on two randomized clinical trials involving more than 1000 patients with proven scaphoid fracture.

MAIN MESSAGE.
Fracture of the scaphoid requires a specific mechanism of injury. “Snuffbox” tenderness is not specific for scaphoid fracture and is not the most useful physical finding; other physical findings provide more specific evidence for or against scaphoid fracture. Physical examination remains the basis of initial treatment and should be thorough and meticulous. X-ray films must be of high quality and should be examined carefully for bone and soft tissue signs of fracture. A Colles’-type short arm cast is adequate for treating common undisplaced scaphoid waist fractures; the thumb need not be immobilized. For suspected scaphoid fractures, without radiologic evidence of fracture, treating symptoms is likely sufficient.

CONCLUSION.
Evidence found in the literature can be used to improve diagnostic accuracy for scaphoid fractures, to optimize treatment for these injuries, and to reduce unnecessary immobilization and disability for patients.

treatment-article

Fracture of the finger bone

SportNetDoc

Metacarpal and phalangeal fractures in athletes.

Capo JT, Hastings H 2nd. Clin Sports Med 1998 Jul;17(3):491-511.

The high demands placed on the upper extremity in sporting activities subject the competitive athlete to common injuries of the hand. Treatment options are based on the fracture configuration, associated extremity injuries, and status of the surrounding soft tissue. Metacarpal and phalangeal fractures may usually be treated by closed, nonoperative methods, and most athletes may quickly return to play with a protective orthosis. Supplemental methods of fixation, such as percutaneous pins and tension-band wires, may be used for unstable fractures. When required, open reduction and internal fixation can provide optimum stability to the fracture, which allows immediate range-of-motion and early return to play.

complication-article

Sprained finger joint

SportNetDoc

Hyperextension injury to the PIP joint or to the MP joint of the thumb–a clinical study.

Jespersen B, Nielsen NS, Bonnevie BE, Boeckstyns ME. Scand J Plast Reconstr Surg Hand Surg 1998 Sep;32(3):317-21.

We present a prospective study of the diagnosis and clinical course of 60 patients with 57 pure hyperextension injuries to the proximal interphalangeal (PIP) joint of the long fingers (fingers 2-5) and seven injuries to the metacarpophalangeal (MP) joint of the thumb. Thirty four of the injuries (57%) were related to ball sports, and the ulnar fingers of the non-dominant hand were usually affected. There were 24 avulsion fractures at the site of the insertion of the volar plate on to the middle phalanx. Twelve (20%) initially presented with hyperextension instability, and this was usually associated with an avulsion fracture. Thirty four of the patients (57%) had symptoms for less than one month, while 10 (17%) complained of symptoms six months after the injury. Severe complications such as daily pain and stiffness were encountered in three cases. The triad sign (pain on extreme flexion and extension) was of no use as a diagnostic or prognostic factor, nor did the radiographic stress-view help to identify acute instability of the joint.

treatment-article3

Sprained finger joint

SportNetDoc

Early active mobilisation of volar plate avulsion fractures.

Gaine WJ, Beardsmore J, Fahmy N. Injury 1998 Oct;29(8):589-91.

This is a prospective follow up of 190 consecutive cases of volar plate avulsion fractures. A standard management regimen of immediate, active movement was followed in all cases and physiotherapy was rarely required. Of the 190 patients, 162 were followed up for at least one year. An excellent or good outcome was achieved in 98 per cent. Patients presenting more than three weeks from injury had a worse outcome. The size and displacement of the avulsed fragment did not affect the outcome. For the stable joint, early active mobilisation with minimal or no splintage provides a good result.

KONDITION

step4

Inflammation of the tendon sheath on outer wrist

[Back]

Training ladder for:
INFLAMMATION OF THE TENDON SHEATH ON THE OUTER WRIST
(TENOSYNOVITIS STYLOIDEAE RADII, DE QUERVAIN)

STEP 4
KONDITION
Unlimited: Cycling. Swimming. Running.

UDSPÆNDING
(20 min)

Stand with outstretched arm by your side with fist lightly clenched. Rotate your arm so that the thumb is drawn inwards and backwards as far as possible. Bend your wrist as far as it can go, so that the back of the hand faces downwards. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Go down on all fours with your fingers and elbow facing towards the knees. Your arms should be outstretched. Move your body backwards so that increased stretching is felt in the forearm. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Sit at a table with the injured arm hanging over the edge with the palm facing downwards. Use the other arm to apply pressure on the back of the injured hand so that the injured lower arm becomes increasingly stretched on the upper side. Repeat the exercise where the injured hand is alternately pressed from side to side. The injured arm should finally be turned over and the exercise repeated by pressing the underside of the hand so that the injured lower arm becomes increasingly stretched on the under side. The stretching positions should be held for 20 seconds followed by 20 seconds of rest before repeating.

Bend your wrist up as far as possible and press with the opposite hand. Hold the position for 20 seconds. Repeat the exercise pressing the wrist downwards. Hold the position for 20 seconds.

Press your hands together and lift your elbows while holding your arms in front of your chest. Hold the position for 20 seconds and relax for 20 seconds before repeating.

STYRKE
(40 min)

Using an elastic band around the back of the injured hand, move the wrist upwards while keeping the elastic taut.

Sit at a table with the side of the injured hand resting on the table edge. Place the elastic around the thumb, draw it downwards over the back of the hand and hold with the good hand. Slowly rotate the lower arm from side to side to stretch the elastic.

Let the injured hand hang over the edge of a table with the palm facing downwards. Move the hand slowly up and down while holding a weight. Support the injured arm with the good arm.

Lie on your back with support at the elbow. Slowly bend and stretch the elbow while holding a weight.

Squeeze a soft ball.

Put an elastic band around your fingers. Spread your fingers so that the elastic is stretched.

Let the injured hand hang over the edge of a table with the back of the hand facing downwards. Holding a weight, slowly move your hand up and down while supporting the arm with the good hand.

Stretching is carried out in the following way: stretch the muscle group for 3-5 seconds. Relax for 3-5 seconds. The muscle group should subsequently be stretched for 20 seconds. The muscle is allowed to be tender, but must not hurt. Relax for 20 seconds, after which the procedure can be repeated. The time consumed for stretching, coordination and strength training can be altered depending on the training opportunities available and individual requirements.

KONDITION

step3

Inflammation of the tendon sheath on outer wrist

[Back]

Training ladder for:
INFLAMMATION OF THE TENDON SHEATH ON THE OUTER WRIST
(TENOSYNOVITIS STYLOIDEAE RADII, DE QUERVAIN)

STEP 3
KONDITION
Unlimited: Cycling. Swimming. Running.

UDSPÆNDING
(20 min)

Stand with outstretched arm by your side with fist lightly clenched. Rotate your arm so that the thumb is drawn inwards and backwards as far as possible. Bend your wrist as far as it can go, so that the back of the hand faces downwards. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Go down on all fours with your fingers and elbow facing towards the knees. Your arms should be outstretched. Move your body backwards so that increased stretching is felt in the forearm. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Sit at a table with the injured arm hanging over the edge with the palm facing downwards. Use the other arm to apply pressure on the back of the injured hand so that the injured lower arm becomes increasingly stretched on the upper side. Repeat the exercise where the injured hand is alternately pressed from side to side. The injured arm should finally be turned over and the exercise repeated by pressing the underside of the hand so that the injured lower arm becomes increasingly stretched on the under side. The stretching positions should be held for 20 seconds followed by 20 seconds of rest before repeating.

Bend your wrist up as far as possible and press with the opposite hand. Hold the position for 20 seconds. Repeat the exercise pressing the wrist downwards. Hold the position for 20 seconds.

Press your hands together and lift your elbows while holding your arms in front of your chest. Hold the position for 20 seconds and relax for 20 seconds before repeating.


STYRKE
(40 min)

Using an elastic band around the back of the injured hand, move the wrist upwards while keeping the elastic taut.

Sit at a table with the side of the injured hand resting on the table edge. Place the elastic around the thumb, draw it downwards over the back of the hand and hold with the good hand. Slowly rotate the lower arm from side to side to stretch the elastic.

Let the injured hand hang over the edge of a table with the palm facing downwards. Move the hand slowly up and down while holding a weight. Support the injured arm with the good arm.

Lie on your back with support at the elbow. Slowly bend and stretch the elbow while holding a weight.

Squeeze a soft ball.

Put an elastic band around your fingers. Spread your fingers so that the elastic is stretched.

Stretching is carried out in the following way: stretch the muscle group for 3-5 seconds. Relax for 3-5 seconds. The muscle group should subsequently be stretched for 20 seconds. The muscle is allowed to be tender, but must not hurt. Relax for 20 seconds, after which the procedure can be repeated. The time consumed for stretching, coordination and strength training can be altered depending on the training opportunities available and individual requirements.

KONDITION

step2

Inflammation of the tendon sheath on outer wrist

[Back]

Training ladder for:
INFLAMMATION OF THE TENDON SHEATH ON THE OUTER WRIST
(TENOSYNOVITIS STYLOIDEAE RADII, DE QUERVAIN)

STEP 2
KONDITION
Unlimited: Cycling. Swimming. Running.

UDSPÆNDING
(20 min)

Stand with outstretched arm by your side with fist lightly clenched. Rotate your arm so that the thumb is drawn inwards and backwards as far as possible. Bend your wrist as far as it can go, so that the back of the hand faces downwards. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Go down on all fours with your fingers and elbow facing towards the knees. Your arms should be outstretched. Move your body backwards so that increased stretching is felt in the forearm. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Sit at a table with the injured arm hanging over the edge with the palm facing downwards. Use the other arm to apply pressure on the back of the injured hand so that the injured lower arm becomes increasingly stretched on the upper side. Repeat the exercise where the injured hand is alternately pressed from side to side. The injured arm should finally be turned over and the exercise repeated by pressing the underside of the hand so that the injured lower arm becomes increasingly stretched on the under side. The stretching positions should be held for 20 seconds followed by 20 seconds of rest before repeating.

Bend your wrist up as far as possible and press with the opposite hand. Hold the position for 20 seconds. Repeat the exercise pressing the wrist downwards. Hold the position for 20 seconds.

Press your hands together and lift your elbows while holding your arms in front of your chest. Hold the position for 20 seconds and relax for 20 seconds before repeating.

STYRKE
(40 min)

Sit at a table with the injured hand over the edge and the palm facing upwards. Use the good hand to place slight pressure on the injured hand and hold the position for 10 seconds. Rest for 10 seconds before repeating.

Sit at a table with your hand over the edge and the palm facing downwards. Using the good hand apply slight pressure to the injured hand and hold the position for 10 seconds. Relax for 10 seconds before repeating.

Squeeze a soft ball.

Put an elastic band around your fingers. Spread your fingers so that the elastic is stretched.

Curl a tea towel with outstretched arms.

Stretching is carried out in the following way: stretch the muscle group for 3-5 seconds. Relax for 3-5 seconds. The muscle group should subsequently be stretched for 20 seconds. The muscle is allowed to be tender, but must not hurt. Relax for 20 seconds, after which the procedure can be repeated. The time consumed for stretching, coordination and strength training can be altered depending on the training opportunities available and individual requirements.

KONDITION

step1

Inflammation of the tendon sheath on outer wrist

[Back]

Training ladder for:
INFLAMMATION OF THE TENDON SHEATH ON THE OUTER WRIST
(TENOSYNOVITIS STYLOIDEAE RADII, DE QUERVAIN)

STEP 1
The indications of time after stretching, coordination training and strength training show the division of time for the respective type of training when training for a period of one hour. The time indications are therefore not a definition of the daily training needs, as the daily training is determined on an individual basis.

KONDITION
Unlimited: Cycling. Running.

UDSPÆNDING
(20 min)

Stand with outstretched arm by your side with fist lightly clenched. Rotate your arm so that the thumb is drawn inwards and backwards as far as possible. Bend your wrist as far as it can go, so that the back of the hand faces downwards. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Go down on all fours with your fingers and elbow facing towards the knees. Your arms should be outstretched. Move your body backwards so that increased stretching is felt in the forearm. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Sit at a table with the injured arm hanging over the edge with the palm facing downwards. Use the other arm to apply pressure on the back of the injured hand so that the injured lower arm becomes increasingly stretched on the upper side. Repeat the exercise where the injured hand is alternately pressed from side to side. The injured arm should finally be turned over and the exercise repeated by pressing the underside of the hand so that the injured lower arm becomes increasingly stretched on the under side. The stretching positions should be held for 20 seconds followed by 20 seconds of rest before repeating.

Bend your wrist up as far as possible and press with the opposite hand. Hold the position for 20 seconds. Repeat the exercise pressing the wrist downwards. Hold the position for 20 seconds.

Press your hands together and lift your elbows while holding your arms in front of your chest. Hold the position for 20 seconds and relax for 20 seconds before repeating.

STYRKE
(40 min)

Sit at a table with the injured hand on a ball and roll slowly from side to side.

Sit at a table with the injured hand over the edge with the palm facing upwards. Bend and stretch the wrist.

Sit at a table with the injured hand over the edge with the palm facing downwards. Bend and stretch the wrist.

Sit at a table with the injured hand on a ball and roll slowly backwards and forwards.

Sit at a table with your hand over the edge and the palm facing downwards. Using the good hand apply slight pressure to the injured hand and hold the position for 10 seconds. Relax for 10 seconds before repeating.

Stretching is carried out in the following way: stretch the muscle group for 3-5 seconds. Relax for 3-5 seconds. The muscle group should subsequently be stretched for 20 seconds. The muscle is allowed to be tender, but must not hurt. Relax for 20 seconds, after which the procedure can be repeated. The time consumed for stretching, coordination and strength training can be altered depending on the training opportunities available and individual requirements.