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Fractures
Types of fractures and tips for intervention
Question | Answer |
---|---|
Colles' | Distal Radius DORSAL displacement |
Smith | Distal Radius VOLAR displacement |
Boxer's fracture | 5th metacarpal / Ulnar gutter splint |
Tips for intervention | DO NOT assess ROM or STRENGTH until physician's order (humerus fracture is the exception?) (arthrodesis means joint fusion) |
Kleinert Protocol | Early mobilization program for flexor tendons. Passive flexion with use of rubberbands active extension to confines of splint. |
Kleinert Protocol 0-4 weeks | Early Phase: dorsal block splint: 20-30 degrees of wrist flexion, 50-60 degrees of MCP flexion, and IP extension. Have patient perform passive FLEXion and active EXTENsion within limits of splint. |
Kleinert Protocol 4-7 weeks | Intermediate Phase: Continue splint-adjust wrist to neutral. Have patient perform tendon gliding exercises (straight/hook/fist/tabeltop/straight fist) and scar management.. |
Kleinert Protocol 6-8 weeks | Discontinue splint. Have pt perform AROM and light ADLs. |
Kleinert Protocol 8-12 weeks | Strengthening and leisure activities. |
Duran Protocol | The other or alternative flexor tendon early mobilization program. |
Duran Protocol 0-4.5 weeks | Again Dorsal block splint. PASSIVE Flexion / 10 reps per hour. |
Duran Protocol 4.5 -6 weeks | ACTIVE flexion and extension within limits. |
Duran Protocol 6-8 weeks | Tendon gliding exercises, scar management, and light ADLs. |
Duran Protocol 8-12 weeks | Strengthening and work activities. |
Arthritis Deformities and Tips | Boutonniere, Swan Neck (and Mallet Finger is a fracture) FOCUS on AROM and only PROM if patient cannot perform AROM. Nodes at the PIP joints = Bouchard's, and at the DIP joints = Herberden's. AVOID strength testing (if necessary sphymomanometer) try to re |
Boutonniere | PIP Flexion and DIP Hyperextension. Central Slips (split in tendon) of the extensor digitorum communis tendons. |
Swan Neck | PIP Hyperextension and DIP flexion |
Mallet Finger (really a fracture no AD) | Flexion of DIP (extensor tendon tear) |
Extension Tendon Mobilization Zones | |
Extension Tendon Mobilization I-II | Mallet Finger. 0-6 weeks DIP extension splint. |
Extension Tendon Mobilization III-IV | Boutonniere. 0-4 weeks PIP extension splint (DIP free). 4-6 weeks begin AROM and flexion to DPC |
Extension Tendon Mobilization V-VII | 0-2 weeks:Volar wrist splint (wrist 20-30 degrees of extension, MCP 0-10 flexion, and IP in extension). 2-3 weeks: shorten splint to release IP joints.4 weeks: remove splint/AROM. 5 weeks:wear splint inbetween exercising/AROM of wrist. 6 weeks: D/C splint |
Isometric versus Isotonic Contractions | Isometric - contraction without movement. Isotonic - contraction with movement (eccentric isotonic / concentric isotonic) |