Elbow, Wrist and Hand Rehab Course

Course Objectives

Upon Successful Completion of this course, the participant will be able to:

• Identify the 20 muscle groups of the forearm.
• Palpate the 20 muscles of the forearm.
• Identify and palpate the bones and articulations of the elbow wrist and hand.
• Identify and palpate the intrinsic muscles of the hand.
• Identify nerve innervations and implications after injury.
• Discuss the importance of the position of the interosseous membrane during injury.
• Identify claw hand deformity, and Martin-Gruber anastomosis.
• Identify the action of the flexor digitorum profundus, pulley system, pulley injuries.
• Identify the function of the collateral ligaments at your MCP joint versus IP joints.
• Discuss a Boxers fracture, splinting, and healing implications on rotation, and the importance of understanding the specific options for surgical procedures.
• Identify distal radius fracture mechanism, common pain complaints, classifications of radial head fractures; Type I and Type II, surgical repair, splinting options.
• Discuss the importance of the TFCC.
• Describe how to initiate an evaluation for a distal radial fracture-closed reduction.
• Identify appropriate ways to measure edema.
• Describe common complications after a fracture and how to minimize them with proper rehab and splinting.
• Discuss the differences between the Galeazzi fracture, the Monteggia, and the Essex-Lopresti fracture.
• Describe post-surgical rehab management of mallet finger.
• Discuss radial head fractures, heterotopic ossification, and preparatory methods prior to ROM.
• Describe postoperative rehabilitation and re-education of any nerve repair or nerve transfers.
• Identify appropriate postoperative splinting for isolated digital nerve injuries.
• Identify extensor tendon Injury, complications, gapping and ruptures, and zones.
• Describe techniques for early mobilization for flexor tendon repairs.
• Describe the differences in post-op exudate on surgical bandages and the importance of managing the phases of healing.
• Difference between nonadherent,moisture-retentive dressings and the importance of application after surgery.
• Identify how to properly manage wound healing after a Mccash procedure.
• Discuss the biomechanics behind fabricating orthotics, and the function of basic universal splints.
• Discuss the blocking splint and proper wear times, precautions.
• Describe how to fabricate an orthotic after thumb ligament reconstruction.
• Describe how to fabricate a volar cock up splint and timelines for wearing.
• Identify complications, therapy, and wear time, for humeral bracing for the mid humeral fracture.
• Discuss the purpose of a long arm orthosis, with and without the wrist for either ulnar nerve compression, cubital tunnel compression, or a fracture.
• Describe the important components of an orthosis for radial and ulnar fractures.
• Describe the orthosis for a CMC arthroplasty.

Learn From the Expert -Rozanni Senanayake, OT-RL, CEAS, CHT, MS

Rozanni Senanayake, OT-RL, CEAS, CHT, MS is an occupational therapist, hand occupational therapist, and physical rehabilitation occupational therapist. She has more than 26 years of experience as a clinician. Ms. Senayake has managed independent clinics and expanded her practice throughout the Washington area.

Anatomy, Biomechanics, and injuries

• Articulations of radioulnar, radiohumeral joint, and relation to mobilizations post-fracture
• Ligaments involved with specific injuries such as radial head fractures
• Importance of the interosseous membrane and forearm position during injury
• Nerve positions and implications during specific injuries
• Mnemonics for palpation of the 20 muscle groups of the forearm
• Action for the 20 muscle groups of the forearm
• Potential injuries to specific muscles and implications for rehab
• Mnemonics for palpating the carpal and metacarpal bones, discussion of common injuries
• Biomechanics of the wrist and implications for injuries
• The action of the flexor digitorum profundus, pulley system, pulley injuries, collateral ligaments at your MCP joint versus IP joints, distal radial fracture and Scaphoid fracture
• TFCC attachments and importance
• Boxers fracture, structures involved, surgical options
• “Gaming” Thumb
• Implications for falling on an outstretched hand
• The upper quadrant, distal radius fracture mechanism, common pain complaints, classifications of radial head fractures; Type I and Type II, surgical repair, splinting options

Evaluation Overview

• Initial assessment
• Evaluation: history, observation, an example of an evaluation for a distal radial fracture-closed reduction; initial evaluation, post-surgical dressings, checking incisions, bony landmarks, UE eval, nerve tests
• DASH form
• Observing post-surgical dressings
• Palpations
• ROM
• Nerve function
• Positive ulnar variance
• Edema measurements

Fractures and Injuries

• Intro to fractures, stiffness after fractures, phalange stiffness
• Three phases of healing and rehab
• Radiographs during the repair stage, callus formation, and ROM
• Complications that can occur
• Galeazzi fracture
• Monteggia fracture
• Essex injury
• Hand fractures
• Mallet finger
• Radial head fracture
• Activities and splinting

Nerve Injuries

• Nerve compression and injury
• Postoperative rehabilitation and re-education of any nerve repair or nerve transfers.
• Postoperative splinting for isolated digital nerve injuries

Tendon Injuries

• Extensor tendon injury, complications, gapping and ruptures, and zones
• Tips for fabricating orthotics for extensor injuries
• Techniques for early mobilization for flexor tendon repairs
• Reason for a dorsal blocking splint and application
• Patient education on the progression of activities

Wound Care

• McCash Procedure, wound management
• Post-op bandages, examination of exudate, three-color wound principle
• Surgical dressings: non adherent dressing, gauze, moisture-retentive dressing

Orthotic Fabrication

• Orthotic fabrication using BSN material
• Clinical pearls, and reasoning for a specific orthotic for ligament reconstruction of the thumb
• Volar cock-up splint: finalizing the splint clearing the edging to ensure proper ROM, guidelines for wearing time
• Fabrication of a Sarmiento
• Complications, therapy, and wear time, for humeral bracing for the mid humeral fracture
• Longarm orthosis, with and without the wrist for either ulnar nerve compression, cubital tunnel compression, or fracture
• Review of biomechanics for fabricating orthotics, description of functional basic splints that can be fabricated for many diagnoses
• Example orthosis for radial and ulnar fractures

Case Studies

• Distal phalanx amputation
• CMC Arthroplasty and the Anterior Interosseous Nerve Release
• Fractured forearm and wrist
• Metacarpal fracture
• Right distal humerus fracture