Hand and Wrist Therapy: Clinical Examination and Advanced Rehabilitation Tools

Description

This book developed from the experience of the ISAMMS team (Institut Sud Aquitain de la Main et du Membre Supérieur), that has been treating hand and wrist pathologies for over 20 years. Hand and wrist require specific care from a multidisciplinary staff. The patient has to be treated efficiently from injury in order to be able to return to work and sports activities. The book presents the most validated clinical examination, clinical reasoning, rehabilitation techniques and orthoses allowing the therapist to maximize their efficiency in treating patients with hand and wrist pathologies. This publication is intended for physiotherapists and occupational therapists, surgeons and practitioners specialized in physical rehabilitation, as well as for the students in these fields. Foreword Contents Contributors Part I: Clinical Examination and Clinical Reasoning 1: Clinical Examination of the Wrist and Hand 1.1 Notion of Multidisciplinary Team and Position in the Care Protocol 1.1.1 The Notion of “Team” 1.1.2 The Clinical Assessment in the Care Protocol 1.2 Tools Needed 1.2.1 Visual Analog Scale (VAS) 1.2.2 Measuring Tape 1.2.3 Laser Thermometer 1.2.4 Transcutaneous Vibratory Stimulating Device 1.2.5 Semmes-Weinstein Monofilaments 1.2.6 Goniometers 1.2.6.1 Cochin Goniometer 1.2.6.2 Rippstein Goniometer 1.2.7 Dynamometers 1.2.7.1 Dynamometer Measuring Grasp (Jamar) 1.2.7.2 Vigorimeter Measuring Grip (Martin) 1.2.7.3 Dynamometer Measuring the Pinch 1.2.7.4 Measuring the Clamp 1.2.7.5 Dynamometer Measuring the Wrist Strength in Flexion and Extension, and Ulnar and Radial Inclinations 1.2.7.6 Dynamometer Measuring the Strength in Pronosupination 1.2.8 Ruler 1.2.9 Camera 1.2.10 Echograph 1.3 General Organization of the Assessments 1.3.1 Anamnesis 1.3.1.1 Environment 1.3.1.2 Observation 1.3.1.3 Etiology 1.3.1.4 Functional Signs Pain Nociceptive Pain Neuropathic Pain (No Allodynia) Allodynia Mobility Loss of Strength “Jumps” and Cracking 1.3.2 Clinical Signs 1.3.2.1 Palpation (Fig. 1.17) 1.3.2.2 Trophic Examination 1.3.2.3 Scar Examination Objective Assessment Tools Wound Size Wound Location Diascopy (Skin Recoloring) Skin Stretching and Pulling Tests Hybrid Assessment Tools (Objective and Subjective) Vancouver Scar Scale POSAS 1.3.2.4 Sensory Examination Spatial and Temporal Conditions Time Environment Nomenclature Stages of Cutaneous Sensorial Recovery [18–20] Quantitative Test: Aesthesiography Qualitative Tests Thermal Nociception and Mechanical Nociception Sympathetic Nervous System Threshold Tests Density Tests (Fig. 1.33): Static Two-Point Discrimination Test (Weber Test) Density Tests: Moving Two-Point Discrimination Test (Dellon Test) Density Tests: Tingling Test (Table 1.5) Functional Tests Functional Tests: Stereognosis and Morphognosia Assessment Functional Tests: Hylognosia Assessment 1.3.2.5 Mobility Assessment Quantitative Aspects Wrist Hand Qualitative Aspects Type of “Stop” and Range of Motion Limitation Depending on the Adjacent Joints Significant Difference Between Active Range of Motion and Passive Range of Motion Joint Glidings 1.3.2.6 Neuromotor Assessment Reflex Motricity Automatic Motricity Voluntary Motricity Muscular Testing Dynamometric Measurements 1.3.2.7 Clinical Tests Mobility Finochietto Test Kilgore Test Haines Test Blocked Finger After Active fFexion Instability In the Hand: Joint Laxity Tests In the Wrist Tendons Tendinous “Triad” Cyriax’s Criteria Eichhoff’s Test (Sensitivity 89%, Specificity 14%) Extensor Carpi Ulnaris Instability Nerves Wartenberg’s Sign Froment’s Sign Ulnar Claw “Monkey” Hand “Falling” Hand Pseudo-Tinel (Sensitivity 70% and Specificity 98%) [62] Phalen’s Test + Compression (Sensitivity 89% and Specificity 96%): Median Nerve Reversed Phalen’s Test + Compression: Ulnar Nerve Resisted Supination with Extended Elbow Scratch Collapse Test 1.3.2.8 Functional Scores 1.3.2.9 Echoscopy Assessment Assessment and Implementation of the Most Adapted Treatment: Case Example 1 Assessing the Treatment Efficiency Didactic Aspect Scientific Research References 2: Clinical Reasoning in the Traumatic and Micro-Traumatic Pathologies of the Hand 2.1 Lack of Motion 2.1.1 Lack of Motion Depending on the Position of the Upper and Lower Joints 2.1.2 Lack of Motion Not Depending on the Position of the Upper and Lower Joints 2.1.3 Lack of Active Motion 2.2 Instabilities (Fig. 2.6) 2.2.1 Instabilities with Objective Evidence of Damaged Joint 2.2.2 Instabilities with No Objective Evidence of Damaged Joint 2.3 Pain (Fig. 2.7) 2.3.1 Nociceptive Pain 2.3.2 Neuropathic Pain 2.4 Conclusion References Part II: Rehabilitation Tools and Techniques 3: Physical Agents 3.1 Cryotherapy 3.1.1 Local Effects When Applying Cold 3.1.2 Application 3.1.3 Ice Bag and Similar Techniques 3.1.4 Immersion 3.1.5 Gaseous Cryotherapy 3.1.6 System Combining Compression and Cryotherapy 3.2 Depresso-Therapy 3.3 Electrotherapy 3.3.1 Essential Notions 3.3.2 Practical Impact: Striomotor Currents 3.3.2.1 Innervated Muscles 3.3.2.2 Denervated Muscles 3.3.3 Practical Impact: Analgesic Currents 3.3.3.1 High Frequency TENS 3.3.3.2 Low Frequency TENS 3.3.3.3 Mixed Currents 3.3.4 Practical Impact: Tonolysis 3.3.5 Practical Impact: Ionophoresis 3.4 Fluidotherapy and Thermotherapy 3.4.1 Fluidotherapy 3.4.2 Heat 3.5 High-Pressure Water Jet 3.6 Mechanical Waves 3.6.1 Transcutaneous Vibratory Stimulations (Fig. 3.19) 3.6.1.1 Pain 3.6.1.2 Proprioception 3.6.1.3 Skin Sensitivity 3.6.1.4 Neuroma 3.6.2 Infrasounds (Fig. 3.20) 3.6.3 Ultrasounds (Fig. 3.21) 3.7 Pressotherapy 3.8 Scottish Baths References 4: Scar Massage and Treatment 4.1 Integumentary Physiology 4.1.1 Skin Anatomy 4.1.2 Palmar Skin 4.1.3 Dorsal Skin 4.1.4 Dorso-Palmar Partition 4.1.5 Functional Units 4.2 Healing Process 4.2.1 Hemostasis 4.2.2 Inflammatory Phase 4.2.3 Granulation Tissue and Neovascularization 4.2.4 Re-Epithelialization 4.2.5 Tissue Maturing and Remodeling 4.3 Pathological Scars 4.3.1 Hypertrophic Scars 4.3.2 Keloid Scars 4.3.3 Adhesive Scars 4.3.4 Retractile Scars 4.3.5 Burn Scars 4.4 Factors Influencing Healing [8, 9] 4.4.1 Local Factors 4.4.2 General Factors 4.5 Scar Treatment (Table 4.6) 4.5.1 Noninvasive Methods 4.5.1.1 Preventive Treatment 4.5.1.2 Compressive Treatment 4.5.1.3 Occlusive Treatment with Silicone 4.5.1.4 Manual Techniques Manual Lymphatic Drainage (MLD) Massages Physiotherapy 4.5.2 Invasive Treatments 4.5.2.1 Corticosteroids 4.5.2.2 Laser 4.5.2.3 Surgery References 5: Hand and Wrist Mobilizations 5.1 General Background 5.1.1 Osteoarticular Kinematics 5.1.2 An Early Mobilization 5.1.3 A Mobilization at the Right Dose 5.1.4 The Total End Range Time Theory 5.1.5 Different Approaches in Joint Mobilization 5.1.5.1 Kaltenborn’s Approach 5.1.5.2 Maitland’s Approach 5.1.5.3 Mulligan’s Approach 5.1.5.4 From Theories to Practice 5.2 Mobilization Techniques 5.2.1 The Convexity and Concavity Rules 5.2.2 How to Use Mobilization Techniques 5.2.3 The Radioulnar Unit Mobilization 5.2.3.1 The Proximal Radioulnar Joint 5.2.3.2 The Interosseous Membrane 5.2.3.3 The Distal Radioulnar Joint 5.2.4 Wrist Mobilizations 5.2.4.1 Radiocarpal Joint Biomechanical Reminder Mobilization Techniques 5.2.4.2 Midcarpal Joint Biomechanical Reminder Mobilization Techniques 5.2.4.3 Scapholunate and Lunotriquetral Joints Scapholunate Joint Mobilization Lunotriquetral Joint Mobilization 5.2.5 Finger Joints Mobilizations 5.2.5.1 Anatomical and Biomechanical Reminder Metacarpophalangeal Joint Proximal Interphalangeal Joint Distal Interphalangeal Joint 5.2.5.2 Mobilization Techniques 5.2.6 Thumb Joints Mobilizations 5.2.6.1 Thumb Carpometacarpal Joint Anatomical Reminder Mobilization Techniques 5.2.6.2 Thumb Metacarpophalangeal Joint Anatomical Reminder Mobilization Techniques 5.2.6.3 Thumb Interphalangeal Joint Anatomical Reminder Mobilization Technique References 6: Neurodynamic Mobilizations 6.1 General Notions 6.1.1 Neuro-Mechanics 6.1.2 Neurophysiology 6.1.3 Patho-Neurodynamics 6.2 Neurodynamic Principles 6.2.1 Assessment 6.2.2 Treatment 6.3 Neurodynamic Mobilization Techniques 6.3.1 Median Nerve 6.3.1.1 Nerve Tension 6.3.1.2 Nerve Gliding 6.3.1.3 Self-Mobilizations 6.3.1.4 Working on Adjacent Tissues 6.3.2 Ulnar Nerve 6.3.2.1 Nerve Tension 6.3.2.2 Nerve Gliding 6.3.2.3 Self-Mobilizations 6.3.2.4 Working on Adjacent Tissues 6.3.3 Radial Nerve 6.3.3.1 Nerve Tension 6.3.3.2 Nerve Gliding 6.3.3.3 Self-Mobilizations 6.3.3.4 Working on Adjacent Tissues References 7: Physiology and Rehabilitation of Sensorial and Motor Disorders 7.1 Nerve Physiology [1] 7.2 Functional Classification of Nervous Injuries 7.3 Chronology of Re-Afferentation [6–8] 7.4 Sensorial Physiology 7.4.1 Receptors for Skin Sensitivity (Table 7.1) [8] 7.4.1.1 Mechanoreceptors 7.4.1.2 Thermoreceptors (Fig. 7.4) 7.4.1.3 Nociceptors 7.4.2 Receptors for Muscles, Tendons, and Joints 7.4.2.1 Musculo-Tendinous Captors 7.4.2.2 Joint Captors (Table 7.2) 7.4.3 Protopathic Sensitivity (Thermo-Algesia or “Protective Sensitivity”) 7.4.3.1 Nociceptive Sensitivity: Types of Pain 7.4.3.2 Nociceptive Sensitivity: Transmission of the  Nociceptive Message 7.4.3.3 Protopathic Sensitivity Other than Nociceptive 7.4.4 Epicritic Sensitivity 7.4.4.1 Vibrotactile Sensitivity 7.4.4.2 Proprioceptive Sensitivity 7.4.5 Autonomic System 7.5 Rehabilitation of Sensorial Disorders 7.5.1 Rehabilitation of Hyposensitivity 7.5.1.1 Phase 1: Vibrotactile Anesthesia (S0 and S1) 7.5.1.2 Phase 2: Vibrotactile Rehabilitation (S2 to S4) 7.5.2 Rehabilitation of Sensorial Disorders (Not Allodynia) 7.5.2.1 Terminology of the Concerned Disorders [22] 7.5.2.2 Rehabilitation of Sensorial Disorders (Not Allodynia) 7.5.3 Rehabilitation of Allodynia 7.5.3.1 Distant Vibrotactile Counter-Stimulation (DVCS) 7.5.3.2 Gradual Motor Imagery 7.6 Rehabilitation of Motor Disorders 7.6.1 Rehabilitation Depending on Stages 7.6.1.1 Stages 0 and 1 7.6.1.2 Stage 2 7.6.1.3 Stage 3 7.6.1.4 Stages 4 and 5 References 8: Rehabilitation of Proprioception 8.1 Sensory Perception 8.1.1 Exteroceptive Receptors 8.1.2 Interoceptive Receptors 8.1.3 Joint Mechanoreceptors (Fig. 8.2) 8.2 Conscious and Unconscious Proprioception 8.2.1 Conscious Proprioception 8.2.2 Unconscious Proprioception 8.2.2.1 Feedback and Feedforward (Fig. 8.5) 8.3 Rehabilitation Steps (Fig. 8.6) 8.3.1 First Stages Recovered: Conscious Proprioception 8.3.1.1 Proprioceptive Consciousness (Hagert’s Second Stage) 8.3.1.2 Joint Position Perception (Hagert’s Third Stage) 8.3.1.3 Kinesthesia (Hagert’s Fourth Stage) 8.3.2 Last Stages Recovered: Unconscious Proprioception 8.3.2.1 Conscious Neuromuscular Rehabilitation (Hagert’s Fifth Stage) Static Contractions Dynamic Contractions 8.3.2.2 Unconscious Neuromuscular Rehabilitation or Reflex Muscle Activation (Hager’s Sixth Stage) References 9: Rehabilitation Using Motor Imagery After a Post-Traumatic Cortical Reorganization 9.1 Introduction 9.2 Brain Plasticity 9.2.1 Illustrations of Brain Plasticity and Cortical Remodeling 9.3 Mirror Neurons and Canonical Neurons 9.4 Phantom Limb 9.5 Complex Regional Pain Syndrome 9.6 Segmentary Exclusion Syndrome 9.7 Consequences of Immobilization and Underutilization 9.8 Mental Imagery and Motor Imagery 9.8.1 Motor Imagery Therapy 9.8.1.1 Implicit Motor Imagery: Left/Right Discrimination 9.8.1.2 Explicit Motor Imagery: Imagined Actions 9.8.2 Motor Observation 9.8.2.1 Direct Vision of an Action 9.8.2.2 Mirror Therapy 9.8.2.3 System of Derived Mirrors 9.8.3 Precautions and Recommendations 9.8.4 Motor Imagery Therapy in Practice 9.9 Other Indications 9.10 Conclusion References 10: Self-Rehabilitation 10.1 Fundamental Concepts 10.1.1 Treatment Plan 10.1.2 Multidisciplinary Care for Patient Education 10.1.3 Physiotherapy Treatment for Treating Impairments and Function (Program Implementation and Progression According to Brody and Hall’s Work [6]) 10.1.3.1 What Is the Optimal “Dosage” for Self-Rehabilitation Exercises? 10.1.3.2 Which Activities and Exercises Can Be Recommended? 10.1.3.3 How to Create a Progression? 10.1.3.4 What Medium Should Be Used to Give the Program to the Patient? References Part III: Common Hand and Wrist Orthoses 11: Common Hand and Wrist Orthoses 11.1 Materials 11.2 Classification 11.2.1 Eponymous 11.2.2 Acronymous 11.2.3 Descriptive 11.3 Mechanical Principles 11.4 Non-Articular Orthoses 11.4.1 Syndactylies 11.4.2 Base for Silicone 11.5 Articular Immobilization Orthoses 11.5.1 Articular Wrist Immobilization Orthosis 11.5.2 Articular Wrist and Thumb TM and MP Joint Immobilization Orthosis 11.5.3 Articular Thumb TM-MP Joint Immobilization Orthosis 11.5.4 Articular Finger CM-MP Joint Immobilization Orthosis 11.5.5 Articular Finger IP Joint Immobilization Orthosis 11.5.6 “Stack” Orthosis—Articular Finger DIP Joint Immobilization Orthosis 11.5.7 “Modified Duran” Orthosis—Articular Wrist, Finger MP-IP Joint (or Thumb TM-MP-IP Joints) Immobilization Orthosis 11.5.8 Articular Finger PIP Joint Immobilization Orthosis 11.5.9 Articular Wrist, Finger MP-IP Joint Immobilization Orthosis 11.5.10 Articular Wrist Immobilization and MP Joint (of the Injured Finger) Restriction Orthosis 11.5.11 Articular Wrist, Thumb TM-MP-IP Joint Immobilization Orthosis 11.6 Articular Mobilization Orthoses 11.6.1 Range Gaining Orthoses 11.6.1.1 Serial Static Orthoses Articular PIP Extension Mobilization Orthoses Articular Finger MP and IP Joint Extension Mobilization Orthosis 11.6.1.2 Static Progressive Orthoses 11.6.1.3 Dynamic Orthoses Pro-Flexion Articular Finger MP-PIP-DIP Joint Flexion Mobilization Orthosis Articular MP Joint Flexion Mobilization Orthosis (Fingers/Thumb) Articular PIP Joint Flexion Mobilization Orthosis for Fingers (and the IP Joint of the Thumb) Articular Interphalangeal Joint Flexion Mobilization Orthosis for Fingers Pro-Extension Articular MP-PIP-DIP Joint Extension Mobilization Orthosis for the Fingers or “Levame” Orthosis Articular PIP Joint Extension Mobilization Orthosis or “Capener” Orthosis 11.6.2 Substitution Orthoses 11.6.2.1 Articular MP Joint Extension Mobilization Orthosis (Radial Nerve Palsy) 11.7 Restriction Orthoses 11.7.1 Articular PIP Joint Extension Limitation Orthosis 11.7.2 Articular MP Joint Extension Limitation Orthosis for Fingers 4 and 5 11.8 Torque Transmission Orthoses 11.8.1 Active Redirecting Orthoses 11.8.2 Casting Motion to Mobilize Stiffness (CMMS) 11.9 Articular Functional Orthoses 11.9.1 For the Wrist 11.9.2 Wrist Wrap 11.9.3 For the Wrist and the Thumb TM-MP Joints 11.9.4 For the Thumb TM Joint 11.9.4.1 Neoprene Straps 11.9.4.2 Made of Thermoplastic 11.9.5 For the Thumb TM-MP Joints References