Hand Therapy

Topics: Carpal tunnel, Ulnar nerve, Wrist Pages: 8 (850 words) Published: May 9, 2013
Hand therapy


Hand outs


CD( interactive hand therapy)

Deep layer- skeletal
Next layer- muscular attachment
Next layer- articular surface
Next layer- collateral ligament 

Plates volar ( palmar ligaments) prevent hyper extension

Check rein ligament ( they emerge from the lateral borders of the plate and pass prox into the middle of the phalangeal neck

Lateral tendon- from your lumbricals and interosseus

Flexor digitorium profundus 

Flexor digitorious superficials

Second lumbrical

Possible test question
A 1 ( annular ) pulley of the flexor tendon sheath and there  A2- proximal phalanx 
A4- middle third of the middle phalanx
a5- distal interphalangeal joint 
Keeps bow stringing of your tendon

Cruciate pulley (C1) - proximal interphalangeal joint

Reinforce your A pulley

Median nerve: proper palmar digital branches ( index, long) 

Natatory ligament

Proper palmar digital veins- these veins drain adjacent sides of the digits and flow into the common palmar digital veins

Flexor carpi ulnaris

Common extensor tendon: central fibers 
Common extensor tendon:  lateral fibers

Question: define boutinerre  deformity and What structures are affected

Sagittal band( zone V extensor injury?)

Lateral tendon:  medially radiating fibers

Triangular ligament - fascism layer at the dorsum of the middle phalanx and the middle conjoined extensor tendon which attaches to the bone at it's base. Prevents excessive volvar sub laxation of the conjoined lateral bands with flexion of the middle phalanx  Zone 2 extensor tendon injury, which results mallet finger deformity

Dorsal digital nerves- arise from the superficial branch of the radial nerve and the dorsal branch of the ulnar nerves


Palmar interosseus( between the bones) 

Abductor ( 2 heads- transverse and oblique head)

Volar plate (MP joint)

First dorsal interosseus - deep ulnar nerve injury, these muscles would be affected

3 volar interossei adduct the fingers

Function of the lumbricals( question)
Extension of the interphalangeal joints while flexing the MP joints

Holding a news paper
Holding playing cards

Palmar region, muscles found in this region
- interossei
- pollicis
- lumbricals

Opponens digiti minimi

DequVein- inflammation of these muscles 

Give me all your hypo thinner muscles? 

Palmar fascia: midpalmar region- region will contractures form ( dUpuytreyns)



Describe the wrist bone and joints

 Carpal Tunnel syndrome
To release the tunnel, they cut the flexor retinaculum

9 tendons in the tunnel( 4 superficialis, 4 profundus and one flexor Pollocis longus and the median and ulnar nerves)

Palmaris longus goes over the tunnel

Median nerve

Compressions/ injury commonly occurs at the following sites
- high medialn palsy 
- pronator syndrom
- carpal tunnel syndrome

Ulnar deformity


Wrist: common injuries and management (2005)
A systematic approach to the painful wrist 

6 dorsal components- transport extensor tendons

2 palmar tunnels- transport nerves, arteries, flexor tendons

2 groups of interosseus
1. Palmar- adduction
2. Dorsal- abduction

Which carpal bone has muscle originate on it.

Arm muscle that originates from your flexor tendon and inserts in your extensor tendon

Hand test
Phalen test
Tinel test

A patient visits a physio with an injure hand

Explain 5 factors that contribute to the hand dysfunction of this patient

Swelling- inflammation of soft tissue
Pain- due to compression from swelling/ tissue trauma from itself ROm- due to pain, decrease of ROM
muscle weakness- muscles not being used due to immobitly of the joints Sensation- nerve injury

Describe five aspects that should evaluated in the hand during his assessment

Pain- VAS
Edema - measuring tape
Rom- goniometer
Rom- muscle length
Muscular strength...
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