Ganglions and Tumors of the Hand and Wrist
If a client has a ganglion cyst in the wrist, what positions do they tend to report pain in?
Extreme wrist flexion, extension, or with weight-bearing activities through the wrist
What side of the hand impact grip more (radial or ulnar)?
Ulnar
Please list 3 parts of your evaluation process when assessing a stiff hand.
Medical chart review, observation, functional assessment, palpation, goniometry, strength, sensation, edema
Name 5 diagnoses associated with the neurological hand
MS, CP, SCI, CVA, TBI, PD, Dystonia
Lateral epicondylitis involves which tendons?
The extrinsic extensors at their origin.
Which are more common, dorsal or volar wrist ganglions?
DORSAL
Which offers more function, finger flexors or extensors? wrist flexors or extensors?
finger flexors and wrist extensors
If placing the MP joint in flexion lessens available passive PIP flexion---->THEN
then there is extrinsic extensor tightness
Describe the different between hemiparesis and hemiplegia
paresis=weakness, plegia=paralysis
What muscle is most commonly involved in medial epicondylitis?
the flexor carpi radialis
What are 3 factors that indicate treatment for a ganglia?
Pain, interference with activity, nerve compression, and ulceration of overlying skin
Typically, surgical repairs of _________ and ___________ is a primary concern when dealing with a traumatic hand injury.
arteries and veins
What sources can contribute to hand stiffness?
muscle tightness, tendon adhesions, scars, skin, and subcutaneous tissue loss, joint capsule tightness, articular problems, and/or psychosomatic stiffness.
Please list 5 points to consider during the ACUTE phase of recovery following a CVA in respect to the neurological hand.
Encourage functional use, repetition in various contexts, movement may not look the same as it did prior to CVA, be cautions when discussing recovery expectations, recovery can go longer than 6 months, think of ROM, positioning, and orthotic needs, patient and family education pertaining to spasticity, and reinforce the importance of BUE involvement in self care.
Describe Finkelstein's test
ulnar deviation while flexing the thumb-indicates De Quervain's Tenosynovitis
What is the aim of therapeutic approaches for ganglions and tumors?
Aim to preserve and improve function while decreasing pain.
What are the treatment priorities in therapy during the intermediate phase of healing?
Increasing ROM of involved structures, managing scarring, continuing wound care and protection, and increasing functional use of the involved extremity
Please name 2 factors that may perpetuate nonuse of the hand
edema and pain
Name 4 inhibitory techniques that can be used for spasticity.
weight bearing, fatigue antagonists of desired movements, e-stim, kinesiotape, mental imagery, vibration, stretching program, orthoses, serial casting, referral for medical management of spasticity
What is a glomus tumor?
Very painful, tumors that cause compression of a nerve
Name 3 precautions with revascularizations
Avoid anything that challenges the weakened peripheral system, no compressive bandages for 3-8 weeks, and avoid cold during the acute phase
Name 5 potential interventions that can be used for the stiff hand.
casting motion to mobilize stiffness, massage, splinting, taping, early active mobilization, physical agents, home program, stretching, manual treatments, and strengthening
Name 5 possible interventions to address edema.
compression glove, kinesiotape, contrast bathing, soft-tissue mobilization, positioning, first pumps above the heart, caregiver education
Name 6 potential treatment options for trigger finger.
•Splinting the MP in neutral to prevent composite digital flexion (preventing triggering)
•Promoting tendon gliding
•Place-and-hold fisting that avoids triggering
•Built-up handles
•Padded gloves
•Practicing strategies
•Educate client on avoiding triggering because this reinflames the tissue