WL Wrist and Hand Surgery and Rehabilitation EBook

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Wellness & Lifestyles Australia

WRIST & HAND SURGERY

& REHABILITATION E-BOOKpr epared by

Well ness & Li f est yl es Aust r al i a

2007,2008,2009


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Tabl e of Cont ent sPage No.

IMPORTANT NOTICE .................................................................................................... 2

INTRODUCTION ......................................................................................................... 3

WRIST AND HAND ANATOMY .......................................................................................... 4

WRIST ARTHROSCOPY ................................................................................................. 8

Indications for surgery ....................................................................................... 8

The procedure ................................................................................................ 8

Advice after the operation .................................................................................. 8

REHABILITATION AFTER WRIST ARTHROSCOPY..................................................................... 9

HAND AND FINGER STRETCHES AND STRENGTHENING ........................................................... 13

Wrist movement exercises ................................................................................. 13

Wrist strengthening ......................................................................................... 16

Wrist stretching ............................................................................................. 18

Finger exercises ............................................................................................. 20

THUMB STRETCHES AND STRENGTHENING ......................................................................... 23

Stretching .................................................................................................... 23

Strengthening ................................................................................................ 26

FLEXOR TENDON REPAIR REHABILITATION ......................................................................... 30

SUMMARY ............................................................................................................... 33

RESOURCES............................................................................................................. 33

CONTACT US ........................................................................................................... 34

MANUAL LAST MODIFIED 20/02/2012


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http://www.wellnesslifestyles.com.au Ph: +61 8 8331 3000 Fax: +61 8 8331 3002 2

IMPORTANT NOTICE

The information provided in this document can only assist you in the most general way. This document

does not replace any statutory requirements under relevant State and Territory legislation.

Wellness & Lifestyles Australia (W&L) accepts no liability arising from the use of, or reliance on, thematerial contained in this document, which is provided on the basis that the Office of W&L is not therebyengaged in rendering professional advice. Before relying on the material, users should carefully make theirown assessment as to its accuracy, currency, completeness and relevance for their purposes, and shouldobtain any appropriate professional advice relevant to their particular circumstances.

To the extent that the material in this document includes views or recommendations of third parties, suchviews or recommendations do not necessarily reflect the views of the Office of W&L or indicate itscommitment to a particular course of action.

Copyr ight Aust ral ia 2009

This work is copyright. You may download, display, print and reproduce this material in unaltered formonly (retaining this notice) for your personal, non-commercial use or use within your organisation. Apartfrom any use as permitted under the Copyright Act 1968, all other rights are reserved.


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INTRODUCTION

Welcome to the W&L series of eBooks. You have chosen the edition on wrist and hand surgery andrehabilitation.

This resource will be beneficial to Anyone who is interested in the anatomy and biomechanics of the hand and wrist Anyone wanting to know about what sort of scenarios require surgery Anyone who is having surgery on their wrist or hand and would like to what exercises should be done

to help recovery

This e-book will provide programs for specific surgeries on The wrist Hand and fingers (including carpal tunnel syndrome) The thumb

Flexor tendons

The information provided is up to date and follows industry standard. W&L recommend that you continueto consult your doctor and physiotherapist so that your progress can be monitored and program tailored toyour specific requirements.


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WRIST AND HAND ANATOMY

Figure 1: Bone anat omy of hand and wr ist

Diagram taken from:Doctor Gates, How To Take A History of Hand & Wrist Joint, accessed 28th February 2012

http://doctorsgates.blogspot.com.au/2010/06/how-to-take-history-of-hand-wrist-joint.html

The wrist and hand comprise of a number of bones. Where the forearm bones (radius and ulna) meet thehand, there are two rows of small bones called the carpals (scaphoid, lunate, triquetrum, pisiform,hamate, capitate, trapezoid, trapezium). From the carpals extend five metacarpals (in the palm) andfrom those are 14 phalanges (making up the fingers).

Due to the large amount of joints in the wrist and hand, there are also many ligaments which helpstabilise these joints. One ligament to take note of is the transverse carpal ligament (also known as theflexor retinaculum) which extends from one side of the wrist to the other on the palm side. This ligamenthelps to form the carpal tunnel.


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Figure 2: Cross sect ion of wr i st j o int

Diagram taken from:Join-Pain-Expert.Net, Relevant, accessed 28th February 2012

http://www.joint-pain-expert.net/wrist-anatomy.html

Some of the muscles which move the wrist and fingers have their muscle bulk in the forearm so that theydont create overcrowding around the hand and limit movement. The tendons of these muscles extendinto the hand with some passing through the carpal tunnel. There is also a nerve (the median nerve) whichpasses through the carpal tunnel. Carpal tunnel syndrome is where there is a lack of space (usually fromswelling) within the carpal tunnel so that the nerve becomes compressed and usually produces symptomsof tingling, numbness, weakness and pain in the hand.

Figure 3: Muscles and t endons of t he wr ist and for earm

Diagram taken from:Rutgers, The State University of New Jersey, Lecture 15: Muscles of the Appendicular Skeleton I, accessed 28th February 2012

http://www.rci.rutgers.edu/~uzwiak/AnatPhys/APFallLect15.html


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Figure 4: Wr ist and f i nger tendons and a select ion of intr insic hand muscles

Diagram taken from:Indiana University-Purdue University Indianapolis, Intrinsic Muscles of the Hand, accessed 28th February 2012

http://iupucbio2.iupui.edu/anatomy/images/Chapt11/FG11_09a.jpg

The fingers are able to do four main movements of bending (flexion), straightening (extension), spreadingout (abducting) and pressing together (adducting). The anatomy of the thumb is slightly different to allowmovement in all directions with great control. This function is important in tasks involving gripping andcarrying. The wrist bends up and down (flexes and extends), as well as tilting side ways (radial and ulnardeviation). Pronation and supination are expressed in a change of hand position although movementactually occurs toward the elbow.


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Figure 5: Movement of t he wr ist and f i ngers

Diagram taken from:American Society for Surgery of the Hand, Hand Anatomy, accessed 28th February 2012

http://www.assh.org/Public/HandAnatomy/Pages/default.aspx


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WRIST ARTHROSCOPY

Indicat ions f or surgeryWrist arthroscopies can be performed in order to examine and repair the bones making up the wrist andsurrounding structures. The main scenarios for surgery include Examining joint cartilage and ligaments Cleaning out any loose fragments in the joint Smoothing out the joint surfaces Removing ganglions Repairing or assessing fractures

The pr ocedureArthroscopy involves keyhole surgery where a small incision is made and a tiny camera is guided into the

wrist where the tissues can be examined and specific surgical treatment can be performed.

Advice af ter t he operat i on

Ask your doctor and surgeon about pain management plans. Once the anaesthetic wears off from theoperation and as you are trying to use your wrist more, you may experience an increase in pain.

Follow the RICE regime below to minimise pain, swelling and inflammation.

R Rest: Limit activity levels with consideration to the amount of swelling and pain.I Ice:Use ice packs or ice wrapped in moistened cloth on your operated wrist for 20 minuets every

2 hours.

C Compression: Keep tubigrip bandage (like an open sock of bandage) around your wrist until itlonger swells.

E Elevation:Keep the wrist resting so that it is elevated above the level of the heart (preferably) toreduce swelling in the joint.

Icing should be performed after exercise for the first couple of weeks after surgery. Commence exercisesin accordance with your therapist, making sure that the type and intensity of your exercises areappropriate for the type of surgery you have had.


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REHABILITATION AFTER WRIST ARTHROSCOPY

Perform this program in consultation with a therapist so that they can prescribe these exercises specific toyour needs. Do not perform exercises by pushing into pain, slowly build up the exercises.

Flexion and extension: range of movement Rest your arm, palm down, on a flat surface with your handover the edge. Gently bend your wrist backwards and forwards holding for 3 seconds each way, repeat 10times.


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Wrist deviation: range of motion Rest your hand palm down on a flat surface and tilt your wrist side toside in a waving movement. Hold for 3 seconds each way, repeat 10 times.


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Static wrist strengthening: flexion and extension Rest your arm, palm down, on a flat surface with yourhand over the edge. Apply force to the back of your hand without allowing it to bend your wristdownwards. Repeat the exercise with the force directed to your palm (pushing upward), again, withoutallowing it to bend. Hold for 3 seconds each way, repeat 10 times.

Static wrist strengthening: deviation Rest your hand palm down on a flat surface and have your goodhand blocking your thumb. Push the thumb side of your hand into your good hand so that you can feel thewrist muscles working. Repeat on the opposite side. Hold for 3 seconds each way, repeat 10 times.

Alternately, use an immobile object to create the blocking force, rather than your opposite hand.


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Opposition: range of movement Touch the end of each finger with your thumb, repeat 5 times.


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HAND AND FINGER STRETCHES AND STRENGTHENING

Surgery can be performed on the hand and fingers for reasons including Release of the carpal tunnel Tears or irritation to the ligaments and tendons Joint changes following arthritis Injury from trauma Fractures or dislocation of bones

The RICE regime should be followed for the first two days. Additional icing sessions should also be doneafter exercise in the following week or until swelling is minimal. Consult your therapist for guidance aboutwhich of the following exercises are appropriate for your particular surgery.

Wr ist movement exerci ses

Flexion and extension: range of motion Rest your arm on a flat surface, palm down, with your handover the edge. Gently bend your wrist backwards and forwards holding for 3 seconds each way, repeat 10times.


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Wrist deviation: range of motion Rest your hand palm down on a flat surface and tilt your wrist side toside in a waving movement. Hold for 3 seconds each way, repeat 10 times.


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Supination and pronation: range of motion Rest your forearm on a table top, with elbow bent to 90.Turn your hand so that your palm alternates between facing up and down. Hold for 3 seconds each way,repeat 10 times.


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Wri st st rengt hening

Repeat the wrist movement exercises but use your good hand to resist and movement occurring.

Flexion and extension Rest your arm palm down on a flat surface with your hand over the edge. Gentlybend your wrist backwards (pushing down with your good hand) and forwards (pushing up with your goodhand) holding for 3 seconds each way, repeat 10 times. Alternately, use a table top to provide theresistance on top of, or below, your hand.


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Wrist deviation Rest your hand palm down on a flat surface and have your good hand blocking yourthumb. Push the thumb side of your hand into your good hand so that you can feel the wrist musclesworking. Repeat on the opposite side. Hold for 3 seconds each way, repeat 10 times.

Supination and pronation Rest your arm on a table top with your elbow bent to 90. Grasp your handwith your good hand. Use your good hand to resist the turning movement, as if trying to turn a locked doorknob or stuck jar lid in both directions. Hold for 3 seconds each way, repeat 10 times.


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Wris t st re t ch ing

Wrist extension stretch Rest your hand palm down on a flat surface. Lift your elbow off of the table sothat you are bending at the wrist. Go as far as comfortable whilst ensuring your palm stays flat. Hold for10-30 seconds.

Wrist flexion stretch Rest your forearm, palm down, on a flat surface and have your hand over theedge. Use your good hand to bend your hand down so that you are bending at the wrist. Go as far as

comfortable and hold for 10-30 seconds.


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Wrist radial & ulna deviation stretch Rest your hand palm down on a flat surface and hold it still usingyour good hand. Allow your shoulder to move your forearm in an arc toward your thumb. Repeat towardthe opposite side. Go as far as comfortable and hold for 10-30 seconds each side.


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Finger exer cises

Opposition Touch the end of each finger with your thumb, repeat 5 times.


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Finger extension Straighten out all fingers and try to bend them backwards. Relax and repeat 5 times.

Finger adduction Have fingers straight and then squeeze them together. Repeat 5 times.


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Lumbrical (Duck beak) position Bend the first knuckle and keep the fingers straight. Repeat 5 times.

Normal fist Bend at all knuckles to clench hand into a fist. Repeat 5 times


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THUMB STRETCHES AND STRENGTHENING

The thumb plays an important role in almost all functional tasks done with the hands. If the thumb hasweakness or restriction in movement following surgery then it is important to quickly regain strength andmovement so that the hand can be used in all required activities.

It is crucial that each aspect of the thumb is exercised to ensure a full recovery. Even if some of theexercises seem like they are very similar, please follow instructions carefully and complete all as directed,in consultation with your therapist.

Stretching

Web stretch Rest your hand palm down on a flat surface and use your good hand to stretch your thumbaway from your index finger. Hold for 5 seconds and repeat 5 times


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Thumb extension stretch Rest your hand palm down on a flat surface. Use your good hand to flatten outyour hand against the surface. Once this can be done comfortably, use your good hand to lift up yourthumb skyward. When lifting the thumb, support it at the base, avoid levering it from the tip. Hold thestretch 5 seconds and repeat 5 times.


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Thumb abduction stretch Rest your hand on a flat surface on its side so that your thumb is up. Use yourgood hand to pull your thumb forward. When stretching the thumb, support it at the base, avoid leveringit from the tip. Hold for 5 seconds and repeat 5 times

Opposition stretch Rest your hand palm up on a flat surface and touch the tip of your thumb with the tipof your 5th finger. Use your good hand push the thumb further across towards your 5thfinger. Hold for 5seconds and repeat 5 times


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Abduction Place your palm face down on a flat surface and slide your thumb away from other fingers.Repeat 10 times. Make the exercise harder by putting hands together and taking the thumb away from theother fingers. A rubber band around the back of your hand between the 5 thfinger and thumb can be usedfor resistance.


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Opposition Touch the end of each finger with your thumb, repeat 5 times.


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Pinch Press your thumb into each of your fingertips in turn with maximum effort. Ensure you keep thesmall joints of your fingers bent at all times, bending them backward can cause pain and damage. Holdingfor 3 seconds with each finger.

Grip wrap your thumb and index finger around your good wrist (or other object of similar size/shape)and squeeze as hard as you can. Hold 3 seconds and repeat 10 times.


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FLEXOR TENDON REPAIR REHABILITATION

The flexor tendons in the hand are involved with curling the fingers under. This movement is important formany tasks such as gripping, carrying and writing. Surgery can be used to repair torn tendons if they are

ruptured. Follow directions given by your therapist and surgeon about wearing braces. They should alsoclarify when and which of the following exercises are appropriate for rehabilitation.

Passive finger flexion Use your other hand to curl each finger individually.

Resisted finger flexion Try to curl each finger but use your other hand to resist the movement. Repeat 5times each finger.


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Lumbical (Duck beak) Bend the first knuckle and keep the fingers straight. Repeat 5 times.

Normal fist Bend at all knuckles to clench hand into a fist. Repeat 5 times


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Flexion and extension Rest your arm palm down on a flat surface with your hand over the edge. Gentlybend your wrist backwards and forwards holding for 3 seconds each way, repeat 10 times.


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CONTACT US

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WL Wrist and Hand Surgery and Rehabilitation EBook