Objectives 目标 Understand and identify common hand therapy evaluation techniques 理解和辨别常见手功能治疗的评估技术 Identify types of splints for wrist, thumb, hand, fi

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1 Hand Therapy Evidenced Based Evaluation and Splinting 询证评估及支具使用 Dr. Angela Patterson, OTD, OTR/L March 2018

2 Objectives 目标 Understand and identify common hand therapy evaluation techniques 理解和辨别常见手功能治疗的评估技术 Identify types of splints for wrist, thumb, hand, fingers, and tendon injuries. 辨识对于手腕拇指手手指以及肌腱损伤所设计的不同类型的支具 Understand wearing schedule for splints for wrist, thumb, hand, fingers, and tendon injuries. 理解对于手腕拇指手手指以及肌腱损伤所设计的不同类型的支具使用周期 Understand materials needed for splints. 理解支具所需要的材料 Understand assessment of patient for splints. 理解使用支具前的评估手段及方法

3 Hand Therapy Evaluation 手功能评估 Range of motion 关节活动度 Strength 力量 Coordination 协调 Sensation 感觉 3

4 Hand Therapy Evaluation 手功能治疗评估 Hand Innervation 手上的神经分布 Median 正中神经 Radial 桡神经 Ulnar 尺神经 4

5 Hand Therapy Evaluation Range of motion Goniometric measurements Active/passive movement Coordination Opposition Speed Bilateral integration Strength Manual Muscle testing Grip strength Sensation Stereognosis Monofilament testing 手治疗评估活动范围角度测量主动 / 被动活动协调对比速度双边一体化强度徒手肌肉评定握力感觉实体辨别单丝测试 5

6 Types of Splinting 夹板的种类 Splints Acting on the Wrist Thumb Immobilization Splints Hand Immobilizations Splints Splinting for the Fingers Splinting for Tendon Injuries 手腕上的夹板拇指固定夹板手固定夹板手指夹板肌腱损伤夹板

7 Splinting Materials 夹板材料 Thermoplastic Splinting Materials Splint Patterns Utility Knife Electric Fry Pan Scissors Heat Gun Strapping and Velcro Padding 热塑性夹板材料夹板模式工具刀电煎锅剪刀热枪捆带和魔术贴衬垫

8 Evaluate the Patient 对病人的评估 Pain Skin wound Range of Motion Strength Sensation Function Hand Dominance 疼痛皮肤 - 伤口关节活动度肌力感觉功能优势手

9 Documentation 记录 Order from Doctor 医嘱 Diagnosis 诊断 Type of splint 夹板类型 Position of splint 夹板位置 Timing for splint wear 夹板穿戴时间

10 Documentation 记录 Splint Wearing Schedule 夹板穿戴计划 Day, night or both 白天夜晚或 24 小时 Purpose of the splint 夹板使用目的 Patient need to do exercise 患者需要锻炼 Does the patient need help applying the splint 患者穿戴夹板时, 是否需要帮助? 10

11 Splints Acting on the Wrist 作用于腕部的夹板 Volar Wrist Immobilization Splint 腕部掌侧制动夹板 Dorsal Wrist Immobilization Splint 腕部掌侧制动夹板

12 Splints Acting on the Wrist 作用于腕部的夹板 Ulnar Wrist Immobilization Splint 腕部尺侧制动夹板 Circumferential Immobilization Splint 环绕型制动夹板

13 Splints Acting on the Wrist Condition Wearing Schedule Splint Carpal Tunnel Syndrome Carpal Tunnel Surgery Day/Night/Continuous 4-6 weeks Varies Continuous 1 week and then decrease Volar, dorsal, or ulnar Wrist in neutral Volar Wrist in neutral or slightly extended position Radial Nerve Palsy Tendinitis Arthritis Wrist Fracture Wrist immobilization in functional position Splint continuously followed with removal for ROM exercises Splint continuously with removal for ROM exercises Splint after removal of cast and remove splint for functional movement Volar or dorsal, 15 to 30 degrees of wrist extension Volar or dorsal, 20 to 30 degrees of wrist extension Volar in extension up to 30 degrees Dorsal, volar, or circumferential with extension up to 30 degrees

14 佩戴腕关节支具诊断佩戴时长支具腕管综合征昼 / 夜 / 连续 4-6 周手掌, 手背或尺侧腕关节保护支具腕部中立位腕管综合征依具体情况而变化持续佩戴一周然后减少佩戴时间手掌侧腕关节保护支具手腕保持中立位或轻微外展位桡神经麻痹手腕保持中立位手掌, 手背腕关节保护支具腕关节外展度肌腱炎关节炎腕部骨折在进行关节活动度锻炼时取下支具在进行关节活动度锻炼时取下支具在脱模后和功能训练时取下支具手掌, 手背腕关节保护支具腕关节外展度手掌腕关节保护支具腕关节外展最大 30 度手掌, 手背腕关节保护支具或圆周夹板腕关节外展最大 30 度

15 Thumb Immobilization Splints Long Forearm-based Splint Hand-based Splint 前臂型支具手掌型支具

16 Thumb Immobilization Splints Condition Wearing Schedule Splint de Quervain s tenosynovitis Continuous Long forearm-based Wrist 15 degrees extension, CMC joint palmarly abducted degrees, thumb MCP 5-10 degrees flexion Arthritis Continuous during pain and inflammation Long forearm-based Wrist degrees extension, CMC joint palmarly abducted 45 degrees thumb MCP 5 degrees flexion Traumatic Injury Continuous for 4-5 weeks Hand-based Thumb MCP immobilized and the CMC palmarly abducted degrees

17 拇指固定支具诊断佩戴时长支具狭窄性腱鞘炎持续佩戴前臂支撑型支具腕关节外展 15 度, 腕掌关节屈曲度拇指掌指关节屈曲 5-10 度关节炎在疼痛期间持续佩戴前臂支撑型支具腕关节外展度腕掌关节屈曲 45 度拇指掌指关节屈曲 5 度外伤持续佩戴 4-5 周手掌型支具固定拇指掌指关节拇指腕掌关节屈曲 40 度

18 Hand Immobilization Splints 手掌休息位支具 Volar Resting Hand Splint 手固定支具

19 Hand Immobilization Splints Condition Wearing Schedule Splint Arthritis Continuous during flare up Wrist neutral or degrees extension, MCPs degrees flexion, Ulnar deviation 5-10 degrees Burns Worn at all times except for during OT Wrist 0 degrees for dorsal burn degrees extension for volar burn, MCPs degrees flexion, PIP and DIPs full extension, thumb palmer abduction and extension Dupuytren s Disease Trauma Continuous after surgery then worn at night Continuous after surgery then worn at night Wrist neutral, MCP, PIP and DIPs full extension Wrist 0-30 degrees extension, MCPs degrees flexion, PIP and DIPs full extension

20 手固定夹板条件穿戴计划夹板关节炎持续穿戴手腕正中或度伸展, 掌指关节度屈曲, 尺侧偏移 5-10 度烧伤 Dupuytren 病创伤除在 OT 期间外, 任何时候都要穿戴手术后持续穿戴, 在晚上穿手术后持续穿戴, 在晚上穿背侧灼伤手腕 0 度 - 掌侧灼伤度延伸, 掌指关节度屈曲, 近端指间关节和远端指间关节完全伸展, 拇指掌侧外展和伸展手腕正中, 掌指关节, 近端指间关节和远端指间关节完全伸展腕部 0-30 度延伸, 掌指关节度屈曲, 近端指间关节和远端指间关节完全伸展

21 Splinting for the Fingers Finger Extension Splint 手指扩展夹板 PIP Hyperextension block 近端指间关节过伸 Gutter Splint

22 Finger Deformities 手指畸形槌状指钮孔状畸形鹅颈畸形

23 Splinting for the Fingers Condition Wearing Schedule Splint Mallet Finger Continuous 6 weeks Gutter splint DIP neutral Boutonniere Deformity Continuous 6-8 weeks Finger extension splint PIP neutral Swan Neck Deformity Continuous PIP hyperextension block PIP slight flexion Finger Sprain Continuous 2-4 weeks Immobilize joint in full extension Buddy taping

24 手指夹板条件穿戴计划夹板槌状指持续 6 周 Gutter 夹板远端指间关节正中钮孔状畸形持续 6-8 周手指伸展夹板近端指间关节正中鹅颈畸形持续近端指间关节过伸近端指间关节轻微屈曲手指扭伤持续 2-4 周完全伸直固定关节 Buddy taping

25 Splinting for Tendon Injuries 用于肌腱损伤的夹板 Flexor Tendon Dorsal splint Wrist flexion degrees MCPs flexion degrees IPs flexion degrees 屈肌腱背侧板腕关节屈曲度掌指关节屈曲度指间关节屈曲度

26 Splinting for Tendon Injuries 用于肌腱损伤的夹板 Extensor Tendon Volar splint Wrist extension 20 degrees MCPs degrees flexion IPs neutral 伸肌腱掌侧夹板腕关节伸展 20 度掌指关节屈曲度指间关节中立位 26

27 Splinting for Tendon Injuries Flexor Tendon 屈肌腱 Extensor Tendon 伸肌腱

28 References Coppard, B.M., & Lohman, H. (2015) Splinting A Clinical Reasoning & Problem- Solving Approach. St. Louis: Mosby, Inc. Vining Radomski, M. & Trombly Latham, C. A. (2008). Occupational Therapy for Physical Dysfunction (6 th ed). Baltimore, MD: Lippincott Williams & Wilkins.

Radiocarpal- and midcarpal joints 桡腕关节及中腕关节 Midcarpal Radio-carpal

手 / 腕关节标准扫查 & 基本病变 Hilde Berner Hammer Senior consultant, PhD Dept. of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway Radiocarpal- and midcarpal joints 桡腕关节及中腕关节 Midcarpal Radio-carpal Ultralyd MR