Hand & Upper Extremity

Hand Therapists’ Management of Common Upper Extremity Conditions

Hand Conditions

Finger Fractures and Dislocations

• Finger splint
• Edema management
• Range of motion exercises

Arthritis

• Paraffin and moist heat
• Edema management
• Range of motion exercises
• Isometric strengthening exercises
• Joint protection techniques
• Adaptive equipment

Thumb Basal Joint Arthritis

• Hand-based thumb spica
• Deep tissue massage of thenar eminence
• Range of motion and strengthening exercises
• Education regarding joint protection principles
• Adaptive equipment

Flexor Tendon Laceration

• Dorsal blocking splint
• Range of motion exercises
• Edema and scar management

Extensor Tendon Laceration

• Dynamic dorsal extension outrigger
• Range of motion exercises
• Edema and scar management

Mallet Finger

• Finger extension splint
• Edema management
• Update every 2-4 weeks

Trigger Thumb / Finger

• Finger / thumb splint
• Iontophoresis and edema management
• Activity modification

Skier’s Thumb (Gamekeeper’s) (Ulnar collateral ligament injury)

• Hand-based thumb spica
• Edema management
• Range of motion exercises

Amputations

• Whirlpool and wound care
• Dressing changes
• Range of motion exercises
• Desensitization
• Stump shaping

Burns and Frostbite

• Whirlpool and wound care
• Dressing changes
• Splinting (as needed)
• Range of motion exercises

Wrist Disorders

Carpal Tunnel Syndrome

• Wrist splint
• Tendon and median nerve glides
• Education regarding avoidance of aggravating activities

DeQuervain’s Tenosynovitis

• Forearm-based thumb spica
• Edema management
• Range of motion and strengthening exercises
• Activity modification

Wrist Tendonitis

• Wrist immobilization splint
• Edema management
• Activity modification and symptom management

Intersection Syndrome
(Inflammation at the intersection of thumb extensors and radial wrist extensors approx. 4-6 cm proximal to dorsal wrist crease)

• Forearm-based thumb spica
• Edema management
• Activity modification and symptom management

Scaphoid Fractures

• Forearm-based thumb spica with ulnar clamshell
• Edema management
• Range of motion and strengthening following bony healing

Wrist Sprain

• Wrist immobilization splint
• Edema management
• Range of motion exercises/strengthening
• Activity modification and symptom management

Wrist Fractures

• Wrist splint
• Edema management
• Range of motion exercises
• Strengthening exercises following bony healing

Degenerative Joint Disease of the Wrist

• Wrist immobilization splint
• Paraffin and moist heat
• Activity modification, adaptive equipment, and joint protection principles
• Range of motion exercises

Midcarpal Instability

• Forearm-based ulnar gutter / radial clamshell splint
• Edema management
• Education regarding avoidance of aggravating activities

Triangular Fibrocartilage Complex (TFCC) Injury

• Forearm-based ulnar gutter / radial clamshell splint
• Education regarding avoidance of aggravating activities
• Strengthening

Elbow Disorders

Tennis and Golfer’s Elbow

• Wrist immobilization splint / aircast
• Iontophoresis (acute)
• Electrical stimulation and heat (chronic)
• Deep tissue massage
• Forearm stretches and icing
• Strengthening
• Activity modification and symptom management

Cubital Tunnel Syndrome

• Elbow gel pad
• Elbow extension splint
• Ulnar nerve glides
• Education regarding avoidance of aggravating activities

Radial Nerve Palsy

• Dynamic dorsal extension outrigger
• Passive range of motion exercises
• Monitor monthly for regeneration / update exercises

Thoracic Outlet Syndrome
(Compression of the brachial plexus through area bordered by first rib, clavicle, and neck muscles. symptoms include numbness and tingling in the arm or hands, pain radiating up or down the arm, hand, or neck, and occasional muscular weakness.)

• Brachial plexus nerve glides
• Postural stretches and exercises
• Back strengthening exercises
• Education regarding proper posture