Discontinue use of splint except heavy lifting or when in crowds.Wrist and forearm isotonic strengthening (2-3x/day x 15-20 reps with 1# dumbbell or lightest theraband).Continue wearing splint with heavy activity, lifting, and community mobility.Begin weaning from splint with light functional activities (dressing, cooking, folding laundry, house cleaning).Light grip strengthening with sponge or theraputty (throughout day as pain allows).Wrist and forearm isometrics within pain-free ranges (2-3x/day x 5-7 reps). Begin active-assist and passive wrist range of motion as tolerated (4-6x/day x 10 reps).Edema management (elevation, compression, active range of motion, icing).Wrist active range of motion within tolerable ranges (4-6x/day x 10 reps MINIMUM).Fabricate custom volar wrist cock-up (~30 degrees wrist extension) removing only for hygiene and home exercises.This protocol is a guide and is commonly accelerated or decelerated depending on therapist or physician’s discretion. Special considerations must be made for some patients depending on quality of fixation/bone, pain, edema, work requirements, or psychosocial factors. The key is to mobilize the wrist aggressively (as pain allows) the first few weeks to avoid scar adhesions, reduce swelling, and minimize stiffness. In general, patients who undergo a distal radius ORIF have great outcomes with minimal complications. Not too long ago, these patients would have been casted for 4-6 weeks and been extremely stiff afterwards, with long recoveries likely. Due to the advancements in surgical techniques, we are now mobilizing distal radius ORIF’s 3-5 days after surgery. This is likely the most common post-surgical diagnosis I see, especially with the winters we have here in Minnesota. Distal Radius Fracture & Open Reduction Internal Fixation (ORIF) Gentle grip strengthening (3-4x/day x 10 reps)Ģ.Tendon glides (4-6x/day x 10 reps MINIMUM).Wrist active range of motion (4-6x/day x 10 reps MINIMUM).Modalities (if applicable) – ultrasound or iontophoresis with dexamethasone.Nerve glides – proximal and/or distal median nerve glides (these must be completed pain-free!).Education – pathophysiology, purpose of splint, ergonomics, activity modifications.Night-time splinting – prefab volar wrist cock-up splint.There are differing surgical techniques (open versus endoscopic release) which may determine what treatment interventions and outcomes are most appropriate. In regards to post-surgical carpal tunnel releases (and actually all post-surgical diagnoses), it is important to read the operative report in detail prior to treatment. However, I tend to see more orders for post-surgical treatment than conservative. Carpal Tunnel Syndrome (Conservative & Post-Surgical)Ĭarpal tunnel syndrome is in the top 5 most common diagnoses I see. It is by no means an exhaustive list, but hopefully will provide you with a direction to take when seeing an unfamiliar diagnosis. This article will focus on common diagnoses seen in hand therapy (and possibly in your setting) with typical hand therapy interventions and treatment protocols in an easy to read list form. What is really exciting about hand therapy (but also challenging at times) is how many different “road maps” exist for treating the same diagnosis since each patient presents with unique problems and issues. The plan is built from a thorough understanding of protocols, personal experience, and collaboration with fellow hand therapists. Regardless of how simple or complicated the diagnosis or treatment plan, I try to have a “road map” in my head planned out. The same is true for me now when treating a patient in my hand therapy setting. I quickly learned in graduate school (in my physiology and neuroscience courses) that I learn best with flow charts – when I can form a plan and visualize what steps come next.
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