Hand Rehabilitation. A Quick Reference Guide and Review PDF
Preview Hand Rehabilitation. A Quick Reference Guide and Review
FM.qxd 7/31/04 1:56 PM Page vii Contributors Susan Weiss and Nancy Falkenstein developed and contributed to all chapters. Contributors are listed in alphabetical order. Contributed topics are italicized. Randall D. Alley, BSc, CP, FAAOP Dale G. Bramlet, MD ISPO, ABC, Chair Upper Limb Prosthetic Society Clinical Associate Professor Innovative Neurotronics, Inc. University of South Florida Thousand Oaks, California Tampa, Florida Congenital Anomalies/Amputations/Prosthetics Director of Hand Surgery Orthopaedic Surgery Bayfront Medical Center Jacqueline Alton St. Petersburg, Florida St. Petersburg, Florida Fractures Wounds/Infection George H. Canizares, MD Orthopaedic Surgeon Bambi L. Anderson, OTR/L All Florida Orthopaedic Association Clinical Specialist, Upper Extremity Prosthetics St. Petersburg, Florida Otto Bock Health Care Sports Injuries of the Upper Extremity Minneapolis, Minnesota Congenital Anomalies/Amputations/Prosthetics Philip A. Davidson, MD Assistant Clinical Professor Surgery, Division—Orthopedics Karen Baker, PT, Cert. MDT University of South Florida College of Medicine Physical Therapist Tampa, Florida Outpatient Physical Therapy Tampa Bay Orthopaedic Specialists Tampa Bay Orthopaedic Specialists St. Petersburg, Florida St. Petersburg, Florida Elbow, Shoulder Hodge Podge of Treatment Techniques A. Lee Dellon, MD Brigitte Borsh-Zimmer, OTR/L, CHT Professor of Plastic Surgery, Professor of Neurosurgery Clinical Manager Johns Hopkins University Occupational Therapy—Hand Therapy Clinic Baltimore, Maryland Mease Countryside Hospital Professor of Plastic Surgery, Neurosurgery, and Anatomy Safety Harbor, Florida University of Arizona Cumulative Trauma and Differential Diagnosis Tucson, Arizona Neuroanatomy and Sensory Reeducation Roxanne C. Bottum, OTR/L, CHT Lloyd Allen Deneau, BS, CPT Director of Hand Therapy Director of Physical Therapy Occupational Therapy Physical Therapy All Florida Orthopaedic Associates Commonwealth Rehabilitation St. Petersburg, Florida Largo, Florida Cumulative Trauma and Differential Diagnosis Shoulder vii FM.qxd 7/31/04 1:56 PM Page viii viii Contributors Karen Dhanens, OTR/L, CHT Jodi Jones Knauf, OTR, PAC Occupational Therapy Physician Assistant Trinity Medical Center All Florida Orthopaedics Rock Island, Illinois St. Petersburg, Florida Anatomy Extravaganza Drugs Commonly Encountered in Hand Therapy Jon J. Ehrich, DO, MD Constance Kurash, OTR/L, CHT Board-Certified Physiatrist Independent Contractor Diplomate, American Board of Physical Medicine and Lee Memorial Health Systems Rehabilitation Fort Meyers, Florida Palm Beach Gardens, Florida Intrinsic Mechanism Complex Regional Pain Syndrome/Reflex Sympathetic Dystrophy Leonard Elbaum, EdD, PT Paul C. LaStayo, PhD, PT, CHT Associate Professor Associate Professor Department of Physical Therapy, School of Health Physical Therapy Florida International University University of Utah Miami, Florida Salt Lake City, Utah Principal Wrist Elbaum & Associates Research, Education, and Consultation in Physical Kathryn L. Lowenstein, OTR/L Rehabilitation Arthritis Center Miami, Florida Palm Harbor, Florida Modalities Arthritis Georgianna Gacula Fres, OTR/L Occupational Therapist Mitchell B. Lowenstein, MD Hand Therapy Fellow of the American College of Rheumatology and All Florida Orthopedic Associates Internal Medicine St. Petersburg, Florida Arthritis Center Hand Enthusiasts Vendor and Website List Palm Harbor, Florida Arthritis Antonio J. Gayoso, MD Plastic Surgery Anne M. Lucado, MS, PT, CHT All Florida Orthopaedics Associates Staff Physical Therapist St. Petersburg, Florida The Hand Center Flaps/Grafts/Thermal Conditions Wake Forest University Baptist Medical Center Winston Salem, North Carolina Casey Hoover, OTR/L Tendons Staff Occupational Therapist Hand Therapy All Florida Orthopaedic Associates Amy Mills, OTR/L, CHT St. Petersburg, Florida Occupational Therapist Evaluation, Hand Enthusiasts Vendor and Website List, All Florida Orthopaedic Associates Nutrition St. Petersburg, Florida Hand Enthusiasts Vendor and Website List, Nutrition Heather Hoyt, OTR/L Upper Extremity Clinical Specialist Patrick C. Prigge, CP Professional Services Upper Extremity Manager Otto Bock Health Care Professional Services Minneapolis, Minnesota Otto Bock Health Care Congenital Anomalies/Amputations/Prosthetics Minneapolis, Minnesota Congenital Anomalies/Amputations/Prosthetics Eric P. Keefer, MD Chief Resident Department of Orthopedic Surgery Jorge Rodriguez, MD Lenox Hill Hospital Private Practice New York, New York St. Petersburg, Florida Biomechanics and Tendon Transfers Elbow FM.qxd 7/31/04 1:56 PM Page ix Contributors ix Julie A. Schick, CP, OTR/L Paul Van Lede, OT, MS Clinical Specialist, Upper Extremity Prosthetics Orfit Industries Professional Services Wijnegam, Belgium Otto Bock Health Care Splinting Minneapolis, Minnesota Congenital Anomalies/Amputations/Prosthetics Wayne B. Whittle, BS, PT Owner Douglas R. Shier, PhD Next Step Rehabilitation Professor St. Petersburg, Florida Department of Mathematical Sciences Elbow Clemson University Clemson, South Carolina S. Steven Yang, MD, MPH Research and Statistics Assistant Adjunct Division Hand Surgery Stephen D. Simonich, MD Department of Orthopedic Surgery Tampa Bay Orthopaedic Specialists Lenox Hill Hospital St. Petersburg, Florida New York, New York Sports Injuries of the Upper Extremity Biomechanics and Tendon Transfers Gerald E. Stark, Jr., BSME, CP, FAAOP Contributors to the first edition: Guest Lecturer Patricia Anderson Physical Medicine Brett Bolhofner Prosthetic-Orthotic Center Arlicia Brown Chicago, Illinois Phyllis J. Bruni Vice President of Education and Technical Support Barbara A. Carmen The Fillauer Companies, Inc. Lisa Rementer Choe Chattanooga, Tennessee Kate Cooper Congenital Anomalies/Amputations/Prosthetics Gail P. Counts Lawrence Gnage Charlene Stennett, OTR/L, CHT Daniel Greenwald Director of Hand Therapy Barbara G. Henry Miami Hand Center Jeri Lynn Houck Miami, Florida Jennifer J. Jones King Fractures John J. O’Brien, Jr. Scott Raub Shawn Swanson, BS, OTR/L John M. Rayhack Occupational Therapist Lori Long Root Clinical Specialist, Upper Extremity Prosthetics Sharon Root Spiegel Professional Services Otto Bock Health Care Minneapolis, Minnesota Congenital Anomalies/Amputations/Prosthetics FM.qxd 7/31/04 1:56 PM Page xi Foreword In this expanded second edition of Hand Rehabilitation: A Quick Reference Guide and Review, Susan Weiss and Nancy Falkenstein give us a unique approach to critical thinking in hand therapy. In addition to questions relating to specific diagnoses, other areas of clinical practice are included such as anatomy, signs and symptoms, terminology, treatment decisions, use of modalities, and splinting. Unlike many texts that give us sequential information about one subject, this book requires consideration of a wide array of hand therapy information. The question format with multiple choice answers requires the reader to connect theory to real clinical circumstances. With each question being supported by specific references, the reader can conveniently pursue further study of any unfamiliar question or answer. This text is vital for those preparing for the hand therapy certification examination or for those thinking of beginning practice in hand therapy. For those who have already been practicing in the specialty, it is an excellent review. Wrap your brain around this book...your clinical rea- soning skills will be better for it! Judy C. Colditz, OTR/L, CHT, FAOTA HandLab Raleigh, North Carolina xi FM.qxd 7/31/04 1:56 PM Page xii Foreword The term “Purple Book” echoed through the cell phones and e-mails as the must-read book for future CHTs. Not until my partner, Christa Baggott, challenged me to complete a chapter (just before she passed the CHT examination), did I realize the “Purple Book” was the very same book my Florida Hand Society friends, Susan and Nancy, had published 4 years earlier. I erroneously assumed Hand Rehabilitation: A Quick Reference Guide and Review was primarily for pre-CHTs. I took the challenge lightly at first, then seriously. Each question seemed to trigger those cere- bral neurons to pull, gather, and blend latent and recent therapeutic knowledge, techniques, and experiences into accessible thoughts. From the commanding voice of my mentor, Dr. William Burkhalter, to a flash of a familiar photo from a landmark article, from a famous quote of Dr. Brands to the texture of a stiff brawny hand, all re-collected then recollected. Self-examination does that. The manuscript of this second edition follows the previously proven test format of the first “Purple Book,” only it is enriched with almost twice the content. Do you know how Eqawa, Jean Duchene, Andre Thomas, Masse, Wartenberg, and Froment’s signs are related? Now describe each one. Like a teen lost in an interactive video game, you will anticipate each topic for the thrill of conquering an upcoming difficult question. Bonuses in the form of Clinical Gems weave a string of pearls that connect one chapter to the next. Right or wrong, there will be a continued satisfaction in settling on a final selection, each not unlike placing that final jigsaw puzzle peace, except the accomplishment is enjoyed repeatedly. Take the challenge, it’s rewarding. Have you kept up with the explosion of information? Since attaining CHT status in 1991, I had questioned the outcome of retaking the CHT examination. Well, the questions in the form of these well-planned pages fulfilled my curiosity. Seasoned therapists should take an earnest approach to this test within a text. It will not only reflect your core knowledge of hand basics, but also be the mirror of proof regarding your continuing education. Cure your curiosity. Susan and Nancy have left personality prints throughout these pages. If you subscribe to their Exploring Hand Therapy newsletter, you are well aware of the wide appeal in the consistency of their casual and concise writing style that also permeates this edition. This appeal is so wide that their first edition spurred quite a competition at the silent auction of the International Federa- tion of Society of Hand Therapists meeting in Scotland this year. Their newly trademarked and timely motto “Treatment to Go” follows their style. This edition, in my opinion is “Knowledge to Go.” Go. Get addicted to the “Purple Book.” Nelson Vazquez, OTR/L, CHT Co-Owner, H.A.N.D.S Rehab Miami, Florida xii FM.qxd 7/31/04 1:56 PM Page xiii Foreword to the First Edition No doubt Socrates is smiling. In Hand Rehabilitation: A Quick Reference Guide and Review, Nancy Falkenstein and Susan Weiss use a mostly Socratic method—question and answer format—to teach a wide range of topics on hand therapy. In so doing, the authors demonstrate their wealth of knowledge on hand therapy and their skills in teaching hand therapy. They also reveal their creativity and sense of fun. In this long-awaited book, health professionals and students interested in hand therapy will finally have the opportunity to test and enhance their knowledge with a series of structured questions and comprehensive answers. While other disciplines have long enjoyed this format, hand rehabilitation has been without—until now. However, Falkenstein and Weiss go well beyond the basics of question and answer. Each answer includes a well-developed rationale with references in order to bring the reader to a higher level in his or her grasp of the informa- tion. With this approach, the authors bring the reader face to face with hand therapy’s core literature. Hand Rehabilitation: A Quick Reference Guide and Reviewoffers a great deal of information and enjoyment for students and health professionals of all levels of expertise. Falkenstein and Weiss have walked the difficult path of incorporating the breadth of hand therapy wisdom—from the basic core concepts (that always seem to need review) to the most esoteric topics. I was thrilled to finally have a name for a sign that I commonly find in my patients but have never seen refer- enced—despite many years of reading. Who among us is familiar with Linburg’s sign? This is the anatomic interconnection between the flexor pollicis longus and the index finger flexor dig- itorum profundus that causes the index distal interphalangeal joint to flex when the thumb inter- phalangeal joint flexes and vice versa. This is only one example of the answers to career-long questions that I found in this text. The authors have carefully sifted through the huge range of hand therapy topics and selected strategic chapters, including evaluation; flaps, grafts, and thermal conditions; wounds and infec- tion; Dupuytren’s disease and tumors; fractures; arthritis; reflex sympathetic dystrophy; tendons; splinting; congenital anomalies, amputations, prosthetics; modalities; cumulative trauma; joint mobilization and other treatment techniques; and several chapters on anatomy. This book covers all commonly seen pathologies, as well as some rarer hand pathologies. It also includes topics usually omitted from texts on hand therapy, and a resource list of vendors offering hand therapy products. I commend Falkenstein and Weiss for including a nutritional quick reference— a topic so critical to excellent outcomes and so often ignored. In keeping with the up-to-date nature of this text, the authors have also included a list of hand therapy–related Internet web- sites. With such a wellspring of information, no therapist should ever want for references or resources. I predict Hand Rehabilitation: A Quick Reference Guide and Reviewwill be the number one pub- lication sought by therapists studying for the Hand Certification exam. All health professionals and students interested in hand rehabilitation will find this to be a one-of-a-kind, quick xiii FM.qxd 7/31/04 1:56 PM Page xiv xiv Foreword to the Firsst Edition reference text that provides a comprehensive overview. It is well thought out, creatively designed, and packed with the resources we all need as hand rehabilitation professionals. I cannot thank the authors enough for providing the hand therapy community with this book. Karen Schultz-Johnson, MS, OTR, FAOTA, CHT Director, Rocky Mountain Hand Therapy President, UE Tech FM.qxd 7/31/04 1:56 PM Page xv Foreword to the First Edition Those in the upper extremity rehabilitation world know that it takes a Herculean effort to under- stand and keep up with massive amounts of information. We are now inundated with books, jour- nals, and web pages. Continuing education and society meetings fill your calendar. So why would I agree to support yet another book on the hand and upper extremity? The reason is simple. This book amplifies and defines the areas of the upper extremity you need to bone up on and reviews the areas you are competent in. This aptitude assessment is easily evaluated with this book. As well, this book is another nice clinical resource that uses a creative and unique format (thank you Nancy Falkenstein and Susan Weiss) to present hand and upper extremity information. At first glance this is a book of test questions and answers on the upper extremity. Although this conjures up images of hours spent reading preparatory books for standardized tests such as the SAT or GRE, there is much more to this book. “Clinical Gems” permeate each chapter and provide easy-to-remember pearls of wisdom regarding various anatomic regions of the upper extremity, specific pathologic states, splinting, modalities, occupational considerations, and research. Answers to the questions are clearly and concisely stated and supplemented with inform- ative illustrations. Quick referencing is made easy through a detailed index at the front of the book. The slide rule helps suppress the desire to check the correct answer before formulating it yourself. Obviously, the structure of this book is designed to aid readers preparing for exams on the upper extremity. There is no other book on the upper extremity available that meets this need, and it serves that purpose extremely well. I hope, however, that readers use it for more than just preparing for “the test.” The format of this book lends itself to self-assessment, which all too often stops once we leave the confines of professional schooling. The exercise of testing yourself is akin to looking at your professional image in the mirror. Is there substance to what you see or is it simply superficial and without state-of-the-art content? This book is the tool for such an assessment. Certainly when areas of weakness are identified, definitive books and specialized journals are essential for in-depth discussion. I’ll never forget how failing a test in school served as a well-defined signal that I had areas of study that needed significant attention. This type of critique should not be limited to your professional education. I encourage all upper extremity rehabilitation professionals to take advantage of this opportunity to assess your level of competence and better define your areas of need. After doing this, read, attend meetings, “surf the net,” question mentors and colleagues, and encourage questions from students. Then combine these academic experiences with the art of treating patients. Good luck and fear not the “test” as it is the test that crystallizes and better defines opportunities for growth. Paul LaStayo, MPT, CHT Northern Arizona University, Department of Biology and DeRosa Physical Therapy, P.C. Flagstaff, Arizona xv FM.qxd 7/31/04 1:56 PM Page xvii Preface The art and science of asking questions is the source of all knowledge.—Adolf Berle The question-and-answer format of the second edition book is designed with a thorough Quick Reference of Hand Rehabilitation: A Quick Reference Guide and Guide, found at the beginning of the book, to assist the Reviewprovides readers with the unique opportunity to reader in quickly finding information on any topic. A answer questions and the inspiration to ask more. We wealth of special features are provided in this book, have written this book to challenge readers to learn and including Clinical Gems, case studies, a slide rule to aid develop a better understanding of the exciting art of in self-testing, a list of drugs commonly encountered hand rehabilitation. We hope that this book will become in hand rehabilitation, nutrition resources, vendors/ a premier resource for many individuals in the health website resources, and the addition of a bind-in CD- sciences, including hand specialists, certified hand ROM that contains the practice questions in a quiz therapists, occupational and physical therapists and format, allowing the user to perform random self-tests students, occupational therapy and physical therapy multiple times. We have added two chapters, The assistants in hand rehabilitation settings, medical and Elbow and Sports Injuries of the Upper Extremity, nursing students, physicians, physician assistants, oper- making the book more comprehensive. In addition, we ating room technicians, and orthopedic technicians. have doubled the information included in the text. This book can be used in a classroom setting or by prac- There are several different ways to use this text: (1) titioners who work with or would like to work with Readers can review questions and answer explanations patients who have hand or upper extremity disorders. as a method of learning the material. (2) The book can In addition, of course, it is an excellent resource and be used as a quick reference to access information on a study guide for professionals preparing for specialty particular topic or clinical problem. (3) Readers can examinations such as the Certified Hand Therapy perform self-assessments using the slide rule method, examination, the Board-Certified Hand Surgery exam- covering up the answer portion with the slide rule pro- ination, and the Certified Orthopaedic Specialty exam- vided in the back of the book. (This is part of the back ination. Students preparing for general registration cover and perforated for easy removal.) Readers can examinations will also greatly benefit from the self- take their time to come up with the correct answer and study method presented. then move the slide rule down to reveal the answer. This book provides a comprehensive overview of Readers may want to write their answers on a separate hand rehabilitation through a detailed question-and- sheet of paper so they can test themselves more than answer format that consists of multiple choice, true once. (4) Case studies have been used throughout the and false, matching, and fill-in-the-blank questions. book to show the reader how content applies to clinical Following the question-and-answer choices, we have practice. (5) The CD-ROM is used for random testing, provided detailed explanations of the correct answer. allowing you to scramble the questions to test your References, including page numbers, are cited with each knowledge. (6) There are four appendixes at the end of question to provide the reader with a simple avenue for the book to use as a quick reference on various subjects. further study on a particular subject. In addition, many We have included more than 200 Clinical Gems illustrations have been included to aid in the ease of compiled by therapists, physicians, and educators. learning and understanding the topics presented. This Clinical Gems range from splinting tips to mnemonics xvii FM.qxd 7/31/04 1:56 PM Page xviii xviii Preface for remembering hand surgery and rehabilitation www.exploringhandtherapy.com and register for our facts. The Clinical Gems provide invaluable clinical comprehensive newsletter. We have devoted countless information. hours to preparing and writing this book. Our goal is This book has been developed through years of to provide a quick reference resource that continues to experience, preparation for specialty certification, fill a void in hand rehabilitation literature. We devel- and the desire to learn the art of exploring hand reha- oped all of the chapters with the assistance of our con- bilitation. Through the dedication to learning and tributors who have diverse professional backgrounds. teaching we have founded Exploring Hand Therapy, We express our deep appreciation to the contributors Inc. To learn more about hand therapy, please visit for sharing their knowledge.
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