Therapy of the Hand and Upper Extremity: Rehabilitation Protocols

250 Pages·2015·6.25 MB·English

by  Scott F. M. Duncan

Scott F.M. Duncan
Christopher W. Flowers
Therapy of the Hand
and Upper Extremity
Rehabilitation Protocols
123
Therapy of the Hand
and Upper Extremity

Scott F. M. Duncan
Christopher W. Flowers
Therapy of the Hand
and Upper Extremity
Rehabilitation Protocols
Scott F. M. Duncan Christopher W. Flowers
Department of Orthopedic Department of Orthopedic
Surgery Surgery
Boston University/Boston Ochsner Medical Center
Medical Center New Orleans , LA , USA
Boston , MA , USA
ISBN 978-3-319-14411-5 ISBN 978-3-319-14412-2 (eBook)
DOI 10.1007/978-3-319-14412-2
Library of Congress Control Number: 2015930049
Springer Cham Heidelberg New York Dordrecht London
© Springer International Publishing Switzerland 2015
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Pref ace
T he purpose of this book is to provide the orthopedic sur-
geon and hand surgeon as well as the physical, occupational,
and hand therapist with an easy, “go-to” quick reference
source for potential rehabilitation protocols. By no means
does this book represent the only way to rehabilitate an
injury or a surgery postoperatively, but it does represent our
collective synthesizing of various therapy protocols over the
last 15 years. This book has been written to try and meet the
need for a quick reference text for rehabilitative protocols
that the active clinician needs in their practice.
The evolution of orthopedic surgery, hand surgery, and
rehabilitative therapy has been challenging in that some
treatments have not withstood the test of time or the rigors
of scientific evaluation. Nonetheless, this book tries to still
honor the art of medicine while incorporating the latest
accepted rehabilitative protocols that many surgeons and
therapists are currently using. No one protocol is necessarily
entirely satisfactory, but these outlines of protocols should
allow the surgeon and therapist to build upon them to meet
the needs of their patients. One of the important aspects of
rehabilitation is to understand the different phases of treat-
ment and that not all phases are necessarily “cut and dry,”
ending at one particular point of time and beginning at
another. Much of therapy is really a fluid situation and must
v
vi Preface
be adjusted accordingly to the type of surgery (or injury) as
well as the day-to-day condition of the patient. There is the
old adage that great therapy can overcome even mediocre
surgeries, and in some cases, that adage is quite correct. As
therapy visits become more expensive for patients with
higher deductibles and higher co-pays, as well as a limit on
the absolute number of visits that the payer will cover, it is all
the more important for each therapy visit to have a more
significant impact both educationally as well as on the
patient’s physical condition.
In conclusion, we hope that this book benefits patients and
helps the orthopedic surgeon, hand surgeon, physical thera-
pist, occupational therapist, and the hand therapist provide
better care for the patients that they all serve. We appreciate
the many mentors who have imparted this knowledge to us,
and this book represents our humble way of giving back for
what so many have given to us.
Boston, MA Scott F. M. Duncan
New Orleans, LA Christopher W. Flowers
Contents
Part I Shoulder Arthroplasty
1 Hemiarthroplasty/Total Shoulder Arthroplasty ...... 3
2 Reverse Total Shoulder Arthroplasty ....................... 7
Part II Shoulder Sports Injuries
3 AC Joint Reconstruction ............................................ 11
4 Arthroscopic Anterior Stabilization
(Latarjet Procedure) ................................................... 13
5 Arthroscopic Bankart/SLAP Repair
+/− Capsulorrhaphy .................................................... 19
6 Arthroscopic Posterior Labral Repair ...................... 23
7 Arthroscopic Rotator Cuff Repair
(Large/Massive) ........................................................... 27
8 Arthroscopic Rotator Cuff Repair
(Small/Medium) ........................................................... 31
9 Arthroscopic Subacromial Decompression,
+/− Acromioplasty/Distal Clavicle Excision,
+/− Biceps Tenotomy .................................................. 37
10 Humeral Head Microfracture .................................... 39
vii
viii Contents
11 Pectoralis Major Repair ............................................. 41
12 Scapular Dyskinesia (Periscapular and Rotator
Cuff Strengthening) ..................................................... 43
Part III Shoulder Trauma
13 Clavicle Fracture .......................................................... 47
14 Mid-Shaft Humerus Fracture Nonoperative ............ 49
15 Midshaft Humerus ORIF ........................................... 51
16 Proximal Humerus Fracture Nonoperative ............. 53
17 Proximal Humerus Fracture ORIF ........................... 55
Part IV Elbow Nerve Injuries
18 Cubital Tunnel In Situ Release .................................. 59
19 Cubital Tunnel Syndrome Nonoperative .................. 61
20 Cubital Tunnel with Anterior Transposition ............ 63
21 Cubital Tunnel with Intramuscular
Transposition ................................................................ 65
22 Radial Nerve Repair ................................................... 67
23 Radial Tunnel Syndrome ............................................ 69
24 Splinting for Nerve Palsies
of the Upper Extremity .............................................. 71
25 Ulnar and/or Median Nerve Repair .......................... 73
Contents ix
Part V Elbow Sports Injuries
26 Distal Biceps Repair ................................................... 77
27 Elbow Arthroscopy ..................................................... 79
28 Elbow UCL Reconstruction....................................... 81
29 Lateral Epicondyleplasty ............................................ 83
30 Lateral Epicondylitis “Tennis Elbow”
Nonoperative ................................................................ 85
31 Lateral Epicondylitis/Extensor Carpi Radialis
Brevis Release (Elbow) .............................................. 89
32 Medial Epicondylitis Nonoperative .......................... 91
33 Medial and Lateral Epicondylectomy ...................... 93
34 Triceps Reconstruction ............................................... 95
Part VI Elbow Trauma
35 Above or Below the Elbow Amputation .................. 99
36 Distal Humerus Fracture ORIF ................................ 101
37 Elbow Resection Arthroplasty .................................. 103
38 Radial Head Fractures, Olecranon Fractures,
and Elbow Dislocation ................................................ 105
Part VII Wrist Bone Injuries
39 Wrist Arthrodesis ........................................................ 109
40 Wrist Arthroplasty ....................................................... 111