Hand and Wrist Therapy: Clinical Examination and Advanced Rehabilitation Tools

Foreword
Contents
Contributors
Part I: Clinical Examination and Clinical Reasoning
1: Clinical Examination of the Wrist and Hand
1.1 Notion of Multidisciplinary Team and Position in the Care Protocol
1.1.1 The Notion of “Team”
1.1.2 The Clinical Assessment in the Care Protocol
1.2 Tools Needed
1.2.1 Visual Analog Scale (VAS)
1.2.2 Measuring Tape
1.2.3 Laser Thermometer
1.2.4 Transcutaneous Vibratory Stimulating Device
1.2.5 Semmes-Weinstein Monofilaments
1.2.6 Goniometers
1.2.6.1 Cochin Goniometer
1.2.6.2 Rippstein Goniometer
1.2.7 Dynamometers
1.2.7.1 Dynamometer Measuring Grasp (Jamar)
1.2.7.2 Vigorimeter Measuring Grip (Martin)
1.2.7.3 Dynamometer Measuring the Pinch
1.2.7.4 Measuring the Clamp
1.2.7.5 Dynamometer Measuring the Wrist Strength in Flexion and Extension, and Ulnar and Radial Inclinations
1.2.7.6 Dynamometer Measuring the Strength in Pronosupination
1.2.8 Ruler
1.2.9 Camera
1.2.10 Echograph
1.3 General Organization of the Assessments
1.3.1 Anamnesis
1.3.1.1 Environment
1.3.1.2 Observation
1.3.1.3 Etiology
1.3.1.4 Functional Signs
Pain
Nociceptive Pain
Neuropathic Pain (No Allodynia)
Allodynia
Mobility
Loss of Strength
“Jumps” and Cracking
1.3.2 Clinical Signs
1.3.2.1 Palpation (Fig. 1.17)
1.3.2.2 Trophic Examination
1.3.2.3 Scar Examination
Objective Assessment Tools
Wound Size
Wound Location
Diascopy (Skin Recoloring)
Skin Stretching and Pulling Tests
Hybrid Assessment Tools (Objective and Subjective)
Vancouver Scar Scale
POSAS
1.3.2.4 Sensory Examination
Spatial and Temporal Conditions
Time
Environment
Nomenclature
Stages of Cutaneous Sensorial Recovery [18–20]
Quantitative Test: Aesthesiography
Qualitative Tests
Thermal Nociception and Mechanical Nociception
Sympathetic Nervous System
Threshold Tests
Density Tests (Fig. 1.33): Static Two-Point Discrimination Test (Weber Test)
Density Tests: Moving Two-Point Discrimination Test (Dellon Test)
Density Tests: Tingling Test (Table 1.5)
Functional Tests
Functional Tests: Stereognosis and Morphognosia Assessment
Functional Tests: Hylognosia Assessment
1.3.2.5 Mobility Assessment
Quantitative Aspects
Wrist
Hand
Qualitative Aspects
Type of “Stop” and Range of Motion Limitation Depending on the Adjacent Joints
Significant Difference Between Active Range of Motion and Passive Range of Motion
Joint Glidings
1.3.2.6 Neuromotor Assessment
Reflex Motricity
Automatic Motricity
Voluntary Motricity
Muscular Testing
Dynamometric Measurements
1.3.2.7 Clinical Tests
Mobility
Finochietto Test
Kilgore Test
Haines Test
Blocked Finger After Active fFexion
Instability
In the Hand: Joint Laxity Tests
In the Wrist
Tendons
Tendinous “Triad”
Cyriax’s Criteria
Eichhoff’s Test (Sensitivity 89%, Specificity 14%)
Extensor Carpi Ulnaris Instability
Nerves
Wartenberg’s Sign
Froment’s Sign
Ulnar Claw
“Monkey” Hand
“Falling” Hand
Pseudo-Tinel (Sensitivity 70% and Specificity 98%) [62]
Phalen’s Test + Compression (Sensitivity 89% and Specificity 96%): Median Nerve
Reversed Phalen’s Test + Compression: Ulnar Nerve
Resisted Supination with Extended Elbow
Scratch Collapse Test
1.3.2.8 Functional Scores
1.3.2.9 Echoscopy
Assessment
Assessment and Implementation of the Most Adapted Treatment: Case Example 1
Assessing the Treatment Efficiency
Didactic Aspect
Scientific Research
References
2: Clinical Reasoning in the Traumatic and Micro-Traumatic Pathologies of the Hand
2.1 Lack of Motion
2.1.1 Lack of Motion Depending on the Position of the Upper and Lower Joints
2.1.2 Lack of Motion Not Depending on the Position of the Upper and Lower Joints
2.1.3 Lack of Active Motion
2.2 Instabilities (Fig. 2.6)
2.2.1 Instabilities with Objective Evidence of Damaged Joint
2.2.2 Instabilities with No Objective Evidence of Damaged Joint
2.3 Pain (Fig. 2.7)
2.3.1 Nociceptive Pain
2.3.2 Neuropathic Pain
2.4 Conclusion
References
Part II: Rehabilitation Tools and Techniques
3: Physical Agents
3.1 Cryotherapy
3.1.1 Local Effects When Applying Cold
3.1.2 Application
3.1.3 Ice Bag and Similar Techniques
3.1.4 Immersion
3.1.5 Gaseous Cryotherapy
3.1.6 System Combining Compression and Cryotherapy
3.2 Depresso-Therapy
3.3 Electrotherapy
3.3.1 Essential Notions
3.3.2 Practical Impact: Striomotor Currents
3.3.2.1 Innervated Muscles
3.3.2.2 Denervated Muscles
3.3.3 Practical Impact: Analgesic Currents
3.3.3.1 High Frequency TENS
3.3.3.2 Low Frequency TENS
3.3.3.3 Mixed Currents
3.3.4 Practical Impact: Tonolysis
3.3.5 Practical Impact: Ionophoresis
3.4 Fluidotherapy and Thermotherapy
3.4.1 Fluidotherapy
3.4.2 Heat
3.5 High-Pressure Water Jet
3.6 Mechanical Waves
3.6.1 Transcutaneous Vibratory Stimulations (Fig. 3.19)
3.6.1.1 Pain
3.6.1.2 Proprioception
3.6.1.3 Skin Sensitivity
3.6.1.4 Neuroma
3.6.2 Infrasounds (Fig. 3.20)
3.6.3 Ultrasounds (Fig. 3.21)
3.7 Pressotherapy
3.8 Scottish Baths
References
4: Scar Massage and Treatment
4.1 Integumentary Physiology
4.1.1 Skin Anatomy
4.1.2 Palmar Skin
4.1.3 Dorsal Skin
4.1.4 Dorso-Palmar Partition
4.1.5 Functional Units
4.2 Healing Process
4.2.1 Hemostasis
4.2.2 Inflammatory Phase
4.2.3 Granulation Tissue and Neovascularization
4.2.4 Re-Epithelialization
4.2.5 Tissue Maturing and Remodeling
4.3 Pathological Scars
4.3.1 Hypertrophic Scars
4.3.2 Keloid Scars
4.3.3 Adhesive Scars
4.3.4 Retractile Scars
4.3.5 Burn Scars
4.4 Factors Influencing Healing [8, 9]
4.4.1 Local Factors
4.4.2 General Factors
4.5 Scar Treatment (Table 4.6)
4.5.1 Noninvasive Methods
4.5.1.1 Preventive Treatment
4.5.1.2 Compressive Treatment
4.5.1.3 Occlusive Treatment with Silicone
4.5.1.4 Manual Techniques
Manual Lymphatic Drainage (MLD)
Massages
Physiotherapy
4.5.2 Invasive Treatments
4.5.2.1 Corticosteroids
4.5.2.2 Laser
4.5.2.3 Surgery
References
5: Hand and Wrist Mobilizations
5.1 General Background
5.1.1 Osteoarticular Kinematics
5.1.2 An Early Mobilization
5.1.3 A Mobilization at the Right Dose
5.1.4 The Total End Range Time Theory
5.1.5 Different Approaches in Joint Mobilization
5.1.5.1 Kaltenborn’s Approach
5.1.5.2 Maitland’s Approach
5.1.5.3 Mulligan’s Approach
5.1.5.4 From Theories to Practice
5.2 Mobilization Techniques
5.2.1 The Convexity and Concavity Rules
5.2.2 How to Use Mobilization Techniques
5.2.3 The Radioulnar Unit Mobilization
5.2.3.1 The Proximal Radioulnar Joint
5.2.3.2 The Interosseous Membrane
5.2.3.3 The Distal Radioulnar Joint
5.2.4 Wrist Mobilizations
5.2.4.1 Radiocarpal Joint
Biomechanical Reminder
Mobilization Techniques
5.2.4.2 Midcarpal Joint
Biomechanical Reminder
Mobilization Techniques
5.2.4.3 Scapholunate and Lunotriquetral Joints
Scapholunate Joint Mobilization
Lunotriquetral Joint Mobilization
5.2.5 Finger Joints Mobilizations
5.2.5.1 Anatomical and Biomechanical Reminder
Metacarpophalangeal Joint
Proximal Interphalangeal Joint
Distal Interphalangeal Joint
5.2.5.2 Mobilization Techniques
5.2.6 Thumb Joints Mobilizations
5.2.6.1 Thumb Carpometacarpal Joint
Anatomical Reminder
Mobilization Techniques
5.2.6.2 Thumb Metacarpophalangeal Joint
Anatomical Reminder
Mobilization Techniques
5.2.6.3 Thumb Interphalangeal Joint
Anatomical Reminder
Mobilization Technique
References
6: Neurodynamic Mobilizations
6.1 General Notions
6.1.1 Neuro-Mechanics
6.1.2 Neurophysiology
6.1.3 Patho-Neurodynamics
6.2 Neurodynamic Principles
6.2.1 Assessment
6.2.2 Treatment
6.3 Neurodynamic Mobilization Techniques
6.3.1 Median Nerve
6.3.1.1 Nerve Tension
6.3.1.2 Nerve Gliding
6.3.1.3 Self-Mobilizations
6.3.1.4 Working on Adjacent Tissues
6.3.2 Ulnar Nerve
6.3.2.1 Nerve Tension
6.3.2.2 Nerve Gliding
6.3.2.3 Self-Mobilizations
6.3.2.4 Working on Adjacent Tissues
6.3.3 Radial Nerve
6.3.3.1 Nerve Tension
6.3.3.2 Nerve Gliding
6.3.3.3 Self-Mobilizations
6.3.3.4 Working on Adjacent Tissues
References
7: Physiology and Rehabilitation of Sensorial and Motor Disorders
7.1 Nerve Physiology [1]
7.2 Functional Classification of Nervous Injuries
7.3 Chronology of Re-Afferentation [6–8]
7.4 Sensorial Physiology
7.4.1 Receptors for Skin Sensitivity (Table 7.1) [8]
7.4.1.1 Mechanoreceptors
7.4.1.2 Thermoreceptors (Fig. 7.4)
7.4.1.3 Nociceptors
7.4.2 Receptors for Muscles, Tendons, and Joints
7.4.2.1 Musculo-Tendinous Captors
7.4.2.2 Joint Captors (Table 7.2)
7.4.3 Protopathic Sensitivity (Thermo-Algesia or “Protective Sensitivity”)
7.4.3.1 Nociceptive Sensitivity: Types of Pain
7.4.3.2 Nociceptive Sensitivity: Transmission of the  Nociceptive Message
7.4.3.3 Protopathic Sensitivity Other than Nociceptive
7.4.4 Epicritic Sensitivity
7.4.4.1 Vibrotactile Sensitivity
7.4.4.2 Proprioceptive Sensitivity
7.4.5 Autonomic System
7.5 Rehabilitation of Sensorial Disorders
7.5.1 Rehabilitation of Hyposensitivity
7.5.1.1 Phase 1: Vibrotactile Anesthesia (S0 and S1)
7.5.1.2 Phase 2: Vibrotactile Rehabilitation (S2 to S4)
7.5.2 Rehabilitation of Sensorial Disorders (Not Allodynia)
7.5.2.1 Terminology of the Concerned Disorders [22]
7.5.2.2 Rehabilitation of Sensorial Disorders (Not Allodynia)
7.5.3 Rehabilitation of Allodynia
7.5.3.1 Distant Vibrotactile Counter-Stimulation (DVCS)
7.5.3.2 Gradual Motor Imagery
7.6 Rehabilitation of Motor Disorders
7.6.1 Rehabilitation Depending on Stages
7.6.1.1 Stages 0 and 1
7.6.1.2 Stage 2
7.6.1.3 Stage 3
7.6.1.4 Stages 4 and 5
References
8: Rehabilitation of Proprioception
8.1 Sensory Perception
8.1.1 Exteroceptive Receptors
8.1.2 Interoceptive Receptors
8.1.3 Joint Mechanoreceptors (Fig. 8.2)
8.2 Conscious and Unconscious Proprioception
8.2.1 Conscious Proprioception
8.2.2 Unconscious Proprioception
8.2.2.1 Feedback and Feedforward (Fig. 8.5)
8.3 Rehabilitation Steps (Fig. 8.6)
8.3.1 First Stages Recovered: Conscious Proprioception
8.3.1.1 Proprioceptive Consciousness (Hagert’s Second Stage)
8.3.1.2 Joint Position Perception (Hagert’s Third Stage)
8.3.1.3 Kinesthesia (Hagert’s Fourth Stage)
8.3.2 Last Stages Recovered: Unconscious Proprioception
8.3.2.1 Conscious Neuromuscular Rehabilitation (Hagert’s Fifth Stage)
Static Contractions
Dynamic Contractions
8.3.2.2 Unconscious Neuromuscular Rehabilitation or Reflex Muscle Activation (Hager’s Sixth Stage)
References
9: Rehabilitation Using Motor Imagery After a Post-Traumatic Cortical Reorganization
9.1 Introduction
9.2 Brain Plasticity
9.2.1 Illustrations of Brain Plasticity and Cortical Remodeling
9.3 Mirror Neurons and Canonical Neurons
9.4 Phantom Limb
9.5 Complex Regional Pain Syndrome
9.6 Segmentary Exclusion Syndrome
9.7 Consequences of Immobilization and Underutilization
9.8 Mental Imagery and Motor Imagery
9.8.1 Motor Imagery Therapy
9.8.1.1 Implicit Motor Imagery: Left/Right Discrimination
9.8.1.2 Explicit Motor Imagery: Imagined Actions
9.8.2 Motor Observation
9.8.2.1 Direct Vision of an Action
9.8.2.2 Mirror Therapy
9.8.2.3 System of Derived Mirrors
9.8.3 Precautions and Recommendations
9.8.4 Motor Imagery Therapy in Practice
9.9 Other Indications
9.10 Conclusion
References
10: Self-Rehabilitation
10.1 Fundamental Concepts
10.1.1 Treatment Plan
10.1.2 Multidisciplinary Care for Patient Education
10.1.3 Physiotherapy Treatment for Treating Impairments and Function (Program Implementation and Progression According to Brody and Hall’s Work [6])
10.1.3.1 What Is the Optimal “Dosage” for Self-Rehabilitation Exercises?
10.1.3.2 Which Activities and Exercises Can Be Recommended?
10.1.3.3 How to Create a Progression?
10.1.3.4 What Medium Should Be Used to Give the Program to the Patient?
References
Part III: Common Hand and Wrist Orthoses
11: Common Hand and Wrist Orthoses
11.1 Materials
11.2 Classification
11.2.1 Eponymous
11.2.2 Acronymous
11.2.3 Descriptive
11.3 Mechanical Principles
11.4 Non-Articular Orthoses
11.4.1 Syndactylies
11.4.2 Base for Silicone
11.5 Articular Immobilization Orthoses
11.5.1 Articular Wrist Immobilization Orthosis
11.5.2 Articular Wrist and Thumb TM and MP Joint Immobilization Orthosis
11.5.3 Articular Thumb TM-MP Joint Immobilization Orthosis
11.5.4 Articular Finger CM-MP Joint Immobilization Orthosis
11.5.5 Articular Finger IP Joint Immobilization Orthosis
11.5.6 “Stack” Orthosis—Articular Finger DIP Joint Immobilization Orthosis
11.5.7 “Modified Duran” Orthosis—Articular Wrist, Finger MP-IP Joint (or Thumb TM-MP-IP Joints) Immobilization Orthosis
11.5.8 Articular Finger PIP Joint Immobilization Orthosis
11.5.9 Articular Wrist, Finger MP-IP Joint Immobilization Orthosis
11.5.10 Articular Wrist Immobilization and MP Joint (of the Injured Finger) Restriction Orthosis
11.5.11 Articular Wrist, Thumb TM-MP-IP Joint Immobilization Orthosis
11.6 Articular Mobilization Orthoses
11.6.1 Range Gaining Orthoses
11.6.1.1 Serial Static Orthoses
Articular PIP Extension Mobilization Orthoses
Articular Finger MP and IP Joint Extension Mobilization Orthosis
11.6.1.2 Static Progressive Orthoses
11.6.1.3 Dynamic Orthoses
Pro-Flexion
Articular Finger MP-PIP-DIP Joint Flexion Mobilization Orthosis
Articular MP Joint Flexion Mobilization Orthosis (Fingers/Thumb)
Articular PIP Joint Flexion Mobilization Orthosis for Fingers (and the IP Joint of the Thumb)
Articular Interphalangeal Joint Flexion Mobilization Orthosis for Fingers
Pro-Extension
Articular MP-PIP-DIP Joint Extension Mobilization Orthosis for the Fingers or “Levame” Orthosis
Articular PIP Joint Extension Mobilization Orthosis or “Capener” Orthosis
11.6.2 Substitution Orthoses
11.6.2.1 Articular MP Joint Extension Mobilization Orthosis (Radial Nerve Palsy)
11.7 Restriction Orthoses
11.7.1 Articular PIP Joint Extension Limitation Orthosis
11.7.2 Articular MP Joint Extension Limitation Orthosis for Fingers 4 and 5
11.8 Torque Transmission Orthoses
11.8.1 Active Redirecting Orthoses
11.8.2 Casting Motion to Mobilize Stiffness (CMMS)
11.9 Articular Functional Orthoses
11.9.1 For the Wrist
11.9.2 Wrist Wrap
11.9.3 For the Wrist and the Thumb TM-MP Joints
11.9.4 For the Thumb TM Joint
11.9.4.1 Neoprene Straps
11.9.4.2 Made of Thermoplastic
11.9.5 For the Thumb TM-MP Joints
References