Hand and Upper Extremity Rehabilitation

A Practical Guide

Rebecca Saunders, Romina Astifidis, Susan L. Burke, James Higgins, Michael A. McClinton

• Publisher: Churchill Livingstone
• Year: 2015
• ISBN:
  9781455756490
• Edition: 4
• Topic: Medicine
• Subtopic: Occupational Therapy

Blending the latest technical and clinical skills of hand surgery and hand therapy, Hand and Upper Extremity Rehabilitation: A Practical Guide, 4th Edition walks you through the treatment of common medical conditions affecting the upper extremities and highlights non-surgical and surgical procedures for these conditions. This expanded fourth edition presents the latest research in hand and upper extremity rehabilitation and provides the purpose and rationale for treatment options.

• Clinical outcomes included in each chapter relate clinical expectations to the results of clinical research trials, providing you with the expected range of motion and function based on evidence in the literature.
• Highly structured organization makes information easy to find, allowing the text to function as a quick reference in the clinical setting.
• Contributors from a variety of clinical settings like hand therapy clinics, hospitals, and outpatient clinics means you get to learn from the experience of clinicians working in diverse clinical contexts like yourself.
• Over 400 line drawings and clinical photographs delineate important concepts described in text.
• Chapters divided into eight parts - Wound Management, Nerve Injuries, Tendon Injuries, Shoulder, Elbow, Wrist and Distal Radial Ulnar Joint, Hand, and Special Topics - so information can be located quickly.
• 51 leading experts offer fresh insight and authoritative guidance on therapeutic approaches for many common diagnoses.
• Treatment guidelines presented for each stage of recovery from a wide range of upper extremity conditions.

• NEW! Authoritative quick reference guide to surgical and non-surgical procedures for hand and all upper extremity conditions.
• NEW! Updated information and references offers the latest information and research in the areas of hand and upper extremity rehabilitation.
• NEW! Larger trim size and new design accommodates a two-column format that is easier to follow.

II

Nerve Injuries and Compression

In Memoriam

Elaine Ewing Fess, MS, OTR, FAOTA, CHT, Adjunct Assistant Professor, Indiana University, School of Health & Rehabilitation Sciences, Department of Occupational Therapy, 1140 West Michigan Street, Room 311A, Indianapolis, IN 46202–5119, USA

Judith Bell-Krotoski, MA, OTR, FAOTA, CHT March 30, 1945 – October 20, 2013

Through her research, teaching, and clinical application of sensibility testing concepts, Judith Bell-Krotoski made an indelible and lasting contribution to current understanding and subsequent documentation of peripheral nerve function. Her interest in sensibility testing escalated when, working at the Hand Center* in Philadelphia, PA, she recognized the potential of the Semmes-Weinstein monofilaments to delineate clinical changes in sensory nerves.

A few years later, when she returned to Carville, LA, in 1978, to work with Paul Brand, MB, BS, FRCS, at the National Hansen’s Disease Center (GWLHDC), Judy took the concept of the monofilaments with her; a step that would forever influence the trajectory of her career. Working with Dr. Brand’s team of elite bioengineers, Judy delved into the instrumentation properties of hand-held sensibility testing devices including 2-point discrimination (2-PD), tuning forks, and the Semmes-Weinstein monofilaments. Spanning a thirty-six year period that culminated in multiple seminal research papers, Judy, her bioengineer research team, and her research colleagues described the following pivotal concepts regarding peripheral nerve testing:

(1) “Spectral analysis of the force frequency signal produced by hand held sensibility measurement instruments shows they all produce both high and low frequency signals sufficient in strength to stimulate both slowly adapting and quickly adapting end organs, and are not capable of stimulating one particular group.”^1,2

(2) “If their lengths and diameters are correct, the filaments produce application forces that are repeatable within a predictable range”.^3,4

(3) “Only the Semmes-Weinstein monofilaments provide some control of force during application and can be considered force controlled if calibrated and applied correctly.”^1,2

(4) “The 2.83 filament was a good predictor of normal … for the hand, the arm, and the leg, as was expected. It was suprathreshold for the face, making use of a lighter filament possible for facial testing, and subthreshold for the plantar surface of the foot, which required a slightly heavier filament (3.61 marking number, mean force, 279 mg) for normal threshold detection.”⁴

(5) “The mini-kit is sufficient for most purposes and requires greatly reduced time for the test, making patient testing more advantageous. The mini-kit employs five^† specially selected forces of the 20 available in the full set.”⁵

(6) Mapping using color coded “filaments that apply force greater than that of the 2.83 filament may be used to quantify degrees of abnormality.”⁶

(7) During the manufacturing process, it is crucial that extruded filament material be released and stored on a flat, level surface; as opposed to being wound onto spools. Winding filament onto spools damages the inherent column mechanics of extruded filament, rendering it weaker, less durable, and defective for use in sensibility testing instruments.⁷

In 2000, the nonpareil clinical efficacy of the monofilaments was further underscored when Judy noticed that the sensibility status of some of her Hansen’s Disease (HD) patients continued to deteriorate despite the sophisticated pharmacologic interventions they were receiving. Judy’s tenacity and persistence in alerting other personnel to her patients’ worsening neurologic changes impelled a referring physician to biopsy the peripheral nerves of the involved patients. Much to everyone’s surprise (except Judy’s), live mycobacterium leprae bacilli were found in the biopsied nerves. The monofilaments were the only hand-held instruments to identify the moderate, but highly significant, decline in patient nerve status. Subsequently, world-wide alerts were issued describing the problem; and additional pharmacologic management was initiated for the specific HD subpopulation that was nonresponsive to the original drug medications.

While Judy’s work mistakenly is associated solely with the Semmes-Weinstein monofilaments, the significance of her research regarding other hand-held sensibility testing instruments and their associated instrumentation properties and limitations is equally important. Shortcomings must first be identified before appropriate solutions may be generated. Throughout her professional career, Judy never deviated from her primary focus of improving patient care. The above scenario is an excellent example of how a knowledgeable and tenacious therapist, armed with a valid and reliable assessment instrument, can positively influence patient treatment on a global scale. The magnitude of Judy’s research in sensibility testing is valued universally; not only...