Rehabilitation of Elbow Instability.

The elbow is the second most commonly dislocated major joint in adults with estimated incidence of 5 dislocations per 100,000 persons per year. A comprehensive understanding of elbow anatomy and biomechanics is essential to optimize rehabilitation of elbow injuries. This allows for implementation of a systematic therapy program that encourages early mobilization within a safe arc of motion while maintaining joint stability. To optimize outcomes, close communication between surgeon and therapist is necessary to allow for implementation of an individualized rehabilitation program. This article reviews key concepts that enable the clinician to apply an evidence-informed approach when managing elbow instability.

Zone III flexor tendon injuries - A proposed modification to rehabilitation.

In this manuscript, these authors have utilized years of clinical experience to suggest rehabilitation modifications for Zone III flexor tendon injuries. - VictoriaPriganc, PhD, OTR, CHT, CLT, Practice Forum Editor.

Static progressive orthosis for patients with limited radial and/or ulnar deviation: an innovative orthotic design.

After injury to the wrist and forearm, therapists and patients frequently work to regain the motions of wrist flexion/extension and forearm pronation/supination. Although these motions play a vital role in everyday functioning, for some, limitations in wrist radial/ulnar deviation can also present functional challenges. These authors describe the creation and utilization of a static progressive orthosis to assist a patient in regaining wrist radioulnar deviation

Rehabilitation considerations in the management of terrible triad injury to the elbow.

An elbow dislocation associated with a radial head and coronoid fractures is termed a terrible triad. This injury almost always renders the elbow unstable requiring surgical intervention. The primary goal of surgery is to stabilize the elbow to permit early motion to prevent stiffness. Recent literature has improved our understanding of elbow anatomy and biomechanics as well as the pathoanatomy of this injury. This article reviews key concepts that will allow the surgeon and therapist to apply an systematic rehabilitation approach when managing such injuries.

Controlled active mobilization after dorsal capsulodesis to correct capitolunate dissociation.

STUDY DESIGN: Case Report. Capitolunate instability is a form of midcarpal instability. If conservative management is unsuccessful, surgical reconstruction is often indicated. However, the literature is limited regarding postoperative management after reconstruction. Often patients are immobilized for a 6- to 12-week period, which can produce secondary complications, including wrist stiffness, tendon adherence, and muscle atrophy. The purpose of the case report was to demonstrate that controlled early mobilization may be implemented postoperatively after dorsal capsulodesis procedures to correct capitolunate instability. This early mobilization may prevent secondary complications, which can be associated with lengthy immobilization periods. A 27-year-old female underwent a dorsal capsulodesis procedure to correct capitolunate instability. The intraoperative findings of the reconstruction and tension on the capsulodesis procedure were communicated to the therapist by the surgeon. This close communication allowed the therapist to institute early controlled mobilization immediately postoperatively using a hinged wrist splint. The patient was followed by our unit for 13 years. Early controlled mobilization using a hinged wrist splint may have maximized the subject's recovery, with no secondary complications. At 13-year follow-up, fluoroscopic and radiographic examination was normal, and no symptoms of pain or instability had reoccurred. In conclusion, early controlled mobilization using a hinged wrist splint may optimize the recovery period while retaining the desired arc of motion that is set intraoperatively. LEVEL OF EVIDENCE: 4.

Postoperative management of extensor pollicis longus repairs within close vicinity to or within the extensor retinaculum.

Therapists are continually modifying tendon protocols as part of the quest to create the perfect balance between tendon protection and tendon glide. Although much literature exists on the rehabilitation of the long flexor and extensor tendons to the digits, little literature exists on the rehabilitation of the extensor pollicis longus (EPL) tendon. This author used concepts related to tendon glide, tendon tethering, and early active mobilization to create a new splint and subsequent protocol for patients after an EPL laceration near the extensor retinaculum.

Complications of extensor tendon repairs at the extensor retinaculum.

Literature describing surgical, post-operative management and outcomes following EDC repairs in close proximity to or within the extensor retinaculum is limited. This complex injury can result in decreased wrist and digital motion as well as loss of independent motion of the digits. This paper reviews complications following such injuries observed clinically as well as experimental simulation performed on cadaveric specimens. Our observations have direct implications to hand therapy practice and outcomes used following such injuries.