Hand/Wrist Rehabilitation Pearls

Sonja Kranz OTR/L, CHT

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26th Annual Mayo Clinic

Symposium on Sports Medicine

November 11-12, 2016

Disclosure

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Relevant Financial Relationship(s)

None

Off Label Usage

OR None

Learning Objectives

• Participants will be able to identify common wrist injuries

• Determine when a client can start stage II program

• Will be able to progress rehabilitation after wrist injury

• Can name specific exercises for wrist rehabilitation

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Common Wrist Sports Injuries

• Wrist ECU conservative

or post surgical

• UT split tear

• DRUJ

• Fractures

• Scapolunate Ligament Injury

Type the footnote/source in this space

How can hand therapy assist in returning to a specific sport?

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What needs to be addressed?

• History of injury

• Surgical or conservative intervention

• Orthotic requirements

• Treatment plans

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Initial 6 week immobilization

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Wrist supports: Exos/prefabricated

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Taping

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Taping methods for pain

relief, support as needed

(consider ____________)

- ____________

• Kinesiotaping

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Rehabilitation for the Athlete: Second Stage: usually 6 weeks

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Pain is the guide: not activities

that result in pain at the time of

the activity, later that day, or the

next day

In the absence of tenderness:

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- Work first on active range

of motion of the forearm

and the wrist.

- Progress to passive

range of motion per pain

tolerance.

- May begin progressive

strengthening

Therapy

• 6 Weeks

• Begin with pain free active

range of motion for wrist

and forearm

• As tolerated,

advance to pain

free passive range of

motion with prolong

stretch

Once patient achieves ~ 90% of motion may begin progressive strengthening

• Isometrics

• Rep band/weight

• Advance to BTE as

needed

Be in Control of the Hammer!

Proprioceptive Strengthening

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- With eyes closed have

trainer hold or push the end

position on bat/ tennis

racket

- Have trainer slightly add

some additional resistance

(pull on the Thera-Band)

Dart Throwing

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Flexbar

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Flex Bar

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__________ or push on the weight)

briefly and suddenly.

The goal is to have you be able to

instantly respond to this additional

force through your reflexes.

-Grasp one end of the __________

and begin to wiggle the free end of

the bar back and forth. Go as fast

and hard as you can tolerate

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Keep your wrist steady and do not let your

elbow lift up off the table.

_________ Powerball ™(Powerballs.com).

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It has a built in gyroscope that

can be activated by pulling on a

small cord or even has an

“autowind” model called the

Autostart.

Once the gyroscope spins, the

goal is to keep it spinning by

moving your wrist.

Powerball

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™(Powerballs.com).

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Other Exercises

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-Use bat or __________

___________ to simulate strike

of ball ( ie. resists against hand

or soft object)

-Grip strengthening using Hand

Helper™, with graded

resistance

Conditioning

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Overall upper back, shoulder

and biceps/triceps

strengthening without weight

bearing or lifting weight

-Progress to graded weight

strengthening (isometric,

eccentric and isotonic) or

________________ resistance

-Cardiovascular conditioning

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For swing, start with getting the feel of

holding a bat with a Whiffle or

plastic ( _______) Junior size racket

Start going through motions of swing

mechanics

Progress with standard type bat/racket

Progress to with standard ball

Progress to full swing, full speed.

Swing for Tennis or Baseball

Baseball Throw

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Progress to throw with Whiffle

ball

Progress to easy throw with

standard ball

Progress to full throw with

standard ball

Ping Pong

• Mimics eye hand coordination

• Range of motion

• Proprioception

• Spatial awareness

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Listen to the athlete~

If any swelling or pain

develops, reduce

exercises and allow

more time.

Trainers and Therapist

excel at this!

When to progress?

Final thoughts

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Work closely with athletic

trainer/coach

Understand the sport specific

demands on the wrist~ watch

videos or study up

Help the athlete distinguish

what type of pain may be

acceptable as they return to

sport or play

Case Studies

• Professional baseball player

• 23 year old female tennis player

• 19 year old college basketball athlete

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Resources

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Ping pong photo taken from

https://www.sciencedaily.com/releases/2012/08/120808104454.htm

©2015 Mayo Foundation for Medical Education and Research

MC7221PF

5 of 5 mc7221pf

Dynaflex Powerball ™(Powerballs.com).

Altman, E. (2016, March/April). The ulnar side of the wrist:

Clinically relevant anatomy and biomechanics. Journal of Hand

Therapy, 29(2), 111-122. doi:10.1016/j.jht.2016.03.012

Feehan, L. ( 2016, March/April). Early controlled mobilization using

dart-throwing motion with a twist for the conservative management

of an intra-articular distal radius fracture and scapholunate

ligament injury: A case report. Journal of Hand Therapy, 29 (2),

191-198.doi:10.1016/j.jht.2016.02.012

THANK YOU!

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