Plenary Session 1 - Opening Session
Hand Therapy Considerations for Wrist Instability
Over the past two decades both hand surgeons and hand therapists have a better understanding of wrist biomechanics especially carpal kinetics. This panel will present updated recommendations regarding hand therapy interventions for various wrist instability conditions presented in case format. Therapists will also learn how to screen for wrist instability in patient cases where the wrist instability is not the primary referring diagnosis. These updated principles provide an opportunity to enhance communication between the surgeon and therapist to improve patient outcomes.
- To describe relevant wrist anatomy and biomechanics directly related to commonly seen wrist instabilities to improve identification of instability especially during hand therapy.
- To appreciate that the patient must be individually managed according to his or her unique set of variables and responses to injury, repair, healing, and recovery of function eliminating the need for a therapy protocol.
- To develop a rehabilitation approach for wrist instability based on the emerging scientific and clinical evidence.
The Role of Ligaments in Wrist Stabilization
Ligaments are not static cable-like collections of fibers holding bones together but complex bone binding structures containing sensors aimed at detecting changes in bone position and transmitting that information to the sensorimotor system for control of joint stability. Ligaments exhibit different kinetic behaviors depending upon the direction and point of application of the forces being applied. The so-called “Helical Anti-Pronation Ligaments” (HAPL’s) are mostly active when the wrist is axially loaded, whereas the “Helical Anti-Supination Ligaments” (HASL’s) are more prone to constrain intracarpal supination torques. This novel way of interpreting carpal kinetics helps developing new strategies to treat carpal instability.
- To reconsider the role of ligaments. Instead of static bone-binding elements, they are more complex neurophysiology structures
- To propose a functional classification of ligaments based on their kinetic behaviour
- To get an updated view of the new interventions for conservative treatment of carpal instability that the above information recommends to implement.
The Unforgiving Elbow
The propensity for post-traumatic elbow stiffness is high. Hand therapy professionals are challenged to optimize motion while maintaining stability of the elbow. This presentation will review the pathogenesis of elbow stiffness and make recommendations for both operative and non-operative interventions to optimize patient outcomes follow traumatic elbow injuries.
- Describe the pathogenesis and risk factors associated with post-traumatic elbow stiffness.
- Identify the intrinsic and extrinsic components of elbow stiffness.
- Discuss surgical considerations for resolving elbow stiffness and the role of hand therapy pre-and post-operatively.
The Unforgiving Elbow: How Hand Therapists Take on the Challenge
Hand therapists are challenged to optimize motion while maintaining stability of the elbow following traumatic injuries such as fractures and/or dislocations. The is a high incidence of elbow stiffness regardless of the patient’s age and level of cooperation. This panel will present hand therapy recommendations for examination and treatment for traumatic elbow injuries in patients across the lifespan based on emerging evidence and clinical wisdom.
- Discuss examination techniques to identify the contributing factors to elbow stiffness.
- Describe treatment recommendations to address the intrinsic and extrinsic components of elbow stiffness.
- Identify emerging scientific and clinical evidence to demonstrate the value of hand therapy in optimizing patient outcomes.