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The Upper Extremity

The following charts and illustrations will review conditions of the upper extremities, including the hands. The charts are organized by category of diagnosis.

Joints of the hand & Nerve distribution of hand (know both of these)

Nerve Compression Syndromes – the nerve is compressed due to entrapment within other tissues, such as muscles, tendons and ligaments. The cause of nerve compression syndromes is most often poor positioning. Severity can range from mild to severe. Once a nerve is severely damaged due to compression, it may never fully recover. Deformities in the affected area may develop.

Condition and Cause Symptoms OT Treatments for Conservative Management OT Treatments for Post-Surgical Management Contraindications Photo
Carpal Tunnel Syndrome – caused by compression of the median nerve where it passes through the carpal tunnel. Result of inflammation or repetitive motion with poor positioning. Palmar numbness and numbness of first digit to half of the fourth digit, with generalized weakness and pain,
including pain at night.
Wrist splint with wrist positioned in 0-15 degrees of extension, median nerve gliding exercises, activity modification, ergonomics. Edema control, AROM, nerve/tendon gliding exercises, sensory re-education, strengthening, activity modification. –Pillar pain is pain on either side of the carpal tunnel release surgery site. The source of the pain is unknown and may be ligamentous or muscular in origin. Avoid repetitive motion, vibration to volar wrist.
Cubital tunnel syndrome – caused by compression of the ulnar nerve at the elbow. Result of repetitive pressure on the elbow or repetitive or sustained bending of the elbow. Numbness and tingling along ulnar aspect of forearm/ hand, pain at elbow with extreme , weak power grip; + tinel sign at elbow (pain or sensation) Elbow pad or elbow splint to decrease compression of nerve, activity modification. Edema control, AROM, nerve glides, strengthening, MCP blocking splint if clawing is noted. Avoid movements or postures that aggravate symptoms.

Double Crush Injury- occurs when a peripheral nerve is entrapped in more than one location. Inter-mittent diffuse arm pain and paresthe-sias with specific postures. Treat according to protocols for each nerve syndrome involved. For example, if the two syndromes involved are carpal tunnel syndrome and brachial plexus injury, treat each syndrome. Treat according to protocols for each nerve syndrome involved, following the surgeon’s orders.
Guyon’s Canal Syndrome – occurs when the ulnar nerve is compressed as it passes through Guyon’s Canal at the wrist. Caused by inflammation or other irritation to the ulnar nerve at the wrist. Numbness and tingling in ulnar nerve distribution of hand; motor weakness of ulnar nerve innervated musculature; + tinel’s sign at Guyon’s canal. Work activity modification, wrist splint in neutral. Edema control, AROM, nerve glides, sensory re-education, strengthening.
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