Joey G. Pipicelli

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.

Therapeutic implications of the radiographic "drop sign" following elbow dislocation.

A radiographic drop sign following elbow trauma is an abnormality that is controversial with limited information describing optimal management. The consequences of this complex clinical situation includes limited motion, pain, and joint impingement, which may lead to joint stiffness and contracture formation. These authors describe the therapeutic implications of this radiographic finding and present a treatment approach in order to enhance patient outcomes.—V ictoria P riganc , PhD, OTR, CHT, CLT, Practice Forum Editor

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.

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.

Management of Complications of Extensor Tendon Injuries

Treatment goals for the management of extensor tendon injuries include restoration of function, minimizing disability, and decreasing the risk of complications. These goals can be achieved with an accurate understanding of the zone-specific concerns for extensor tendon injuries, early referral to hand therapy, and active communication between hand surgeons and therapists. This article reviews extensor tendon injuries by zone, outlines optimal management strategies that help prevent complications, and describes the treatment of these complications.

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

Biomechanical Analysis of Secondary Swan Neck Deformity Following IP Joint Flexion Contracture of the Thumb

proving function for lateral epicondylosis but optimal dosing is not defined. Conclusion: There are a number of good-quality studies on the effects of strengthening exercises on lateral epicondylosis that will enable conservative management of lateral epicondylosis. However, the evidence is still incomplete and does not permit strong conclusions to be made on a number of commonly used approaches. At this time, the positive effects of strengthening exercises cannot be refuted. Additional RCTs that focus on quality research designs and use appropriate outcomes are needed to provide a stronger foundation for hand therapy management of these patients. Hand therapists can use the results of this review as a guide to design strengthening exercise programs to treat lateral epicondylosis, but should demonstrate outcomes more objectively.