By David C. Saidoff BS PT, Andrew L. McDonough EdD PT
Serious Pathways presents a clinically-based, problem-solving method of rehabilitation that integrates techniques from activities drugs, actual and occupational treatment, geriatrics, ergonomics, kinesiology, and physiatry. It makes use of a case-study structure that simulates actual encounters with sufferer and covers some of the maladies most typically visible in outpatient rehabilitation.
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Extra resources for Critical Pathways in Therapeutic Intervention: Upper Extremities
Schumacher RH, Bomalski JS: Case studies in rheuma tology for the house officer, Baltimore, 1990, Williams & Wilkins. 18. Spinner M, Spencer PS: Nerve compression lesions of the upper extremity: a clinical and experimental review, Clin Orthop Rel Res 104:46, 1974. _ _____ 38 Part 1 Hand and Wrist 19. Werner CO, Rosen 1, Thorngren K: Clinical and neuro physiological characteristics of the pronator syndrome, Clin Orthop 197:231-236, 1985. Recommended reading Baxter-Petralia PL: Therapist's management of carpal tun nel syndrome.
I _ _ _ _ _ 36 Part 1 Hand and Wrist NERVE GLIDING PROGRAM For Median Nerve Decomposition at the Wrist Exercises to be done Hold position to a count of Starting position 1 Wrist in neutral. fingers and thumb in flexion times each, _ times a day. Position 2 Wrist in neutral, fingers and thumb extended Position 3 Thumb in neutral, wrist and fingers extended Therareu sensitivity, an sion site, elas the digits ane form overhe2 helpful, as ,,: reduction. :l essary to Fr~" These exerci5 At the ei! hand and \" ovitis.
What is the double-crush phenomenon? A nerve may be compressed at more than one site (Fig. 4-9), a condition known as double-crush syndrome. Since nerve tissue is extremely sensitive to ischemia, pressure on the nerve at the neck, at the thoracic out let, or at the elbow will make the nerve even more susceptible to even mild pressure in the carpal tunnel. The idea here is that the nerve tract is susceptible to mechanical injury because of either tethering at the intervertebral foramen or proximity to unyielding bone or simply because branching at an abrupt angle involves a diminishing of the nerve's gliding mechanisms.