At the hand therapy unit, mount vernon hospital, middlesex we have been rehabilitating patients after metacarpophangeal joint arthroplasty using a dynamic extension splint for many years. Thumb cmc arthroplasty lrti boston, ma hand surgical. Preoperative physical therapy in primary total knee arthroplasty 1. The thumb also acts as a stabilizer to allow the fingers to manipulate items.
Trapeziectomy or total joint arthroplasty in primary thumb. Thumb flexor tendon repair oxford university hospitals. Diane heislein, pt, dpt, ms, boardcertified orthopaedic clinical specialist increasing incidence of total hip arthroplasty tha is driven by the aging population. Treatment before starting any therapy, clarify with the surgeon whether the routine protocol is followed. Arom thumb ip and mcp with the cmc supported in abduction 2. Physical medicine language workshop physical therapists, and physiatrists in general, will refer to the position of a structure in relationship to another. Trainor on physical therapy exercises for basal joint arthroplasty. Physical therapy after a resection arthroplasty without reimplantation or a twostaged reimplantation is dependent on the extent of joint or bone destruction caused by the infection and the removal of the prosthetic components and cement and debridement of soft tissue.
The protocols listed below were developed by southeast georgia health system physicians and therapists and are intended for use by clinicians and patients alike. Keep the surgical splint completely clean and dry after surgery. To stabilize the thumb base and address the trapezial void, a ligament reconstruction and tendon interposition lrti, also called. Each case can be very different depending on the goals of the patient, the age of the patient, the size of the repair, type off repair, etc. Apply ice, or the cooling unit, to the shoulder as it will be quite helpful. It causes pain at the thumb side of your wrist where the base of your thumb meets your forearm. Total shoulder replacement protocol sports and ortho. The thumb joint at the base of the thumb is the most mobile in the hand. Physical therapy exercises for basal joint arthroplasty. Postoperative therapy protocols also varied but followed three general patterns. The energy of applied force determined the severity of the fracture. Postoperative rehabilitation following trapeziectomy and. Preoperative physical therapy in primary total knee.
Postoperative rehabilitation following thumb base surgery. Total hip replacement rehabilitation protocol outpatient physical therapyphase i weeks 1 6 postop patient is evaluated weekly in outpatient pt unless deemed otherwise, or in inpatient setting evaluate and document. A patient visiting an orthopedist or one who is involved in a physical therapyoccupational therapy protocol ordered by a. At week 6, gentle strengthening is begun with discontinuation of the splint. Total hip arthroplastyhemiarthroplasty rehab protocol. Home exercise vs pt for reverse total shoulder arthroplasty. Occupational therapy services cmc arthroplasty protocol weeks post op thumb spica orthotic with ip free and in mid position to be worn at all times eval thumb ip and mp flexion extension arom exercise as follows 6 times a day for 10 repetitions each 1. Physical therapy department kaiser permanente 99 monticello rd. Information about procedures performed by timothy b. Splinting is available to help position your hand and thumb in a resting position to allow for healing throughout the day andor night. Patient should elevate the arm above the level of the heart as much as possible, and do digit flexion and extension exercises and fds glides hourly, to help. Klika cmc arthroplasty when conservative treatment of thumb osteoarthritis fails to control pain surgical treatment may be indicated. Srf, ca 94903 4154442962 rehabilitation after trapeziometacarpal arthroplasty. The intent of posting these standards of care and protocols is to provide clinicians and patients.
This helps reduce swelling, and your hand may throb and feel worse if it is hanging down. The thumb carpometacarpal joint, or cmc joint, is a very common place for arthritis to occur, especially in women. A resource book, such as stedmans medical and surgical. Thumb cmc joint arthroplasty surgery home program phase 2. Reverse total shoulder replacement rehabilitation guidelines the following is a detailed outline of the rehabilitation regime for patients who have had a reverse total shoulder replacement by dr. Md physical therapy section kenneth kirby, pt, dpt william beaumont army medical center. At week 2, active and passive mcp and ip range of motion is started. Gait c orrect any abnormal gait patterns noted hip rom s tay within the precaution limits hip strength. It is also important in minimizing the risk of developing a frozen shoulder postoperatively. Aquatic therapy when sutures removes arom with shoulder submerged within precautionary rom. Doing a 10 minute warm water soak or hot pack beforehand will help you do the exercises with less discomfort, and will. Most fractures are due to local trauma caused by an applied force. You have had surgery to repair one or more of the tendons which bend your thumb.
If extensor mechanism involved amend rehabilitation as. Rehabilitation following thumb cmc, radiocarpal, and druj. Physical therapy standards of care brigham and womens. Active thumb abductions involve moving the affected thumb down away from the palm and then back to touch the index finger. Development and implementation of a trapeziectomy rehabilitation. Initiation of light resistive exercises such as therapy putty, clothespins, pinch, foam blocks, etc. Physical therapy exercises for postoperative basal joint arthroplasty from eight to 11 weeks generally include active thumb abductions, oppositions, extensions and circumductions.
Rehabilitation protocols southeast georgia health system. Pendulum exercises bend forward at the waist, back parallel to ground is ideal. This joint, located at the very base of the thumb, is subject to large physical stresses throughout life. When conservative treatment of thumb osteoarthritis fails to control pain surgical treatment may be indicated. Contact hand surgical associates boston today at 78189023 or visit our office servicing boston, ma. Quad, hamstring, and glute sets, gait training on level. Independence in home program understanding and use of joint protection principles functional thumb and wrist rom functional hand and wrist strength. Reverse total shoulder replacement rehabilitation guidelines.
A removable handbased splint is fabricated to support the new joint while allowingthe wrist, tip of. The information contained in these standards of care or protocols is not intended in any way to be used as primary medical advice or to replace medical advice offered by physical, occupational, speech therapists or other health care professionals. Conservative treatment consists of splinting, exercises, physical therapy. Article information, pdf download for development and. Early aquatic physical therapy improves function and does not increase risk of woundrelated adverse events for adults after orthopedic surgery. W a l k e r, m d, t d e e m o r f o r d, rn, m p a, j o s h u r b a n, m d, a n d j o e b e d a r d, b s t abstract.
Allow involved arm to hang down, perpendicular to the floor. The primary objective of this study is to compare outcomes between formal clinic based physical therapy pt rehabilitation and surgeon directed home therapy ht after reverse total shoulder arthroplasty rsa as measured by pain, range of motion, single assessment numerical evaluation sane, and american shoulder and elbow surgery ases scores at 6 weeks, 3, 6, 12, and 24 months. Protocol w3 physical therapy or occupational therapy protocol for open reduction and internal fixation of distal radius fracture. Passive finger elbow exercises o use your nonsurgical hand to move the surgical. A carpometacarpal splint immediately followed for 2 weeks, taken off for exercises and selfcare. These protocols are listed by diagnosis, so clinicians who are providing patient care may reference the applicable protocol to help rehabilitate their patients condition. Conservative and operative rehabilitation from the physical therapy library of. Total wrist replacement rehabiltation total wrist replacement rehabiltation week 02 after surgery immediately after your operation it is important to start bending and straightening your fingers and thumb as your dressings allow. Thumb cmc joint arthroplasty surgery home program phase 2 exercises david gesensway, md exercises should be done with your splint off, just 3 times per day.
After any type of surgery for basal joint arthritis of the thumb complex. The thumb works as a grip when we use a hammer or hold a glass. Cmc suspension arthroplasty protocol days 35 remove surgical dressing, clean and dress wound fabricate shortarm thumb spica splint with the mp at 20 degrees or as pinned. Active and self passive rom exercises are initiated to the thumb and wrist 6 8.
Standarised hand therapy following surgery of the base of the thumb. Excision arthroplasty an overview sciencedirect topics. Total knee arthroplasty protocol postop week week 46. Rehabilitation after total shoulder arthroplasty activities and advice for in the hospital and while at home. Doctors give unbiased, helpful information on indications, contraindications, benefits, and complications. Total shoulder arthroplastyhemiarthroplasty protocol. A cast or splint which immobilizes the wrist and thumb is worn. The most common surgical technique involves complete resection of the trapezium. The effectiveness of a manual therapy and exercise. Variability in trapeziectomy rehabilitation protocols and the arrival of. The carpometacarpal cmc of the thumb is a saddle joint that permits a wide range of motion and is largely responsible for the characteristic dexterity of human prehension. This protocol was adapted from the articles titled. Clinical results of 40 consecutive basal thumb prostheses and no. A custom circumferential orfit forearm based thumb spica splint is fabricated, with the thumb in a palmarly abducted position.
Reverse shoulder arthroplasty protocol with subscapularis release see last page for patients with special considerations related to surgical approach and procedure week one weeks two to three. Thumb must not be positioned in radial abd, this would risk stretching the reconstruction. Cmc arthroplasty suspensionplasty rehabilitation protocol. The rehabilitation protocol for total shoulder arthroplasty tsa hemiarthroplasty hhr is based on the latest research. You will be taught very specific exercises to perform in the splint see.
A custom circumferential orfit forearm based thumb spica splint is fabricated, with the thumb in a palmarly abducted position, with the mp joint supported in mild flexion, ip. Limonis total ankle arthroplasty physical therapy protocol week physical therapy guidelines goals 02 casted or walker boot nwb education on proper crutchwalker use hip and knee range arom rest and elevation of limb to 14 cm above the heart adls with safe crutchwalker use control swelling and pain 2 1st postop visit at clinic and. Click on your rehabilitation protocol to download a pdf file containing specific exercises and instructions for each phase of your recovery. Background digital and hand fractures are seen in many settings and more commonly in situations involving machinery and heavy labor. Total hip replacement rehabilitation protocol outpatient physical therapy phase i weeks 1 6 postop patient is evaluated weekly in outpatient pt unless deemed otherwise, or in inpatient setting evaluate and document. Furthermore, three postoperative exercisestherapy phases were. Aim to improve joint function and alignment and decrease pain. Rehabilitation following total shoulder arthroplasty. No part of this book may be reproduced or transmitted in any form or by any. Current practice patterns in conservative thumb cmc joint care.
Wrist 20 degrees extension, cmc joint midway between palmar abduction and. T physical therapy, protocols, shoulder rehabilitation he. You can use your other hand to increase the range of movement you can achieve. One high standard, three local partners for more information go to. The thumb can move up and down, in and out, and rotate slightly to touch the fingers. Iontophoresis, ra, weight management, hydrotherapy and information on wheelchair and ambulation aids. A hemiarthroplasty is a surgical procedure that involves replacing half of the hip joint. Postoperative therapy for metacarpophalangeal arthroplasty. Rehabilitation following ulnar wrist procedures terri l. Physical therapy after hip or knee resection arthroplasty.
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