Pediatric Sports Injuries of the Wrist and Hand腕、手部儿童运动损伤.pptxVIP

Pediatric Sports Injuries of the Wrist and Hand Sunni Alford, OTR/L,CHT Preferred Physical Therapy Wrist injuries TFCC ECU/ FCU tendonitis Instability Growth Plate Fractures Ulnar abutment syndrome Triangular Fibrocartilage Complex (TFCC) Similar to the meniscus in the knee. Evolutionary theorist- Used to be more bony for weight-bearing. As we evolved the ulna retracted and was replaced with the TFCC. Triangular Fibrocartilage Complex Palmar and Werner introduced term TFCC 1981 Structures include: Articular disc Meniscus homologue Prestyloid recess Dorsal volar radioulnar ligaments TFCC Innervation Volar, ulnar portions: Ulnar N Dorsal portion: PIN, dorsal sensory branch Central disc relatively aneural Vascularity Anterior interosseous ulnar arteries Central disc relatively avascular Peripheral 15-20% well vascularized, will heal Attachments Originates from medial border of distal radius Inserts into base of ulnar styloid (fovea) Central disc is avascular and aneural. Conservative management 0-6 Weeks Splinting in a long arm cast or splint with the elbow in 90° flexion and the forearm neutral for 0-6 weeks to reduce the symptoms 6 weeks Active and active-assistive ROM exercises are initiated to the wrist and forearm. A wrist immobilization splint is fabricated for comfort and protection. 8 weeks If patient is asymptomatic, progressive strengthening to the hand and wrist, avoiding a torsion load at the wrist. If the patient’s symptoms are not alleviated in 4-6 weeks surgical repair or debridement is suggested. Central Debridement Central and radial injuries are avascular and won’t heal thus they are debrided. 3-5 day post- op bulky dressing removed and gentle AROM exercises initiated. Splint worn between exercise sessions. 10-14 days-scar massage initiated within 48 hours following suture removal 3-4 weeks – PROM initiated. 6 weeks progressive strengthening as long as the patient is pain free. Splint discontinued. D