By David C. Saidoff BS PT, Andrew L. McDonough EdD PT

Severe Pathways presents a clinically-based, problem-solving method of rehabilitation that integrates thoughts from activities medication, 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 a number of the maladies most typically obvious in outpatient rehabilitation.

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_... :. Chapter 4 29 pronator muscle, and pain and median nerve paresthesias with forced pronation, as well as passive supina­ tion at the limit of full extension. Like anterior osseous syndrome, there is also difficulty with pincer move­ ment involving the thumb to the index finger. Nerve conduction velocity (NCV) and EMG studies show slowed conduction velocity across the forearm and denervation potentials of flexor pollicis longus and abductor pollicis brevis. Treatment includes stretching exercises to both pronator and supinator muscles; surgical decompression is appropriate when conservative treatment is ineffective.

If painful restriction occurs with deformity, excision of the distal end of the ulna will relieve pain, and improve the range of motion and cosmesis, as it recreates the original anatomic alignment. • Many patients will have bony resorption at the fracture site that, over time, translates into shortening of the radius. 6. When is external fixation appropriate? External fixators such as the Hoffman frame or the Roger-Anderson frame have two pins proximally through the radius and two pins distally in the second and third metacarpals and are used as anchors because they are immobile.

6 • Isolated fracture of the ulnar styloid is rare and occurs when one lands on the ulnar side of the radially deviated hand. Although there is little swelling, there is considerable pain. Treatment is by wrist immo­ bilization in ulnar deviation for 3 to 4 weeks. If nonunion occurs, the fragment should be removed. • Triquetral fractures may occur from either one of two possible mechanisms: (1) falling onto a flexed wrist held in radial deviation resulting in an avulsion fracture of the dorsal surface of the bone, or less commonly (2) compression fracture from falling onto a hyperextended wrist.

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Critical Pathways in Therapeutic Intervention: Upper by David C. Saidoff BS PT, Andrew L. McDonough EdD PT
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