scaphoid fracture physical therapy presentation.pptx

scaphoid fracture physical therapy

1. Scaphoid Fractures rehabi l itation

2. The scaphoid bone It is one of the carpal bones in the wrist joint . It is located in the second row of carpal bones at the radial side . It has oblique orientation in the wrist Size It is the largest bone of the second row of carpal bones. Location

3. Parts of scaphoid Tubercle Capitate fossa Lunate fossa

4. The ligaments that support to the scaphoid are The scaphoid-trapezoid-trapezium ligament The radial collateral ligament T he scaphocapitate ligament T he scapholunate ligament .

5. Function The carpal bones function as a unit to provide a bony structure for the hand The scaphoid bone is particularly important helping to stabilize the wrist because it links the two rows of carpal bones together .   It , along with the lunate , articulates with the radius and ulna to form the major bones involved in movement of the wrist .

6. The Anatomical Snuffbox It is a triangular depression found on the lateral aspect of the dorsum of the hand As the snuffbox is triangularly shaped , it has three borders , a floor, and a roof : Borders Ulnar (medial) border : extensor pollicis longus tendon. Radial (lateral) border : extensor pollicis brevis and abductor pollicis longus tendons . Proximal border : Styloid process of the radius . Floor : scaphoid and trapezium . Roof : Skin. Contents Radial artery Superficial branch of the radial nerve Cephalic vein

7. The scaphoid blood supply The blood supply to the distal pole of scaphoid comes from two branches of the radial artery . 1- The palmar scaphoid branch 2- The dorsal scaphoid branch The blood supply to the proximal pole of scaphoid The blood supply to the distal pole of scaphoid comes only from the dorsal scaphoid branch via retrograde intraosseous flow . Accordingly , the blood supply to the proximal pole is poor and fractures compromising the vessels place the bone at risk for nonunion

8. Scaphoid fracture The scaphoid is the most commonly fractured of the carpal bones The mechanism of injury A fall on an outstretched hand (FOOSH), causing a hyperextension and radial deviation force on the wrist . This position locks the scaphoid within the scaphoid facet . D irect trauma from road traffic accidents Repeated stress can also lead to fracture, as in gymnasts

9. Types of scaphoid fractures They are classified by location of fracture : Distal third, or tuberosity Middle Third (or waist ) Proximal third Comminution Fractures of the middle third are most common

10. C omplications Carpal fractures often are difficult to diagnose . These fractures sometimes are missed or misdiagnosed . Left untreated , a scaphoid fracture may develop a malunion or nonunion . Malunions and nonunions may lead to altered carpal kinematics (with resultant pain ), diminished ROM , grip strength , and wrist arthritis Untreated proximal pole fracture can cause impairment of the vascular supply to the involved bone fragment and can lead to avascular necrosis and progressive pain on radial-side of wrist .

11. symptoms Pain Swelling contusion Loss of wrist motion

12. CLINICAL EXAMINATION There are clinical tests for evaluation of patients with suspected scaphoid fracture include : P alpation on anatomical snuff box elicits tenderness ( In central scaphoid fracture ) Palpation on scaphoid tubercle elicits tenderness ( In distal scaphoid fracture )

13. A xial compression of the thumb Elicits pain Palpation on the Lister's tubercle elicits tenderness ( In proximal scaphoid fracture )

14. Imaging plain radiographs simply take a PA radiograph of the wrist with the hand in ulnar deviation ; this extends the scaphoid and makes the waist more easily seen Fractures are often difficult to evaluate radiographically Because of the bone’s oblique orientation in the wrist and the minimal calcific disruption seen . X-ray

15. Ct scan Thin-cut CT is superior in determining displacement scaphoid fracture.

16. MRI Bone contusion and micro fractures will produce edematous changes that will be seen on the MRI It is also useful in assessing for osteonecrosis MRI is extremely sensitive in detecting scaphoid fractures as early as 2 days after injury .

17. T reatment The treatment recommendations for scaphoid fractures will depend on: Location of the fracture Displaced or non-displaced fracture Blood supply to the injured area Time passed since the injury

18. TREATMENT 1-Conservative treatment Truly nondisplaced fractures can be treated closed and nearly always heal with well molded cast immobilization and physiotherapy rehabilitation

19. 2-Surgical treatment Surgical treatment is indicated for the following : Displaced scaphoid fractures more than 1mm Fracture to the most proximal pole of the scaphoid Delayed presentation > 3wks untreated Nondisplaced fractures in which early return of work or sports is required To avoid complications of prolonged immobilization (wrist stiffness , thenar atrophy ) The goal of surgery is to realign and stabilize the fracture .

20. Methods of fixation K-wire screw Bone graft as in avascular necrosis apply vascular graft from distal radius or iliac crest

21. REHABILITATION of non-surgical scaphoid fracture

22. to 6 wks above elbow thumb spica short arm thumb spica For proximal pole fracture For mid and distal poles fractures

23. Active ROM to joints outside the splint Active shoulder ROM Active second through fifth MCP/PIP/DIP joint ROM Active elbow flex.ext ,sup., pron . ROM in case of ( mid or distal scaphoid fracture ) 0 to 6 wks

24. 6 to 12 wks For proximal pole fracture: short arm thumb spica cast Continue shoulder and fingers exercises Begin active elbow flexion/extension/supination/pronation to maintain strength and range of motion .

25. P recausions If on follow-up radiographs the fracture displaces or fracture line significantly widens , patient must be referred to surgean . 6 to 12 wks

26. 12 to 14 wks Assuming union at 12 wks , removable thumb spica splint Begin home exercise program AAROM for wrist flex., ext ., radial and ulnar deviation AAROM for thumb MCP/IPJ and thenar ms .

27. Precausions If Radiographs do not demonstrate Healing , We Immobilize with short arm thumb spica cast for another 3 weeks Until Radiographic union . 12 to 14 wks

28. 14 to 18 wks Occupational therapy Mild resistance for wrist flex., ext ., radial and ulnar deviation Mild resistance for for thumb MCP/IPJ and thenar ms

29. 18 wks to ++ Grip strengthening Aggressive ROM for all joints Return to work .