Wednesday, March 3, 2010

1st observation RA, splinting

Today I observed a hand therapist, completing an initial assessment, which included talking about how long the patient had had RA for, and talking about the referral. She then talked about what the main problems were, then went on to assess the hands, joints and tendon placement. She talked through her observations and she interacted with the patient by asking how long a particular joint had been like it was and asked if it was painful and what impact it had on her ADL's.
I have happened to come accross the below guide for taking history, which i think may be very helpful.

1. Evaluation of the history including onset, duration and distribution of joint disease.
2. Assessment of pain, stiffness and function.
3. A full systematic history, as the condition is a systemic disease.
4. A genetic history may be useful in view of the hereditary aspects of disease.
5. Impact of the disease on daily life.

Today, I observed
An example of
a) extensor subluxation - which inhibited the paitents ability to extend her fingers as essentially the tendon had dropped and become a flexor. These tendons on the dorsal aspect are below

The dorsal tendon compartments

Identify the tendons that, encased in synovial tendon sheaths, comprise six numbered dorsal compartments of interests to hand therapists:

  1. abductor pollicis longus and extensor pollicis brevis
  2. extensor carpi radialis longus and brevis
  3. extensor pollicis longus
  4. extensor digitorum comunis (four tendons) and extensor indicis
  5. extensor digiti minimi
  6. extensor carpi ulnaris

b) ulna deviation - as a result of the extensor subluxation

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