Improving Clinical Outcomes Through Collaboration and Innovation: Pearls for Diagnosis and Treatment of the Imbalance Between Extrinsic and Intrinsic Tendons of the Hand
A 36-year-old laborer sustained a crushing injury to the hand seven months previously and now complains of weakness of grip and difficulty clenching a fist--- Extrinsic tightness? Intrinsic tightness? Flexor adhesions? Extensor adhesions? Joint contracture? “Dazed and confused” like the Led Zeppelin song? This collaborative course given by hand surgeons and a hand therapist will utilize a background of case-based clinical examples along with a review of normal flexor/extensor/intrinsic anatomy. Based on a clear anatomical knowledge, the care team can then make the correct clinical diagnosis and move forward to the most appropriate treatment course. By understanding the pathology and arriving at the correct target mechanics, the hand therapist is then empowered to employ a dynamic course of care and consistent clinical evaluation of progress. The role of the specialty trained hand therapist in optimizing outcomes through careful therapeutic planning based on pathomechanics will be emphasized. Physician/therapist collaboration and mutual understanding are crucial. If corrective surgery is required, “wide-awake” local anesthesia enables intraoperative functional assessment. Where possible, best evidence will be provided and elaborate use will be made of videos to demonstrate the dynamic interplay between the extrinsic and intrinsic tendon systems.
Understand the anatomy of the extrinsic flexor and extensor tendons, and also of the intrinsic system of the hand.
Review the interplay between the intrinsic and extrinsic systems in normal hand function.
Diagnose disorders of the extrinsic flexor and extensor tendons, and disorders of imbalance between intrinsic and extrinsic mechanism
Understand how hand therapy can treat these disorders primarily and can enhance outcomes following injury or surgery