Therex Final 2

Greater mobility in the external rotators than the internal rotators.

Appropriate movement and stability of the scapula.

A balance in strength of the external and internal rotators.

Thoracic extension and axial extension of the cervical spine.

Upper and lower trapezius and pectoralis minor

Serratus anterior and levator scapulae

Pectoralis minor and levator scapulae

Upper and lower trapezius and serratus anterior

As a strengthening exercise when a weight is held in the hand or placed around the wrist.

As a grade II oscillation technique to inhibit pain and maintain mobility.

To stretch the shoulder musculature and increase range of motion (ROM) when a patient does not have antigravity control of shoulder movement.

As a grade III distraction technique to increase ROM when mobility of the scapula is normal but there is chronic stiffness of the glenohumeral joint.

Low-intensity progressive resistance exercise, mobilization with movement techniques, and manual stretching of the shoulder and scapular stabilization exercises with progressive weight bearing through the upper extremity

Grades I and II joint distraction and gliding techniques, pendulum exercises, passive or active-assistive ROM within pain-free ranges, and muscle setting exercises for shoulder musculature

Grade III joint-mobilization techniques, self-stretching, and strengthening exercises

Gentle weight bearing on the involved upper extremity to develop scapular control and active ROM of the shoulder (e.g., wand and wall-climbing exercises)

Hemiarthroplasty is most often performed using an arthroscopic approach.

The primary indication for glenohumeral arthroplasty is limited mobility of the shoulder.

A reverse total shoulder arthroplasty (rTSA) is an appropriate procedure for a patient with marked instability of the glenohumeral joint and a rotator cuff that is not repairable.

For adequate exposure of the joint during surgery, the muscle that routinely must be released (and reattached prior to closure) is the anterior deltoid.

Wand exercises for active-assistive external rotation to neutral with the arm positioned near the side of the chest

Wand exercises for active-assistive shoulder extension (combined with internal rotation) by placing the wand behind the back and sliding it up the back

Pendulum exercises

Wand exercises for active-assistive elevation of the arm in the plane of the scapula to approximately 90 while in a supine or sitting position

Increased active shoulder ROM.

Pain relief.

Increased shoulder-joint stability.

Improved function of the rotator cuff mechanism.

Stage I

Stage II

Stage III

Stage IV

Hypertrophic degenerative changes of the acromioclavicular joint

Vascular changes in the rotator cuff tendons

The shape of the acromion

Increased thoracic extension

Teres major and minor, subscapularis, infraspinatus, and triceps.

Pectoralis major and minor, latissimus dorsi, infraspinatus, and teres minor.

Pectoralis minor, subscapularis, and levator scapulae.

Pectoralis major, teres major and minor, and serratus anterior.

As the patient actively elevates the arm within the pain-free range, apply an anterior glide of the head of the humerus (mobilization with movement technique).

Reinforce the importance of maintaining an erect trunk during elevation of the arm.

Teach the patient to apply cross-fiber massage to the supraspinatus tendon while it is on a stretch, followed by isometric contractions of the muscle.

Strengthen key scapular stabilizers, such as the serratus anterior, middle trapezius, and lower trapezius, in closed-chain and open-chain positions.

It is indicated for a patient who sustains a full-thickness, traumatic tear of the rotator cuff if coupled with a repair of torn cuff tissues.

It is indicated for a patient with secondary impingement syndrome due to glenohumeral joint hypermobility/instability.

It may or may not involve resection of the anterior acromial protuberance and contouring of the undersurface of the remaining acromion.

During surgery, the deltoid must be detached for adequate exposure of the suprahumeral space.

Regardless of the size of the cuff tear, the shoulder is immobilized in an abduction splint for a period of time after surgery.

If the size and severity of the tears are similar, rehabilitation after repair of an acute, traumatic cuff tear typically progresses more rapidly than after repair of an atraumatic tear associated with chronic impingement.

Detachment of the deltoid from its proximal insertion is a necessary component of a traditional open repair or an arthroscopically assisted repair (mini-open).

The quality of the patient’s tissues (tendon and bone) has little to no impact on the progression of rehabilitation.

After a traditional open repair for a massive cuff tear, postpone active ROM exercises until about 2 weeks postoperatively to avoid avulsion of the deltoid that was detached and reattached during the procedure.

When the patient is lying in the supine position during the early postoperative days, place a folded towel under the humerus to position the arm slightly anterior to the frontal plane of the body to minimize anterior translation of the head of the humerus and the potential for impingement.

Before initiating active elevation of the arm in the sitting or standing position, restore strength in the rotator cuff muscles, especially the supraspinatus and infraspinatus muscles, to prevent superior translation of the head of the humerus during active elevation of the arm.

Delay weight-bearing/closed-chain exercises on the operated upper extremity for about 6 weeks.

While in the supine position, have the patient perform repeated concentric contractions of the scapular protractors against manual resistance applied to the anterior aspect of the shoulder.

While standing, have the patient place the arms in a reverse-T position while holding a piece of elastic tubing between the hands. Then have the patient attempt to “pinch the shoulder blades together” repeatedly against the elastic resistance.

Have the patient stand, face a wall, place the hands on the wall, and lean into the wall as the therapist applies alternating resistance against the shoulders.

Have the patient hold the arms in various positions in space (perform isometric contractions) as the therapist applies resistance in various directions.

Anterior dislocation is far more common than posterior dislocation.

After an initial dislocation and a course of nonoperative management, recurrence of a dislocation is higher in older patients (greater than 40 years of age) than in younger patients (less than 30 years of age).

A compression fracture of the posterolateral margin of the humeral head is an associated lesion that may occur as the result of a traumatic anterior dislocation.

A fall on the arm when it is positioned in flexion, adduction, and internal rotation can result in a posterior dislocation.

With the shoulder in the resting position, apply a grade III anterior glide of the humerus.

With the shoulder in the resting position, apply a grade II distraction of the humerus.

With the shoulder in the resting position, externally rotate the shoulder and apply a grade III distraction of the humerus.

With the shoulder placed at the end of the available range of external rotation, apply a grade III anterior glide of the humerus.

Anterior capsular shift

Bankart repair

Hill-Sachs repair

SLAP lesion repair

Progress exercises more slowly/cautiously if the origin of the instability was traumatic versus atraumatic.

Progress upper extremity weight-bearing exercises more slowly/cautiously after surgery for posterior instability than for anterior instability.

Progress exercises more slowly/cautiously after an arthroscopic capsular shift involving imbrication and suturing the capsule than after an arthroscopic thermally assisted capsular shift.

Progress ROM into internal rotation more slowly/cautiously after surgery for anterior instability than for posterior instability.

Reaching overhead

Fastening a bra behind the back

Hugging with both arms

Reaching into abduction in the plane of the scapula at a drive-through window

Upper trapezius.

Pectoralis minor.

Lower trapezius.

Serratus anterior.

Tightness in the pectoralis minor.

Weakness in the shoulder internal rotators.

Weakness in the shoulder external rotators.

Tightness in the scalenes.

Deltoid and pectoralis major

Supraspinatus and teres minor

Infraspinatus and teres minor

Teres minor and teres major

More functional activities occur in the scaption plane than the others.

Less muscle effort is required to raise the arm in the scaption plane.

No external rotation is required to prevent impingement from the greater tubercle.

There is less tension on the joint capsule in the scaption plane.

Stage 1

Stage 2, or freezing stage

Stage 4, or thawing stage

Stage 3, or frozen stage

Codman’s exercises.

Gentle isometric exercise to scapular muscles.

Grade III glenohumeral joint distraction.

Passive range of motion in pain-free ranges.

Shoulder girdle elevation and shoulder flexion

Shoulder abduction and external rotation

Shoulder girdle elevation and shoulder adduction

Shoulder adduction and internal rotation

Improve range of motion of the glenohumeral joint

Pain relief

Improved function with ADLs

Improved strength of glenohumeral muscle groups

Shoulder horizontal abduction

Shoulder internal rotation with hand behind the back

Shoulder external rotation in the 90/90 position

Shoulder abduction

Scapular elevation

Scapular winging

Scapular depression

Scapular tipping

Teres minor

Infraspinatus

Supraspinatus

Subscapularis

Self-assisted range of motion

Passive shoulder stretching

Supine shoulder elevation

Upper extremity ergometry

Shoulder external rotation with elbow at side

Shoulder internal rotation with elbow at side

Shoulder extension beyond 0°

Shoulder flexion

Latissimus dorsi

Pectoralis major

Teres major

Serratus anterior

In supine, support the humerus on a folded towel.

For passive internal rotation, position the humerus in slight flexion and 45° abduction.

For passive external rotation, position the humerus in slight flexion and 45° abduction.

For initial shoulder-assisted extension, position the patient prone and work from 90° to 0° extension.

Superior to the coracoid process with the patient’s hand at his side

Just inferior to the anterior aspect of the acromion with the patient’s hand positioned behind his back

Inferior to the posterior corner of the acromion with the patient’s arm in 90/90 and horizontal adduction

Medial to the bicipital groove of the humerus with the patient’s arm in external rotation

“Full can” arm elevation

“Empty can” arm elevation

Military press

Elastic resistance to elevation of the arm while in shoulder abduction and external rotation

Sagittal

Frontal

Transverse

Shoulder flexion and abduction with the Bodyblade

Shoulder flexion and abduction with free weights

Shoulder flexion and abduction with elastic resistance

Closed-chain wall leans in a position of flexion and abduction

Manual passive stretching to lengthen muscles that cross the elbow

Cross-fiber massage of the tendons inserting at the elbow

Joint-mobilization techniques to stretch the restricted joints (grade III sustained glide or grade IV oscillation techniques) after evaluating the reactivity of the elbow joints with grade II sustained glides

Passive ROM within pain-free ranges

Decrease the risk of radial neuropathy from compression of the radial nerve in the cubital tunnel.

Decrease the risk of ulnar neuropathy from compression of the ulnar nerve in the cubital tunnel.

Decrease the risk of median nerve neuropathy from compression in the cubital tunnel.

Decrease the risk of overstretching the lateral collateral ligament complex of the elbow that could cause posterior translation of the radial head.

Improved ROM is the primary indication for surgery and the primary goal of postoperative rehabilitation following a radial head fracture.

Open reduction and internal fixation is the preferred technique if stable fixation can be achieved and the patient is a young, active adult.

Closed reduction is preferred for radial head fractures in children.

Biomechanical studies demonstrate that implant arthroplasty after a severely comminuted fracture restores stability and kinematics similar to the native radial head.

Synovectomy

Total elbow arthroplasty

Excision of the radial head coupled with prosthetic implant

Arthrodesis of the elbow

A semiconstrained, linked prosthesis allows flexion and extension of the elbow but not varus, valgus, or rotational motions.

One of the more common, long-term complications after TEA is joint instability, particularly with unlinked implants or in patients who previously underwent excision of the radial head.

The typical method of fixation of the implants is all-cementless (all-biological) fixation.

The surgical approach most often used leaves the triceps tendon intact.

Limit assisted elbow flexion to about 90 to 100 for the first 3 to 4 weeks postoperatively.

For about the first 3 to 4 weeks, perform active elbow flexion/extension only while lying in the supine position.

Postpone elbow extension against manual resistance or light weights for 6 weeks or longer.

Avoid pushing motions with the operated upper extremity during functional activities, such as pushing up from a chair, for at least 6 weeks.

After the acute inflammatory period, heterotopic bone is laid down within muscle fibers and within the joint.

The muscle most often affected in the elbow region is the biceps brachii.

It is distinguished from traumatic arthritis of the humeroulnar joint in that passive extension is more limited than flexion.

Before the bony mass in the muscle has matured, the muscle should be stretched and massaged regularly to prevent a contracture.

Have the patient remove the splint several times a day and perform gentle muscle-setting exercises, elongating the involved muscle-tendon unit slightly after each contraction but not beyond the pain-free ranges.

Have the patient remove the splint several times each day and perform active or self-assisted ROM of the wrist within pain-free ranges.

Have the patient wear a splint to immobilize the wrist continuously for at least 2 weeks or until there is no pain.

Apply cross-fiber massage at the site of the lesion.

Extend and ulnarly deviate the wrist and extend the fingers while the elbow is extended and the forearm is pronated.

Flex and radially deviate the wrist and flex the fingers while the elbow is extended and the forearm is supinated.

Flex and ulnarly deviate the wrist and flex the fingers while the elbow is extended and the forearm is pronated.

Extend and radially deviate the wrist and extend the fingers while the elbow is extended and the forearm is supinated.

Bilateral push-ups while in a fully prone position on the floor with weight on the hands and toes

Bilateral wall push-ups while in a standing position and leaning into and pushing away from the wall

Bilateral push-ups while standing and leaning on the hands on a kitchen countertop

Bilateral push-ups in a prone position with weight on the hands and knees

Have the patient assume a prone-lying position with the shoulder in 90 abduction, the upper arm supported on the table, and the elbow flexed to 90

With the patient standing or sitting in a chair, begin with the elbow fully flexed and the arm elevated overhead and stabilized to maintain the shoulder in as much flexion as possible.

Have the patient assume the supine position with the shoulder flexed to 90 and the elbow flexed so the handheld weight touches the opposite shoulder.

While the patient is in a standing position and the hips are flexed to 90, begin with the shoulder in hyperextension.

Stabilize the distal humerus and apply a proximal glide of the ulna

Stabilize the distal humerus and apply an ulnar (lateral) glide of the ulna

Apply a valgus stress at the elbow

Stabilize the humerus and apply a dorsal glide to the head of the radius

Because she had a radial head implant, she may return to these activities after 6 months.

Avoid these activities on a permanent basis.

She may return to heavy lifting after 6 months, but not high-impact (tennis or golf) activities because of the ballistic force these activities create.

She should have had a TEA if she wanted to return to these activities.

Annular ligament.

Extensor communis.

Extensor carpi radialis brevis.

Pronator teres.

30% over a 10-year period.

Greater for patients with rheumatoid arthritis than for those with traumatic arthritis or osteoarthritis.

Highly correlated with the type of implant (prosthesis).

Greater for young, active adults who provide consistent stress to the fixation, encouraging increased bone formation and less loosening of the implant.

Medial collateral ligament

Lateral collateral ligament

Annular ligament

Coracoacromial arch ligament

Brachioradialis

Biceps brachii

Pronator teres

Brachialis

Median nerve

Hypothenar nerve

Radial nerve

Ulnar nerve

A fall on an outstretched hand.

Lifting a child off the ground by the hand.

Hanging by the arms from a high bar at the playground.

Jerking to lift a heavy object such as a suitcase.

Elbow arthroplasty.

Bankart procedure.

Resection of the radial head.

Arthrodesis.

Cardiovascular accident.

A burn.

Traumatic brain injury.

Tear of the brachialis tendon.

Radial deviation

Neutral

Flexion

Extension

High weight, high repetitions

High weight, low repetitions

Low weight, low repetitions

Low weight, high repetitions

Bench press.

Rowing motions.

Upper extremity ergometry.

“Walking” hands on a stair-climbing machine.

Submaximal isometric exercises

Stretching to the elbow flexors

Cryotherapy to the injured area

Passive range of motion of the elbow

Avoid recreational activities such as golf and tennis.

Perform ROM exercises only within the range achieved during surgery.

Avoid any single lift of more than 25 lb.

If symptoms of ulnar nerve compression are noted, avoid prolonged positioning in end-range flexion.

Ulnar neuropathy.

High-impact activities.

Infection.

Lack of adherence to postoperative activity modification.

Power

Strength

Endurance

Flexibility

Elbows extended, forearms pronated

Elbows flexed, forearms supinated

Elbows flexed, forearms pronated

Elbows extended, forearms supinated

Recoil

Elasticity

Shear

Creep

Tennis elbow.

Medial epicondylitis.

Medial epicondylalgia.

Medial epicondylosis.

Heberden’s deformity.

Swan-neck deformity.

Boutonnière deformity.

Saddleback deformity.

Rupture of the central band (central slip) of the extensor hood mechanism, causing the lateral bands to slip in a volar direction at the PIP joint

Overstretching of the volar plate (palmar plate) and bowstringing of the lateral bands of the extensor hood mechanism

Volar displacement of the extensor carpi ulnaris tendon, causing a flexion force at the wrist joint

Overstretching or rupture of the collateral ligaments of the metacarpophalangeal (MP) joints

With MP joint deformities, forceful pinch and grip exercises are contraindicated.

Principles of joint protection and energy conservation are integral components of patient education to reduce deforming forces on involved joints and reduce excessive fatigue.

Progressive resistance exercise is contraindicated so long as there are signs of inflammation.

Application of an orthosis should be avoided in the rheumatoid hand because it promotes loss of joint mobility.

Minimize deforming forces by maintaining ROM with gentle, passive stretching to the involved joints.

Maintain joint mobility and decrease pain by using grade I or II joint-oscillation techniques.

Increase muscle length by using contract–relax (hold–relax) techniques.

Control pain by imposing continuous rest and using orthoses on the wrists and hands.

Avoid all activities with the hands until there is no pain.

Avoid strong gripping motions that require wrist extension, radial deviation of the wrist, and ulnar deviation of the fingers.

Exercise the hands in functional ways such as wringing out a dishrag under warm water.

Stretch the extrinsic finger tendons across all the joints simultaneously to gain mobility and counter contractures.

The need to perform high-load, high-impact occupational tasks postoperatively

Significant, arthritis-related, ipsilateral limitation of motion of joints proximal and distal of the wrist

Subluxation or dislocation of the radiocarpal joint

Previous arthritis-related arthrodesis of the opposite wrist where arthrodesis of both wrists would potentially reduce, rather than improve, function

Manual stretching techniques to restore full ROM of the wrist during the final phase of rehabilitation

Active wrist flexion/extension (greater emphasis on extension) and forearm pronation/supination (greater emphasis on supination) as soon as the immobilization device can be removed for exercise

Low-intensity (about 1 lb) dynamic resistance exercises of the wrist and hand during the intermediate and late phases of rehabilitation

Use of the hand for light functional activities at about 3 months postoperatively

After MP arthroplasty and removal of the postoperative compression dressing, a dynamic orthosis with an outrigger is worn to maintain the MP joints in full extension when the fingers are relaxed but allow active MP flexion within a limited range and unrestricted interphalangeal (IP) motions.

Repair of ruptured extrinsic finger flexor tendons often is coupled with MP joint replacement arthroplasty for the patient with RA and chronic tenosynovitis.

If a patient has an ulnar drift deformity of the fingers, use of a dynamic orthosis is contraindicated postoperatively.

Use of a static orthosis has been shown to be an ineffective alternative to a dynamic orthosis for improving ROM and function after MP arthroplasty.

After PIP arthroplasty that included correction of a swan-neck deformity, emphasize PIP flexion and DIP extension more so than PIP extension and DIP flexion.

When initiating ROM of the PIP joint after PIP arthroplasty, stabilize the MP and DIP joints in neutral.

Because correction of a boutonnière deformity during PIP arthroplasty involves a central slip-splitting approach, it is important to postpone resisted PIP extension exercises for at least 6 to 8 weeks.

For functional grasp after PIP arthroplasty, more flexion of the PIP joints of the index and middle fingers is necessary than flexion of the ring and little fingers.

For a patient with erosion of the articular surfaces and subluxation of the CMC joint, joint replacement arthroplasty with prosthetic implants is a far more common procedure than trapezial resection/tendon interposition arthroplasty with ligament reconstruction.

After CMC arthroplasty, the thumb is immobilized in palmar abduction.

A longer period of immobilization of the thumb is required after total joint arthroplasty with prosthetic implants than after trapezial resection/tendon interposition arthroplasty with ligament reconstruction.

A priority in a postoperative exercise program is to gain active radial adduction combined with palmar adduction of the thumb (sliding the thumb across the palm) as early as possible.

Zone IV includes the carpal tunnel; the extrinsic flexor tendons can adhere in the tunnel following inflammation.

Zone III is in the palm of the hand; injury in this area can damage the lumbricales and interfere with MP flexion.

Zone II, known as “no-man’s land,” is where the extrinsic flexor tendons (flexor digitorum superficialis and profundus) lie in close proximity; range-limiting adhesions that prevent tendon gliding are likely to develop in this area after injury and repair.

Zone I is where the flexor digitorum superficialis (FDS) tendon inserts; if the tendon avulses, the patient will be unable to flex the DIP joint.

When ROM exercises are initiated, they are performed within a protected range to minimize the risk of excessive stress on the repair site and gapping of the repaired tendon ends.

It is used more often after extensor tendon repair than after flexor tendon repair.

It has been shown to increase the tensile strength of the scar at the repair site more effectively than the use of prolonged immobilization after a surgical repair.

It is thought to improve synovial fluid diffusion, thereby improving tendon nutrition and promoting tendon healing.

Gentle prolonged stretch.

Tendon-gliding exercises.

Scar management with pressure on the scar.

Progressive resistance exercise.

Begin tendon-gliding exercises to minimize the formation of range-limiting adhesions.

Keep the fingers immobile because there is poor circulation and therefore poor healing in this area.

Initiate maximum-level resistance exercises of the extrinsic flexors to regain normal strength of the injured muscle-tendon unit.

Limit exercise to passive ROM to protect the healing tendons.

May involve the use of a dorsal tenodesis orthosis that allows full active extension of the wrist and MP joints

May involve the use of a dynamic dorsal blocking orthosis with elastic bands attached, allowing limited active finger extension and providing passive finger flexion

May involve the use of a dynamic dorsal blocking orthosis with elastic bands attached, providing full passive extension of the fingers and allowing limited active flexion of the fingers

May involve the use of a volar tenodesis orthosis that allows full ROM of the wrist while maintaining the fingers in full extension

A laceration of the extensor tendons in zone VII can cause a wrist flexion deformity and requires surgery to repair the lesion.

A lesion of the central tendon (central slip) of the extensor hood, if untreated, will result in a PIP flexion contracture and boutonnière deformity over time.

A mallet finger is a lesion of the extensor mechanism of the DIP joint and is managed nonoperatively with an orthosis for positioning in full extension.

If a tendon lesion occurs in zone V, PIP and DIP extension is disrupted, but MP extension remains intact.

Gentle muscle setting (isometric/static) exercises used during the early phase of rehabilitation after, for example, a tendon repair, whereby an involved finger is placed passively in a particular position (by the therapist or by the patient using the sound hand); the patient then is asked to try actively to hold the position without assistance.

A form of dynamic exercises in which the patient actively moves through a series of hand positions to prevent tendon adhesions.

A form of isometric exercise in which the therapist places a finger in a particular position and then asks the patient to hold the position as manual resistance is applied to the contracting muscle.

A form of stretching exercise in which a patient is asked to perform an isometric contraction of a muscle-tendon unit against low-intensity resistance followed by relaxation and elongation of that muscle.

Maintain or develop free gliding between the FDS and FDP tendons and adjacent bones.

To perform these exercises, the patient actively moves the fingers into five different positions.

Maintain or develop free gliding between the FDS and FDP tendons.

To perform these exercises, the therapist passively moves the patient’s fingers into five different positions in a particular sequence.

It is possible to extend the MP joint passively through the full range of extension, but full active MP extension is not possible, owing to weakness of the extensor digitorum.

Posterior (dorsal) sliding of the proximal phalanx on the head of the metacarpal is restricted.

Full passive MP extension is not possible.

It is possible to extend the MP joint passively through the full range of extension, but full active MP extension is not possible, owing to weakness of the lumbricales.

Have the patient move actively from the full fist position of the hand to the hook fist position.

While stabilizing the IP joints of one finger in extension, passively extend the MP joint of that finger.

Have the patient move actively from the straight fist position to the tabletop position of the hand.

Have the patient move actively from the full fist position of the hand to the tabletop position.

Adequate bone stock.

No history of chronic synovitis.

Intact neurovascular system.

Functioning flexor/extensor mechanism.

Power grip

Combined grip

Precision grip

Hook grip

Pad to side.

Tip to tip.

Pad to pad.

Pinch.

Subluxation of affected joints.

Joint swelling.

Pain.

Systemic fatigue.

Grade III mobilization techniques.

Tendon-gliding exercises.

Gentle ISOM exercises.

Active assistive ROM exercises.

30° extension

15° extension

Neutral position

15° flexion

It does not matter

Halfway between full flexion and extension

Extension

Flexion

Zone IV

Zone III

Zone I

Zone II

Wrist flexion, finger flexion

Wrist extension, finger extension

Wrist flexion, finger extension

Wrist extension, finger flexion

Tabletop

Straight fist

Full fist

Hook fist

Extensor lag exercises

Tendon-gliding exercises

Tendon-blocking exercises

Place and hold exercises

Tendon lengthened, massage parallel to tendon and longitudinally proximal and distal

Tendon lengthened, massage perpendicular to tendon and longitudinally proximal and distal

Tendon shortened, massage perpendicular to tendon and longitudinally proximal and distal

Tendon shortened, massage parallel to tendon and longitudinally proximal and distal

Palm on table with fingers extended; patient moves forearm over stabilized hand

Palm on table with fingers flexed over the edge; patient moves forearm over stabilized hand

Dorsum of hand on table with fingers flexed; patient moves forearm over stabilized hand

Dorsum of hand on table with fingers extended; patient moves forearm over stabilized hand

Flexion of MCP joints, flexion of IP joints

Flexion of MCP joints, extension of IP joints

Extension of MCP joints, extension of IP joints

Extension of MCP joints, flexion of IP joints

Resist on dorsal surface of second and third metacarpals

Resist on volar surface of second and third metacarpals

Resist on dorsal surface of fourth and fifth metacarpals

Resist on volar surface of fourth and fifth metacarpals

Avoid functional activities that place loads on the wrist while the forearm is supinated.

If an ambulation aid is required, use platform attachment initially.

Avoid weight bearing on operated hand during transfers initially.

Permanently refrain from high-impact recreational activities such as racquet sports.