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Expected Rehabilitation Times for Common Upper Extremity Injuries Gordon Iiams, MD
What constitutes a common upper extremity injury?
A Review of One Hand Surgeons Workers Compensation Case Load: Time Frame 19 Months From September 2008 ToMarch 2010
Surgical Case Log Review of Workers Comp Cases Total # of WC Patients 49 Total # of WC Surgeries 66 (9.6%) All Surgeries688
Body PartsTotal Finger Tips6 Hand/Finger21 Wrist16 Forearm2 Elbow8 = 53
Are there any really simple injuries? Laceration Fracture Crush Soft tissue Bone Everything
Even a simple cut is usually complex M.T.: 32 yo WM RHDBox cutter laceration L Hand/ Index Finger Multiple Structures:Flexor Tendons RDA, RDN, FDS, FDP
R.T.:42 yo WM RDH L Wrist Laceration-Jigsaw (jagged/ugly)No functional structures injured
Recovery Times MMI M.T.1 yrND 8 day RD 11 wks SSLT 2 pt 80% 6 mm R.T.5 ½ weeksRD 1 Week Jagged skin scar
Is it fractured or just broken? Its just a fractured finger.
What constitutes a Boo Boo?
6 Finger Tip Crush Injuries (12%) Open Tuft Fx Nail Bed Laceration Nerves & Small Vessels of Finger Tip Pulp
Summary of Finger Tip Crush Injuries Full Duty – 3 to 9 weeks MMI months AgeMMI No Duty (days) Restricte d Duty (wks) Full Duty (wks) JJ58 M HLF35 F GR69 M EC21 M4678 CG37 M GM48 M
Distal Radius Fractures (18%) Extra Articular Intra Articular Comminuted Displaced
Summary of Distal Radius Fracture Patients Full Duty 7 wks-6.5 mo MMI 8 mo- 18mo AgeMMIFull DutyJob DL38 F186.5 moStore Mgr SP59 M14Const. Acute-on Chronic CR63 M613 wksMail Carrier JL26 M-Fisherman RSD EH66 F85 moCook RSD RH24 M- MJ45 M-M. Seaman Non- union JV57F7 wks OR RN- Colles JS52 MDOS Electrician
13 other Hand/Finger Crush Injuries = 26%
Hand Crush Patients Ages: Male/Female: 10/3 Return to Full Duty: 3 to 20 weeks Permanent Impairments: 3 MMI: 4.5 to 18 months
Office Evaluation Tools A. B. C. D. A.Goniometer B.Grip Dynamometer C.Pinch Discriminator D.2 Point Discriminator E.ROM F.Grip Strength G.Pinch Strength H.Sensation
Sample Impairment Rating G.M 51 FRHDFx-Dx Lt. 5 th CMCJ 1 yr = MMI L SF ROMMP % PIP % DIP zero
Sample Impairment Rating Grip StationRightLeft% SLI I II III IV V654531
Sample Impairment Rating G.M. Grip
Other Cases Not Discussed Nerve Repair/Decompression Elbow Fractures +/or Dislocations Global Extremity Injuries Ex: Brachial Plexus RSD
Reflex Sympathetic Dystrophy Causalgia: Chronic Regional Pain Syndrome Fracture Disease
Conclusion Simple or uncomplicated injuries Are not so common
Conclusion Recovery times for upper extremity injuries Take 6 months to 1 year Sometimes longer
Mitigating Circumstances Crush component RSD Nerve Involvement Elbows Intra-articular Extension Smoking Medical Conditions (ex Diabetes)
Peripheral Nerve Injuries Ulnar, median and common peroneal nerves.
Basics of Tissue Injury Chapter 2. Soft Tissue Injury AKA wounds When the tissue is injured it may bleed, become inflamed or produce extra fluid.
Clinical Correlations – Upper Limb. During this surgery – what is at risk? If injured what would occur? Where are they from, where do they go?
Carpal Tunnel Syndrome Hand/Finger/Wrist Issues. 2 Presentation: A 64-year-old, right-handed, retired woman presents with: intermittent numbness, tingling,
Terminology Code Organization Special Codes Modifiers Case Examples Tips for Op Report Dictation.
1 2 Teeth and Function 3 Tooth structure 4 Dental Problems.
MaK_Full ahead loaded 1 Alarm Page Directory (F11)
THE ANKLE CHAPTER 18 The Ankle and Lower Leg. Introduction Have you ever sprained your ankle, or do you know anyone who has? What did you do for it? How.
Pain Acute Chronic Neuropathic Chronic Regional Syndromes Psychological interface Jonathan Dixon GP Trainer Moorside Surgery Eccleshill.
Clavicle fracture. Frequency Clavicle fractures involve approximately 5% of all fractures seen in hospital emergency admissions. Clavicles are the most.
WHAT IS HAND THERAPY? WHAT IS HAND THERAPY? Treating more than just a hand… Hand Therapy Week [Insert dates]
Fracture Description & Classification Regions Emergency Medicine.
Upper Limb Orthopaedic update Steven Barnes Inverclyde Royal Hospital.
Break Time Remaining 10:00. Break Time Remaining 9:59.
PROCESS vs. WA State SCS Study A Comparison of Study Design, Patient Population, and Outcomes August 29,2007.
CALENDAR NEW CALENDAR
Unit # 3 Basics of Tissue Injury. Soft Tissue Injuries Often called- Wounds –The tissue may bleed, become inflamed or produce extra fluid.
Dr. Saad Abdul Aziz. is a transverse fracture of the distal radius just above the wrist with dorsal displacement of the distal fragment. It’s the.
Basics of Tissue Injury. Injury Types Soft Tissue Affects Skin, muscle, ligaments, and tendons, and nerves When soft tissue is injured it may: Bleed Become.
13:00 Clock will move after 1 minute PPT – VCIC Timer 15.ppt.
×1= 9 4 1×1= 1 5 8×1= 8 6 7×1= 7 7 8×3= 24.
Paediatric Hand Injuries Dr Brigid Corrigan Plastic Surgery Registrar.
Basics of Tissue Injuries. Soft Tissue Injuries Wounds, Strains, Sprains ▫Bleed, become infected, produced extra fluid Classification: Acute ▫Occurs suddenly.
Hand Injuries Dr Mark Putland MBBS FACEM Emergency Physician Bendigo Health Care Group 22/9/2011.
© 2011 National Safety Council BONE, JOINT AND MUSCLE INJURIES LESSON
Elbow and Forearm Injuries Taelar Shelton, MS, ATC, AT/L.
General Injuries. Soft-Tissue Injuries Aka wounds When a tissue is injured, it may bleed, become inflamed or produce extra fluid Handout of Soft.
Copyright © 2012, Elsevier Inc. All rights Reserved. 1 Chapter 7 Modeling Structure with Blocks.
Disability status in Ethiopia in 1984, 1994 & 2007 population and housing sensus Ehete Bekele Seyoum ESA/STAT/AC.219/25.
Fractures and Injuries of the Upper Limb. Fractures of the Clavicle Common in children - usually ‘greenstick’ Caused by fall on outstretched hand or direct.
Copyright © Action Works 2008 All Rights Reserved - Photos by David D. Kempster 1.
DLMSO Classroom Timer Select a time to count down from the clock above 60 min 45 min 30 min 20 min 15 min 10 min 5 min or less.
POSTOPERATIVE MANAGEMENT OF ORTHOPEDIC PATIENTS THE SURGEONS PERSPECTIVE ED SZALAPSKI JR., M.D. TWIN CITIES ORTHOEDICS.
Axillary & Median Nerves Prof. Saeed Abuel Makarem.
1 Before Between After 2 What comes before. _____ 10 _____
Introduction 1 The Cost of Occupational Fraud 2.
MUN Orthopedics HAND &WRIST INJURIES. MUN Orthopedics.
1 นพ. ไพศาล ดำขำ กลุ่มงานศัลยกรรมออร์ โธปิดิกส์ โรงพยาบาลมหาราช นครศรีธรรมราช.
Copyright © The McGraw-Hill Companies, Inc.Chapter 7 Diseases and Disorders 7.3 Diseases and Disorders of the Skeletal and Muscular Systems Fractures Skeletal.
NTDB ® Annual Report 2010 © American College of Surgeons All Rights Reserved Worldwide National Trauma Data Bank 2010 Annual Report.
Support a painful joint Immobilize for healing or to protect tissues Provide stability or restrict unwanted motion Restore mobility Subsitute.
Mr G Shyamalan (Shyam) Hand Surgeon HEFT. So Much Choice!
1 Budapest University of Technology and Economics, BME, 1872 Budapest University of Technology and Economics, BME, 1872 Happy New Year 2012.
Colles’ Fractures Charles Caltagirone. Wrist Anatomy Motions Boney anatomy Soft anatomy Colles fracture site.
Chapter 12 Static Equilibrium; Elasticity and Fracture Physics for Scientists & Engineers, 3 rd Edition Douglas C. Giancoli © Prentice Hall.
1 FOOTCARE : What You Should Know!. 2 Feet: Most efficient form of transportation Stable base Composed of many small parts Fully integrated and adapted.
WEEK 1 You have 10 seconds to name…
Dr Mohamed El Safwany, MD.. The student should be able at the end of this lecture to recognize various radiographic principles of fractures.
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