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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)
1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 42 Fractures.
Chapter 23: The Elbow © 2011 McGraw-Hill Higher Education. All rights reserved.
Shoulder Pain in the Workers Compensation Patient William F Bennett MD PA.
Principles of Tendon Transfers What is a tendon transfer? The tendon of a functioning muscle is detached from its insertion and reattached to another.
Pain Management Methodology in Occupational Medicine James Petros MD Physical Medicine & Rehabilitation Internal Medicine Qualified Medical Evaluator.
Fractures from Hand to Elbow. Concave articular surface MC PP MP DP Biconcave with a median ridge Sesamoid bone, found on the palmar surface. Found within.
Ch. 2 Tissue Healing. Introduction Tissue healing occurs and is influenced by several factors There are three phases: – Inflammatory response – Repair/regeneration.
Fracture Description & Classification Regions Emergency Medicine.
Basic Injury Evaluation: HOPS Sara Thomas, MEd, ATC Clinical Lead- Dr. Cooper/DME Coordinator Fort Wayne Orthopedics.
Provided by Coventry Health Care® ©2010 Coventry Health Care. All rights reserved. Proprietary – Do not copy, distribute or disclose without permission.
©2011 Coventry Health Care. All rights reserved. Proprietary – Do not copy, distribute or disclose without permission of Coventry Health Care. Provided.
1 Living With Arthritis I.M. Doctor, M.D. My Office My City, State.
Carpal Tunnel Syndrome Hand/Finger/Wrist Issues. 2 Presentation: A 64-year-old, right-handed, retired woman presents with: intermittent numbness, tingling,
Pain Acute Chronic Neuropathic Chronic Regional Syndromes Psychological interface Jonathan Dixon GP Trainer Moorside Surgery Eccleshill.
Pediatric Ankle & Foot Fractures Steven Rabin, MD Revised: March 2011 Original authors (2004): Laura Phieffer, MD & Steven Frick, MD Revised (2006): Steven.
SAR Ebrahimzadeh MD Rotator cuff tearing and treatment A rotator cuff tear is a common cause of pain and disability among adults Difficulties are: Dressing.
JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.
The Use of a Functional Digit Extension Splint to Promote The Integration of the Hemiparetic Hand during Activities of Daily Living. Joseph R. Padova,
Provided by Coventry Health Care® ©2011 Coventry Health Care. All rights reserved. Proprietary – Do not copy, distribute or disclose without permission.
1 Musculoskeletal Injuries/Splinting Identify three types of forces that can act upon the body and how these forces can lead to injury. Identify four basic.
Arthritis What is arthritis? What is arthritis? Who is affected? Who is affected? What treatment options are available? What treatment options are available?
Chapter 18: The Foot © 2011 McGraw-Hill Higher Education. All rights reserved.
Shoulder Arthroplasty Daniel Penello Upper Extremity Rounds April 26, 2006.
Chapter 19: The Ankle and Lower Leg © 2011 McGraw-Hill Higher Education. All rights reserved.
Chapter 24 The Child with a Musculoskeletal Condition.
After this presentation, you should be able to: › Know that E/M stands for › Know the 3 components of the E/M › Distinguish different categories of.
Injury and the Healing Process. Introduction to Injury When an injury takes place some responses are predictable, but others are unexpected It is not.
Page 1 Occupations with the Most Injuries and Illnesses with Days Away from Work, 2002 Injuries and Illnesses (thousands) (1,436,194 injuries and illnesses.
NTDB ® Annual Report 2010 © American College of Surgeons All Rights Reserved Worldwide National Trauma Data Bank 2010 Annual Report.
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