What are the Special Assessments For a Distal Radius Fracture_
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[00:00:00] So today's question that I got is what are the special assessments for a distal radius fracture? So my name is Hoang. I'm an occupational therapist and certified hand therapist. And over 10 years ago, over 10 years ago, I started my own therapy clinic. And with hand therapy secrets, my goal is to help more occupational therapists develop their clinical and business skills.
So you can have more choices in your career. So let's get into this question. Um, so This is a OT that's specialized or is interested in specializing in hand therapy and doing some research I wanted to know what assessments would you perform for a Client with a distal radius fracture. So first off the bat One of the things that I would do for a distal radius fracture is I would ask them like what happened Like how how did they get this injury?
How did they get this fracture? Because in my mind, I want to know You how they fell, the position that they fell, because it can help you to think through, well, is it a fracture? Is it a. [00:01:00] fracture with dislocation. And then it's really important to understand and know if you have an intra articular fracture or an extra articular fracture.
And the reason why you want to know if it's an intra or an extra is because, um, it will help you manage your expectations in terms of, uh, recovery. Any kind of problems you're going to kind of run into and it helps you when you understand it helps you to manage your patient's expectations. So knowing that the like the severity basically of the fracture is going to be really important.
And then I want to know and find out. So after I found out their story, um, I want to find out what they do for a living and I want to find out what they're trying to get back into because that's part of the evaluation. And it's a really huge, important part of the evaluation. If you are working with someone who's just coming to you from, from a, um, I got injured on my own time.
And then you want to find [00:02:00] out what's most important to help them get back to, because you have to think about like, uh, always kind of using, um, That go to to say, okay, I want to help you to become more independent. I want to help you to fully recover and to be able to do everything you want. Right. Some people, um, don't really want to do too much.
They just want to do their everyday lives. They just don't want to have a deformity look. They don't want a deformed looking hand. Some people are like, I'm trying to get back to yoga. I'm trying to get back to weightlifting. I'm trying to get back to swimming, things like that. If you're working within the workers comp realm, then you need to know what their job duties are, the title and their job duties.
And then you want to know, like, are they currently working? Are they working light duty? Because you need to get them back to work. If someone else is paying you, right, the workers comp, the company's paying, they need justification in terms of Why they should keep coming to therapy and you play a crucial role in getting them back to work, but also communicating with the surgeon, like where they're [00:03:00] at and what they can do, right?
How you want to get them back to, like, doing, everything normal. Uh, so, so that's really important. Um, and then I, then I start into my like actual getting objective measurements. So one of the things that I always look at is I always look at, um, hand function. So fingers, do they move, right? So if it looks like they Um, have a full fist.
You think, oh, I don't need to take measurements. But the second thing I look at is hook fisting because hook fisting is going to tell you if their intrinsics are tight or not. And it's really important to understand because sometimes people can look like they have a full fist, but when they continue to have hand pain, it's because they have really tight intrinsics.
Um, so you want to take a look at that. I look at that and then I'll take measurements and then I look at thumb function. So opposition is like really one of the easiest things to look at. And opposition is nail to nail, not like this. If they're like this, they don't got opposition, right? Opposition to like [00:04:00] index finger, but you want to have them go nail to nail because you want that.
Okay. Right. And then you're trying to see how far they go. And then I, if they can come all the way down to the distal palmar crease, then I'll write that as well. Um, then I look at wrist range of motion and you have to determine what is the common thing that you do in your clinic. So that everyone is doing the same thing.
So when you're looking at measurements that they're always consistent. So when I, when I do range of motion measurements in my clinic, we always, 100 percent always measure on the roller aspects for risk extension and then on the role on the dorsal aspect for risk. Flexion now when someone does not have any wrist extension, right?
They'll still look like they have wrist extension because we have a natural curvature to our hand So when they're at zero, but you're looking and you're measuring and almost like at 20 degrees But they're they don't have any wrist extension. I will say zero and then parentheses dorsal [00:05:00] So anytime I do anything outside of what I normally do, I notate that.
Otherwise we do the same thing all the time, right? Um, so wrist flexion extension, and then I measure supination pronation. So then I go into elbow, right? So supination pronation falls between the wrist and the elbow. So I'll measure supination pronation, and then, um, If I suspect any kind of elbow or shoulder problem, I will measure elbow extension, elbow flexion.
Usually flexion is not a problem and extension is where you're kind of stuck. And I always measure supination, um, uh, sorry, elbow flexion extension in neutral forearm position. And then if their elbows are messed up, I look at the shoulder. So I do a very simple scan of the shoulder. So then I go into shoulder forward flexion, and then I'll look at flexion.
functional internal, uh, sorry, external and internal rotation. If I really need to, then I'll lay them on the mat and I'll check internal external and internal rotation. You know what I mean? [00:06:00] Um, so I always measure my shoulders, uh, the same way. Um, and I would recommend you highly the same way. Like, if you're measuring something, measure the same way.
Because it's with the practice over and over and over that you get really good, you get really fast, and you're just really consistent. And consistency is key when you're taking measurements, you're taking objective measurements so that you can show and prove time over time someone's getting better.
This is very important for insurance, workers comp, that kind of stuff. For your patients that are coming in from a cash perspective, they don't care. You're always going to take it back to function. Yes, we're Do range of motion matter for some of them? Sometimes, but for the most part, you're going to take them back to function more than just numbers.
Numbers is just proof that you're getting better. Um, so range of motion measurements is number one after a distal radius fracture from an objective measurement [00:07:00] standpoint. Number two is I will test grip strength. Um, And you can, you can test grip strength at almost any time. I tend not to do it very early on.
Like let's say in the first two weeks, I just don't do it. Um, because they're really sensitive and you don't want someone to like go ham on the grip strength. As long as they have some motion, you I always say, you know, assess later. So usually by three to four weeks I'll measure grip strength and then I'll take it from there.
This is just my method. Um, I tend not to take grip strength measurements at the beginning because they're so early in their surgery that you just wanting, um, just like the structures and the bones and the, all the places, it's just to heal and not like irritate the area. That's what I do. I, you can take a DEMA measurements.
Oh my God. I used to remember when I was at the hospital, I would use a volume, a volume meter. Um, and so we would fill it up with water and if someone [00:08:00] was really edematous, we would measure for a DEMA in a private clinic. I never do that. Um, we used to, I used to measure, you can measure circumferential. Um, honestly, I never do that because when you get motion, you'll get rid of your swelling.
Um, so that's just my, just my take on it. Uh, but you can if you want to, you know, it's not a big deal. You could do that. So those are some special assessments for distal radius fracture. And then, um, the last assessment that you potentially could do is, um, Simon's Weinstein, right? So Simon's Weinstein is the.
It's a test for sensory types of issues. Now it is common for distal radius fractures to have some carpal tunnel or sensory disturbances to it. I only measure for the things that I have a problem with and if I want to make it a goal. If they don't have numbness and tingling, I don't measure [00:09:00] for numbness and tingling because they don't have anything.
So all you have to be is like, do you have numbness and tingling in your fingers? If they don't have any, great. I don't measure for that. Why would you measure for it? If I look at their fingers and they have great range of motion of their fingers and their thumb, why would I measure that? I won't, right?
So special assessments for a distal radius fracture is like measure. What you want to get measure what you want to be improved if there's nothing to necessarily improve and work on Why are you measuring it? Right? Why are you measuring it? You can spend more of your time in the treatment versus and like oh, let me get more numbers All right, so that's my take on special assessments for distal radius fracture.
If, if this helped you, you know, like and subscribe for more videos. And you can always leave me a question below. Uh, let me know [00:10:00] what you think about this video. But if you have Further questions, let me know below and I'll be able to make and create more videos like this for you in the future. And I'll include also, um, other videos that can be helpful for you when you're working with a distal radius fracture until next time.
See you later.
