中級 手関節・手指 術後 リハビリテーション

Wound healing at incision sites without signs of infection,Pain controlled at rest (VAS ≤ 3/10),Soft tissue edema reduced as measured by figure-8 wrist circumference,Digital sensation intact bilaterally to light touch,Active digital flexion/extension within pain limits,Wrist immobilized in prescribed position with median nerve protected

→ 次の段階へ： Early Motion Phase

Incision sites demonstrating early granulation tissue formation,Passive wrist flexion to 30 degrees without increased pain,Passive wrist extension to 20 degrees within tolerance,Finger tenodesis effect achievable without resistance,No signs of complex regional pain syndrome (CRPS),Radial and ulnar artery pulses palpable and symmetric

→ 次の段階へ： Early Motion Phase

Passive wrist flexion to 45 degrees, extension to 35 degrees,Radial deviation to 15 degrees, ulnar deviation to 25 degrees,Supination to 45 degrees, pronation to 60 degrees,Minimal tenderness over carpal tunnel release site,Grip strength measurable at >30% of contralateral side,No pain with passive stretch of flexor digitorum superficialis/profundus tendons

→ 次の段階へ： Intermediate Motion Phase

Passive wrist flexion to 60 degrees, extension to 50 degrees,Full radial and ulnar deviation ranges achieved,Supination to 70 degrees, pronation to 80 degrees,Carpometacarpal joint mobility normalized,Metacarpophalangeal and interphalangeal joint flexion within 10 degrees of normal,Tenderness resolved over flexor carpi radialis and flexor carpi ulnaris tendons

→ 次の段階へ： Strengthening Phase

Full active wrist range of motion achieved (flexion 70, extension 60),Grip strength ≥50% of contralateral side using Jamar dynamometer,Pinch strength (key pinch) ≥60% of contralateral side,No pain with resisted wrist flexion using flexor carpi radialis,No pain with resisted wrist extension using extensor carpi radialis brevis/longus,Distal radioulnar joint (DRUJ) stability confirmed via press test

→ 次の段階へ： Advanced Strengthening Phase

Grip strength ≥70% of contralateral side,Wrist flexor strength 5/5 on manual muscle testing,Wrist extensor strength 5/5 on manual muscle testing,No pain with repetitive gripping activities,Scapholunate and lunotriquetral ligament stability confirmed negative for catch-up clunk,Triangular fibrocartilage complex (TFCC) stability test negative

→ 次の段階へ： Return to Function Phase

Grip strength ≥80% of contralateral side,Full functional range of motion in all wrist and finger joints,Tolerance of workplace simulation activities for 30 minutes,No reproduction of carpal tunnel symptoms with sustained wrist flexion,Median nerve gliding exercises tolerated without symptoms,Ulnar nerve conduction studies (if applicable) showing improvement

→ 次の段階へ： Final Conditioning Phase

Grip strength ≥90% of contralateral side,Return to light-duty work activities without restrictions,No limitations in activities of daily living involving wrist-hand function,Dexterity assessed via Nine-Hole Peg Test within 10% of baseline,No night pain or paresthesia in median nerve distribution,Endurance testing of wrist flexors/extensors >3 minutes without fatigue

→ 次の段階へ： Discharge Criteria

Grip strength ≥95% of contralateral side (or at pre-injury baseline),Full, pain-free range of motion in radiocarpal and midcarpal joints,Return to full work duties including lifting up to pre-injury capacity,No restrictions in recreational or sport activities,Patient education completed on prevention of re-injury and ergonomics,Discharge outcome measures documented and goals met

→ 次の段階へ： Discharge