Many patients get their fingers caught in doors, windows, garages as well as hurt them in doing routine activities. Sprain-strain can be serious and may need orthopedic hand surgery opinion. Once confirmed that there is no fracture, the hand therapist may fabricate a custom splint to immobilize a particular finger or a joint to give complete rest to the healing ligaments. Continued hand therapy is required in many instances if the stiffness persists and patient is unable to make a fist.
After minor sprain-injury of a finger, if untreated, patient may start developing mild stiffness of the digit. He or she may not be able to make a complete fist or straighten the digit, compared to the contra-lateral hand. If unchecked, this problem can worsen and develop in Trigger finger, where patient will feel a single click or multiple clicks, while bending and straightening the finger and the stiffness will slowly get worst.
The hand therapist can help patients in regaining full range of motion with modalities/stretching and at times splinting to prevent progression. Patients will however, need surgical intervention to release the trigger finger in most cases.
Carpal Tunnel Syndrome
Cubital Tunnel Syndrome
Tennis Elbow, Golfer’s elbow
Radial Tunnel Syndrome
Thumb CMC & other arthritis
All the syndromes mentioned above are cumulative trauma (repetitive) disorders. Repetitive motion of joints and body parts sometimes leads to swelling, thickening and scarring of all the structures near the nerves or tendons and interfere with daily activities through pain, numbness and weakness. Hand Therapists can help in custom fabrication of orthoses to keep the involved joints in the least stressful position as well as conservative management with ergonomic evaluation and intervention, instructions for proper body mechanics and joint protection techniques, heat, ultrasound, scar (deep tissue) massage/mobilization and long held stretches and modified activities of daily living with adaptive devices if needed. However, most often, the usual plan of action is surgical release followed by a short period of hand therapy to regain full hand functions permanently.
Fractures of upper extremity especially wrist and hand can be very complicated. They also make the bulk of caseload for a Hand Therapist. Fractures (Broken bones) can be caused by falls, being hit by a blunt object with high velocity, result of crushing industrial accidents in all professions, which depend on the use of hands, hands being chopped off with a snow blower, lawn mower as well as fracture-lacerations with all kinds of powered tools especially saws. There are literally hundreds of ways that our hands can be broken in addition to above.
These complicated injuries pose serious challenge to a Hand Therapist. The treatment plan includes delicate wound-care & orthotic management for the protection initially, edema control, scar management, guarded range of motion according to multiple scientific protocols established, to regain movements while protecting the repaired structures. Close interaction between the therapist and the operating surgeon is crucial for these injuries. Home program is crucial in all phases of hand rehabilitation.
Tendons and nerves are usually lacerated partially or completely due to traumatic injuries of the hand. They are also very challenging for a hand therapist (Similar to laceration and fractures as above). Initial phase is always protection with custom orthosis and guarded mobilization protocols. These protocols differ for each particular condition and are usually customized in consultation with operating hand surgeon. Once tendons and nerves are healed sufficiently, an aggressive static, static progressive and dynamic splinting (Orthotic) protocols are instituted. Aggressive home program will then follow for edema control, scar management and regaining almost full range motion of all joints and flexibility of all tight structure, with the use of multiple, creative splints, as well as supplies provided for edema control and silicon products for scar softening, to regain the best possible hand function and appearance.