INJURY TO HAND AND FINGERS-REHABILITATION
AFTER INJURY TO HAND AND FINGERS
Failure to identify a significant hand injury may result in prolonged
disability due to excessive scarring, which can significantly reduce hand and
finger motion. Early diagnosis and treatment and proper rehabilitation are
needed to establish full function (see Plate 4-56). The goal of treatment of hand and finger injuries is to promote
healing of the injured structures while maintaining a functional range of
motion and preventing the formation of joint contractures. Because certain
structures of the hand are fragile, the rehabilitation team must clearly
understand the extent and severity of the injury and take appropriate
precautions, as identified by the attending hand surgeon, before initiating
rehabilitation therapy.
The first step in hand and finger rehabilitation consists
of assessment of muscle strength and restriction of range of motion, with
formal measurement of the motion of each involved joint on both hands. After
the baseline factors are established, progress should be monitored at weekly or
biweekly intervals. During passive range-of-motion exercises, the range of
motion should be increased to the point of discomfort, but not beyond. As the
injury heals, a more aggressive program can be adopted, including active and
active-assisted range-of-motion exercises of the affected joints. Importantly,
soft tissue swelling must resolve before full range of motion can be achieved
and all efforts should be placed on this goal.
If possible, the hand should be warmed in a paraffin
bath or deep moist or dry heat before the range-of-motion activity. The hand
should then be kept in the stretched position until it has cooled to normal
temperatures. Exercises can be performed by the patient at home, with weekly
monitoring by the physical therapist.
