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.