“Working with a knowledgeable hand therapist can make the difference between success and failure in complex hand surgical cases. The therapist extends the continuum of our care, as well as functioning as coach and trainer for our patients.”
Marybeth Ezaki, MD, Past President, American Society for Surgery of the Hand
Hand therapists implement hand rehabilitation on individuals who suffer from upper extremity injuries in order to reduce their pain, inflammation and pathologies, and thus to ensure their maximum independence in their individual activities and regain the lost functionalities.
Hand therapists make an extensive and customized evaluation for each individual and create a therapy plan based on this evaluation. The goal of the hand therapy is to achieve a maximum attendance of the patient in the daily life activities and decrease the dependence on the caregiver. Splints are given to the patient to ensure the most appropriate position of the hand. Assistive devices are recommended for daily life activities. Exercises are recommended to increase the joint’s range of motion and flexibility.
Hand therapists provide preventive care and rehabilitation services for patients with disorder ranging from simple fingertip injuries to fractures, hemiplegia, and many upper extremity disorders.
Hand rehabilitation services
- Daily life activities
- Exercise and strengthening
- Joint energy maintenance techniques
- Mirror therapy
- Pain management
- Occupational rehabilitation
- Ergonomic environment arrangements
- Customized (appropriate for the patient her/himself) assistive devices and training the patient how to use it
- Sensory rehabilitation (Protective sense training)
After the nerve repair (neuroregeneration)
The purpose of nerve repair rehabilitation is to ensure the hand to achieve its normal functions by eliminating immobility and loss of strength and senses. Decision on the content of rehabilitation is made based on the nerve injured and its damage level. Depending on the case, splinting, massage, exercises and sense training are conducted. Sensation training has an essential role in the reparation of ulnar and median nerves, and this training last longer than training for radial nerves. In the nerve repairs, exercises start in around second week.
After the tendon transfer in nerve paralysis
In order to fulfill the functions of a weak and paralyzed muscle, tendon transfer is the process to move the insertion point of a stronger muscle.
The most common transfer procedure in the hand is the tendon transfer which is made to ensure thumb opposition (ability to turn and rotate the thumb so that it can touch each fingertip) in the median nerve paralysis. Rehabilitation starts before the surgery in order to prevent the thumb from adduction and supination by applying passive stretches and using splint (C-bar). Both active and passive range of motion exercises are applied. If the muscle that was transferred in the surgery was attached to a bone, range of motion exercises start earlier. If it was attached to a tendon, exercises start later.
In radial nerve paralysis before the transfer, in order to prevent the development of contracture which may be caused by wrist drop, and shortening of tendon, splints which has rigid wrist section and dynamic in the finger section are used. Muscles that will be transferred are strengthened with resistant exercises and electric stimulation. After the surgery, elbow, forearm and hand are fixed with a splint for 4 weeks. After the fourth week, protective splint is used, and exercises start. It is strived to regain normal functions of the hand by increasing exercises gradually.
In ulnar nerve palsy, patient cannot achieve a strong grasping, and claw deformity develops. After the transfer, splint is used for 3 weeks in general. In the following 3 weeks, wrist and fingers are moved gradually. In this period, night splint is worn. Heavy works are avoided for three months.
After tendon repair
The purpose in the rehabilitation period following the tendon repair is to ensure the flexibility and strength in the tendon by coping with the attachments and stiffnesses.
Early mobilization is preferred for the flexor tendon repairs. In particular in the beginning, high attention should be paid to avoid tendon rupture while performing movement exercises. Hand stays in a dynamic splint for four weeks. Passive flexion is allowed while active and full extension are applied to finger joints. In the sixth week, isolated superficial flexor tendon gliding exercises start. 10-12 weeks later, hand can be used in a normal routine.
Functional recovery is better in extensor tendon repairs than flexor tendons. Initially, hand is splinted, and active flexion exercises start with small angles. Then, angle is increased gradually. Splint is removed in the 35th day, active and passive flexion and extension exercises are made. In the seventh week, resistant active flexion and extension start.
After the fracture
Although wrist and finger fractures may take different forms, rehabilitation principles have similar features. After the fracture surgeries and cast, pain in the movements, edema, limitation of movement, loss in muscle strength, and reduction in hand’s functional capability may occur. In order to reduce the pain, physical therapy agents are utilized. In order to reduce the edema, certain positions are instructed, and massage is given. Active movements should be started as soon as possible, and the patient should be encouraged. Stretching exercises are made to open the joint contracture.