Journal articles on the topic 'Hand Surgery Patients Rehabilitation'
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WATTS, A. M. I., M. GREENSTOCK, and R. P. COLE. "Outcome Following the Rehabilitation of Hand Trauma Patients." Journal of Hand Surgery 23, no. 4 (August 1998): 485–89. http://dx.doi.org/10.1016/s0266-7681(98)80128-9.
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Objective measures of hand function have been used to assess the outcome of rehabilitation following trauma. However, subjective assessments of function have been avoided by clinicians due to the difficulty in proving their validity and reliability. We have developed a subjective hand function scoring system (HFS), based on an activities of daily living assessment, which is used in planning and monitoring progress through rehabilitation. The HFS for 64 traumatic hand injuries were assessed on admission and discharge, and a significant improvement was found. There was a positive correlation between the HFS on admission and both the severity of injury, and the length of time off work. This scoring system is not validated, but this study illustrates the use of subjective functional scoring systems in the planning, delivery and evaluation of rehabilitation.
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BULSTRODE, N. W., N. BURR, A. L. PRATT, and A. O. GROBBELAAR. "Extensor Tendon Rehabilitation a Prospective Trial Comparing Three Rehabilitation Regimes." Journal of Hand Surgery 30, no. 2 (April 2005): 175–79. http://dx.doi.org/10.1016/j.jhsb.2004.10.016.
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Forty-two patients with 46 complete extensor tendon injuries were prospectively allocated to one of three rehabilitation regimes: static splintage; interphalangeal joint mobilization with metacarpophalangeal joint immobilization or; the “Norwich” regime. All 42 patients were operated on by one surgeon and assessed by one hand therapist. At 4 weeks the total active motion in the static splintage group was significantly reduced but by 12 weeks there was no difference between the regimes. There was no difference in total active motion between the repaired and uninjured hand at 12 weeks, with all patients achieving good or excellent results. However, grip strength at 12 weeks was significantly reduced compared to the uninjured hand after static splintage. There was no difference in hand therapy input between the regimes.
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Burmatov, N. A., K. S. Sergeev, A. A. Gerasimov, and N. V. Zykova. "On rehabilitation of patients with severe traumatic hand injury (case history)." Medical Science And Education Of Ural 22, no. 3 (September 30, 2021): 33–36. http://dx.doi.org/10.36361/1814-8999-2021-22-3-33-36.
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Reconstruction of flexor tendons anatomic continuity at the level of osteofibrous canals is one of the most challenging in hand surgery. Due to the complex anatomy of the hand and a high risk of developing postoperative adhesions choosing the optimal treatment protocol remains crucial during flexor tendons rehabilitation period. Surgeons and rehabilitation specialists agree that a number of poor results of flexor tendon surgery can be caused by a wrong postoperative treatment, violation of treatment protocols or just by the lack of adequate rehabilitation measures. The aim of this study is analysis and the description of the case history of treating the teenager with concomitant hand injury after staged reconstructive and restorative nerve and tendon surgery. Materials and methods. The study analyses the use of intratissual electric stimulation (ITES) combined with the complex of special exercises for recovery of upper extremity function at the outpatient rehabilitation stage in patients who underwent nerve and tendon surgery. The objective pain syndrome and trophic innervation of the injured extremity assessment was performed by measuring skin surface electric potential using Gerasimov’s method. The results were interpreted according to “Personalized system of assessing the results of treating trauma and orthopedic patients”. Results. “Combination treatment in the rehabilitation of the upper extremity” proved to be effective to fight pain syndrome and trophic dysfunction of the nervous system. It allows the patient to do the complex of special exercises to prevent limb contracture if used during the late rehabilitation period. It is an efficient method of preventing and treating neurotrophic dysfunctions. Conclusion. The pathogenetically substantiated method of treating upper extremity, the use of intratissual electric stimulation at the outpatient rehabilitation stage of humerus fractures prove to be effective.
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Palmatier, Janet. "Review of Hand Surgery." Physical Therapy 86, no. 1 (January 1, 2006): 147. http://dx.doi.org/10.1093/ptj/86.1.147.
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Abstract This book's major focus is on surgical management of the hand and distal upper extremity. This book is intended to serve as a primary resource for hand surgery fellows and as a test preparation for orthopedic and plastic surgery residents (ie, boards, certificate for added qualifications, and residency examinations). In addition, it is intended to serve as a reference for hand surgeons, physical therapists, and occupational therapists involved in the care of patients with hand and distal upper-extremity disorders. For the physical therapist, the text provides insight into the medical and surgical management of the patient with a hand disorder, and, in turn, helps to provide a better understanding and rationale for therapeutic management of this patient population. However, keeping within the scope of hand surgery, this work provides very little substance for the physical therapist looking for specific information on the therapeutic management and rehabilitation of this particular patient population.
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HAESE, JULIA B. "Psychological Aspects of Hand Injuries their Treatment and Rehabilitation." Journal of Hand Surgery 10, no. 3 (October 1985): 283–87. http://dx.doi.org/10.1016/s0266-7681_85_80044-9.
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Psychological factors related to the treatment and rehabilitation of hand-injured patients were identified by interviewing of thirty patients under treatment. Findings were compared with those reported in the literature. Concern for inactivity, desire to return to work, and effort toward recovery were identified as significantly common factors; pain and fear of disfigurement were not. Patients perceived themselves as making the greatest effort toward recovery but not that this was the most important factor in the recovery process. Responsibility varied significantly among the early, middle, and final phases of treatment. The results of the investigation were discussed in relation to hand-rehabilitation and implications for counselling and occupational therapy.
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Rajesh, G., WY Ip, SP Chow, and BKK Fung. "Dynamic Treatment for Proximal Phalangeal Fracture of the Hand." Journal of Orthopaedic Surgery 15, no. 2 (August 2007): 211–15. http://dx.doi.org/10.1177/230949900701500218.
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Purpose. To assess a protected mobilisation programme (dynamic treatment) for proximal phalangeal fracture of the hand, irrespective of the geometry. Methods. Clinical and radiological results of 32 consecutive patients with proximal phalangeal fracture of the hand treated from January 2001 to February 2007 were evaluated. Our supervised rehabilitation programme was strictly followed to gain full range of movement of the proximal interphalangeal joint and to prevent the development of an extension lag contracture. Patients were followed up for a mean period of 15 (range, 13–16) months. Results were evaluated using the Belsky classification. Results. The results were excellent in 72% of the patients, good in 22%, and poor in 6%. Some patients defaulted follow-up, which made long-term assessment difficult. The poor results may have been related to patient non-compliance or default from rehabilitation. Many good results upgraded to excellent following further rehabilitation. Conclusion. Skeletal stability, not rigidity, is necessary for functional movements of the hand. Proximal phalangeal fractures can be effectively treated by closed methods, using the stabilising effect of soft tissues (zancolli complex–metacarpophalangeal retention apparatus) and external devices (metacarpophalangeal block splint), thus enabling bone healing and movement recovery at the same time.
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Outzen, Marianne. "Attitudes of Hand Surgeons, Hand Surgery Patients, and the General Public Regarding Psychologic Influences on Illness." Journal of Hand Therapy 21, no. 3 (July 2008): 297–98. http://dx.doi.org/10.1197/j.jht.2008.04.001.
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HARTH, A., G. GERMANN, and A. JESTER. "Evaluating the Effectiveness of a Patient-Oriented Hand Rehabilitation Programme." Journal of Hand Surgery (European Volume) 33, no. 6 (October 20, 2008): 771–78. http://dx.doi.org/10.1177/1753193408091602.
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This study evaluated the effectiveness of a patient-oriented, hand rehabilitation programme compared to a standard programme regarding functional outcomes, return to work, patient satisfaction and costs. Patients were recruited in two consecutive cohorts. One cohort received the standard treatment programme ( n = 75) and the other a programme based on principles of patient orientation ( n = 75). Data were collected at the beginning and end of rehabilitation and 6 months after discharge. Clinical variables included range of motion, grip and pinch strength. Self-reported measures included pain, upper extremity functioning, health status, satisfaction and job situation. Analysis of variance for repeated measurements was used to calculate the main effects. The patient-oriented group showed more favourable results with respect to DASH scores ( P <.05), pain ( P <.001) and patient satisfaction ( P <.0001). More patients returned to their former jobs and time off sick was reduced. We concluded that the patient-oriented approach was more effective and cost-saving.
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Choi, Katherine J., Christopher H. Pham, Zachary J. Collier, John Carney, Dawn Kurakazu, Haig A. Yenikomshian, and Justin Gillenwater. "77 Functional Outcomes in Patients with Hand Burns Receiving Long Term Hand Therapy." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S50. http://dx.doi.org/10.1093/jbcr/iraa024.081.
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Abstract Introduction Sparse data exists on functional outcomes of patients receiving outpatient therapy after admission with hand burns. The purpose of our study is to evaluate the effectiveness of long-term outpatient occupational therapy (OT) on hand joint range of motion (ROM), activities of daily living (ADL) status, and pain after burn injury. Methods All patients with hand burns admitted to a single ABA verified burn center from January 2015 to May 2016 with properly documented outpatient OT follow up were included. Demographics (TBSA, hand dominance, mechanism), interventions (time-to-surgery, procedures), and long-term outcomes (further procedures, pain, ROM, contractures, scars, ADL) were evaluated. The effect of patient demographics and interventions on outcomes were evaluated with descriptive statistics and multivariate logistic regression. Results Of 61 patients with hand burns, 43 were referred for outpatient therapy, but only 31% (n=19) consistently presented for follow up. Mean age was 37±14 years, 74% (n=14) were male, and mean TBSA was 12%±17. Surgical management was required in 63% (n=12), and the mean time-to-surgery was 16±37 days from injury. Contractures occurred in 16% (n=3), 11% (n=2) had hypertrophic scarring, and 21% (n=4) developed both contractures and hypertrophic scarring. Of these patients, 21% (n=4) required further surgical intervention, including 3 contracture releases and 1 triamcinolone injection. Mean OT follow up was 16±14 weeks. As of the last OT note, 84% (n=16) had independent ADL function, 16% (n=3) required assistance, and none were poorly functioning. Likewise, 47% (n=9) had normal ROM, 53% (n=10) were within functional limits, and none had poor ROM. 79% (n=15) demonstrated improvement of ADL function, and 84% (n=16) had improvement of ROM. At OT intake, 68% (n=13) reported pain as a major limitation, but by end of therapy, only 21% (n=4) were limited by pain. Those with contractures or hypertrophic scars were 9.9 times less likely to have improvement in ADL status (p=.03, RR 9.9, CI 1.3–67). Conclusions Most patients referred for hand therapy after burn injury return to functional independence and have functional ROM. Applicability of Research to Practice Referral to and compliance with dedicated long-term hand therapy leads to improvements to ADL and ROM in patients admitted with hand burn injuries.
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Weng, Li-Yao, Ching-Lin Hsieh, Kwang-Yi Tung, Tzyy-Jiuan Wang, Yu-Chih Ou, Li-Ru Chen, Shiun-Lei Ban, Wei-Wei Chen, and Chin-Feng Liu. "Excellent Reliability of the Sollerman Hand Function Test for Patients With Burned Hands." Journal of Burn Care & Research 31, no. 6 (November 2010): 904–10. http://dx.doi.org/10.1097/bcr.0b013e3181f93583.
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GRUNERT, B. K., CINDY J. SMITH, CECILIA A. DEVINE, BONNIE A. FEHRING, H. S. MATLOUB, J. R. SANGER, and N. J. YOUSIF. "Early Psychological Aspects of Severe Hand Injury." Journal of Hand Surgery 13, no. 2 (April 1988): 177–80. http://dx.doi.org/10.1016/0266-7681_88_90132-5.
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We investigated the incidence and nature of psychological symptoms occurring during the first two months after severe hand injuries. 94% of patients had significant symptoms at some point early in rehabilitation, including nightmares (92%), flashbacks (88%), affective lability (84%), preoccupation with phantom limb sensations (13%), concentration/attention problems (12%), cosmetic concerns (10%), fear of death (5%), and denial of amputation (3%). Two months later, flashbacks (63%) remained pronounced. Nightmares (13%), affective lability (48%), concentration/attention problems (5%), fear of death (0%), and denial of amputation (0%) declined markedly, while cosmetic concerns (17%) and preoccupation with phantom limb sensations (17%) increased. Based on these findings, we believe that psychological treatment should often be given as part of the rehabilitation process.
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SCHUIND, F., D. ABRAMOWICZ, and S. SCHNEEBERGER. "Hand Transplantation: The State-of-the-Art." Journal of Hand Surgery (European Volume) 32, no. 1 (February 2007): 2–17. http://dx.doi.org/10.1016/j.jhsb.2006.09.008.
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The feasibility of hand transplantation has been demonstrated, both surgically and immunologically. Levels of immunosuppression comparable to regimens used in solid organ transplantation are proving sufficient to prevent graft loss. Many patients have achieved discriminative sensibility and recovery of intrinsic muscle function. In addition to restoration of function, hand transplantation offers considerable psychological benefits. The recipient’s pre-operative psychological status, his motivation and his compliance with the intense rehabilitation programme are key issues. While the induction of graft specific tolerance represents a hope for the future, immunosuppression currently remains necessary and carries significant risks. Hand transplantation should, therefore, only be considered a therapeutic option for a carefully selected group of patients.
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Luo, Pengbo, Jinjie Lou, and Shengwu Yang. "Pain Management during Rehabilitation after Distal Radius Fracture Stabilized with Volar Locking Plate: A Prospective Cohort Study." BioMed Research International 2018 (November 5, 2018): 1–6. http://dx.doi.org/10.1155/2018/5786089.
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Introduction. Internal fixation with volar locking plate (VLP) was widely adopted as a first-line choice in treatment of distal radius fracture (DRF). Methods. Total 315 patients with distal radius fracture receiving VLP fixation were included for analysis in this study. The rehabilitation protocol was started immediately after surgery for all patients. During the initial two weeks after surgery, 149 patients received 200 mg celecoxib twice per day, 89 received buprenorphine transdermal patch at 5 μg/h, and 77 received 13 mg codeine plus 200 mg ibuprofen twice per day for pain management. Visual analog scale (VAS) scores of pain at rest, daily activity, and rehabilitative exercise were measured, respectively, every week according to the experiences of the past week in the initial six weeks after surgery. Functional outcomes including range of motion (ROM) for extension, flexion, pronation, supination, ulnar and radial abduction, the disabilities of arm, shoulder, and hand (DASH) score and the validated patient rated wrist evaluation (PRWE), and grip strength were collected at one, three, and six months after surgery. Results. We showed that patients receiving transdermal buprenorphine and codeine/ibuprofen had decreased VAS scores during rehabilitative exercise, better compliance to the rehabilitation program, and thus faster functional recovery. Conclusions. We recommend transdermal buprenorphine or codeine/ibuprofen for pain management during rehabilitation after distal radius fracture stabilized with VLP.
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Kostorz-Nosal, Sabina, Dariusz Jastrzębski, Aleksandra Żebrowska, Agnieszka Bartoszewicz, and Dariusz Ziora. "Three Weeks of Pulmonary Rehabilitation Do Not Influence Oscillometry Parameters in Postoperative Lung Cancer Patients." Medicina 58, no. 11 (October 28, 2022): 1551. http://dx.doi.org/10.3390/medicina58111551.
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Background: Thoracic surgery is a recommended treatment option for non-small cell lung cancer patients. An important part of a patient’s therapy, which helps to prevent postoperative complications and improve quality of life, is pulmonary rehabilitation (PR). The aim of this study was to assess whether the implementation of physical activity has an influence on forced oscillation technique (FOT) values in patients after thoracic surgery due to lung cancer. Methods: In this observational study, we enrolled 54 patients after thoracic surgery due to lung cancer, 49 patients with idiopathic interstitial fibrosis (IPF), and 54 patients with chronic obstructive pulmonary disease/asthma–COPD overlap (COPD/ACO). All patients were subjected to three weeks of in-hospital PR and assessed at the baseline as well as after completing PR by FOT, spirometry, grip strength measurement, and the 6-min walk test (6MWT). Results: We observed differences between FOT values under the influence of physical activity in studied groups, mostly between patients after thoracic surgery and COPD/ACO patients; however, no significant improvement after completing PR among FOT parameters was noticed in any group of patients. Improvements in the 6MWT distance, left hand strength, and right hand strength after PR were noticed (p < 0.001, 0.002, and 0.012, respectively). Conclusions: Three weeks of pulmonary rehabilitation had no impact on FOT values in patients after thoracic surgery due to lung cancer. Instead, we observed improvements in the 6MWT distance and the strength of both hands. Similarly, no FOT changes were observed in IPF and COPD/ACO patients after completing PR.
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McBride, Jaclyn M., Kathleen S. Romanowski, Soman Sen, Tina L. Palmieri, and David G. Greenhalgh. "60 Contact Hand Burns in Children: Still a Major Prevention Need." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S39—S40. http://dx.doi.org/10.1093/jbcr/iraa024.064.
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Abstract Introduction Since toddlers explore with their hands, contact burns continue to be a major pediatric problem. The purpose of this report is to review a pediatric burn unit’s 8-year experience with contact burns of the hand. Methods After IRB approval, a review of pediatric contact hand burns that occurred between 2006–2014 was performed. We examined the causes and outcomes in pediatric contact hand burns in a single pediatric burn program. Results In the 8-year span, 535 children suffered contact burns to the hand (67 per year). The majority suffered hands burns from an oven or stove (120). The other etiologies included burns from a fireplace (76), clothing iron (65), curling or straightening iron (50), and firepit or campfire (46). The mean age at time of injury was 2.62 years old, with a range of 2 months old to18 years old. Male children (339) typically burned their hands more than females (197). Locations of injury included the palmar surface, dorsal surface, fingers tips/thumb, wrist or a combination of several different areas. Most children burned the palmar aspect of their hand (384) compared to the dorsal aspect (61). These burns typically cover small total body surface areas (mean 1.08% TBSA), with only 2% of burns comprising >5% TBSA. Approximately, 84% of these patients did not need surgery, but 86 (16%) had skin grafting (usually full-thickness) and 26% needed a secondary surgery. Of those that needed more than two, the average number of procedures was 3.6. Approximately 4.1% of patients needed a tertiary surgery. Causes for tertiary surgeries included contractures and graft loss. Out of twenty-two patients that needed a third surgery, 59% were due to graft loss and 41% were due to contractures. Conclusions Contact burns to the hand continue to be a major problem for toddlers. Children are most likely to burn themselves on an oven or stove, fireplace, clothing iron or curling/straightening iron. The palmar surface of the hand is the most likely site. While most children do not require surgery, approximately 16% require grafting. A significant number of those patients need reconstructive surgery. Clearly, current prevention efforts have failed to reduce these injuries. Applicability of Research to Practice Palm burns are common in young children. Efforts should focus on preventing these injuries.
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Żyluk, Andrzej. "Outcomes of Surgery for Enchondromas within the Hand." Ortopedia Traumatologia Rehabilitacja 23, no. 5 (October 31, 2021): 325–34. http://dx.doi.org/10.5604/01.3001.0015.4344.
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Background. Enchondromas are the most common benign bone tumours found in the hand. They are usually accidentally diagnosed on an X-ray, because they grow asymptomatically. In some cases, a pathological fracture of the involved phalanx may be the first sign. The objective of this study was to assess the results of operative treatment of enchondromas involving hand phalanges and metacarpals. Material and methods. The study group consisted of 24 patients, 16 women (67%) and 8 men, (33%), aged a mean of 31 years, who were operated on at our centre. The surgery consisted in curettage, and - in most cases - filling the bone defect with either a bone graft or a bone substitute. Follow-up assessment was performed over the telephone in 17 patients (79% of the group) at a mean of 2 years after surgery. Results. Half of the patients were asymptomatic and fully recovered functionally, whereas the other half complained of some not troublesome symptoms such as scar discomfort, limitation of finger movement or cold sensitivity. No differences were observed with regard to the material used for filling of the bone defect following curettage. Two cases of recurrence were noted after surgery: one in the bone substitute group and one in the bone graft group. Conclusions. 1. Enchondromas are the most common benign bone tumours encountered in bones of the hand. 2. The first line treatment in these lesions is curettage and filling of the bone defect with a bone substitute or cancellous bone graft. 3. Both the results of the present study and literature data show that the approach to managing the tumour cavity after curettage has no significant effect on outcomes, which are essentially satisfactory.
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McBride, Jaclyn M., Kathleen S. Romanowski, Soman Sen, Tina L. Palmieri, and David G. Greenhalgh. "Contact Hand Burns in Children: Still a Major Prevention Need." Journal of Burn Care & Research 41, no. 5 (June 28, 2020): 1000–1003. http://dx.doi.org/10.1093/jbcr/iraa102.
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Abstract Since toddlers explore with their hands, contact burns continue to be a major pediatric problem. The purpose of this report is to review our 8-year experience with contact burns of the hand. After institutional review board approval, a review of pediatric contact hand burns that occurred between 2006 and 2014 was performed. In the 8-year span, 536 children had contact hand burns. The majority suffered burns from an oven or stove (120). The other etiologies included burns from a fireplace (76), clothing iron (65), curling or straightening iron (50), and firepit or campfire (46). The mean age was 2.62 years, with a range of 2 months to 18 years. Male children (339) burned their hands more than females (197). Most children burned the palmar aspect of their hand (384) compared to the dorsum (61). These burns typically cover small TBSAs (mean 1.08% TBSA), with only 2% of burns comprising >5% TBSA. Approximately, 84% of these patients did not need surgery, but 86 (16%) had skin grafting (usually full thickness) and roughly 26% of those needed reconstructive surgery. Contact burns to the hand continue to be a major problem for toddlers. Children are most likely to burn themselves on an oven or stove, fireplace, clothing iron or curling/straightening iron. The palmar surface of the hand is the most likely site. While most children do not require surgery, approximately 16% require grafting. A significant number of those patients need reconstructive surgery. Clearly, current prevention efforts have failed to reduce these injuries.
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Coward, Alexandra, Rachel M. Nygaard, and Frederick W. Endorf. "605 Revision Surgery Following Severe Frostbite Compared to Similar Hand and Foot Burns." Journal of Burn Care & Research 43, Supplement_1 (March 23, 2022): S142. http://dx.doi.org/10.1093/jbcr/irac012.233.
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Abstract Introduction Severe frostbite is associated with high levels of morbidity through loss of digits or limbs. The current practice is to salvage as much of the limb/digit as possible with the use of thrombolytic and adjuvant therapies. Sequalae from amputation can include severe nerve pain and poor wound healing requiring revision surgery. The aim of this study was to examine the rate of revision surgery after primary amputation and compare this to revision surgery in isolated hand/foot burns. Methods Frostbite and burn patients from 2006 to 2019 were identified in the prospectively maintained database at a single urban burn and trauma center. Patients with primary amputations related to isolated hand/foot burns or frostbite were included in the study. Descriptive statistics included Student’s T-test and Fisher’s Exact test. Results A total of 63 patients, 54 frostbite injuries and 9 isolated hand or foot burns, met inclusion criteria for the study. The rate of revision surgery was similar following frostbite and burn injury (24% vs 33%, P=0.681). There were no significant differences in age, gender, or LOS on the primary hospitalization. Neither the impacted limb nor the presence of infection or cellulitis on primary amputation were associated with future need for revision surgery. Of the 16 patients requiring revision surgery, 5 (31%) required additional debridement alone, 6 (38%) required re-amputation alone, and 5 required both. A total of 6 patients (38%) had cellulitis or infection at the time of revision surgery. Time from primary surgery to revision ranged from 4 days to 3 years. Conclusions Planned, delayed primary amputation is a mainstay of frostbite management. To our knowledge, this is the first assessment of revision surgery in the setting of severe frostbite injury. Our observed rate of revision surgery following frostbite injury did not differ significantly from revision surgery in the setting of isolated hand or foot burns. This study brings up important questions of timing and surgical planning in these complex patients that will require a multicenter collaborative study.
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Vocke, Scott F., Joseph S. Puthumana, Brooke Dean, Gregory Andre, Joshua Rodriguez, Misao Mercadante, Charles S. Hultman, et al. "81 Post-operative Self-adherent Compression Wrapping of the Hand and Its Impact on Skin-graft Viability." Journal of Burn Care & Research 43, Supplement_1 (March 23, 2022): S53—S54. http://dx.doi.org/10.1093/jbcr/irac012.084.
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Abstract Introduction Potential complications of autografting for burn wound coverage of the hand include edema, hematoma formation, and bleeding; all of which can lead to graft failure. Self-adherent elastic wraps are commonly used by burn rehabilitation clinicians to minimize complications by providing graft protection and decreasing edema post-operatively; however, there is a lack of evidence on its impact on graft healing. The purpose of this study was to determine if the application of self-adherent elastic wraps to the hand in the operating room after autografting improves the percentage of graft viability. Methods A retrospective chart review was performed for 37 patients with burned hands who underwent autografting from January 2017 to July 2021. Grafted hands were categorized into 2 groups: post-operative dressings with and without self-adherent elastic wraps. Post-operative day 4 pictures for both groups were collected from the medical record and a blinded digital photograph analysis of graft viability was performed by 5 expert raters including 3 Burn Surgery Fellows,1 Burn Attending Surgeon and 1 Hand Attending Surgeon. A rating system was developed based on percentage of graft take as seen in Table 1 and presence of hematomas were assessed. Results Patients who received self-adherent elastic wraps suffered burns with significantly larger TBSA (p=0.007) and were admitted for a longer duration (p=0.009) than patients who did not. Patients with elastic wrap had a higher percentage of grafts with >95% take (64.0% vs 41.7%, p=0.227) and a lower rate of hematoma formation (24.0% vs. 41.7%, p=0.443). Intra-class correlation coefficient across raters was 0.90 for graft take and 0.87 for determining presence of hematomas, indicating excellent interrater reliability. Conclusions Despite suffering larger burns requiring longer hospitalizations, patients who received elastic wrap had a higher rate of >95% graft take than those without. This study is limited by a relatively small sample size, however these findings warrant continued research in the use of self-adherent elastic wrap to maximize graft take in hand burns.
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Deikalo, V. P., and A. N. Tolstik. "The Use of Cutaneous Autoplasty in the Rehabilitation of Patients with an Acute Hand Injury." Novosti Khirurgii 23, no. 5 (October 15, 2015): 577–81. http://dx.doi.org/10.18484/2305-0047.2015.5.577.
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Aksenenko, I. P. "Management of patients during medical rehabilitation after contour plastic surgery of the hand in cosmetology." Klinicheskaya dermatologiya i venerologiya 21, no. 1 (2022): 138. http://dx.doi.org/10.17116/klinderma202221011138.
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Hillebrecht, Karalyn E., and Jenny A. Ziembicki. "657 Bilayer Dermal Substitute in Management of Deep Hand Burns." Journal of Burn Care & Research 42, Supplement_1 (April 1, 2021): S185. http://dx.doi.org/10.1093/jbcr/irab032.305.
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Abstract Introduction Bilayer dermal substitutes, composed of bovine collagen cross-linked with glycosaminoglycan and silicone, have become increasingly integrated into the algorithm for management of complex burns. In complex hand burns, dermal substitutes improve functional and aesthetic outcomes while also allowing early excision in high percentage TBSA burns. We detail the outcomes of 17 patients with 25 cases of complex hand burns managed at our center using a staged procedure of cadaveric allografting followed by dermal substitute placement and early definitive STSG. Methods Between Jan 2018 and Aug 2019, all patients who sustained deep partial/full thickness burns to their hands managed with dermal substitution were identified. Patients less than 18 yo, with additional non-burn trauma to the hands, and with initial operative management at another center prior to transfer were excluded. A retrospective chart review was used to collect data regarding time to operative excision, placement of allografts and substitutes, definitive STSG, and functional outcome. Results 17 patients from 18 and 89 yo presented with 25 deep partial/full thickness hand burns. TBSA varied from 0.75 to 78% (mean 17.7%). On average, patients underwent first excision 5.3 (2–16) days after initial burn or 4.2 days after presentation. Our protocol often uses allografting prior to placement of the dermal substitute, therefore, 22 of 25 burned hands received cadaver allografts at initial excision. Dermal substitute was placed an average of 9.2 days later. 3 of 25 burns had immediate application of dermal substitute at first excision. Following substitute, non-meshed, split-thickness autografts were placed on 18 hands. 5 of the burns did not require STSG and two hands were not further evaluated due to loss of patient follow-up. Of the 25 cases, all had near complete incorporation of the substitute without need for revision. In follow-up, patients who did not require STSG have shown no major limitations in ROM/scarring. Of those who underwent STSG, 6 hands underwent contracture release, with 2 of these progressing to amputation. One hand required repeat autografting due to graft loss. All remaining 18 hands healed well with near complete graft take and minimal scarring or functional limitation. Conclusions Dermal substitutes assist in the closure of complex deep hand burns. Cadaveric allografting prior to placement of the substitute ensures an appropriately excised wound base, allowing for near complete integration without need for reapplication. Autografting following dermal substitution placement may be initiated earlier than previously pursued and occasionally allows for healing without STSG.
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Lin, H., C. Hou, A. Chen, and Z. Xu. "Long-term outcome of division of the C8 nerve root for spasticity of the hand in cerebral palsy." Journal of Hand Surgery (European Volume) 35, no. 7 (March 26, 2010): 558–62. http://dx.doi.org/10.1177/1753193410368200.
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Division of the C8 nerve root results in short-term relief of spasticity in the hands of cerebral palsy patients. In the present study, we assessed the long-term outcome of C8 nerve root division. Between March 1997 and January 2002, this procedure was done in 13 patients. All received consistent postoperative functional rehabilitation training. The hands were assessed before operation and at follow-up using the Lazareff grading system. The average follow-up time was 8.6 years. Two hands showed excellent improvement, three limbs showed good improvement and eight hands showed no improvement. No long-term complications occurred in any patient. These results indicate that the long-term outcome of C8 nerve root rhizotomy for the treatment of hand spasticity in CP is generally poor.
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Burdon, Joanna, Sarah Taplin, Simon P. Kay, and Daniel J. Wilks. "The functional assessment and rehabilitation programme of the UK hand and upper limb transplant service." Hand Therapy 25, no. 1 (October 4, 2019): 18–25. http://dx.doi.org/10.1177/1758998319875759.
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Introduction Hand and upper limb transplants are becoming internationally recognised as an effective treatment to improve function and quality of life in carefully selected patients. A comprehensive functional assessment and rehabilitation programme are an essential component of the multi-disciplinary assessment and treatment approach. Although there is an increasing body of published data on the surgical techniques and outcomes following hand transplant, little exists in the literature to guide the hand therapist. Method The pre-transplant functional assessments and rehabilitation programme provided for patients undergoing hand transplantation in the UK are described and critically analysed. The UK programme is based on that provided in Lyon, France, but adapted to suit the resources and structure of the UK National Health Service. Results Twelve patients have received a functional assessment as part of the multi-disciplinary hand transplant assessment process, with the loss of autonomy a key reason for patients seeking hand transplant. Six of these patients have received hand transplants, with patients more than one year post-transplant having achieved good and fair outcomes according to the Hand Transplantation Score System. Conclusions Although hand and upper limb transplant surgery is innovative, the therapy provided is based on the fundamental principles of good communication, accurate assessment and delivery of a bespoke rehabilitation programme; values which are common to all areas of hand therapy practice. A future study reporting the long-term outcomes of patients following hand transplant in the UK is needed to allow the effectiveness of the programme to be evaluated.
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Thomas, Mini, David Chung, and Christopher de La Cruz. "830 Voice Activated Tool: A Successful Assistance for Patients with Limited Hand Function." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S252—S253. http://dx.doi.org/10.1093/jbcr/iraa024.403.
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Abstract Introduction Burn survivors require significant assistance in physical functions and independence during their recovery and rehabilitation phase. Amputation, splints, bulky dressings, and pain attribute to limited or lack of hand mobility. Voice activated tools (VAT) have rapidly grown in popularity including in healthcare. Prior to the implementation of this project, patients mostly depended on soft touch call lights which were suboptimal for most patients. We piloted VAT to assist in hand functions of patients with limited or lack of hand mobility. Methods The project was piloted in collaboration with IT, Occupational Therapy, Nursing, and patients’ family. IT enabled with uninterrupted source of wireless network connection in the patients’ room. Voice assistance was incorporated both through mobile phone and an added virtual assistant tool. Patients’ personal devices were used to promote utilization of stored information in the device. Occupational therapist assisted in mounting the device through a spring clamp and gooseneck cell phone holder to visualize the device screen. Speech therapists, nurses, and patient family helped in training the patient to voice appropriate commands. The patient utilized VAT for a wide variety of purposes including calling nurses, ordering hospital meals, phone calls, music, web browsing, and more. A survey was done to evaluate health care team’s opinion on VAT usage. Results Of the total burn team members, 34 (77%) staff responded to the survey including physicians, nurses, therapists, and nursing assistants. All survey responders reported VAT as a useful tool to be offered to all future patients with limited hand mobility. Majority (74%) of responders witnessed or participated in the successful use of VAT during the pilot period. Survey participants reported three reasons for the current soft touch call light system to be suboptimal: 1.Too sensitive, 2. Not all patients can use it 3. Conclusions Voice activated tool can be successfully utilized for assisting patients with limited hand mobility considering the current available tool is suboptimal. Adoption of a simple and popular technology of VAT can be easily incorporated in hospitals through collaboration of health care team. Applicability of Research to Practice Use of VAT could be successfully implemented for other hospital units including paralyzed patients, blind, and patients with orthopedic conditions or trauma to hands. Additionally, VAT could be incorporated in to rehabilitation and home training of patients with limited hand mobility. Further, VAT could be considered in the designing and planning of hospitals.
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Pham, Christopher H., Zachary J. Collier, Clifford C. Sheckter, Haig A. Yenikomshian, and Justin Gillenwater. "99 Hand Burns: An Independent Risk Factor for Worse Hospital Outcomes." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S65. http://dx.doi.org/10.1093/jbcr/iraa024.102.
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Abstract Introduction Hand burns cause disability, loss of productivity, and psychological distress. While rarely life-threatening, hand burns are life-altering. There are limited large-scale investigations on the prevalence of hand burns and the impact on hospital outcomes. We present the first National Burn Repository (NBR) study on the prevalence of hand burns and associated outcomes. Methods We used NBR Version 8.0 to identify patients who sustained isolated and non-isolated hand burns. These patients were then sub-stratified into operative vs. non-operative hand burns and compared with non-hand burns as controls. Patient demographics and hospital outcomes (mortality, length of stay [LOS], intensive care unit LOS [ICU LOS], hospital charges) were collected. Multivariable logistic and multiple linear regressions determined the effect of hand burns on outcomes adjusting for age, %TBSA, full-thickness involvement, and inhalation injury. Results Of 172,640 NBR patients, 47,424 patients had hand burns and 5,870 (12%) were operative. Patients with hand burns had significantly larger %TBSA burns (12±18% vs. 7±8%, P< 10–4), more full-thickness involvement (6±16% vs. 2±6%, p< 10–4), a higher prevalence of inhalation injury (7% vs. 5%, p< 10–4), were more often male (73% vs. 66%, p< 10–4), higher mortality (5% vs. 2%, p< 10–4), longer LOS (12±22 vs. 8±21 days, p< 10–4) and ICU LOS (7±18 vs. 3±10 days, p< 10–4). Similarly, operative hand burns had longer LOS (25±30 vs. 10±20, p< 10–4) and ICU LOS (25±29 vs. 12±22, p< 10–4) but lower mortality (3% vs. 6%, p< 10–4) than non-operative hands. When controlling for age, sex, TBSA, full-thickness involvement, and inhalation injury, the presence of hand burns significantly predicted higher mortality (OR=1.6, 95% CI 1.5–1.8, p< 10–4) and prolonged ICU stays by 0.79 days (p=0.003), but was not associated with prolonged LOS (p >0.05). Billing data revealed significantly higher hospital charges ($114,608±294,289 vs. $58,314±158,758, p< 10–4) in patients with hand burns (N=17,140) compared to those without (N=12,530). Conclusions Patients with hand burns had worse inpatient outcomes and were also more costly to the healthcare system. Practitioners must pay close attention to hand burns as the cost to the system and society warrants improved management. In a society increasingly focused on value and quality, additional investigations are needed to understand how we can better treat hand burns to decrease inpatient morbidity. Applicability of Research to Practice Granular data for the hospital course of patients with hand burns may better elucidate why they require more healthcare resources than others.
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Buta, Martin, Callie Abouzeid, Khushbu F. Patel, Olivia Stockly, Ryan Cauley, Liang Chen, Audrey E. Wolfe, et al. "113 Long-term Reconstructive Surgery of the Burned Hand: 16-year Experience at a Major Burn Center." Journal of Burn Care & Research 42, Supplement_1 (April 1, 2021): S75—S76. http://dx.doi.org/10.1093/jbcr/irab032.117.
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Abstract Introduction Early excision and grafting for deeper hand burns is important for preservation of long-term hand function. Little information exists on long-term reconstructive and revision operations after acute grafting. Limited quantitative data is available on early predictors of this outcome. This study retrospectively examines a cohort of patients who underwent excision and grafting of acute hand burns and details their reconstructive course in the years after injury. Predictors of future reconstructive hand surgery are examined. Methods A retrospective review was conducted using medical records of patients admitted with acute burn injury to a major regional burn center from February 1999 to October 2015 and who subsequently underwent excision and grafting for closure of the acute wound. Information collected included demographics, burn size and etiology, anatomical involvement, grafting, contracture release, local tissue rearrangement, and regional and distant flaps. Regression analysis assessed for demographic and clinical predictors for future contracture release with grafts and/or local tissue rearrangement surgery. Results A total of 704 hands in 532 adults (71% male, median age 40 years, average burn size 14.9% TBSA) met study criteria (Table 1). Ninety-eight patients underwent at least one reconstructive surgery (122 burned hands). Mean length of follow-up was 1000 days. Multivariable logistic regression analysis showed that male gender was negatively associated (p< 0.001; OR 0.369; 90% CI, 0.233–0.584) with contracture release with graft whereas white race (p=0.030; OR 2.060; 90% CI, 1.192–3.560) and burn size ≥21% TBSA (p< 0.001; OR 3.962; 90% CI, 2.224–7.057) were positively associated. Males had a negative association (p=0.023; OR 0.527; 90% CI, 0.332–0.837) and burn size a positive association with local tissue rearrangement (5–10% TBSA - p=0.041; OR 2.149; 90% CI, 1.161–3.975 and >21% TBSA - p< 0.001; OR 4.230; 90% CI, 7.927). Conclusions Approximately 1 in 6 acutely grafted hands underwent at least one reconstructive surgery of clinically significant contractures, primarily in digits and web spaces. Female gender and burn size were positive predictors of both categories of reconstructive surgery while white race was a positive predictor of release and graft.
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Kronheim, J. K., O. Katsumi, and T. Hirose. "The Visual Hand Display: A Focus on Collaboration." Journal of Visual Impairment & Blindness 85, no. 8 (October 1991): 338–39. http://dx.doi.org/10.1177/0145482x9108500809.
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When young children experience subnormal vision, an array of evaluation tools and techniques is used to assess visual function. Some children who have retinopathy of prematurity may require surgery. Post-operatively, at the Children's Low Vision Center in Boston, the pediatric ophthalmologist evaluates the child's visual functioning using a variety of devices. A tool called the Visual Hand Display has been introduced to enhance the physician's methods of evaluation, thereby achieving greater understanding of the child's visual responses. Collaborations among the doctors, educators, therapists, and patients are emphasized.
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Cacchio, Angelo, Giancarlo Di Carlo, Cofini Vincenza, and De Blasis Elisabetta. "Effectiveness and safety of a mixture of diosmin, coumarin and arbutin (Linfadren®) in addition to conventional treatment in the management of patients with post-trauma/surgery persistent hand edema: a randomized controlled trial." Clinical Rehabilitation 33, no. 5 (February 13, 2019): 904–12. http://dx.doi.org/10.1177/0269215519829797.
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Objective: To evaluate the effectiveness and safety of oral administration of Linfadren® in addition to conventional treatment in patients with post-trauma/surgery persistent hand edema. Design: Parallel-group randomized controlled trial. Setting: Outpatient rehabilitation center. Subjects: A total of 60 outpatients (mean age 48.5 (standard deviation (SD) = 12.3) years) with post-trauma/surgery persistent hand edema. Interventions: Patients were randomized to either receive six-week conventional treatment plus Linfadren® (Study Group) or conventional treatment (Control Group). Main Measures: Primary outcome was hand edema as measured by figure-of-eight method. Secondary outcomes were hand function, patient’s overall perceived treatment effectiveness and rescue medication request. Tolerability of Linfadren® was also evaluated. Assessments were performed at baseline, at the end of treatment and three months after the end of treatment. Results: All patients completed the six-week program and 57 patients (95%) completed the three-month follow-up. At six weeks, the Study Group had significantly greater improvement in hand edema (423.3 (SD = 23.8) mm vs 439.4 (SD = 22.6) mm; P = 0.009) and upper limb function ( Quick Disabilities of Arm, Shoulder and Hand questionnaire: 23.6 (SD = 13.6) vs 37.7 (SD = 15.9); P = 0.005) compared to the Control Group. Moreover, the percentage of patients who perceived treatment as effective was significantly higher in the Study Group than in the Control Group both after treatment (70% vs 37%, P = 0.002) and at follow-up (77% vs 30%, P < 0.0001). The rescue medication request was not different between groups. No adverse events were recorded. Conclusion: Linfadren® in addition to conventional treatment was safe and more effective than conventional treatment alone in patients with post-trauma/surgery persistent hand edema.
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Cristescu, Ioan, Daniel Vilcioiu, Liliana Mirea, Claudia Milea, Ileana Mates, and Aurel Mohan. "Functional Outcomes after Surgical Treatment of Hand Fractures - ORIF vs. CRIF Analysis." Key Engineering Materials 745 (July 2017): 124–33. http://dx.doi.org/10.4028/www.scientific.net/kem.745.124.
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Hand fractures are the most common fractures presenting at both accident and emergency and within emergency clinics. Appropriate evaluation at first presentation, as well as during their management, can significantly prevent both morbidity and disability to a patient. These decisions are dependent on a wide range of factors including age, hand dominance, occupation and co-morbidities. Usually, conservative treatment is the best solution for the patients but the indication for such treatment should be really precise. Unstable or multiple fractures are treated in a surgical manner, more or less invasive. When surgical treatment is the main indication, the hand surgeon has to choose the best bone implant, which can assure fast rehabilitation of the hand. We report our surgical experience in hand fractures that includes metacarpal and phalanges fractures and different bone implants application: Kirschner wires, mini-plates and screws and external fixation. We designed a retrospective clinical study on 32 patients that were treated in our department during the interval 2015-2016. Rehabilitation of the hand after surgery is the most important aspect of treatment, because it is necessary in every patient, and because it is no use splinting or operating on a hand if it ends up stiffed. Stable fixation of fractures and early mobilization will prevent stiffness and will be the key for successfully treatment of hand fractures. This can be possible only when the surgeon will choose the best way of treatment using different type of surgical management.
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Seo, Cheong Hoon, and So Young Joo. "792 Exoskeleton Robot Using 3-Dimensional Modeling in Burn Patient." Journal of Burn Care & Research 43, Supplement_1 (March 23, 2022): S202. http://dx.doi.org/10.1093/jbcr/irac012.342.
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Abstract Introduction Hands are the part of the body that are most commonly involved in burns, and the main complications are finger joint contractures and nerve injuries. Hypertrophic scarring cannot be avoided despite early management of acute hand burn injuries, and some patients may need application of an exoskeleton robot to restore hand function. To do this, it is essential to individualize the customization of the robot for each patient. Three-dimensional (3D) technology, which is widely used in the field of implants, anatomical models, and tissue fabrication, makes this goal achievable. Methods Therefore, this report is a study on the usefulness of an exoskeleton robot using 3D technology for patients who lost bilateral hand function due to burn injury. Five burn patients with upper limb dysfunction after a flame and chemical burn injury, with resultant impairment of manual physical abilities. Results After wearing an exoskeleton robot made using 3D printing technology, the patients could handle objects effectively and satisfactorily. Conclusions This innovative approach provided considerable advantages in terms of customization of size and reduction in manufacturing time and costs, thereby showing great potential for use in patients with hand dysfunction after burn injury.
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Brown, Jeffrey A., Helmi L. Lutsep, Martin Weinand, and Steven C. Cramer. "Motor Cortex Stimulation for the Enhancement of Recovery from Stroke: A Prospective, Multicenter Safety Study." Neurosurgery 58, no. 3 (March 1, 2006): 464–73. http://dx.doi.org/10.1227/01.neu.0000197100.63931.04.
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Abstract OBJECTIVE: Functional magnetic resonance imaging and transcranial magnetic stimulation studies suggest that human cortex shows evidence of neuroplasticity. Preclinical studies in rats and monkeys suggest that motor cortical stimulation can enhance plasticity and improve recovery after stroke. This study assesses the safety and preliminary efficacy of targeted subthreshold epidural cortical stimulation delivered concurrently with intensive rehabilitation therapy while using an investigational device in patients with chronic hemiparetic stroke. METHODS: This is a prospective, multicenter, and nonblinded trial randomizing patients to rehabilitation with or without cortical stimulation. Patients aged 20 to 75 years who had had an ischemic stroke at least 4 months previously causing persistent moderate weakness of the arm were included. Functional magnetic resonance imaging localized hand motor function before surgery to place an epidural cortical electrode. Both groups then underwent rehabilitation for 3 weeks after which the electrode was removed. Outcome measures were obtained at baseline, during therapy, and at 1, 4, 8, and 12 weeks postprocedure. RESULTS: Ten patients were randomized; six patients to surgery, four to the control group. No patient deaths, neurological deterioration, or seizures occurred. There were two infections from nonprotocol-related causes. Of the eight patients completing the treatment, the stimulation plus rehabilitation group improved significantly better than controls in the Upper Extremity Fugl-Meyer (P = 0.003 overall) and the hand function score of the Stroke Impact Scale (P = 0.001 overall). CONCLUSION: The technique of cortical stimulation to enhance stroke recovery is well tolerated and safe.
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Maldonado Carrasco, Claudia Lucía, Manuel Edmundo Espinoza Espinoza, Rómulo Augusto Idrovo Carrasco, and Luis Alberto Tinoco Cazorla. "Reporte de un caso clínico: Reimplante de mano." Revista Médica del Hospital José Carrasco Arteaga 13, no. 1 (July 31, 2021): 125–30. http://dx.doi.org/10.14410/2021.13.2.cc.20.
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BACKGROUND: The upper limb plays a vital role in our daily function; injuries to this vital structure can result in devastating consequences to functional, psychological and social well-being; especially traumatic amputations of the upper limb are challenging to manage and deciding which patients would benefit from limb salvage versus amputation is critical. CASE REPORTS: A 52-year-old male patient, who suffered a traumatic partial amputation in the distal third of his right forearm with an industrial machine, presenting an ulnar and radius fracture, with severe soft tissue injuries, who underwent a replantation surgery after 12 hours of ischemia. EVOLUTION: Patient presented good postsurgical outcome. 24 hours after surgery he presented normal Allen’s test results, adequate temperature, pink coloration, hypoesthesia and 2/5 muscle strength in the injured limb. He was discharged 7 days after surgery with follow-up and rehabilitation prescription. The percutaneous needles were removed 13 weeks after, with proper bone healing of the fracture. 5 months after surgery, he presented a DASH Score of 60.83. CONCLUSION: The replantation field has become very sophisticated in recent years; the decision to perform replantation of the amputated limb must be individualized to each patient, based on several established factors such as the characteristics of the injury, patient related factors, and the functional recovery capacity.
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Choi, Katherine J., Christopher H. Pham, Zachary J. Collier, John Carney, Dawn Kurakazu, Haig A. Yenikomshian, and Justin Gillenwater. "814 Do Patients Receive Reliable Outpatient Occupational Therapy After Hand Burns." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S246. http://dx.doi.org/10.1093/jbcr/iraa024.391.
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Abstract Introduction Hands are the most commonly burned body part, and are prone to developing limited range of motion and scar contractures, which benefit from aggressive occupational therapy (OT). Many burn survivors are vulnerable with limited resources and poor follow up. The purpose of this study is to determine outpatient OT referral and compliance rates in our patient population. Methods All patients with hand burns admitted to a single ABA verified burn center from January 2015 to May 2016 were reviewed. Demographics (living situation, substance use, psychiatric illness), TBSA, interventions (type/number of surgeries), outcomes (length of stay [LOS]), and OT outcomes (inpatient and outpatient treatment, reason for discontinuation) were evaluated. Results Sixty-one patients met inclusion criteria. Mean age was 33±18 years. In terms of living situation, 17% (n=10) were homeless, and 3% (n=2) were incarcerated. A documented history of alcohol abuse was present in 13% (n=8), 23% (n=14) had positive urine toxicology screens, and 15% (n=9) had diagnosed psychiatric illness. Mean TBSA was 10%±6. Half (N=30, 51%) were managed non-operatively. At discharge, 30% (n=18) had normal hand function and did not meet criteria for outpatient hand therapy. Over 70% (n=43) received outpatient referrals, but only 44% (n=19) of those referred reliably returned for outpatient OT. Despite having outpatient OT referrals, 33% (n=14) did not present to outpatient therapy after repeats attempts of contact, and 67% (n=29) of those with referrals only came to one visit. Of those that did not complete therapy, most (n=14, 58%) were lost to follow up and unable to be contacted. Other reasons for not completing therapy within our system were out-of-network insurances requiring follow-up outside our hospital (36%) and incarceration (6%). Conclusions At our center, nearly 1 in 3 patients with hand burns had excellent function upon discharge and did not require outpatient therapy. However, when patients are referred for outpatient therapy, many do not show up or maintain reliable compliance. Many patients are simply lost to follow up. Applicability of Research to Practice While occupational therapy remains an effective and viable option for hand rehabilitation, further efforts must be aimed at providing patients mechanisms and education for achieving reliable outpatient follow up.
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Lee, Ellen Y., Josephine Wing-Yuk Ip, Boris Kwok Keung Fung, and Edmond Ted U. "MYCOBACTERIUM CHELONAE HAND INFECTION: A REVIEW." Hand Surgery 14, no. 01 (January 2009): 7–13. http://dx.doi.org/10.1142/s0218810409004219.
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Six cases of culture-proven Mycobacterium chelonae tenosynovitis were identified through retrospective chart review. Fifteen cases were identified using computerised Medline search. Clinical features, treatment and outcome were described. Infection control was achieved in our patients with an average of 3.2 surgeries each and antibiotic treatment for six months to one year. Eleven published cases were managed by combined surgery and systemic antibiotics, with an average of 1.73 surgeries per patient and seven weeks to 24 months of antibiotics. All our patients were disease free on final follow-up. Thirteen cases were resolved. Functional outcomes were reported for eight cases. Comparison of functional outcome was not possible because different parameters were used in different reports. Aggressive debridement, susceptibility-guided antibiotics, and supervised rehabilitation resulted in infection control and acceptable hand function for our patients. Standardised data collection on subsequent cases would facilitate outcome monitoring and formulation of a treatment guideline for this disease.
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Bergfeldt, Ulla, Joakim Strömberg, Therese Ramström, Katarzyna Kulbacka-Ortiz, and Carina Reinholdt. "Functional outcomes of spasticity-reducing surgery and rehabilitation at 1-year follow-up in 30 patients." Journal of Hand Surgery (European Volume) 45, no. 8 (April 26, 2020): 807–12. http://dx.doi.org/10.1177/1753193420918743.
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The effects of spasticity-reducing surgery in the upper extremity were assessed in a prospective observational study of 30 consecutive patients with stroke ( n = 13), incomplete spinal cord injury ( n = 9), traumatic brain injury ( n = 5), cerebral palsy ( n = 2), and degenerative central nervous system disease ( n = 1). Surgery, which included lengthening of tendons and release of muscles, was followed by early rehabilitation at three intensity levels depending on the patients’ specific needs and conditions. At 12 months follow-up there were significant improvements in all outcome measures with the following mean values: spasticity decreased by 1.4 points (Modified Ashworth Scale, 0–5), visual analogue pain score by 1.3 points, and both Canadian Occupational Performance Measures increased (performance by 3.4 and satisfaction by 3.6), and most measures of joint position or mobility improved. Hand surgery combined with early and comprehensive rehabilitation improves function, activity and patients’ satisfaction in patients with disabling spasticity with improvement lasting for at least 1 year. Level of evidence: II
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Edwick, Dale O., Dana A. Hince, Jeremy M. Rawlins, Fiona M. Wood, and Dale W. Edgar. "Bioimpedance Spectroscopy Is a Valid and Reliable Measure of Edema Following Hand Burn Injury (Part 1—Method Validation)." Journal of Burn Care & Research 41, no. 4 (May 9, 2020): 780–87. http://dx.doi.org/10.1093/jbcr/iraa071.
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Abstract The assessment of swelling following burn injury is complicated by the presence of wounds and dressings and due to patients experiencing significant pain and impaired movement. There remains a lack of sensitive objective measures for edema in patients presenting with hand burn injury. Bioimpedance spectroscopy (BIS) is a measure of body composition that has been demonstrated by our group to be reliable for measuring whole body and limb edema during resuscitation and to be sensitive to edema changes within healing wounds. The aim of this study was to determine the reliability and validity of BIS as a measure of edema following hand burn injury specifically. One hundred patients presenting with burn injury including a portion of a hand were recruited to this trial. Repeated measures of the hand were recorded using a novel application of BIS and in parallel with water displacement volumetry (WDV). The results were analyzed using mixed-effects regressions. Paired repeated measures were obtained for 195 hands, using four electrode configurations. BIS demonstrated high reliability in measuring hand BIS—Intraclass Correlation Coefficient 0.995 to 0.999 (95% CI 0.992–1.000) and sensitivity—Minimum Detectable Difference 0.74 to 3.86 Ω (0.09–0.48 Ω/cm). A strong correlation was shown with WDV, Pearson’s r = −0.831 to −0.798 (P < .001). BIS is a sensitive and reliable measure of edema following acute hand burn injury.
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Dewey, William S., Kyle B. Cunningham, Sarah K. Shingleton, Kaitlin A. Pruskowski, Ashley M. Welsh, and Julie A. Rizzo. "T2 Safety of Early Post-operative Range of Motion in Burn Patients with Newly Placed Hand Autografts." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S1—S2. http://dx.doi.org/10.1093/jbcr/iraa024.001.
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Abstract Introduction Patients who suffer hand burns are at a high risk for developing contractures, partly due to the presence of numerous cutaneous functional units, or contracture risk areas, located within the hand. Patients who undergo split-thickness skin grafting (STSG) are often immobilized post-operatively for graft protection. Restricting mobility following a STSG is thought to protect against subdermal edema and shear forces, despite limited evidence. Early range of motion (EROM) has been described previously. Recent practice at our burn center includes EROM following hand STSG to limit unnecessary immobilization. The purpose of this retrospective study was to determine if EROM is safe to perform after hand STSG and if there is any clinical benefit. Methods In an approved, retrospective, matched case-control study of adult patients who sustained hand burns, patients who received EROM were defined as cases; patients who did not receive EROM were considered controls and received the standard 3–5 days of post-operative immobilization in a resting hand splint. Adult patients admitted over a 3-year period were eligible for inclusion. Patients were evaluated for graft loss and range of motion. Results Seventy-two patients were included in this study; 37 EROM patients and 35 matched controls. EROM patients tended to have a larger area excised (170.4 ± 69.8cm2 vs. 132.9 ± 76.2cm2; p=0.034) and grafted (171 ± 70.8 cm2 vs. 132.9 ± 76.2 cm2; p=0.033). Most patients were male, with an average age of 39 years. Patients had an average of approximately 5% TBSA burns with 1.5% to the hands. On post-op day (POD) 1 and 2, patients received EROM for an average of 30 minutes (29.25 ± 14.9 vs. 31 ± 16.4 minutes). Six patients experienced minor graft loss. Three patients (8%) experienced graft loss not attributable to EROM. One patient (2.7%) experienced graft loss pre-EROM on POD2 and 3 patients (8%) experienced graft loss post-EROM on either POD1 or POD2. All graft loss was less than 1 cm in greatest dimension and no patient who experienced graft loss required additional surgery as they all closed by their first outpatient follow-up. Significantly more patients who received EROM achieved full digital flexion by the first outpatient visit (25/27=92.6% vs. 15/22=68.2%; p=0.028). Conclusions Performing EROM does not cause an increase in graft loss. All areas of graft loss from the EROM group healed without intervention. There appears to be a benefit to EROM since there was a significant improvement in the patients’ ability to make a full fist at initial outpatient follow up. Further prospective analysis is needed to examine the true clinical utility of EROM in the hand and other contracture-prone areas. Applicability of Research to Practice Clinical change in post-operative management after hand grafting.
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Noviana, Astika Cahya, I. Putu Alit Pawana, and Martha Kurnia Kusumawardani. "Case Report: Rehabilitation of bilateral below-knee and partial-hand amputations in a developing country." F1000Research 11 (December 20, 2022): 1537. http://dx.doi.org/10.12688/f1000research.128322.1.
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Limb ischemia is a complication of peripheral artery disease (PAD)which can lead to amputation. Amputation occurs in approximately 3-4% of PAD patients. In Indonesia, post-amputation patients are only hospitalized for the acute phase and the post-amputation rehabilitation programs must be done as an outpatient. This could be a barrier to the continuity of rehabilitation programs. A solution is the application of home-based rehabilitation programs. A 57-year-old female was referred from the Cardiothoracic Surgery Outpatient Clinic post-amputation with bilateral below-knees and partial-hands amputation after being diagnosed with PAD. On initial examination, all her elbows, wrists, thumbs, hips, and knees showed weakness. The patient received neuromuscular electrical stimulations (NMES) as well as a home-based rehabilitation programs. On the second examination, after considering the data from the clinical finding and supporting examination, the patient received bilateral below-knee prostheses and bilateral functional partial-hand prostheses, created using 3D printing technology with polylactic acid material. After a few months, she was able to do most of her activities of daily living (ADLs) independently, work as a shopkeeper in her store, and feel more confident interacting with others. A comprehensive rehabilitation programs, patient adherence to exercise, and caregiver support are critical to improving functional capacity and the quality of life in a patient with bilateral below-knee and bilateral partial-hand amputation caused by PAD.
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ALVES, RAFAEL SALEME, DANIEL ALEXANDRE PEREIRA CONSONI, PEDRO HENRIQUE OLIVEIRA FERNANDES, SANDRA UMEDA SASAKI, ISABELLA MARTINS ZAIA, SOFIA BRANDÃO DOS SANTOS, and MONICA AKEMI SATO. "BENEFITS OF THE WALANT TECHNIQUE AGAINST THE COVID-19 PANDEMIC." Acta Ortopédica Brasileira 29, no. 5 (October 2021): 274–76. http://dx.doi.org/10.1590/1413-785220212905244505.
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ABSTRACT Objective: Evaluate the experience of private and public health services with the WALANT procedure in the COVID-19 pandemic. Methods: This is a retrospective, multicenter longitudinal study gathering cases of hand surgery subjected to the WALANT technique in the Hospitals Dr. Radamés Nardini and IFOR during the COVID-19 pandemic (August 2020). As a parameter, the verbal numerical rating scale for twenty patients referring to the preoperative, intraoperative and postoperative periods was applied. Results: The patients did not feel any pain during surgery, which showed the efficiency of the anesthetic technique in its purpose. Conclusion: The results indicate the WALANT technique as beneficial when facing the COVID-19 pandemic, as the main differential of the technique is that it is applied by a well-trained orthopedic hand surgeon. Level of Evidence IV, Case Series.
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Welsh, Ashley M., William S. Dewey, James C. Casey, and Kyle B. Cunningham. "76 The Effect of Splinting of Metacarpophalangeal Joints After Skin Grafting: A Review of the ACT Database." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S49—S50. http://dx.doi.org/10.1093/jbcr/iraa024.080.
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Abstract Introduction Hands are the most common area of the body to sustain a burn injury. Maintaining motion and function throughout the healing process of a burn injury is one of the most important goals of the rehabilitation process. After a deep burn to the dorsal aspect of the hand requiring skin grafting, the adjacent metacarpophalangeal (MCP) joints are at risk for developing a burn scar contracture (BSC), limiting the joints’ ability to fully flex towards a fist position. Post-operative positioning protocols state that patient’s hand should be temporarily immobilized for graft protection. A resting hand splint is used to maintain the wrist in approximately 20–30 degrees of extension, MCP joints at approximately 50–70 degrees of flexion and the interphalangeal joints in full extension. The purpose of this study was to assess the benefit of splinting as a treatment intervention to prevent MCP joint extension contractures following dorsal hand skin grafting. Methods This was a retrospective review of prospectively collected observational data from the “Burn Patient Acuity Demographics, Scar Contractures and Rehabilitation Treatment Time Related to Patient Outcomes” (ACT) study. Patients were included with grafted dorsal hand burns occurring within 1 of the 4 established cutaneous functional units (CFU) along the dorsal aspect of the second through fifth metacarpals. Since most subjects had more than one dorsal hand CFU involved, the number of CFUs were analyzed as opposed to the number of subjects. Isolated MCP joint flexion measurements were utilized to determine incidence of contracture. Included causes of contracture were scar tissue or other soft tissue limitations. Data were then analyzed by two groups: contracted and non-contracted. Results A total of 221 dorsal hand CFUs were included in this study; 119 contracted and 102 non-contracted. There was no statistical significant difference between the average splint wear time between the 2 groups. The average percent of affected CFUs grafted within the contracted group was 92.4% compared to 76.8% in the non-contracted group. In burns to the dorsal hand with less than 99% of the CFU grafted, splinting was effective in preventing 60% of MCP joint extension contractures. When greater than 99% of affected CFU was grafted, splinting was effective in prevention only 36% of contractures. Conclusions Splinting can be an effective intervention option in preventing MCP extension contractures when less than 75% of the affected CFU has been grafted; however, its effectiveness decreases as the percentage of CFU involvement increases to greater than or equal to 99%. Applicability of Research to Practice Determine most effective post-operative rehabilitations plan following dorsal hand skin grafts.
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Miller, L., L. Ada, J. Crosbie, and A. Wajon. "Pattern of recovery after open reduction and internal fixation of proximal phalangeal fractures in the finger: a prospective longitudinal study." Journal of Hand Surgery (European Volume) 42, no. 2 (October 4, 2016): 137–43. http://dx.doi.org/10.1177/1753193416670591.
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The purpose of this study was to determine the pattern of recovery after open reduction and internal fixation of proximal phalangeal fractures. A prospective longitudinal study of 66 patients who started rehabilitation within 1 week of fixation was undertaken. Measures of the level of impairment (range of motion, pain, strength), activity limitation (hand use) and return to work were collected at Weeks 1, 6, 12 and 26 after operation. Before starting rehabilitation, although pain was minimal, the range of motion was severely restricted and there was considerable restriction in ability to work. Most of the recovery in range of motion, pain, strength, hand use and work participation occurred by Week 6, with smaller gains by Week 12 and Week 26. Level of evidence: III
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Mitrovic, Dragica, Mladen Davidovic, Predrag Erceg, and Jelena Marinkovic. "The effectiveness of supplementary arm and upper body exercises following total hip arthroplasty for osteoarthritis in the elderly: a randomized controlled trial." Clinical Rehabilitation 31, no. 7 (June 28, 2016): 881–90. http://dx.doi.org/10.1177/0269215516655591.
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Objective: To determine whether arm and upper body exercises in addition to the standard rehabilitation programme improve outcomes after hip arthroplasty. Design: Prospective, parallel, randomized, controlled trial. Setting: Orthopaedic and rehabilitation departments. Subjects: A total of 70 patients >60 years of age, who underwent hip replacement, out of 98 eligible candidates after exclusion criteria were implemented. Interventions: The study group took part in the supplementary arm and upper body exercise programme to be compared with the standard rehabilitation programme group. Main outcome: The primary outcome was a Harris Hip Score. Secondary outcomes were: Hand grip strength and Medical Outcomes Study 36-Item Short-Form Health Survey. Outcomes were assessed preoperatively, two weeks after surgery and at 12 weeks follow-up. Results: In the intervention group, significant improvements were found: in functional ability – Harris Hip Score after two (mean difference = 4.7 points) and 12 (mean difference = 5.85 points) weeks; in muscle strength – handgrip for both hands (mean difference for dominant hand = 4.16 and for the other hand = 2.8) after 12 weeks; and in role–physical dimension SF-36 Health Survey (mean difference = 6.42 points) after 12 weeks. Conclusion: Results of this study indicate that arm and upper body exercises in addition to the standard rehabilitation programme improve outcomes 12 weeks after hip arthroplasty.
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Khan, Manal M., Mohd Yaseen, L. M. Bariar, and Sheeraz M. Khan. "Clinical study of dorsal ulnar artery flap in hand reconstruction." Indian Journal of Plastic Surgery 42, no. 01 (January 2009): 052–57. http://dx.doi.org/10.1055/s-0039-1699313.
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ABSTRACTSoft tissue defects of hand with exposed tendons, joints, nerves and bone represent a challenge to plastic surgeons. Such defects necessitate early flap coverage to protect underlying vital structures, preserve hand functions and to allow for early rehabilitation. Becker and Gilbert described flap based on the dorsal branch of the ulnar artery for defects around the wrist. We evaluated the use of a dorsal ulnar artery island flap in patients with soft tissue defects of hand. Twelve patients of soft tissue defects of hand underwent dorsal ulnar artery island flap between August 2006 and May 2008. In 10 male and 2 female patients this flap was used to reconstruct defects of the palm, dorsum of hand and first web space. Ten flaps survived completely. Marginal necrosis occurred in two flaps. In one patient suturing was required after debridement and in other patient wound healed by secondary intention. The final outcome was satisfactory. Donor areas which were skin grafted, healed with acceptable cosmetic results. The dorsal ulnar artery island flap is convenient, reliable, and easy to manage and is a single-stage technique for reconstructing soft tissue defects of the palm, dorsum of hand and first web space. Donor site morbidity is minimal, either closed primarily or covered with split thickness skin graft.
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Harel, Hani, Idit Lavi, Raviv Allon, Dafna Michael, and Ronit Wollstein. "Postoperative Treatment of Distal Radius Fractures Using Sensorimotor Rehabilitation." Journal of Wrist Surgery 08, no. 01 (September 27, 2018): 002–9. http://dx.doi.org/10.1055/s-0038-1672151.
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Background Sensorimotor and specifically proprioception sense has been used in rehabilitation to treat neurological and joint injuries. These feedback loops are not well understood or implemented in wrist treatment. We observed a temporary sensorimotor loss, following distal radius fractures (DRF) that should be addressed postsurgery. Purpose The purpose of this prospective therapeutic study was to compare the outcomes of patients following surgery for DRF treated using a sensorimotor treatment protocol with those patients treated according to the postoperative standard of care. Patients and Methods Patients following surgery for DRF sent for hand therapy were eligible for the study. Both the evaluation and treatment protocols included a comprehensive sensorimotor panel. Patients were randomized into standard and standard plus sensorimotor postoperative therapy and were evaluated a few days following surgery, at 6 weeks, and 3 months postsurgery. Results Sixty patients following surgery were randomized into the two treatment regimens. The initial evaluation was similar for both groups and both demonstrated significant sensorimotor deficits, following surgery for DRF. There was documented sensorimotor and functional improvement in both groups with treatment. The clinical results were better in the group treated with the sensorimotor-proprioception protocol mostly in the wrist; however, not all of the differences were significant. Conclusion Patients after surgery for DRF demonstrate significant sensorimotor deficits which may improve faster when utilizing a comprehensive sensorimotor treatment protocol. However, we did not demonstrate efficacy of the protocol in treating proprioceptive deficits. Further study should include refinement of functional outcome evaluation, studying of the treatment protocol, and establishment of sensorimotor therapeutic guidelines for other conditions. Level of Evidence This is a level II, therapeutic study.
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Abbas, Paulette, Mia Choe, Elika Ridelman, Beth A. Angst, Justin D. Klein, and Christina M. Shanti. "737 Treadmill Friction Hand Injuries in the Pediatric Patient." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S200—S201. http://dx.doi.org/10.1093/jbcr/iraa024.320.
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Abstract Introduction Pediatric friction hand injuries are prevalent, likely due to the increasing presence of home exercise equipment. While friction injuries often appear deeper on initial assessment, not all are treated surgically during the acute phase. We sought to characterize our experience with outcomes based on acute (< 30 days) surgical intervention compared to delayed intervention. Methods Patients were queried from a single institution, verified pediatric burn center database. A retrospective chart review of pediatric patients (< 18 years) over a 5 year period was performed. Data collected included demographics, treatment methods (acute vs. delayed), dressing type, scar management, and follow-up. Outcomes included additional surgical and non-surgical adjuncts to treat the sequela of injury. Results Our institution treated 23 treadmill hand injuries over the 5-year period. There was a slight predominance of female (n=13, 57%) vs. male (n=10, 43%) patients. Median age at injury was 2 years (IQR 1–3). Thirteen patients (57%) sustained an injury equivalent to a second degree burn and ten (43%) to third degree. Injuries were initially treated with silvadene (n=14) and/or xeroform (n=21). Involvement of left and right hands were equally divided and all injuries involved the digits. The median number of digits involved was 2 (range 1–4). The most commonly injured digits were the middle and ring fingers (19 each). Average length of stay was 14 hours. All but one patient followed-up with a median number of 4 clinic visits. All of these patients were reported as healed at time of last follow-up. Median time to healing was 31.5 days (IQR 29 – 58). Overall, 4 patients (17%) underwent acute surgical intervention with a median of 7 days from injury (IQR 1.75–13.5). Of these 4 patients, 2 (50%) required additional operations for scar management and 2 (50%) required non-surgical management. Of the 19 (83%) who did not undergo early surgical management, only 1 patient (6%) required a Z-plasty, 12 (63%) were managed with non-surgical intervention and 6 (31%) needed no further treatment after healing. Conclusions Pediatric friction hand injuries often affect multiple digits and lead to a median of 4 clinic visits. Our data suggest that early surgical intervention in this cohort did not minimize future surgical procedures or non-surgical management. Rather, delayed intervention appears to allow for fewer surgical procedures and similar non-surgical management. Larger studies are required to validate this finding; however, this data suggests that continued initial management with a combination of silvadene and xeroform may be a safe option. Applicability of Research to Practice Our study provides guidance in the evaluation and treatment of pediatric treadmill friction injury. This data supports delaying surgical interventions on these seemingly deep hand injuries.
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Gil, Joseph A., Barrett Weiss, Justin Kleiner, Edward Akelman, and Arnold-Peter C. Weiss. "A Prospective Evaluation of the Effect of Supervised Hand Therapy After Carpal Tunnel Surgery." HAND 15, no. 3 (November 12, 2018): 315–21. http://dx.doi.org/10.1177/1558944718812155.
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Background: The objective of this investigation is to examine the effect of postoperative therapy after routine carpal tunnel release. Our hypothesis was that supervised hand therapy does not improve outcomes after routine carpal tunnel release. Methods: Patients with carpal tunnel syndrome were randomly assigned to one of 3 groups based on the last digit of their medical record numbers to one of 3 groups: standard 6-week postoperative rehabilitation (standard therapy), expedited one-session postoperative rehabilitation group (expedited therapy), and no postoperative rehabilitation group (no therapy). The primary outcome measures were Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and return to work. The outcome questionnaire was completed preoperatively, at the 2-week follow-up visit, and monthly to 6 months after surgery. Results: All 3 treatment groups had similar mean QuickDASH scores preoperatively. At 1- to 6-month follow-up, all 3 groups had similar QuickDASH scores at each visit, and all showed a significant decline from baseline (preoperative) QuickDASH score. Overall, QuickDASH score decreased significantly from a preoperative visit mean of 42.7 to a final postoperative (visit 8) mean of 6.69. There was no significant difference in the mean QuickDASH score among all 3 groups at 6-month follow-up. There was no significance in the time of return to work among the 3 groups (standard therapy, 21.8 days; expedited therapy, 20.9 days; no therapy, 16.6 days). Conclusions: This investigation adds evidence that supervised hand therapy does not improve the outcomes of routine carpal tunnel surgery as measured by QuickDASH and return to work.
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Edwick, Dale O., Dana A. Hince, Jeremy M. Rawlins, Fiona M. Wood, and Dale W. Edgar. "78 Optimising Compression for the Management of Acute Hand Burn Edema." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S50—S51. http://dx.doi.org/10.1093/jbcr/iraa024.082.
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Abstract Introduction Compression, a common treatment of choice for the management of edema, is one intervention which is applied with little objective understanding of the optimal parameters of application or efficacy in a patient with an acute burn wound. The aim of this study was to determine the effectiveness of different methods of compression for the management of hand edema following burn injury. The hypothesis tested was: in alert acute hand burn injury patients, application of cohesive bandage will reduce edema faster than an off the shelf compression glove. Methods A randomized control study of 100 patients presenting with hand burn injury. Compression was randomized to one of three methods of application - 1) spiral application of cohesive bandage to fingers, figure of eight to hand and wrist; 2) pinch application or cohesive bandage to fingers, spiral application to hand and wrist; or 3) an off-the-shelf compression glove (control condition). Repeated volume measures of the hand were recorded using water displacement volumetry. The results were analysed using multi-level mixed effects regressions. Outcome measures were hand and wrist active range of movement, pain VAS and QuickDASH. ROM measures were collected with and without compression in situ. Patients were provided with a home exercise program including standardized exercises to optimize venous and lymphatic outflow, and exercises tailored depending on the location of the patients’ injury. Standard instruction to patients was to continue using their hand with the compression in situ, and to elevate at rest and overnight. Results One hundred patients (68 males) demonstrated significant reductions in hand volumes, using all compression methods (10.0–14.5mL, p< 0.001). There was no evidence of difference between methods of compression for managing edema. All ROM measures improved, with significant improvement in hand composite finger flexion (p=0.001), hand span (p=0.022) and wrist flexion (p=0.022). QuickDASH decreased between sessions (p< 0.001) indicating reduced upper limb disability. There was no evidence of differences in ROM measures between compression methods. Conclusions There is no evidence of difference between these methods of compression for managing acute hand burn edema. ROM improves with reductions in hand burn edema. Applicability of Research to Practice For the management of acute edema following hand burn injury, this study demonstrates that compression can be applied by therapists of different experience, using methods they are familiar with, to positively influence edema following hand burn injury.
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Shim, Hyung Sup, Ji Seon Choi, and Sang Wha Kim. "A Role for Postoperative Negative Pressure Wound Therapy in Multitissue Hand Injuries." BioMed Research International 2018 (2018): 1–7. http://dx.doi.org/10.1155/2018/3629643.
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In this study, we compared outcomes in patients with acute hand injury, who were managed with or without negative pressure wound therapy (NPWT) after reconstructive surgery. All of the patients who sustained acute and multitissue injuries of the hand were identified. After reconstructive surgery, a conventional dressing was applied in Group 1 and NPWT was applied in Group 2. The dressing and NPWT were changed every 3 days. The mean age and Hand Injury Severity Scoring System score of both groups were not significantly different. Disabilities of the Arm, Shoulder, and Hand (DASH) scores were evaluated 1 month after all the sutures were removed and 1 year postoperatively, which were both significantly lower in Group 2. Applying NPWT to the hand promoted wound healing by reducing edema, stabilizing the wound, and providing immobilization in a functional position. Early wound healing and decreased complications enabled early rehabilitation, which led to successful functional recovery, both objectively and subjectively.
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Villafañe, Jorge H., Giovanni Taveggia, Silvia Galeri, Luciano Bissolotti, Chiara Mullè, Grace Imperio, Kristin Valdes, Alberto Borboni, and Stefano Negrini. "Efficacy of Short-Term Robot-Assisted Rehabilitation in Patients With Hand Paralysis After Stroke: A Randomized Clinical Trial." HAND 13, no. 1 (February 16, 2017): 95–102. http://dx.doi.org/10.1177/1558944717692096.
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Background: We evaluated the effectiveness of robot-assisted motion and activity in additional to physiotherapy (PT) and occupational therapy (OT) on stroke patients with hand paralysis. Methods: A randomized controlled trial was conducted. Thirty-two patients, 34.4% female (mean ± SD age: 68.9 ± 11.6 years), with hand paralysis after stroke participated. The experimental group received 30 minutes of passive mobilization of the hand through the robotic device Gloreha (Brescia, Italy), and the control group received an additional 30 minutes of PT and OT for 3 consecutive weeks (3 d/wk) in addition to traditional rehabilitation. Outcomes included the National Institutes of Health Stroke Scale (NIHSS), Modified Ashworth Scale, Barthel Index (BI), Motricity Index (MI), short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), and the visual analog scale (VAS) measurements. All measures were collected at baseline and end of the intervention (3 weeks). Results: A significant effect of time interaction existed for NIHSS, BI, MI, and QuickDASH, after stroke immediately after the interventions (all, P < .001). The experimental group had a greater reduction in pain compared with the control group at the end of the intervention, a reduction of 11.3 mm compared with 3.7 mm, using the 100-mm VAS scale. Conclusions: In the treatment of pain and spasticity in hand paralysis after stroke, robot-assisted mobilization performed in conjunction with traditional PT and OT is as effective as traditional rehabilitation.