Keeping patients 'in good hands'

August 3, 2010, American Academy of Orthopaedic Surgeons

Hand therapy is one of the most vital treatment steps in recovery from hand injury surgery, according to a literature review published in the August 2010 issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS). In fact, many patients spend more time with the hand therapist than the orthopaedic surgeon in the effort to ensure the best results and long-term recovery.

" therapy is the critical link between certain surgeries on the hand and a good outcome," said Erik Dorf, M.D., an orthopaedic surgeon and upper extremity specialist at Vail Summit Orthopaedics in Vail, and Frisco, Colorado, and a co-author of the review. "Collaboration and cooperation between the patient, the therapist, and the orthopaedic surgeon is critical."

Dr. Dorf added that not all hand injuries need surgery or intense therapy; but typically, injuries like tendon lacerations, or hand, wrist or finger fractures have a better long-term recovery following hand therapy.

The review found that hand therapy addresses important factors in any hand injury recovery. Some include:

  • swelling control;
  • wound management;
  • range of motion;
  • strengthening of the hand; and
  • work conditioning.
These goals are not necessarily sequential; some factors may be addressed simultaneously, depending on the injury and treatment plan. In addition, treatment may also include some combination of splinting, taping, or wrapping the hand to provide support and/or prevent swelling.

To ensure the best result after a hand injury, Dr. Dorf recommends finding a therapist who is both qualified and convenient. It is important for both the patient and treating physician to be confident in the therapist. After a qualified therapist has been agreed upon, the patient should participate in a structured therapy program and perform at-home exercises as instructed.

"If therapy is not part of the overall treatment plan, the long-term consequences can include ongoing pain, decreased range of motion, decreased strength, and difficulty with fine motor tasks," added Dr. Dorf. "The activities of daily life can become very difficult."

The article describes different modalities used by hand therapists to improve results, including:

  • Fluidotherapy (a dry heat treatment that helps range of motion)
  • Paraffin therapy (a warm paraffin wax bath that helps range of motion)
  • Cryotherapy (application of cold water to reduce swelling)
  • Various modes of electrical stimulation (to decrease fluid in the hand and accelerate wound healing)
  • Phonophoresis and iontophoresis (instillation of low dose medications into the tissues of the hand using an electrical charge or ultrasound).
Dr. Dorf also notes that persistence is important. "People want to get better quickly, but recovery from hand injuries and subsequent surgery can take a long time. Working with a hand therapist encourages patients to get involved in their own recovery by enabling them to follow the small but significant changes that occur over time."

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