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Healing Injured Hands

Healing Injured Hands

By Jeffrey Humphrey, PT, CHT, CEAS

Our hands are amazing tools and when they are injured, our ability to perform even the simplest tasks is severely compromised. Due to the anatomical complexity of our hands and wrists, hand injuries often require treatment by physicians and physical therapists who are experienced in hand surgery and hand therapy.

Why are hand injuries sometimes difficult to treat?

To answer this question, it helps to think about how unique our hands are. When we extend and flex our hands, they can move through a range of 180 degrees. They can rotate palms up to palms down. The small joints in the fingers and thumbs allow us to cup our hands and to fold them into a full fist, and our opposable thumbs enable us to grasp both tiny and large objects.

We use our hands constantly throughout the day, and though they work hard, our hands are actually very delicate and complex. The fingers and thumbs of one hand have a total of fourteen joints. There are eight bones in the wrist alone, many tendons and muscles, and three large nerves that supply both sensation and movement to the hand. Muscles and tendons in the forearm and hand power the wrists and hands in an intricate anatomical design that extends through the elbow, up the arm, to the shoulder and neck.

What are the most common injuries to the hands?

One of the most typical hand injuries (in fact, the most frequently broken bones in the body) are fractures to the hand skeleton. Tendonitis, sprains, and arthritis in the wrist and thumb are also commonplace, as is carpal tunnel syndrome. Other injuries that can be more serious include dog and cat bites; injuries from snow blowers and lawn mowers; carpentry injuries from hammers, saws, and other power tools; and industrial and domestic injuries from burns and knives.

What types of healing approaches do hand therapists utilize?

In treating any hand injury, hand therapists use their own hands to help patients increase the range of motion and to strengthen injured tissue. If a patient has undergone hand surgery, we can use massage to decrease swelling and increase mobility around the surgical scar. Modalities such as ultrasound, electric stimulation, heat and cold are utilized to treat pain and swelling. We also teach our patients strategies for using their hands and wrists to avoid re-injury, and how to perform daily tasks in ways that are ergonomically safe.

In addition to hands-on care and patient education, hand therapists often employ splinting techniques to protect and rest joints, muscles, tendons, and nerves that are injured.

To return to normal use, hands require strength and fine motor skills. Hand therapists use many different objects and tools to strengthen the hand, (such as weights, thera-putty, and clothespins) and games to increase dexterity. Additional exercises encourage the return of normal sensation, which is also critical for full use of the hand.

What about hand surgery?

Some hand injuries require surgery, followed by rehabilitation with a hand therapist. Amputation of fingers, severely injured tendons and nerves, and bad bone fractures require surgical repair. Advanced cases of carpal tunnel syndrome are surgically treated, as are conditions like Dupyutren's disease in which the soft tissues in the palm of the hand contract, pulling down the fingers, especially the ring and little fingers. Severely arthritic joints in fingers, thumbs and wrists may be replaced, fused, or removed surgically, as well. In these cases, hand therapists work very closely with the patient's surgeon through the rehabilitation process. Four surgeons on staff at Cayuga Medical Center are experienced hand surgeons: Daniel Jorgenson, MD, David Monacelli, MD, Yasmeen Moody, MD, and Stephanie Roach, MD.

What should I look for in a hand therapist?

Hand therapy focuses on the hand and wrist, but also encompasses all of the upper extremity including the forearm, elbow, shoulder, and neck. If you have a hand injury, seek out a physical therapist who is certified in hand therapy. The certification process ensures that your therapist has been practicing physical therapy for a minimum of five years and has at least 2,000 hours of direct experience treating people with hand injuries. In addition to passing a very comprehensive certification examination, a hand therapist is required to maintain annual continuing education credits to maintain his or her certification.

Jeff Humphrey is a physical therapist specializing in treatment of the upper extremity. He is certified both as a hand therapist and an ergonomic assessment specialist in the Department of Rehabilitation at Cayuga Medical Center. Contact him about hand therapy or ergonomic workplace assessment at (607) 274-4159.

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