Journal of hand therapy : official journal of the American Society of Hand Therapists · 2016
Case Report: The casting motion to mobilize stiffness technique for rehabilitation after a crush and degloving injury of the hand.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Midgley Robyn
Аннотация
STUDY DESIGN: Case report.
INTRODUCTION: This case report describes the use of the casting motion to mobilize stiffness (CMMS) technique in the management of a crush and degloving injury of the hand. The patient was unable to attend multiple hand therapy sessions due to geographic constraints. The CMMS technique involved the application of a nonremovable plaster of paris cast that selectively immobilizes proximal joints in an ideal position while constraining distal joints to direct desired motion over a long period. This uses active motion only. Traditional hand therapy techniques or modalities are not used. This treatment approach was beneficial to the patient as a minimum of 2 appointments per month were needed to regain functional hand use.
PURPOSE OF THE STUDY: To document the use of the CMMS technique as an effective treatment approach in the management of a crush and degloving injury of the hand.
METHODS: The CMMS technique was applied to the patient's left (nondominant) hand 8 weeks after injury. The technique's aim was to improve the 30° flexion deformity of the left wrist and flexion contractures of the index, middle, and ring fingers with a total active motion of 0°. Orthotic devices and traditional therapy were applied once joint stiffness was resolved, and a normal pattern of motion was reinstated.
RESULTS: At 6 months, substantial improvement was noted in wrist as well as metacarpophalangeal and interphalangeal joints. Total active motion exceeded 170° in all fingers excellent functional outcome resulted as measured with the upper limb functional index short form-10. The upper limb functional index increased from 0% to 55% of preinjury status (or capacity) over the 18 months of therapy.
DISCUSSION: Brief immobilization through casting causes certain functional losses, but these are temporary and reversible.
CONCLUSION: Finger stiffness, edema, and tissue fibrosis were successfully managed with the CMMS technique without the need for attendance at multiple hand therapy sessions.
LEVEL OF EVIDENCE: Level V.
INTRODUCTION: This case report describes the use of the casting motion to mobilize stiffness (CMMS) technique in the management of a crush and degloving injury of the hand. The patient was unable to attend multiple hand therapy sessions due to geographic constraints. The CMMS technique involved the application of a nonremovable plaster of paris cast that selectively immobilizes proximal joints in an ideal position while constraining distal joints to direct desired motion over a long period. This uses active motion only. Traditional hand therapy techniques or modalities are not used. This treatment approach was beneficial to the patient as a minimum of 2 appointments per month were needed to regain functional hand use.
PURPOSE OF THE STUDY: To document the use of the CMMS technique as an effective treatment approach in the management of a crush and degloving injury of the hand.
METHODS: The CMMS technique was applied to the patient's left (nondominant) hand 8 weeks after injury. The technique's aim was to improve the 30° flexion deformity of the left wrist and flexion contractures of the index, middle, and ring fingers with a total active motion of 0°. Orthotic devices and traditional therapy were applied once joint stiffness was resolved, and a normal pattern of motion was reinstated.
RESULTS: At 6 months, substantial improvement was noted in wrist as well as metacarpophalangeal and interphalangeal joints. Total active motion exceeded 170° in all fingers excellent functional outcome resulted as measured with the upper limb functional index short form-10. The upper limb functional index increased from 0% to 55% of preinjury status (or capacity) over the 18 months of therapy.
DISCUSSION: Brief immobilization through casting causes certain functional losses, but these are temporary and reversible.
CONCLUSION: Finger stiffness, edema, and tissue fibrosis were successfully managed with the CMMS technique without the need for attendance at multiple hand therapy sessions.
LEVEL OF EVIDENCE: Level V.