Swollen, Painful Hand Case Study
Nick is a 48 year old self-employed joiner, who sustained a minor cut at work, to his left hand. This became infected and required a trip to A and E. Nick’s hand deteriorated, he was admitted to hospital for intravenous anti-biotics and exploratory surgery to his hand.
Upon discharge from hospital Nick was referred for hand therapy. He presented with a stiff, swollen, painful hand, with thickened raised surgical scars. Nick was afraid that he would lose his business, he was anxious and distressed.
Upon the first therapy session the swelling was addressed. Kinesiology tape was applied to the back of the hand, and a specialist glove (oedema glove) was fitted. Nick was taught to elevate his hand and to use massage techniques. These treatments all helped to reduce the swelling. A thermoplastic splint was applied to be used at night, in bed. This placed the hand in a position of comfort and allowed stretching of the soft tissue to reduce stiffness. Specific exercises were taught to improve the movement in Nick’s hand.
During subsequent treatments the surgical scars were massaged. Silicone gel was applied to assist in softening the scar tissue. Nick was taught to massage his scars himself. The scars quickly softened and became less raised and less vivid in colour.
In the early stages of recovery, a major problem was Nick’s inability to use his hand in a useful way. He had started to perform all tasks ‘one handed’, with his right, dominant hand. He had almost forgotten that his left hand was part of him, frequently allowing the hand to hang by his side, while using the right hand. He had lost some sensation in this hand, which compounded the problem. An intense therapy programme began, involving a mirror box, different textured and shaped objects to improve Nick’s awareness of his hand and activities involving a 2 handed, spontaneous response, e.g. ball catching. Therapy activities were graded to become more complex, physically demanding and dextrous, culminating in later stages, in graded press-ups, for wrist strength and manipulating nuts and bolts for dexterity.
Nick was treated over an 8 week period, twice a week in the early stages. He fortunately managed to save his business and returned to work with a functional hand.