Janet is a 40 year old nurse.  She is right hand dominant.  Janet was referred for hand therapy by her consultant following a surgical trigger release to her right middle and ring finger.

 

Janet presented with dense, tender scarring in her palm, restricted finger movement and unable to form a fist or a flat hand.  During Janet’s first therapy session a full assessment was carried out to establish Janet’s problems and agreed treatment goals. The scar was massaged which helped to soften and improve its mobility, exercises were taught to enable the hand to move more freely. Silicon gel was applied to the scar to help to reduce the sensitivity. Janet was also taught how to touch the scar with different textures and amounts of pressure, in order to desensitise the palm.

 

During the next treatment a small thermoplastic finger splint was applied to the ring finger to provide a gentle stretch at night in order to gradually straighten the middle finger joint.  Therapeutic putty was supplied with appropriate exercises, to strengthen janet’s hand and regain full movement.  Specific finger stretching exercises were taught to improve Janet’s ability to straighten her fingers.

 

By the third therapy session Janet’s hand was much better, her grip strength was almost back to normal, the scar was no longer sensitive, however she could still not fully straighten her ring finger or form a flat hand.  The middle joint of the finger was manipulated.  Janet could almost fully straighten her finger following this treatment and was able to form a flat hand again.  The thermoplastic finger splint was adjusted. Janet was advised to continue to wear this at night until her finger was completely straight again.  She was given further strengthening exercises to continue with at home and discharged.