When healthy, the hand and fingers work effortlessly to perform various activities including the ADL’s, leisure, communication and work. However, when stiffness sets in due to scarring of the tendons, joints and soft tissues, function becomes limited. The activities we take for granted can no longer be performed or performed without extreme difficulty.
Stiffness and contractures may result from improper or prolonged splintage, burns, crush or avulsion injuries, following replantation. Often, multiple structures are involved including the soft tissues, tendons, ligaments, joints and bones. A careful examination must be performed to determine the nature of the stiffness and contractures including the range of motion, the difference between active and passive motion, extent of flexion and extension contractures and their impact upon function.
Conservative management includes stretching exercises for the tendons, joints and muscles, use of the CPM machine, various static and dynamic splints or serial casting under the care of an experienced hand therapist. When conservative management is unsuccessful due to the severity of the scarring, stiffness or contracture, surgery is warranted. Successful functional outcomes depend on the combined efforts of the surgeon, therapist and patient.
The Chicago Institute for Hand Surgery & Rehabilitation is one of the major referral centers in the Midwest for care of the stiff contracted hand due to mutilating injuries, replantations, complex fractures and burns. A comprehensive aggressive approach to the severely scarred and contracted hand is undertaken by way of surgery including flexor and extensor tenolyses, joint capsulotomies and capsulectomies and releases of the intrinsic muscles; utilization of the Continuous Passive Motion (CPM) apparatus; rigorous occupational therapy and intraoperative manipulations under anesthesia to provide the optimal functional outcome in a safe and timely manner.
