Therapy is an integral part of the treatment of hand disorders. Both physiotherapists and occupational therapist help with the non-operative, pre- and post-operative management of most hand conditions. Any injury / surgery / immobilization anywhere in the body, but especially in the hand, leads to stiffness. Having stiff joints in the hand and wrist can significantly reduce a persons’ ability to function normally. Surgery without therapy can lead to suboptimal results, thus all patients have a team based care approach involving the patient, surgeon and therapists.
Complex regional pain syndrome
CRPS is a poorly understood condition that affects the hand much more commonly than other parts of the body. It presents as pain that is out of proportion to the injury. It can start after surgery or even after a small trauma such as knocking it against a wall. Often the skin can take on a dull mottled appearance. Non-noxious stimuli such as lightly stroking the skin can cause significant pain. In this condition the nerves have up-regulated for an unknown reason. The treatment is therapy, therapy, therapy and medication. It is best to get onto this as quick as possible. In most instances the condition will resolve within 18 months. Beyond 2 years however the nerves and central nervous system can become permanently up-regulated. For this reason, treatment must be instituted early and aggressively. Deep tissue massage although immensely painful in the short term, does not cause any tissue damage, just like in a non-CRPS person, and is the best way to recover and treat this condition. This can be done by the patient themselves. Protecting the hand or area and allowing nothing to touch it, is the worst way to treat this and is much more likely to lead to long term problems.
This is a surgical procedure used to diagnose and treat wrist conditions. Often it can be performed when the diagnosis is not very clear. A small fibre-optic scope (2.7mm) is placed into the back of the wrist through tiny incisions. Through this the bones and soft tissues can be directly visualized and often the pathology can be addressed at this time, or just identified for further discussion in a clinic setting.
Wrist Arthroscopy: http://orthoinfo.aaos.org/topic.cfm?topic=A00001
Wrist arthroplasty is an option when a persons wrist is very arthritic and other options have failed. This is an alternative to fusing the wrist. It is important to know that although it is similar to hip and knee replacements, it is much less common. To this end, it is not as well studied and at this point may be considered experimental as we are not sure exactly how long they last. The benefits of wrist arthroplasty is that it maintains range of motion, the down side is an unknown longevity. It is possible to convert a wrist arthroplasty to a fusion if it fails but this option is not as good as primary fusion.
Wrist Arthroplasty: http://orthoinfo.aaos.org/topic.cfm?topic=A00019