Yesterday, I had the opportunity to accompany this young man all the way into the operating room to witness the surgery performed on his hand. One year ago, his hand was crushed, resulting in median nerve damage, soft tissue damage resulting in contractures of his thumb and MCP joints in 30 degrees of flexion. He started therapy with me about 3 months after his injury. He was so compliant with all the different treatment strategies, from sensory desensitization, fluid massage, joint mobilization, and soft tissue mobilization all to attempt to decrease the excruciating nerve pain and increases his active range of motion of his hand. We used splinting, serial casting, and other methods to correct his contractures. Although, his thumb motion was improving and his pain was decreasing, after 3 months, he and his doctor decided on 2 surgeries, one to correct his thumb contracture and the second to correct the tightness in his MCP joints. After the first surgery, it took over 6 weeks of wearing a thumb spica cast for the bone to begin to heal. Once healed, he quickly scheduled the next surgery to correct his inability to straighten his fingers. I requested to be able to watch the surgery so I could learn exactly what was done with his hand to provide appropriate therapeutic interventions. At the John's Hopkins Out Patient Center, his doctor and staff graciously allowed me to watch his surgery. They ended up releasing the intrinsic muscles, the joint capsules of all the digit MCP joints, release of the volar plate tightness, and removal of scar tissue in order to allow for full digit extension and hopefully, in time, a functional hand. I am so touched that he felt comfortable for me to be there for the surgery. Now, we wait for 10 days till this cast comes off and start therapy again. The operation was deemed a success and now its up to us to get him back to having his right hand back. He is a strong and determined man that will be able to accomplish anything!
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AuthorDiane Gubisch, PhD, OTRlL Archives
June 2022
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