Rehabilitation of the Hand Bascharage

Rehabilitation of the hand is a specialty in its own right and follows specific rules in order to have a functional recovery of the hand as complete as possible.

The objectives of the physiotherapist during the rehabilitation are the following ones:

• Improve the healing process to prevent and avoid skin complications that may occur.
• Promote the resorption of edema, avoiding complications of secondary healing.
• Mobilize early joints safely, respecting the instructions of the surgeon, healing times, splints, bandages, …
• Reworking the hand in its daily functions and adapting the movements to residual deficits that could persist.
• Stimulate the sensitivity of the hand to recover fine sensitivity, proprioceptive sensitivity and tactile discrimination.
• Maintain the flexibility of articular and myotendinous structures.

To carry out this reeducation, the physiotherapist has a multitude of specific rehabilitation accessories (eggs, rehabilitation balls, elastic webs, finger dynamometers, …)

The sometimes serious and definitive functional consequences (pain, stiffness, deformity, adhesions, …) due to hand trauma can be largely avoided by multi-disciplinary care (doctor, surgeon, physiotherapist, occupational therapist, orthotist) . Nevertheless, there must be good communication between the various actors of the reeducation. The exchange between the reeducator and the surgeon is essential.

Here is a non-exhaustive list of pathologies that may require treatment in physiotherapy of the hand:

• Grip problem
• Weakness of the hand
• Loss of sensitivity
• Fracture or sprain of the wrist, fingers, operated or not
• Amputation of finger (s)
• Dislocation
• Dupuytren’s disease (operated or not)
• Suture surgery of an extensor or flexor tendon of the hand
• Pulley suture operation
• Neurological hands:
• • Sequelae of stroke
  • Hemiplegia, quadriplegia
  • Parkinson

Depending on the pathology and the stage of the rehabilitation, some points will be different but in general, the session will always be composed of the same times.

First of all, it will always be necessary (except at the express request of the surgeon for any reason) to start by removing the bandages, the splints and other accessories, … The physiotherapist specialist of the hand will take care of putting everything in place at the end of session and if possible, he will explain how to do it yourself. In order to be able to appreciate and manipulate the precisely affected area, it is better for it to be exposed rather than wrapped in layers of dressings. Right after an operation, even if the scar is not yet closed, the rehabilitation must already begin. The physiotherapist will work with gloves. At first, he will mobilize the different fingers, the wrist, respecting the pain of the patient and the resistance of bruised tissue. Early mobilization can promote intrinsic healing of tissues (good healing), limit and relax extrinsic healing (poor healing, leading to adhesions). The mobilization will first be passive, that is to say that it is the physiotherapist who will move the hand. As rehabilitation proceeds, mobilization will become more and more active and managed by the patient himself.

Then, if the hand is swollen, the physiotherapist can do a hand drainage and apply cryotherapy to try to clear the area. This edema is quite normal at first, but the swelling remains to be watched anyway. Indeed, it is not uncommon that after a trauma of the hand, a patient develops algoneurodystrophie.

For all that is operation, once the wound is closed, the physiotherapist will be able to work the scar using various techniques of scar massage and LPG endermology equipment.

Once the doctor has agreed, forced labor can begin. It will first be more analytical, against the manual resistance applied by the physiotherapist. Then, with small equipment. As time goes by, the reinforcement will be more and more functional. We will try to get closer to everyday actions so that the hand can fulfill its role in everyday activities.

When the hand has suffered a loss of sensitivity, the physiotherapist will also work the sensory aspect of the hand through discrimination exercises. He will work with the patient’s ability to recognize the materials, the shapes of objects, the position of the hand in space.

During the rehabilitation, the patient will receive exercises to do at home for his self-reeducation. This work at home is an essential part of rehabilitation. The more compliant the patient is, the more orthoses are worn and the exercises, the faster and better the recovery will be.