DRAFT: This module has unpublished changes.
28 September 2010
1:40-4:40pm 3 hours
Accumulated Hours: 12
The patient who had surgery to reattach his middle finger continues to improve past the surgeon’s expectations. Rather than bending his middle finger to about 70degrees as expected, the patient can reach 80degress and is still improving. A goal has been set for 90degrees, which is not full ability as 110degrees before surgery but is still possible through his amazing progress. Strengthening exercises are continued as to increase range of motion. At night and as much as the patient can tolerate during the day, the finger is fitted with a finger sock that has a gel material inside. This helps reduce swelling. As another attempt to eliminate swelling and scar tissue, the patient will be using a vibrating massage tool along the inside palm of his and along the entire middle finger.
Nicole’s patient from last Thursday who had a thumb joint replacement that I did not fully understand returned. I learned that she had severe tendonitis, causing pain and disfiguration of her right thumb joint. To fix this through surgery, the joint was cut apart and the tendon in her wrist was pulled and placed between each part of the joint to comfort and ease the pain. This surgery is very common and most likely is followed through with therapy consisting of mostly strengthening and regaining mobility within the joint. However, due to severe swelling and infection from the tendon from original tendonitis, a second surgery was performed to clear scar tissue and clean up the site of the replacement. This set the patient back as far as therapy is concerned because strengthening and mobility could not be achieved under the swollen and infected site.
Nicole’s next patient was most fascinating to me. He was a 16 year old boy who lost his fingers in a mulch shredder at the age of 13. they were able to reattach the stub of his middle finger and base of thumb. Then he had surgery to put one of his toes attached to the base of his thumb by using skin from his hip and creating a working digit by attaching the tendons and ligaments of the toe to his thumb. After 17 surgeries and years of therapy, the patient’s main goal was to regain as much motion as possible within his injured hand. Within several months this patient will receive a prosthetic hand that will fit over the digits that remain on his hand. The prosthetic will be controlled by setting off different muscles and tendons within the wrist and forearm. The prosthetic is capable of lifting 100lbs. And can pick up a potato chip without breaking it. It has an immense amount of sensitivity and will give the patient full control. Therapy from here involves strengthening the forearm and wrist muscles in order to fully prepare the patient for the prosthetic. Strengthening exercises include palm up and down lifting with a theraband for resistance. After the prosthetic is applied, the patient will return to therapy to learn how to function and use the new hand.
Tracy’s final patient came for a splint for her left hand to eliminate pain from arthritis in the hand. Arthritis pain in joints within the hand are common. To stop pain, the splint must stabilize the joint in pain.
To achieve an occupational therapy degree specializing in hand therapy requires a bachelor’s in biology or pre-pt or kinesiology then three years in occupational therapy school. With an occupational therapy degree, Nicole suggests that you go out into the work force as an OT for a couple of years for experience. To specialize in hand therapy form there you need a large number of hours as an intern shadowing a specialized hand surgeon/therapist/doctor. After taking more credits and passing exams for hand therapy you can be certified an get a job specifically with hand therapy.