Rehabilitation of clawed hands after burn or electrical injury
Burns are injuries caused by heat (flame, hot water, hot steam, hot oil, etc.), electric current, strong corrosive substances or radioactive substances acting on human skin, mucous membranes, muscles, etc. It is the most destructive and far-reaching impact. One of the traumatic injuries that seriously endangers human life and health. Most people only have a superficial understanding of burns, thinking that as long as the wound is healed, there will be no problems. However, moderate to severe burns will bring lifelong pain to the patient, and they will need to spend the rest of their lives dealing with scarring, treatment, tissue repair, and at the same time. Will affect normal mental health. Clawed hands are hand deformities that occur after suffering burns or electric shocks. It is a serious sequelae. Subsequent treatment is a long process, and early rehabilitation treatment is extremely important. The earlier the later rehabilitation, the better the effect.
Hands are an important organ for human survival and work. Food, clothing, housing, and transportation are all inseparable from the cooperation of hands. Although the hands only account for 2.5% to 3% of the body surface area, the skin on the back of the hands is thin and soft, with less fatty tissue under the skin, and the fascia, aponeurosis, tendons and ligaments are intricate. According to relevant clinical statistics, 80% of burn patients suffer from hand burns. This is because in daily life, the hands need to be completely exposed to the environment. Unfortunately, accidents have the highest chance of being burned, and the resulting hand function Defects will affect the patient's normal life, work and social life, reducing the quality of life and self-efficacy.
After deep burns on the back of the hand, scarring occurs from the surface to the soft tissue inside, which can lead to centripetal shrinkage of the entire hand tissue, hyperextension of the metacarpophalangeal joints, contracture of the thumb, flexion of the interphalangeal joints, destruction of the hand structure, and partial or complete loss of function. , surgery is undoubtedly the most effective treatment. Part of the function can be corrected through plastic surgery, such as dorsal scar release, collateral ligament severing or resection, dorsal joint capsule release, extensor tendon lengthening or joint fusion.
What are the functional impairments of clawed hands after burns?
1. Scar contracture, tendon contracture
2. Joint adhesion until joint stiffness
3. Swelling of hands
4. Muscle atrophy
5. Sensory loss or abnormality
Rehabilitation treatment methods
01
Pressure therapy: This is currently the most effective and safe anti-scar treatment measure. It affects the microcirculation within scars, reduces collagen synthesis, and reshapes scars to prevent and treat scar hyperplasia. The key to treatment is appropriate pressure and wearing time of no less than 23 hours.
02
Good limb positioning: The functional position of the hand or the anti-contracture position should be maintained: the thumb is abducted to the palm position, the wrist joint is slightly dorsiflexed, the metacarpophalangeal joint is naturally flexed 50 to 70°, the interphalangeal joint is straightened, and gauze is placed between each finger. The roll prevents adhesion of the finger webs, and orthotics can be used to fix them if necessary.
03
Scar massage: Burn scar massage needs to be performed after the wound has completely healed. It can accelerate blood circulation, enhance the skin's repair ability, and make the scars soften and smooth. In the early stage, use gentle massage, massage, and kneading methods, and frequently change techniques and locations, 1-2 times a day, 30 minutes each time.
04
Active and passive activities: For patients with joint involvement after burns, active activities should start after the injury until hand function improves, while for patients who have undergone surgical treatment, start after the skin graft survives. Active muscle contraction facilitates lymphatic drainage of the hands and upper limbs. ①Flexion and extension functional activities of each joint of the hand: perform finger flexion and extension, finger splitting, and fist making movements. Hand flexion and extension movements should be performed in the order of metacarpophalangeal joints, proximal interphalangeal joints and distal interphalangeal joints, and thumb abduction and palm opposition activities should be performed at the same time. ② The tiger's mouth and the webs of each finger are fully expanded. ③Wrist flexion and extension functional activities.
05
Orthotics: In the early stage, they are mainly used to protect or assist limb placement, promote tissue healing, and prevent contracture and deformity; in the middle stage, they are mainly used to combat contracture, improve joint mobility, and restore limb function to the maximum extent; in the later stage, they are mostly used to correct deformities.
06
Sensory training: Promote the brain to re-understand this part of the changed signals and restore the sense to normal, including sensory re-education and desensitization treatment. You can improve the proprioception by using the affected hand to grasp objects of various shapes and textures.
07
Fine function training: Repeated and accurate practice is the key to fine function training. Generally, you can choose to tighten screws, pick up beans, pick up coins, count money, etc. to train the flexibility and coordination of your hands.
08
ADL training: When formulating the training plan, the patient's hand function at different stages should be taken into consideration. The individualized training program not only helps the patient to complete basic ADL activities independently, but also maintains and improves the limb function, the patient's ability to take care of himself, and his family. and social participation abilities are improved, which can help them rebuild their confidence in life.
