Journal of hand therapy : official journal of the American Society of Hand Therapists
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Review
Diagnosis and management of complex regional pain syndrome complicating upper extremity recovery.
Complex regional pain syndrome (CRPS) is a clinical syndrome of pain, autonomic dysfunction, trophic changes, and functional impairment. CRPS is common after hand trauma or surgery. Early diagnosis and intervention is critical for adequate recovery. ⋯ A large spectrum of pharmacologic interventions is efficacious in treating CRPS. Surgery may be used to relieve nociceptive foci. Patient-specific hand therapy is very important in reducing swelling, decreasing pain, and improving range of motion.
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The authors conducted a systematic review to determine if there is scientifically valid (level I or II) evidence for the effect of early motion (<21 days) of joints surrounding an extraarticular hand fracture on fracture healing or functional outcomes. Two reviewers independently evaluated for study inclusion, trial quality and internal validity. Six poor-quality, quasirandomized studies (level III evidence) involving 459 patients were included. ⋯ The scientific validity of EM interventions after an extraarticular hand fracture has not been established in well-conducted, randomized, controlled trials (level I or II evidence). Current evidence does not support or refute the use of EM after an extraarticular hand fracture. However, further investigations are warranted, as findings to date show a consistent potential for benefit with no significant risk of harm when early regional joint motions are incorporated into the management of closed, extraarticular, finger metacarpal fractures.
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This article presents early controlled mobilization options for potentially unstable, nondisplaced, nonarticular hand fractures. Early controlled mobilization of tissues surrounding a healing fracture has the potential to enhance the quality and rate of fracture healing and a person's functional recovery. The options discussed protect the integrity of the fracture alignment, while permitting safe, pain-free protected motion of joints adjacent to the fracture. ⋯ If clinically unstable, the fracture often is considered unable to tolerate unrestricted active motion during the initial stages of healing. This article offers an alternative perspective, in which clinicians can consider the clinical factors that can be controlled to allow for early protected motion of the regional tissues surrounding a potentially unstable hand fracture. These additional clinical options offer an alternative to acute fracture immobilization and help progress the rehabilitation of hand fracture patients.
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Review
Fracture healing: bone healing, fracture management, and current concepts related to the hand.
Bones fracture frequently and often result in significant impairments, functional limitations, and disabilities, especially when the hand is involved. When fractures occur, there is a disruption of the skeletal tissue organization and a loss of mechanical integrity. ⋯ This article briefly reviews the history of fracture healing and the advances in mechanics and cellular and molecular biology, which should help the reader better understand the current mechanisms related to bone healing (primarily and secondarily). Fracture fixation modes also are described along with the temporal sequencing as to when to protect or move the fractured region.
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Proximal interphalangeal joint (PIP) injuries are among the most common in the hand and their severity is often underestimated. These injuries often lead to prolonged disability, pain, and stiffness. ⋯ Such an approach should lead to a rational treatment plan that focuses on the rehabilitation of all damaged components, including osseous, articular, and soft tissue structures. This article reviews all elements in the management of PIP injuries and introduces an assessment method for PIP injuries based on the mechanism of injury rather than primarily on the basis of radiographic findings.