WHAT YOU SHOULD KNOW
Traumatic contractures of the small joints in the hand can develop after either injury or surgery. Once the limiting scar tissue is mature (usually after 3 months from the last event) no amount of therapy will be able increase motion. All contractures must be considered to potentially involve the joints as well as the flexor and extensor tendons.
MEDICAL HISTORY
Patients typically complain of pain, stiffness, weakness, and loss of hand function. The doctor will ask questions to uncover all the events that led up to or contributed to the development of the contracture. Knowing how the contracture formed is the key in planning to eliminate the contracture.
EXAMINATION
Specific measurements will be made of both the passive (someone else moves the joint by pushing on it) and active (joint is moved by its own tendons) motion of each involved joint. Tests will be done to evaluate the function of the relevant tendons.
ADDITIONAL TESTS
Plain x-rays will show any underlying joint damage that might make achieving good motion more difficult.
TREATMENT OPTIONS
| NON-OPERATIVE | SURGICAL RELEASE | |
| CONSISTS OF | Outpatient therapy | Surgically excising scar tissue from around joints and tendons |
| FEATURES | Stretching exercises and splints | Outpatient surgery, patient actively participates in evaluation at time of surgery |
| ADVANTAGES | Avoids surgery | Maximum correction possible, used when previous scar is mature |
| DISADVANTAGES | Only effective early when scar tissue is immature | Correction proportionate to original problem, some new scar tissue forms after surgery |
RECOVERY
Patients must be very committed to their treatment to choose surgical correction of a contracture. Intense outpatient rehabilitation begins immediately after surgery. Patients must perform motion exercises every hour on the hour when awake, seven days a week. Sutures are taken out after 2 weeks in the office. Splints are used at night and sometimes during the day to preserve increases in motion. New scar tissue gradually forms and matures over about a 3-month period after surgery. When therapy is finished after the scar matures patients will have some percentage of motion that is still less than the freedom achieved on the day of surgery.
