Case of the Week 11-5-12: 1:1 for a Traumatic Hand Injury
The patient was a 32 yo male who had a work related injury that resulted in the digits 3-4 of his left hand being cut off from around the DIPs. After surgery, he attended PT at the surgeon's POPTPs for 8 weeks. The patient was a former college football player and a very strong guy. Grip strength remained unchanged for the past 6 weeks and was significantly weaker than the uninvolved side.
His wife is a PTA/ATC who works at our practice. When I found out he was going to a POPTPs at his surgeon's request, I politely flipped out and told him I would see him for 1 visit as a consult to see if more of a change could be made. The patient agreed.
Here is his evaluation:
Subjective: Pt reports slipping while using a table saw and cutting off L hand digits 3-4, around the DIP on one finger and proximal to the DIP on another. The digits were shredded and not able to be re-attached. He has been receiving PT at another clinic, but mainly doing unsupervised exercise only. Main complaint is hypersensitivity and stiffness around his scars. He also has severe weakness and pain with grasping, but is returned to work full time.
key: F = functional (WNL), D = dysfunctional, N = non-painful, P = painful
All shoulder, elbow, forearm, wrist motions FN bilaterally
3rd and 4th dig PIP and DIP finger flexion 3/5 compared to 5/5 on the right.
Grip strength Left 47# Right 157#
Myofascia: moderate restrictions in L radial bony contours anteriorly and posteriorly.
The deal with the consult was to see the difference in 1:1 care of our practice vs the not allowed to do manual therapy at this specific POPTs. The only 1:1 he would get is light PROM of his hand and wrist, to which the patient would tell the PT, "I already have full ROM," so she would just have him do the same exercises he was doing for 8 weeks.
All I did for the first visit was light IASTM with the EDGE along the anterior and posterior radial bony contours for 5 minutes on each side. After 8 weeks of UBE, towel and puddy squeezes, etc.. no change, 10 minutes of light IASTM improved his grip strength on the left to 80#! I expected some improvement, but not nearly double!
That was enough to get him to take his prescription (needed for worker's comp) and come to our practice. He was only seen for 6 more visits, with variations on IASTM, also done to lateral upper arm, left upper trap and cervical paraspinals to get the neural container and had some neurodynamics as well, which rapidly improved the pain he had with grasping. Each treatment was about 10-15 minutes and he continued his grasping exercises at home.
At discharge, he only had mild pain with grasping and left grip strength was 100# and right was 144# (possibly weaker due to a harder day at work). More change with a little STM plus exercise in 3 weeks than exercise only in 8 weeks.
Bottom line: STM, most likely due to neurophysiologic mechanisms promotes facilitation of movement and muscle recruitment. He certainly did not have any "scar tissue" in the areas that I worked on, considering they were not injured. A little bit of STM goes a long way! Thoughts?