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A patient was admitted to a burn unit
A 42 y.o male was admitted to a burn unit as a result of a deep partial thickness burn to the hand. Upon further examination, the physical therapist determines an appropriate position strategy as an effort for controlling edema and preserving ROM. Which of the following strategies would BEST be appropriate for this patient?
A. Wrist extension, Position MCP into hyperextension and PIP/DIP into Flexion with thumb Adduction
B. Wrist extension, Position MCP into Flexion and PIP/DIP into extension with thumb abduction
C. Wrist extension, Position MCP into Flexion and PIP/DIP into Flexion with thumb abduction
D. Wrist extension, Position MCP into neutral and PIP/DIP into neutral with thumb abduction
Answers (8)
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D. Wrist ext, thumb abduc and other joints neutral.
Next Steps
splinting if required, start with stretching and exercises, early rehab is important.
Health Tips
massage and moisturizing can help as the patient recovers
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Please attach a picture of the affected area because proper positioning itself will assist in draining swelling to a better extent. At least attach the physiotherapist assessment sheet for
1.Percentage of burns
2.Area of joints involved.
If you could send video it's most helpful.
What's the type of burns, chemical or any other reason!
Next Steps
Slight extension position of wrist is suggested for fingers, splinting etc... go for your physiotherapist's choice of position in this scenario.
Health Tips
Discuss with your hand / Plastic surgeon before proceeding.
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Wrist in slight 15 to 20 degrees extension. MCP flexion about 30 to 40 degrees and PIP flexion about 45 degrees, DIP flexion for up to 20 degrees with thumb in abduction is a good functional position in general. But we would need a photograph of the burn area over the hand to be more specific about the measures.
Next Steps
Take all other anti-edema measures.
Elevation.
Encourage active movements.
Assist with passive movements.
For a drug prescription, you can consult an orthopedic or hand specialist.
Health Tips
Tendency to contractures is always present. Take care and please consult a specialist.
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Option C is most appropriate considering the functional position that will not hinder in ADL after healing,Also edema to be controlled by elevation of the hand and maintenance of elbow and shoulder ROM is very much essential as it may lead to secondary complication of stiffness.
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Position C is the best appropriate position.
Hand should be elevated to prevent edema.
Wound sterilization is required to prevent infection.
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Wrist extension with MCP flexion PIP - DIP extension and thumb abduction
Next Steps
hand elevated intermittently on off for 1hr to prevent edema.
if post 3-4 weeks, minimal available painfree ROM as per healing progresses.
infection prevention using sterile techniques.
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Ms. Komal Jagtap Gaonkar (PT)
Physiotherapist
15 yrs exp
Mumbai
Position should be kept elevated
Wound sterilization.
Position C . Thumb adduction, MCP flexion and DIP extension..
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Disclaimer : The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding your medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.