Rehabilitation of Hand Burn Injuries
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Introduction[edit | edit source]
The importance of rehabilitation of burn injuries has been increased due to the improved short and long survival rate of people with large burn. Burns to the hands decline the chances of functional recovery and quality of life, especially when included in larger burns[1]. Successful outcomes following hand burn injury require an understanding of the rehabilitation needs of the patient. Rehabilitation of hand burns begins on admission, and each patient requires a specific plan for range of motion and/or immobilization, functional activities, and modalities. The rehabilitation care plan typically evolves during the acute care period and during the months following injury[2].
Problems list[edit | edit source]
A comprehensive understanding of the effect of hand thermal injury can improve the rehabilitation outcomes and prevent burn-related issues. There are some common complications following a thermal injury to the hands[3], including:
- edema
- join deformities,
- scar contracture,
- restricted or reduced hand function
Below is a brief explanation of these complications:
Post-burn edema[edit | edit source]
The cause of the edema is the increased vascular permeability following a thermal injury to the hand combined with a shift of fluids to the extravascular space. This should be taken into consideration in the rehabilitation period. The severity of edema depends on the severity of the burn. In superficial partial-thickness burn, only minimum amount of fluid leak into the extravascular space, making the edema minor and transient. Contrarily, deep partial thickness and full-thickness burns lead to a bigger, more prolonged and severe edema[3]. Electrical stimulation helps reducing hand burn edema and improves active motion of the hand[4]. Elevation of the hand, passive mobilization, retrograde massage and bandages should also be used in early stages to prevent or reduce edema[5].
Hand deformities[edit | edit source]
The hand is ranked among the three most frequent sites of burns scar contracture deformity[6]. It occurs during the early post-injury period resulting from edema, scar contracture or tendon injury[2].
Scar contracture[edit | edit source]
Hand burn scar contracture can be classified as follows[6]:
| Grade I | Symptomatic tightness but no limitations in range of motion, normal architecture |
| Grade II | Mild decrease in range of motion without significant impact on activities of daily living, no distortion of normal architecture |
| Grade III | Functional deficit noted, with early changes in normal architecture of the hand |
| Grade IV | Loss of hand function with significant distortion of normal architecture of the hand |
| Subset classification for Grade III and Grade IV contractures: A: Flexion contractures, B: Extension contractures, C: Combination of flexion and extension contractures | |
To avoid contractures, a burned hand must be properly positioned, ranged or splinted. a Volar splint, rubber bands, stretching exercise and passive/active movements must also be used to prevent contractures[5]. Contractures lead to major disabilities that are not easily reconstructed by surgery. The typical contracture is an “intrinsic minus” position where the metacarpophalangeal (MP) joints are fixed in hyperextension and the proximal intraphalangeal (PIP) joints are fixed in a position of flexion.The collateral ligaments of the MP joint are the most important structures of the burned hand. For this reason, positioning of the burned hand should place the MP joints at maximum flexion (90 degrees of flexion) to maximally stretch the collateral ligaments. The anatomic position for splinting is not the “Fosters Beer Can” grip but rather involves 30 degrees of wrist extension, MP joints at 90 degrees of flexion, and IP joints fully extended. The thumb should be fully abducted [6]. To manage keloids scars we used postural alignment, splinting, passive/active mobilization, massage and stretching exercise.
Restricted or reduced hand function[edit | edit source]
Physiotherapy rehabilitation is an essential component of burn care. Especially to maintain the functional range of motion of the hand, maximize function, prevent contractures as well as to improve the psychological health[7]. Passive/ active movement and strengthening exercises using theraband with precautions, have been used to maintain or regain muscle force and active function of the hand with positive outcomes[5].
References[edit | edit source]
- ↑ Cowan AC, Stegink-Jansen CW. Rehabilitation of hand burn injuries: Current updates. Injury. 2013 Mar 1;44(3):391-6.
- ↑ 2.0 2.1 Moore ML, Dewey WS, Richard RL. Rehabilitation of the burned hand. Hand clinics. 2009 Nov 1;25(4):529-41.
- ↑ 3.0 3.1 Moore ML, Dewey WS, Richard RL. Rehabilitation of the burned hand. Hand clinics. 2009 Nov 1;25(4):529-41.
- ↑ Edgar DW, Fish JS, Gomez M, Wood FM. Local and systemic treatments for acute edema after burn injury: a systematic review of the literature. Journal of Burn Care & Research. 2011 Mar 1;32(2):334-47.
- ↑ 5.0 5.1 5.2 Rrecaj S, Hysenaj H, Martinaj M, Murtezani A, Ibrahimi-Kacuri D, Haxhiu B, Buja Z. OUTCOME OF PHYSICAL THERAPY AND SPLINTING IN HAND BURNS INJURY. OUR LAST FOUR YEARS’EXPERIENCE. Materia socio-medica. 2015 Dec;27(6):380.
- ↑ 6.0 6.1 6.2 Sabapathy SR, Bajantri B, Bharathi RR. Management of post burn hand deformities. Indian journal of plastic surgery: official publication of the Association of Plastic Surgeons of India. 2010 Sep;43(Suppl):S72.
- ↑ Dunpath T, Chetty V, Van Der Reyden D. Acute burns of the hands–physiotherapy perspective. African health sciences. 2016;16(1):266-75.
