Hello all! I have been contacted by a connection of mine, who is looking for advice:
UPDATED 12/07/19: The individual who reached out to me mistakenly said he had carpel tunnel syndrome when in fact it was Dupuytren's contracture.
'Please can you help! My dad, age 73, had an operation on his (dominant) right hand in January 2019, with a further operation in April. The wound has now "over granulated" and hence is not healing enough for more aggressive therapy. The issue is that he is unable to mobilise two fingers in his hand. The hand is becoming more stuck and stiff, due to lack of use. He is using a night splint, but unable to mobilise the hand at all currently.
My dad wonders whether this is a trapped nerve, or whether the operation has resulted in long lasting damage. He does not want to have more operations, as you can imagine. He is seeing a physio and OT, but we wonder also whether a private hand therapist may also be of use?
What sort of treatment is available for this particular problem? Any aids and adaptations that could help? He is a fit and healthy man - gardener, squash player, etc. He can't eat, read, or do anything ADL wise. He is walking every day for his health, but is very fed up following the operation.
Any advice at all would be most welcome.
UPDATED 12/07/19: The individual who reached out to me mistakenly said her father had carpel tunnel syndrome - it has now been identified as Dupuytren's contracture. Information on this condition: www.nhs.uk/conditions/dupuytrens-contracture
Here are a few additional thoughts and tips, from others across our social media channels:
Try "theraputty"
"He needs to do flexor tendon gliding exercises, median nerve gliding, scar massage when incision is closed, and perform wrist and digital ROM to resolve any deficits in motion"
"Did they not refer him to OT?!? You can always ask for a scrip. An excellent hand therapist would be beneficial, especially to get back to a high demand sport like squash"
"Was it endoscopic or open? On top of scar management, nerve and tendon glides, and AROM, definitely have him pace himself gradually back into his daily activities. A lot of the times patients try to do too much too soon and end up lengthening their recovery"
"Use a night and day splint and don't work the hand too hard. You don't want to cause extra swelling"
"Have him work out his unaffected arm! New research shows that even if you work out on one side, the other side may still benefit"
Thank you all for your thoughts in this forum post. The lady whose Dad is affected is aware of this page and will read through all your ideas and suggestions!
I’m a specialist OT working in Hand Therapy in the UK. Until the stitches are removed the wound should not get wet so that the chances of infection are reduced. Then once the wound is healed scar massage should be started. The main problem I see after CTR is with hypersensitivity from people doing very little or avoiding touching the scar. Normally we encourage light activity from the onset, with no loading for 8-12 weeks, and maintaining range movement at the wrist and fingers. Elevation of the hand above heart level in the early days after surgery is important to help with swelling.
As a CHT, whom has seen MANY carpal tunnel post operative patients AND personally underwent a carpal tunnel release, I would say obtaining normal ROM as quickly as possible (through joint blocking and tendon glides) and minimizing swelling is key. Typical protocol allows the person to move and use their hand based on their pain levels. Most Hand surgeons do not immobilize their patients and want them moving. I am unsure as to why he has to 'be out of action' for 6-8 weeks. There are many unknowns to provide a thorough response- how long did he have the symptoms, how severe, does he have muscle atrophy, what is the surgeons protocol? He should be able to read, perform his ADL's, etc. Of course, he is not to over use his hand in the beginning stages. Putting weight into his palm will take about 3-5 months before it is pain free. Modifications such as a silicone scar pad is good for sensitive scars, edema glove for swelling, moist heat for stiff joints, using large handled utensils, and activity modification can be helpful.
I had my carpel tunnel done a few year back and for me I found crochet really helped to strengthen my grip, although this may not be so appealing for your dad. tOnce he bandace is off and the wound heald, it's about a gentle build up of usual daily activity. Starting with activities that don't use much strength but some dexterity and building up from there. I had two little girls under three at the time and I remember how frustrating it was not being able to do everything I wanted to do. I did read with my kindle and I compensated a little with my non dominant hand for some tasks.
Some initial thoughts from me: From an OT perspective, I'd be focusing on some simple exercises he could do whilst watching telly/resting in his chair. But trying to grade and pace some functional tasks would be initially a challenge but provide more of a focus. Such as practising cutting soft objects, doing up/undoing large buttons and turning pages of a book. Given he is a gardener, perhaps he could practice potting plants? These will be initially frustrating but his grip and range of movement should hopefully get easier over time.