Background
Chris first came to see the team at Osiris Health in September 2019. Chris presented with multiple issues to his left hand that severely limited his practical ability.
It was quickly identified that there was spasticity and/or shortening of the muscles which pull the fingers into a flexed position. In addition to the limited movement Chris was able to achieve, the skin creases at the base of Chris’s fingers and in his palm were sore and infected.
The above two photographs show the maximum extension (hand opening) Chris could achieve, however, the wrist needed to be in a flexed (bent) position to achieve this.
This photograph shows the sore and wet skin creases at the base of Chris’s fingers and in his palm. This situation would only get worse if not treated.
Chris was assessed by Advanced Practitioner Occupational Therapist Angie Henry and a treatment programme was proposed.
Treatment
A multidisciplinary approach was required for Chris’ treatment, involving botulinum toxin injections, splinting, surgery and a hand exercise programme.
Initially, Chris received botulinum toxin injections to the muscles of the forearm and hand, to reduce the muscle spasticity enough to stop Chris’s fingertips rubbing in his palm. Whilst this achieved the result of resolving the skin soreness and infection,
Chris was fitted with a resting splint to his hand to the best position we could achieve when extending the wrist and fingers at the same time. Chris wore the splint for 6 months, however, we were unable to improve the position. This confirmed that two of Chris’s joints in his hand (middle and ring finger MCPJ’s) were fixed in this position.
Chris attended for surgery in September 2020. He had release of the contracture of the joints of the hand (MCPJ’s) and FDS/FDP muscle lengthening.
Two months after the first operation, Chris was able to extend (open) both wrist and hand at the same time and his hand was passively correctable into a fully straight position.
Chris was able to utilise his hand for functional activities. However, there remained m a problem with Chris’s middle finger, with the tendon causing the tip of the finger to hyperextend.
Chris attended for surgery in April 2021. He had release of the tendons that were causing the middle finger deformity.
Outcomes
Chris has had an excellent result from both operations!
He is now able to extend the wrist and open the fingers at the same time, the wrist is now straight when it extends and his palm is clean with the skin in good condition. Importantly, Chris is able to use his hand functionally on a daily basis, helping him to undertake more tasks independently.
Due to the success of his treatments to date, Chris only needs monitoring by his Hand Therapist approximately every 3-4 months to ensure that he keeps the current range of movement he has.
Commenting on his progress so far, Chris said:
“Now that I have had the operation on my hand, I can open it up much better than I could before. I can also use it for things like holding my crutches better which I couldn’t do before. I am very happy with how my hand is now.”
Osiris Advanced Practitioner Occupational Therapist, Angie Henry, said:
“Chris has had an excellent result and exceeded our expectations.
“This case study goes to show how the multidisciplinary approach offered by Osiris Health can combine to produce great results.”