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Orthopedic Services
Glendale Adventist Medical Center
1509 Wilson Terrace
Glendale, CA 91206
Ph: (818) 409-8000

Pain Management

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How can you tell if someone needs to see a hand therapist after breaking the fingers? My brother was in a bad skiing accident and broke the three main fingers of his dominant hand. He didn't break the joints or the baby finger, which they said is usually the most commonly fractured finger bone. Anyway, he was put in a cast up to his elbow and now he's out but he says it's very stiff. I had therapy after I broke my wrist last year and it was very helpful. Would something like this be a good idea for my brother?

Fractures of the fingers that don't involve the joint are called extraarticular phalangeal fractures. The term phalanges refers to the finger bones. Of the three bones in each of the fingers, the phalanges closest to the hand is the proximal phalange. Treatment for nondisplaced phalangeal fractures is usually with cast immobilization. The cast places the large knuckles (metacarpal phalangeal joints) in a bent position to tighten the tendons and protect the healing fractures. Because it is a forearm cast (goes from hand to just below the elbow), the patient's wrist is also immobilized. The result is a stiff wrist when the fracture(s) are finally healed. Most people seem to be able to work through that stiffness and it resolves over time. Some patients may be referred to a hand therapist for various reasons. Referral for hand therapy is usually done at the discretion of the surgeon. There does not appear to be any specific criteria consistently applied to each patient when deciding who needs therapy and who doesn't. One group of patients most likely to be sent to hand therapy are those who develop a condition known as complex regional pain syndrome or CRPS. Immobilization and loss of wrist motion may be contributing factors to this problem. Some surgeons are experimenting with a different type of cast that would allow for wrist motion during immobilization and healing of these kinds of fractures. The advantages of being able to use the wrist are increased patient satisfaction and the potential prevention of some complications like complex regional pain syndrome.


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