The goals of physiotherapy for a Benediction hand deformity are to:-

• Maintain or improve range of motion: Prevent stiffness in the affected joints.
• Strengthen remaining functional muscles: Maximize the strength of the muscles not directly affected by the nerve injury.
• Promote nerve regeneration (if possible): Although physiotherapy cannot directly heal a nerve, it can optimize the environment for potential nerve recovery.
• Improve functional use of the hand: Adapt activities and develop compensatory strategies.
• Manage pain: Address any pain associated with the injury or compensatory movements.
• Prevent secondary complications: Such as contractures or muscle imbalances.

Physiotherapy Interventions May Include:-

• Passive and Active-Assisted Range of Motion Exercises: Gently moving the index and middle fingers through their full range of motion, with assistance if needed. This helps to maintain joint mobility and prevent contractures.
• Active Range of Motion Exercises: Encouraging the patient to actively move all fingers and the wrist within their comfortable range.

Strengthening Exercises:

• For unaffected muscles: Strengthening exercises for the muscles innervated by the ulnar and radial nerves to compensate for the weakness in the median nerve distribution. This might include exercises for grip strength, pinch strength, and wrist movements.
• As nerve regeneration occurs: Gentle, progressive strengthening exercises for the muscles innervated by the median nerve as they begin to recover. This needs to be carefully monitored to avoid overworking recovering muscles.
• Nerve Gliding Exercises (Neural Mobilization): Gentle movements designed to improve the mobility of the median nerve along its pathway. These exercises can help to reduce nerve irritation and promote blood flow.
• Sensory Re-education: If there is sensory loss associated with the nerve injury, techniques to help the patient re-learn to interpret sensory information in the hand.

Splinting:

• Static splinting: May be used initially to support the wrist and hand in a functional position and prevent overstretching of weakened muscles.
• Dynamic splinting: In some cases, dynamic splints may be used to assist with finger flexion while allowing for active extension.

Functional Activities Training: Practicing everyday tasks to help the patient learn to use their hand effectively despite the limitations. This may involve adapting techniques or using adaptive equipment.

Pain Management: Techniques such as heat, ice, transcutaneous electrical nerve stimulation (TENS), or manual therapy may be used to manage pain.