Phases of Rehabilitation and Advanced Techniques:

Phase 1: Immobilization/Protection Phase (Typically 0-4/6 weeks post-injury/surgery)

• Goals: Protect the healing fracture, manage pain and swelling, prevent stiffness in unaffected joints.
• Interventions:
  • Immobilization: The hand will be in a cast, splint, or brace. The specific position (e.g., “intrinsic plus” position for metacarpal shaft/neck fractures) is crucial for preventing contractures.

Pain and Swelling Management:

• RICE Protocol: Rest, Ice (applied to surrounding areas if swelling is outside the cast/splint, or once removed), Compression (if applicable), Elevation.
• Manual Edema Mobilization (MEM): Gentle, specific massage techniques (proximal to distal) to reduce swelling in the fingers and hand, even if part of the hand is immobilized.
• Retrograde Massage: To help push fluid out of the swollen hand.
• Range of Motion (ROM) for Unaffected Joints: Active exercises for the wrist, elbow, and shoulder on the affected side to prevent stiffness. Crucially, active and passive ROM exercises for the thumb and fingers not included in the immobilization are vital. This is why a well-designed splint is often preferred over a full cast.
• Muscle Isometrics (Gentle): Light, non-painful isometric contractions of forearm and upper arm muscles to maintain muscle tone.
• Scar Management (Post-Surgical): If surgery was performed, keeping the incision clean and monitoring for signs of infection.

Phase 2: Early Mobilization/Controlled Motion Phase (Typically 4-8 weeks)

• •  Goals: Gradually restore active and passive range of motion of the fractured digit and hand, reduce stiffness, begin light strengthening.
• Interventions:
  • Splint Removal/Modification: The rigid cast is typically replaced with a removable splint or brace to allow for exercises. The splint is worn for protection during activities or sleep.
  • Active Range of Motion (AROM): Gentle, pain-free active flexion and extension of the affected MCP, PIP, and DIP joints. Examples:
  • Finger flexion/extension: Making a fist and straightening the fingers.
  • Tendon Gliding Exercises: “Hook fist,” “straight fist,” and “full fist” exercises to ensure optimal gliding of flexor tendons.
  • Individual Finger Movement: Isolating movements of the injured finger.
  • Passive Range of Motion (PROM): Gentle passive stretching by the therapist or patient (as instructed) to regain lost motion, especially for any persistent stiffness.

Manual Therapy:

• Joint Mobilization: Gentle, specific glides and oscillations of the MCP, PIP, and DIP joints to restore accessory motion and improve overall ROM.
  • Soft Tissue Mobilization: Around the fracture site and surrounding muscles to reduce adhesions and improve tissue mobility.
  • Scar Massage: Vigorous scar massage (once wound is fully healed) to soften scar tissue, prevent adhesions, and improve skin elasticity. Silicone gel sheeting or topical creams may be used.
  • Isometric Strengthening (Controlled): Gentle isometric exercises for the hand and wrist muscles, as tolerated, to start rebuilding strength.
  • Sensory Re-education: If nerve sensation is affected due to swelling or nerve irritation, specific exercises to re-educate sensation (e.g., discrimination of textures).

Phase 3: Progressive Strengthening and Functional Rehabilitation (Typically 8-12+ weeks)

• • Goals: Restore full strength, endurance, dexterity, and return to pre-injury activities.

Interventions:

• Progressive Resistance Exercises:
  • Therapy Putty/Dough: Using various resistances for finger flexion, extension, pinching, and squeezing exercises.
  • Resistance Bands: For finger and wrist strengthening in various directions.
  • Hand Grippers/Squeeze Balls: To improve grip strength.
  • Small Weights: For wrist flexion, extension, radial, and ulnar deviation.
• Fine Motor Control and Dexterity Training:
  • Picking up small objects: Coins, beads, marbles.
  • Manipulating tools: Screws, nuts, bolts, keys.
  • Writing/Typing/Drawing: Gradually increasing complexity.
  • Buttoning, zipping, tying shoelaces: Rehearsing ADLs.
  • Functional Task Simulation: Mimicking real-life activities that are important to the patient (e.g., cooking, gardening, specific work tasks).
  • Proprioception/Coordination Exercises: Exercises that challenge the hand’s awareness in space and coordination (e.g., catching and throwing small balls, stacking blocks).
  • Return to Activity/Sport-Specific Training: Gradually introducing activities and drills specific to the patient’s hobbies or sport, ensuring the hand can tolerate increasing loads and impacts.
  • Taping: Kinesiology taping or athletic taping can be used for support, swelling reduction, or proprioceptive feedback during activities.