By Shirish Godbole
Occupational Therapist and Certified Hand Therapist (OTR/CHT) with Able Hands.
This is a story of Anthony, severely injuring his hand but miraculously regaining all the hand functions back! How he recovered is both interesting and intriguing! Most people take hands for granted and use them as a first line of defense making them prone to injuries. Community awareness about the intricacies of hand anatomy, complexities of disabling hand injuries and the competence of a certified hand therapists is surprisingly low!
Life was great for Anthony. 24 years young, manager at Tuscany, a specialty Italian deli in Marlboro, married with a lovely wife and a beautiful 4 months old daughter. He was enjoying life, working hard and calling shots, as if there is no tomorrow!
His hands were even busier than his mind cutting fresh vegetables, thin slices or prime pieces of meats, cooking, catering and shaking hands with customers. Making fresh mozzarella first thing in the morning was his favorite activity of the day.
Everything came to a halt one weekend when the Pira family was hosting a pool party. While serving a beverage to his brother in law, Anthony slipped on the wet garage floor. The bottle instantly broke in his hand upon contact with the hard floor resulting in multiple deep cuts to his right hand. Bleeding was profuse due to presence of multiple arteries in the hand and pain was intense due to presence of three nerves.
He was immediately taken to a hospital. ER doctors called for a specialist Hand Surgeon due to complexity of his injuries. Hand surgeons are specialized exactly for these kinds of traumatic injuries.
Dr. Volshteyn, a renowned hand surgeon came for evaluation and decided to perform reconstructive surgery the following morning. Anthony had suffered complete laceration of two major tendons in his index and middle fingers losing ability to bend the fingers. Many nerves and arteries were also lacerated, making his hand numb and swollen.
Microsurgery was performed the next morning to meticulously repair each structure individually to regain as much hand function as possible.
Before he even closed the wounds, he was thinking about a Certified Hand Therapist!!
Soon after the injury, body send an army of blood, plasma and other enzymes to the wounded part to facilitate healing. Unfortunately, this buildup of fluids acts as a superglue, binding all structures including tendon, skin, bones, ligaments, nerves and arteries together rendering the hand stiff and useless.
Dr. Volshteyn had full confidence in Minette Godbole, a Certified Hand Therapist working with Able Hands Rehabilitation, a leader in hand trauma rehabilitation for 25 years.
CHT’s play a crucial role by fabricating custom splints and following specific movement protocols with experienced handling. They make sure that all structures heal well without sticking together. Tendons take 4 weeks to heal to start moving fingers and the nerves take 6 weeks to regain some feeling in the fingers.
A methodical approach is needed to deal with multiple concurrent problems such as pain, bleeding, healing, wound-care, infection, numbness, loss of all hand functions and other psychosocial adjustments due to the injury.
Close communication with the Hand Surgeon is also important.
Minette fabricated a custom dynamic splint made from a thermoplastic material keeping fingers in flexion with rubber-bands and fishing line passing through pulleys created in the palm to re-direct the pull to the particular tendons with dress hooks glued to the nails. Anthony was allowed finger movements only within the boundary of the splint and with assistance from rubber bands. He was expected to strictly follow home program of specific movements to continue tendon gliding at home.
For Anthony, complete loss of his dominant hand in simple activities like brushing teeth, playing with and putting his daughter to sleep and holding hands with his wife was unbearable.
Minette was ready with her extensive experience to regain his hand functions. Hand Therapy program included wound-care initially, followed by modalities such as paraffin wax, hot packs, ultrasound and electrical stimulation.
Manual techniques for edema control, scar management, range of motion exercises and splint adjustments to ensure proper fit and effectiveness.
Minette was now a VIP for Anthony. Her reassurances were encouraging and made him see the light at the end of a tunnel.
At four weeks, Minette started place-hold of the fingers to check the continuity of the tendons and was able to get them moving at 5-6 weeks.
The process was flawless throughout!
He was now able to use his hand though in a guarded way, feel objects though in a sensitive-weird way and hold his daughter, though awkwardly.
He was becoming happier! He loved coming to therapy because of pleasant and caring atmosphere at Able Hands and liked talking with other hand injury patients. Dr. Volshteyn was kept informed routinely. He was very happy with the progress.
Hand Surgeons perform meticulous surgeries and Hand Therapists give them the best possible outcomes by forming bonds with patients.
These bonds between the trio of hand surgeon-hand therapist and hand trauma patients are based on mutual respect and trust for what they can do best, when needed!
Anthony is still the manager and calling shots. However, he does know that there is a tomorrow and there’s more to our hands than eyes can see.
