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Physical Rehabilitation Medicine/Severe finger stiffness & Swelling

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Question
Hello, I am a 48 year old male, in pretty good physical shape. April 6,2015 I injured my right hand in mountain bike wreck. Saw a hand orthopedic on 4/8. X-rays showed on the knuckle between hand and fingers of the index finger was fractured. This fracture is on the inside portion of the finger, between middle finger and index, Doctor said the tendon attaches right at the point of fracture and more than likely the finger was hit hard enough where the tendon pulled the corner of the bone away. Cast removed 7 1/2 weeks later May 27.
the cast went from forearm up to the ends of both middle and index fingers, completely immobilizing those two fingers.
now 3 days out of cast, those two fingers still swollen beyond what I would think is typical.
The day the cast came off doctor gave exercises to rehab hand, scheduled 2 week follow up and said I should be making a complete fist by then. This seems very unlikely as by the end of the day with pretty aggressive exercising to make the '2 week fist' hand becomes very swollen, soar and not much gain on flexibility. the most difficult knuckles to get the flexibility and movement are the boxing knuckle and knocking knuckle of both index and middle finger.
Also at night when sleeping hand has become extremely painful and tingling sensation.
My passion is golf and with this hand like this, golf is not looking good so far !!
I am becoming a bit concerned and frustrated.
any advise would be greatly appreciated.
Regards.

Answer
That's a long time to be immobilized.  You probably need treatment by a certified hand therapist 3x/week for 8-10 weeks or so. Make sure they are a CHT. Look on www.asht.org. Do gentle exercises only with no pain or swelling. You will fall far short on a fist.  

Physical Rehabilitation Medicine

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Brian Neville, OTR/L, CWCE

Expertise

I can answer questions about both conservative and post-operative rehabilitation for UPPER extremity injuries. These include but are not limited to: fractures, tendon repairs, tendon transfers, nerve repairs, lacerations, tenolysis procedures, TFCC injuries, repetitive motion disorders, reconstructive procedures. I have an advanced knowledge of UPPER extremity anatomy and industrial rehabilitation. I have extensive splinting skills for injuries to the upper extremity. Although not a physician or a surgeon I have worked closely with world renowned upper extremity specialists for over 10 years. I can give general information on what some of the most common upper extremity surgeries involve. I can reference those procedures as well. PLEASE DON'T ASK ME QUESTIONS ABOUT ANYTHING OTHER THAN THE NECK, SHOULDER, ARM/HAND. I'M NOT QUALIFIED AND KNOW ABSOLUTELY ZERO ABOUT BACKS/HIPS/KNEES/ANKLES/ETC. THANK YOU!!!

Experience

10+ years working closely with orthopedic and hand surgeons and their patients. I have treated patients with small lacerations to major reconstructive procedures. My knowledge base includes both conservative and post-operative rehab protocols and care for upper extremity injuries. I have treated patients all the way from day 1 post-op to return-to-work status.

Organizations
Kentucky Occupational Therapy Association American Society of Hand Therapy National Nurses in Business Association Roy Matheson and Associates

Publications
RSD article

Education/Credentials
Occupational Therapist former Certified Hand Therapist (license currently inactive) Deep Physical Agent Modalities Instructor Certified Work Capacity Evaluator

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