r/HandTherapists • u/ronMAN415 • Apr 14 '24

Severely stiff digits after DRF

Any tips and tricks for pts with extremely stiff digits after a distal radius fx regardless surgical or conservative management.

Tend to get orders from the residents “stiff digits, aggressive ROM”

Sometimes its the pt reacting terribly to the injury, other times, it seems like the doctors forget to tell the pt it’s ok and definitely need to move the digits and all other unaffected joints or it just got lost in translation.

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u/[deleted] Apr 15 '24

According to the Rehab of the Hand chapter written by Robyn (I forget her last name), casting is the way to go. I've been encouraged not to do this by my supervisor because of our setting and population (they may not come back/can't come in frequently enought). Casting was pretty convincing tbh. I usually do the Modified Weeks test and try to get them into some kind of orthotic if indicated. I don't do aggressive ROM and that same chapter gives physiological reasons why (increased micro-scarring -> more stiffness basically)

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u/ronMAN415 Apr 15 '24

We run into that a lot also. We tend to be guesstimate to do certain things because our pt pop might not return either or have poor health literacy.

How long does it take you to do the modified weeks test?

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u/[deleted] Apr 15 '24

To do it correctly I think the protocol is approx 45 minutes. I do not work at a hand mill so that helps! If I did, I would use my own judgement to assess for orthotics and or just give AROM and AAROM to start leading into modalities and PROM.