Question
Is it important for patients to have early intervention for hand injuries?
Answer
Evidence to Support Early Intervention
Bone
For the bone, I found a couple of different articles to support the idea of having patients come early for therapy. Valdez in 2009, she looked at patients that had volar plate procedures after wrist fractures. She had 14 patients that were started one week after surgery and 9 patients started 6 weeks after surgery. What she found was a statistically significant decrease in number of visits and number of days to function in those patients who were started at one week post-op. That is an important thought. The early we start, the better the outcome with less number of therapy sessions. Feehan in 2003 actually suggested in a bench model that functional and physiological stresses increase both the quality and the rate of healing.
Tendon
For tendon, you have a lot of articles and literature that supports the idea that getting patients with tendon injuries in quickly will actually help their total outcome. Gelberman et al. in 1986 found that early motion restores gliding. It leads to better repair site strength and excursion. Cooney et al. stated good synergistic motion is going to help with different excursion. Other articles showed that synergistic motion has low force and high excursion, and good digital flexion with wrist extension has good pulling force. All of these exercises are studied in the short term. This reinforces the idea of early intervention.
Early Controlled Motion
The simplest way to help achieve the optimal results for our patients is going to be that early controlled motion, and all joints that are safe to move, should be moved frequently against no resistance as early as possible to reduce edema, build strength, to promote bony healing, prevent dysfunctional patterns of disuse, and provide that gliding function. That gliding is so important for the joints, tendons, and for everything to work well together.
