Santacreu Eva Santacreu, Cabezas Núria Villanueva, Graupera Asunción Bosch
Rehabilitation Service, Area of Traumatology, Hospital Universitari Vall d'Hebron, Pg Vall d'Hebron 119-129, Barcelona, 08035 Spain.
Arch Physiother. 2016 Nov 29;6:14. doi: 10.1186/s40945-016-0028-y. eCollection 2016.
The stiff hand is a still common, severe complication of hand injuries.
We report here the case of a 56 year-old woman, professional goldsmith, who suffered a distal radius fracture of her right hand. The patient was treated with surgery followed by four weeks of immobilization, and developed a stiff hand. Physical examination showed mild inflammatory signs, pain and a major limitation in the extension and supination of the wrist, and in the mobility of the II, III, IV and V metacarpophalangeal (-5° and 32° of average passive extension and flexion, respectively) and interphalangeal (-35° and 73° of average passive extension and flexion, respectively) joints. There was a lack of slip of the flexor tendons. The diagnosis of complex regional pain syndrome was considered although it could not be definitely established. After five months of adverse evolution the patient was referred to our center where a combined intervention with paraffin, manual therapy, prolonged active and passive stretch on a pegboard, and splinting was applied. After initiation of this therapy, a marked change in the evolution of the pain, the mobility and functionality of the hand was observed. At the end of the rehabilitation program the patient was able to fully resume her job.
The present case illustrates the need of intensive treatment for post-traumatic hand stiffness, and describes, as an original contribution, a combined intervention therapy including paraffin, manual therapy, pegboard and splinting.
手部僵硬是手部损伤常见且严重的并发症。
我们在此报告一名56岁女性职业金匠的病例，她右手桡骨远端骨折。患者接受手术治疗，随后固定四周，出现了手部僵硬。体格检查显示有轻度炎症迹象、疼痛，腕关节伸展和旋后以及第二、三、四和五指掌指关节（平均被动伸展和屈曲分别为-5°和32°）和指间关节（平均被动伸展和屈曲分别为-35°和73°）的活动度严重受限。屈肌腱缺乏滑动。尽管不能明确诊断，但考虑为复杂性区域疼痛综合征。经过五个月的不良进展，患者被转诊至我们中心，我们采用了石蜡、手法治疗、在钉板上进行长时间主动和被动伸展以及夹板固定的联合干预措施。开始这种治疗后，观察到疼痛、手部活动度和功能的演变有明显变化。康复计划结束时，患者能够完全恢复工作。
本病例说明了创伤后手部僵硬需要强化治疗，并作为一项原创贡献描述了一种包括石蜡、手法治疗、钉板和夹板固定的联合干预治疗方法。
