Advice from a Certified Hand Therapist: Healing and Early Outcomes Complicated by COVID-19

As hand therapists, many of us agree that early treatment is crucial to successful outcomes. You may be surprised to know that it is typical for a patient to be seen for their first therapy visit three to five days after surgery. Here are some key points to remember if you or a loved one is receiving surgery or recently injured the upper extremity:

1. There are four overlapping phases of wound healing: hemostasis, inflammatory, proliferation, and maturation (Dougherty D.B., Spaks-Defriese, B., Wound Healing Physiology).
   1. Hemostasis begins almost immediately and is when the wound begins to clot.
   2. The inflammatory phase occurs one to three days following injury and consists of the immune system activating to clean out the wound to prepare for healing.
   3. The proliferation phase occurs three to ten days after injury and consists of the production of collagen and new scar tissue at the wound site.
   4. The maturation phase and remodeling phase consists of scar tissue strengthening and remodeling. This phase can continue up to two years after the occurrence of injury.
2. Collagen fibers form in a disorganized fashion during the proliferation phase, and these fibers can attach to the layers of bone, muscle, fascia or skin. This means the collagen acts like glue and can solidify a tendon to the skin above it, resulting in decreased motion.
   1. For example, a break in the bone in your palm could easily become scar tissue that adheres to the skin on the back of the hand, resulting in a stuck tendon. When your tendon gets stuck, you can have significant difficulty making a fist or even straightening your finger.
3. Scar massage and early movement before the maturation phase can prevent this stiffness and result in a functional upper extremity post injury or operation.

Certified Hand Therapists, or CHTs, are trained to remove post-operative dressings, address wound care, evaluate clients' needs, recommend exercise programs, and custom make orthoses the same day depending on the client’s needs.

If post-operative cases are not seen promptly for basic education on movement and guidance away from abnormal movement patterns, a stiff elbow, wrist, and/or hand is often the result. Tendon injuries can yield even more drastic consequences if not seen early enough such as rupture or adhesions that require future surgery and months of therapy.

COVID-19 has presented a variety of concerns for the hand therapy community from distancing in the clinic to telehealth demand and application. However, lack of access to early treatment and intervention could have devastating effects. Now more than ever, it will be crucial to seek therapy services early! Some injuries require face-to-face interaction. Ask your local hand therapist if your diagnosis should be seen promptly and early.
 

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Chelsea Taylor, MOT, OTR/L, CHT is a member of the American Society of Hand Therapists