Hand fractures, especially of the metacarpal bone, are relatively common. They are usually caused by direct external force, such as a strong blow with the hand or fist against something hard or a fall on the hand. Symptoms that occur are initially the classic signs of inflammation and fracture, such as swelling, hematoma formation, heat, redness, pain and reduced function.
An x-ray should be taken to confirm the diagnosis of the fracture. After initial sparing and cooling, the broken hand is protected and stabilized with a plaster cast. Subsequently, physiotherapy is started at an early stage, whereby the focus is initially on movement without strain.
This prevents stiffening and a reduction in function. Adapted movements also have a positive effect on the healing process. Physiotherapy always depends on the so-called wound healing phases and the individual condition of the patient.
- Phase 1 (inflammatory phase): Gentle treatment and cooling are the main focus here for a few days. Afterwards the swelling should slowly subside.
- Phase 2 (proliferation phase): Until the third week, the focus here is on the formation of new tissue and the improvement of functional mobility.
- 3rd phase (consolidation phase): Final consolidation of the fracture site. Here the tissue stabilizes and the old resilience is to be regained. This phase is highly dependent on the active cooperation of the patient and can last up to one year.
Appropriate exercises
In active physiotherapy after a hand fracture, mobility, (fine) coordination and strength building are trained in particular. In the following some exercises from the mentioned areas are presented. The mobility of the fingers can be trained early on with active stretching and bending exercises.
Continuous joints of the arm should also be moved. For example with flexion and extension of the elbow joint and circling of the shoulder to loosen the entire muscle chain.
- After the cast is removed, the fist closure and the entire hand opening can be practiced.
- As it progresses, a small soft ball can be squeezed in the hand to train the hand muscles.
- Movement patterns from the PNF concept (Proprioceptive Neuromuscular Facilitation) are suitable for strengthening the entire muscle chain, in which first passive, then active, and finally active movements with resistance are performed in three-dimensional patterns.
- In order to train fine motor skills, exercises such as finger tapping can be performed first.
The thumb taps each other finger on the fingertip and changes in a steady rhythm.
- To practice motor skills in a playful way, plug games can be pulled to help, whereby small wooden sticks must be inserted into suitable holes. For a combination exercise of strength and coordination, small wooden sticks or balls are worked into a ball of plasticine. Now we knead with one hand and pick out the wooden sticks with the fingers of the same hand.
- To stretch the hand and forearm muscles, the arm to be stretched is stretched forward with the fingertips pointing towards the ceiling.
The other hand now grasps the fingers on the inside and gently presses them closer to the body until a stretching sensation is felt. The same is done for the opposite side by folding the hand downwards and pressing the outside of the fingers towards the body. Stretches are held for about 30 seconds to achieve an effect.
Later, manual therapy can be used to move the metacarpals against each other.
- In order to improve sensitivity, a hedgehog ball can be tightened and the hand rolled out from both sides, as well as the forearm. Once the fracture is stable, other aggravating aids such as Thera bands can be added to the therapy. Active cooperation and regular practice are essential.
