Expected Rehabilitation Times for Common Upper Extremity Injuries

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Expected Rehabilitation Times for
Common Upper Extremity Injuries
Gordon Iiams, MD
What constitutes a “common”
upper extremity injury?
A Review of One Hand Surgeon’s
Worker’s Compensation Case Load:
Time Frame
From
To
19 Months
September 2008
March 2010
Surgical Case Log Review
of Worker’s Comp Cases
Total # of WC
Patients
Total # of WC
Surgeries
All Surgeries
49
66 (9.6%)
688
Body Parts
Total
Finger Tips
6
Hand/Finger
21
Wrist
16
Forearm
2
Elbow
8
= 53
Are there any really “simple” injuries?
• Laceration
• Fracture
• Crush
• Soft tissue
• Bone
• Everything
Even a “simple cut” is usually complex
M.T.: 32 yo WM RHD
Box cutter
laceration L Hand/
Index Finger
Multiple Structures:
Flexor Tendons
RDA, RDN, FDS, FDP
R.T.:
42 yo WM RDH
L Wrist Laceration-Jigsaw
(jagged/ugly)
functional structures injured
No
Recovery Times
MMI
M.T.
1 yr
R.T.
5 ½ weeks
ND
RD
8 day
11 wks
RD
1
Week
SSLT
2 pt
80%
6 mm
Jagged skin
scar
“Is it fractured or just broken?”
“It’s just a fractured finger.”
What constitutes a
“Boo Boo”?
6 Finger Tip Crush Injuries (12%)
Open Tuft Fx
Nail Bed
Laceration
Nerves & Small
Vessels of Finger
Tip Pulp
Summary of Finger Tip Crush Injuries
Full Duty – 3 to 9 weeks MMI 2.5-6.5 months
Age
MMI
No Duty
(days)
Restricte
d Duty
(wks)
Full Duty
(wks)
JJ
58 M
2.5
20
4.5
7.5
HLF
35 F
3.5
6
2
3
GR
69 M
6.5
4
8
9
EC
21 M
4
6
7
8
CG
37 M
3
16
2.5
5
GM
48 M
Distal Radius Fractures (18%)
Extra Articular
Intra Articular
Comminuted
Displaced
Summary of Distal Radius Fracture Patients
Full Duty 7 wks-6.5 mo
MMI 8 mo- 18mo
Age
MMI
Full Duty
Job
DL
38 F
18
6.5 mo
Store Mgr
SP
59 M
14
CR
63 M
6
JL
26 M
-
EH
66 F
8
RH
24 M
-
MJ
45 M
-
JV
57F
7 wks
JS
52 M
DOS 04.02.10
Const. Acute-on
Chronic
13 wks
Mail Carrier
Fisherman RSD
5 mo
Cook RSD
M. Seaman Nonunion
7 wks
OR RN- Colles
Electrician
13 “other” Hand/Finger
Crush Injuries =
26%
Hand Crush Patients
Ages: 22-71
Male/Female: 10/3
Return to Full Duty: 3 to 20 weeks
Permanent Impairments: 3
MMI: 4.5 to 18 months
Office Evaluation Tools
A.
C.
A. Goniometer
B. Grip Dynamometer
C. Pinch Discriminator
D. 2 Point Discriminator
E. ROM
F. Grip Strength
G. Pinch Strength
H. Sensation
B.
D.
Sample Impairment Rating
G.M 51 F
RHD Fx-Dx Lt. 5th CMCJ 1 yr = MMI
L SF ROM MP +10-50
PIP 20-80
DIP 0-70
+20-90
0-100
0-70
25%
19%
zero
Sample Impairment Rating
Grip Station
Right
Left
% SLI
I
70
25
64
II
75
50
33
III
85
60
29
IV
65
50
23
V
65
45
31
Sample Impairment Rating
G.M. Grip
Other Cases Not Discussed
Nerve Repair/Decompression
Elbow Fractures +/or Dislocations
Global Extremity Injuries
Ex: Brachial Plexus
RSD
“RSD”
Reflex Sympathetic Dystrophy
Causalgia:
Chronic Regional Pain Syndrome
Fracture Disease
Conclusion
Simple or uncomplicated injuries
Are not so common
Conclusion
Recovery times for upper extremity injuries
Take 6 months to 1 year
Sometimes longer
Mitigating Circumstances
Crush component
RSD
Nerve Involvement
Elbows
Intra-articular Extension
Smoking
Medical Conditions (ex Diabetes)
Thank You!
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