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!