Rehabilitation of Hand Burns
Study
Main
Research
Purpose
Design
Ause-Ellias,
199484
Barillo,
199781
Chung,
199980
Evaluate the
effectiveness
of mechanical
compression
in decreasing
hand edema.
Evaluation of hand
volume before and
after treatment with
a Jobst Intermittent
Compression Pump.
Treatment was an
average of 5.6
treatments over 2
weeks.
Evaluation of Case series.
results of a
Standard treatment
surgical and
protocol with goal of
rehabilitative
wound closure within
treatment
14 days, range of
protocol for
motion therapy,
burned hands. static splinting,
continuous passive
motion.
Assess the
Case series.
sensitivity of
the Michigan
Outcome
Questionnaire
(MHQ) to
clinical change
in patient
status.
Sample
Outcome
Measures
Results
9 chronically
edematous
hands of 5
patients.
Hand volume, hand
range of motion
Mean pretreatment hand Therapeutic
volume was 628.47 ml
and post treatment
volume was 619.02.
This difference was not
statistically significant.
No statistical change in
hand range of motion.
IV
Average of 220.6
degrees of total active
motion at discharge and
229.9 degrees at 3
months after injury.
Mean grip strength of
60.8 pounds at
discharge and 66
pounds at 3 months.
IV
43 patients with
82 hands with
severe burns.
Average TBSA
19.4%. 89% had
hand
autografting
procedure by
day 16.
Total active motion
(TAM) of the hand and
grip strength at the time
of hospital discharge.
Normal TAM is 270
degrees and greater
than 220 degrees is
considered functional. A
grip strength of greater
than 65 pounds is
considered functional.
187 patients with MHQ questionnaire and
chronic hand
patients self-assessment
disorders
of clinical change.
completed a
baseline MHQ
and a second
MHQ 6-18
months later
(follow-up 49%)
Study
Level of
Category Evidence
Therapeutic
The MHQ demonstrated Prognostic
good correlation with the
patients assessment of
clinical change.
IV
Gulati,
200491
Evaluation of
the Joshi
External
Stabilizing
System
(JESS).
Harvey,
199682
Evaluation of a Case series
computer
assisted
impairment
evaluation
system for
upper
extremity
function.
Evaluation of Case series
the use of an
external fixator
in the
treatment of
fixed joint
contractures.
Ilhami,
200392
Retrospective chart
review
218 patients with
severe burns
treated with
JESS from
1982-2002 with
burns 4 months
to 20 years
before
treatment.
80 upper
extremities
evaluated with
the system.
Clinical outcome
Complete correction of
Prognostic
the deformity in the large
majority of patients and
increased number of
patients with new
independence with
ADL’s after the surgery.
IV
Time to complete
examination and
correlation of computer
and conventional
examination.
Computer system
demonstrated good
correlation coefficients
and took less time to
complete.
Prognostic
IV
6 hands in 5
patients
previous failed
reconstructive
surgeries.
Clinical outcome
Improved hand function
and motion after
treatment.
Therapeutic
IV
Lowell,
200386
Evaluation of Case study
the use of
Coban wrap to
decrease hand
edema
Madhuri,
199893
Report of the
use of the
Ilizarov
method for
treatment of
burn
contracture.
Manigandan Description of
200388
need to splint
the wrist in
axillary burns.
Case report
Description of
splinting technique
to extend the axillary
splint to include the
wrist.
One subject with
a 46% TBSA
burn. After
surgery one
hand was
wrapped in
Coban and the
other in standard
gauze dressing.
Random
selection was
used and right
hand was
wrapped in
Coban. Patient
was right hand
dominant.
44-year-old man
with a history of
burn at age of 6
months with
severe
wrist/hand
contracture.
Treated with
Iliazrov device.
No subjects
Measurement of
circumferential
measurements of the
hand/fingers, active
ROM, grip strength, and
hand function up to 17
days post-op.
There was a larger
decrease in
circumferential
measurement in hand
wrapped with Coban.
Therapeutic
IV
Clinical outcome
Deformity was corrected Therapeutic
over a period of 6
weeks.
IV
None
None
IV
Therapeutic
Maslauskas, Describe the
200473
epidemiology
of patients
with severe
hand burns
Case series
A total of 246
cases admitted
to Kaunas
University of
Medicine
Hospital
(Lithuania)
during 4
selected years
(1985, 1995,
2001, 2002)
Clinical outcome
Nuchtern,
199579
Description of
the treatment
of 4th degree
hand burns.
Case series
25 patients (35
hands) with 4th
degree burns
treated over a
10 year period
Clinical outcome
Richard,
199489
Description of Descriptive
the fabrication
of hand
splints.
None
None
74.4% were male,
Prognostic
average age 40, median
TBSA 12%, early skin
grafting in 29.4% and
delayed skin grafting
(primarily in 1985, 1995)
in 70.6%.
There was a significant
decrease in median
hospital length of stay
from 35 days in 1985 to
19 days in 2002.
11 hands were treated
Prognostic
with K-wire
immobilization and
grafting. 33 amputations
in 21 hands including
one above elbow, 5
below elbow, 15 MCP
level amputations.
Evaluation of strength
and ROM showed
severe impairments in 7
hands and 7 with
moderate effects, and 11
with minor sequelae.
Described technique to
Therapeutic
compensate for bandage
thickness in the
fabrication of hand
splints.
IV
IV
IV
Sheridan,
199577
Description of Case series
the outcome of
hand burns
659 patients with Clinical outcome
1047 burned
hands admitted
to burn center
over 10 years.
All treated in a
uniform way with
grafting,
Kirschner wires,
ROM 2x/day and
splinting. 646
burned hands
were followed for
at least 6
months.
Sheridan,
199978
Description of Case series
the outcome of
hand burns in
children
495 children
Clinical outcome
admitted to burn
center with 698
burned hands.
Treatment was
completed in a
uniform way.
In patients with deep
Prognostic
dermal or full-thickness
injuries that required
grafting, 80.9% were
able to perform ADL’s
independently without
compensatory
techniques or equipment
and 18.4% were
independent with ADL’s
with compensatory
techniques or
equipment. In patients
with burns that involved
the underlying tendon,
joint capsule, and bone
81% were able to
perform ADL’s
independently with
compensatory
techniques or equipment
and 9.4% were unable to
perform ADL’s.
In subjects with deep
Prognostic
burns requiring surgery
but not to bone, 85%
had normal hand
function, 9% had
abnormal function but
could complete ADL’s
and 6% were unable to
complete ADL’s. In
subjects with burn
involving bone requiring
the use of K wires, 20%
had normal function,
51% had abnormal
function, and 25% were
unable to complete
ADL’s
III
IV
Smith,
199875
Description of Descriptive
management
techniques for
severe hand
burns.
Torres-Gray, Results of a
Descriptive
199676
questionnaire
distributed at a
breakfast
session at the
1993
American Burn
Association
Meeting.
Umraw,
200474
Comparison of Case series
2 methods of
hand function
assessment.
None
No outcome
38 respondents Results of questionnaire
to questionnaire
to identify
common post
burn deformities
and treatment
obstacles.
Description of treatment
of hand burns.
Therapeutic
The most common
N/A
deformities were thumb
web space contractures,
PIP joint contractures,
and 5th digit boutoniere
deformities. Barriers to
treatment included
prolonged
immobilization, lack of
communication and
support from physicians,
noncompliance with
garments and splints
20 patients with Results of evaluation
Significant correlation of Prognostic
hand burns. All with the Michigan Hand the total scores for the
had surgery 2 or Outcomes Questionnaire MHQ and TEMPA. The
3 days after their (MHQ), a subjective self MHQ showed that 68%
burn injury.
report measure and the of patients reported
Evaluation
Test d’Evaluation des
decreased hand function
completed at
Membres Superieurs
and the level of disability
least 3 months
des Personnes Agees
as measured by the
after burn injury. (TEMPA), a Objective
TEMPA was low.
assessment of hand
function.
IV
IV
IV
Van Straten, Description of
200090
a new hand
splint
technique.
Case series
Van Zuijlen,
199983
Description of Retrospective Case
the outcome of Series
hand burns.
Ward,
199485
Description of Case report
the use of
Coban
pressure wrap
in the
management
of hand burns.
The splint was
Clinical outcome
used on 15
patients and 20
hands. The
splint is made of
thermoplastic
material with a
dorsal outrigger
that provides
passive
extension of the
MCP joints and
active resistive
flexion.
88 patients (143 Jebsen hand function
burned hands)
test.
admitted to burn
center
2 subjects with
hand burns
treated with
Coban wraps
after surgery.
Clinical outcome
Specific data not
reported, but the paper
reported on decreased
cost of splinting and
reduction of therapy
sessions while
maintaining expected
progress toward
treatment goals.
Therapeutic
IV
29 hands had impaired
Prognostic
function and 114 hands
did not have impaired
function. Variables with
significant predictive
value for impaired hand
function were finger
amputation, age,
impaired autograft take,
percent full-thickness
hand burn surface area,
and full-thickness TBSA.
There was no
relationship between the
timing of operation and
long-term hand function.
Good clinical results
Therapeutic
III
IV
WeinstockZlotnick,
200487
Compare the
effect of
pressure
garment work
gloves and
standard
pressure
garment
gloves on
functional
hand use.
Repeated measures 2 subjects with 3
with the standard
burned hands
glove serving as the
control and the work
glove as the
experimental
condition. Each
glove was worn for
one week prior to
testing and testing
was separated by a
period of 1-2 weeks.
Grip strength, hand
function, functional
sensation, and functional
task scores
Decreased grip and
Therapeutic
pinch strength and
functional sensation with
work gloves. Better
performance with work
glove on functional tasks
involving gross and
static fine-motor
movements and simple
dynamic fin-motor
movements.
IV