Expected Rehabilitation Times for Common Upper Extremity Injuries Gordon Iiams, MD.
-
Upload
amber-dunlap -
Category
Documents
-
view
221 -
download
5
Transcript of Expected Rehabilitation Times for Common Upper Extremity Injuries Gordon Iiams, MD.
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 19 Months From September 2008
To March 2010
Surgical Case Log Reviewof Worker’s Comp Cases
Total # of WC Patients 49
Total # of WC Surgeries
66 (9.6%)
All Surgeries 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 cutterlaceration L Hand/
Index Finger
Multiple Structures: Flexor TendonsRDA, RDN, FDS, FDP
R.T.: 42 yo WM RDHL Wrist Laceration-Jigsaw
(jagged/ugly) No functional structures injured
Recovery Times
MMIM.T. 1 yr ND 8 day
RD 11 wksSSLT 2 pt
80%6 mm
R.T. 5 ½ weeks RD 1 Week
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 InjuriesFull Duty – 3 to 9 weeks MMI 2.5-6.5 months
Age MMI No Duty (days)
Restricted 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 ArticularIntra ArticularComminuted
Displaced
Summary of Distal Radius Fracture PatientsFull 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 Const. Acute-on Chronic
CR 63 M 6 13 wks Mail Carrier
JL 26 M - Fisherman RSD
EH 66 F 8 5 mo Cook RSD
RH 24 M -
MJ 45 M - M. Seaman Non-union
JV 57F 7 wks 7 wks OR RN- Colles
JS 52 M DOS 04.02.10 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. B.
C.D.
A. GoniometerB. Grip DynamometerC. Pinch DiscriminatorD. 2 Point DiscriminatorE. ROMF. Grip StrengthG. Pinch StrengthH. Sensation
Sample Impairment Rating
G.M 51 F RHD Fx-Dx Lt. 5th CMCJ 1 yr = MMI
L SF ROM MP +10-50 +20-90 25%
PIP 20-80 0-100 19%
DIP 0-70 0-70 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
ConclusionSimple or uncomplicated injuries
Are not so common
ConclusionRecovery 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!