treatment for stiffness after colleys fracture

[sharmaphysio]

Hi everyone, I'm treating a 5 month old Colles # case. She has developed Sudeck's dystropy. She has very stiff fingers and supination was restricted.

Now supination is ok, passive range for fingers are also ok but when she actively flex her fingers and tries to make a fist then her middel finger gets locked in flexed position.

Elbow ranges were also restricted before, but now it has come up. Swelling has also gone down. So what should I do for this locking?

Please help me in this case.

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[physiobob]

For assistance below is a description of Sudeck's Dystrophy

Description:

A variant of the reflex sympathetic dystrophy syndrome with acute atrophy of bones, commonly of the carpal or tarsal bones, following a minor injury such as sprain. It is characterised by a burning pain that is exacerbated by emotional stress. Prevalent in old people and in women.

Clinical description by Sudeck in 1900, roentgenological by Kienböck in 1901.

[sharmaphysio]

thanks but my problem is the locking og middel finger in flexed position when she try to flex digits actively,i.e when she try to make a fist.

help me in treating this locking,i think it is tigger finger, so tell treatment for it please.

thank u

[arunja]

My Dear Friend,

Sudeck's Dystrophy is very common in colles# . Its very difficult for the patient as well as the Physiotherapist. I would like to suggest some tips which you may have already done , I believe. The locking of the middle finger may be the result of the # due to the calcium deposition. If so mobilise it with proximal phalanx stabilised after moist heat or dipping in moderate warm water. Or check for any nodule in the flexor region which may be locking it. Check for the nerve tension , is there any neuralgic pain , if some entrapment. we cant neglect the possibility of that. Especially Median N. Do neurodynamics.

Sudecks osteodystrophy can only be relieved to some extent by active movmnts. It can be done after masking the pain by some type of moist heat or wax . I think there will be a change after that.
Thankyou

[msathish]

Did u check for other problems like trigger finger or any tendinitis?

[neurospast]

The locking finger has no connection what so ever with Suddeck (a strange word to use nowadays) It is a problem (most likely) of the tendon of the midfinger. AS example a nodule on the tendon might give to much friction with the surrounding sheet (like a brake cable on a pushbike when the cable is worn, and you brake it will not spring back) or the original direction of the tendon has changed due to the fracture. If possible ask for an new X-ray and compare with a previous. Use an atonomy book to look at how the tendons would aligne with the bony structures. (better would be a scan but this will be to time consuming and to costly) Palpate the tendons carefully, do not inflict pain since this could well restart a sudeck (if there was a proper one in the first place).
Best of luck.

[sharmaphysio]

thanks for ur replies.

yes she has a nodule on flexor aspect near mcp.
i can feel it moving n locking also,it is tigger finger.
how to treat this tigger finger?

hope u will guide me further.

[arunja]

The best method of treating Trigger finger is to have laser to the nodule. You can feel the decrease in size of the nodule as you go on with the treatment for 2 or 3 sittings. Ultrasound is also found to be effective. One of the main factor which hindres here is his occupation which may have lead to trigger finger. Position he used to keep his pen or any of his tool should be ruled out.
Hope this will improve the condition a lot. This was my perspective , it may be wrong.

[neurospast]

As said ultra sound seems to work very well. Another means would be friction/massge of the problem area. Having said this you have to be careful in case she did indeed have a Suddeck. Keep in mind that these nodules appear as a result after some from of traumatic event and is some form of scar tissue.

[Dashrath]

I think you should start with ultrasound and friction massage if it is not painful. If not painful start tendon mobilisation and mild stretching. I have tried on one of my patiend and its effective. best of luck.