Crush Injury

Hi all,

Patient after a terrible crush injury in a workplace..however, 3 times X-ray shows no sign of #. Coming to physio after 1 month post injury. Presenting to me with severe sharp excruciating pain especially on the dorsal aspect of wrist the MCP area of the 2,3,4 MCP. Pain is 5/10 but increase to 8/10 when extending all fingers. Unable to keep finger extended for more than 5 minutes(flexed fingers).increase sweating on the palm. when the wrist is left hang...the wrist and hand region will turn bluish.

On superficial palpation..patient c/o pain. I am thinking this must be a nerve injury..perhaps RSD (reflex sympathetic dystrophy/ CRPS)? so, I'm asking for anyone opinion on what are the appropriate treatment for him? He is not able to left the arm hanging..extremely pain.plus..the deltoid region and wrist flexors and extensors muscle wasted.

Current treatment for him:

- gentle massage to remove some of the swelling at the MCP joint
- active ex's for the fingers.
- wax therapy.

Do help me please, thanks.

Hi,
This case indicates to me that a brachial plexus / Cx nerve root traction injury may be the problem. Check the Cx and have scans organised, eg MRI if possible. If the patient has a nerve traction injury, recovery will vary dependent upon severity of injury. CRPS can develop as well, complicating the situation. If the above problems are confirmed, supportive treatment to maximise gains as nerve function returns can be maintained. Good luck
MrPhysio+

Thanks for the reply...

After 3 setting of treatment to this patient..he reported that he felt that he felt better. No longer feeling sensitive only pain oh the 4th digits. My aim of tx was for the desentization beside maintaining the ROM and improve strengh. I encourage WB on the hand.BUt, the circulation of hand seems to be impaired because whenever he leave his hand in anatomical position for 2 min, the finger turn bluish...increse sweating still present but less compare to before.

Thanks.

Hi Jennifer,
I am pleased the treatment is working. If the circulatory symptoms are improving, a good result is likely. You could try contrast baths, warm water then ice slush immersion 5 times on / off to improve circulation, provided any wounds are healed. Swelling can cause the symptoms you report, as well as disuse.
Regard,
MrPhysio+

hI mR pHYSIO..

Yup..that is wat i did, using contrast bath..its working it seems.there is no wound...no even a small one. Thanks for your response.

jennifer