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!