Authors (including presenting author) :
NG HL(1), CHUI TC (1), CHIN YM(1)
Affiliation :
(1) Occupational Therapy Department, Pamela Youde Nethersole Eastern Hospital
Keyword 2: :
Occupational Therapy
Introduction :
Hand and finger amputations significantly impact functional independence and quality of life.
Objectives :
This case series highlights the role of tailored innovative occupational therapy interventions in restoring function, managing pain, and improving independence in patients with varying degrees of hand and finger amputations.
Methodology :
In our case series, we present three patients with different hand and fingers amputation profiles. Case 1 involved a 60-year-old male with traumatic thumb amputation at the Proximal Phalanx (PP) level who underwent Index Finger (I/F) pollicization for thumb reconstruction. Case 2 featured a 59-year-old male with traumatic left I/F amputation at the PP level and Middle Finger (M/F) amputation at the metacarpophalangeal joint (MCPJ). Case 3 involved a 66-year-old male with left wrist disarticulation following recurrent tenosynovial giant cell tumor. All cases received (1) pressure therapy with custom-made pressure garments for scar and stump management, (2) mirror therapy with motor visual feedback for neuropathic pain management, (3) sensory re-education with utilization of 3D-printed desensitization keychain cubes as home programs. (4) Functional hand and upper limb training were done with remedial activities. Adaptive tools for one hand technique were prescribed for Case 3 to enhance functional independence, such as buttoning hook and 3D-printed one-hand nail cutter.
Result & Outcome :
Outcomes demonstrated substantial restoration of motor functions : Case 1 achieved functional range of motion of the reconstructed thumb, achieving thumb opposition to the little finger and ability to complete most of the daily activities. Case 2 demonstrated a range of motion in the left I/F MCPJ comparable to the unaffected side, with normal power grip and lateral pinch, allowing bimanual activity completion. QuickDASH scores improved from 40 to 25 over six months. In Case 3, functional independence improved notably, pain level was decreased from VAS 6 to 2, phantom limb pain was minimal, and QuickDASH scores improved from 36 to 30 over six months, with successful prosthesis use. In terms of sensory outcomes, Static Mechanical Allodynia (SMA) was reduced in all three cases. Allodynography is obtained where the application of a force of 15 g provoked a touch-evoked pain (SMA) of 3/10 cm on the visual analogue scale (VAS) of pain. There was progressive shrinkage of the SMA territory with multimodal treatment modalities as shown in figures. This case series highlights how innovative, comprehensive occupational therapy strategies are essential in promoting functional recovery, pain alleviation, and enhanced independence. These interventions play a vital role in holistic rehabilitation and substantially improve the quality of life for individuals with hand and finger amputations.
