Rehabilitation of Hand Burn Injuries

Original Editor - Your name will be added here if you created the original content for this page. Top Contributors - Rania Nasr and Kim Jackson  

Introduction

The importance of rehabilitation of burn injuries has been increased due to the improved short and long survival rate of people with large burn. Burns to the hands decline the chances of functional recovery and quality of life, especially when included in larger burns[1]. Successful outcomes following hand burn injury require an understanding of the rehabilitation needs of the patient. Rehabilitation of hand burns begins on admission, and each patient requires a specific plan for range of motion and/or immobilization, functional activities, and modalities. The rehabilitation care plan typically evolves during the acute care period and during the months following injury[2].

Problems list

A comprehensive understanding of the effect of hand thermal injury can improve the rehabilitation outcomes and prevent burn-related issues. There are some common complications following a thermal injury to the hands[3], including:

  • edema
  • join deformities,
  • scar contracture,
  • loss of skin integrity and stability,
  • sensation loss or impairment,
  • restricted or reduced hand function

Below is a brief explanation of these complications:

Post-burn edema

The cause of the edema is the increased vascular permeability following a thermal injury to the hand combined with a shift of fluids to the extravascular space. This should be taken into consideration in the rehabilitation period. The severity of edema depends on the severity of the burn. In superficial partial-thickness burn, only minimum amount of fluid leak into the extravascular space, making the edema minor and transient. Contrarily, deep partial thickness and full-thickness burns lead to a bigger, more prolonged and severe edema[3]. Electrical stimulation helps reducing hand burn edema and improves active motion of the hand[4].

Hand deformities

The hand is ranked among the three most frequent sites of burns scar contracture deformity[5]. It occurs during the early post-injury period resulting from edema, scar contracture or tendon injury[2].

Scar contracture

Hand burn scar contracture can be classified as follows[5]:

Grade I Symptomatic tightness but no limitations in range of motion, normal architecture
Grade II Mild decrease in range of motion without significant impact on activities of daily living, no distortion of normal architecture
Grade III Functional deficit noted, with early changes in normal architecture of the hand
Grade IV Loss of hand function with significant distortion of normal architecture of the hand
Subset classification for Grade III and Grade IV contractures: A: Flexion contractures, B: Extension contractures, C: Combination of flexion and extension contractures

Resources

  • bulleted list
  • x

or

  1. numbered list
  2. x

References

  1. Cowan AC, Stegink-Jansen CW. Rehabilitation of hand burn injuries: Current updates. Injury. 2013 Mar 1;44(3):391-6.
  2. 2.0 2.1 Moore ML, Dewey WS, Richard RL. Rehabilitation of the burned hand. Hand clinics. 2009 Nov 1;25(4):529-41.
  3. 3.0 3.1 Moore ML, Dewey WS, Richard RL. Rehabilitation of the burned hand. Hand clinics. 2009 Nov 1;25(4):529-41.
  4. Edgar DW, Fish JS, Gomez M, Wood FM. Local and systemic treatments for acute edema after burn injury: a systematic review of the literature. Journal of Burn Care & Research. 2011 Mar 1;32(2):334-47.
  5. 5.0 5.1 Sabapathy SR, Bajantri B, Bharathi RR. Management of post burn hand deformities. Indian journal of plastic surgery: official publication of the Association of Plastic Surgeons of India. 2010 Sep;43(Suppl):S72.