January 2019

January 2019

Physical Therapy for Hands Can Treat Both Trauma and Chronic Conditions

As a hair stylist for the past five years, Mecca Schindler relies on her hands for her job. But when her right hand was severely injured in a car accident, she didn't expect to be unable to work for six months - in addition to requiring dozens of physical therapy sessions.

Schindler was driving her son to school in November 2017 when another driver hit their car head-on as they waited at a stop sign. The deployed airbag shattered her wrist and split her hand in half nearly to the middle of her palm. Her skin remained intact, so at the time, Schindler didn't realize just how severely she was injured.

"When the paramedics arrived, I was holding my hand," she recalls. "But I didn't know how bad my wrist was, and I told them I needed them to fix my hand so I could get to work."

A week later, she had surgery to insert a plate and screws, along with a donor bone, into her hand. Then, the hand had to be sewn to close the deep split.

"Only after the surgery did I realize how bad it was because I saw the photos," she says.
Fortunately, Schindler didn't have any nerve damage or tear in the tendon. Still, she still faced a long recovery. Work was not an option. When she began physical therapy in December, she only had 16 percent function in her hand.

"She had almost no movement left in her dominant hand," says Scott Richards, SCS, MSPT, a physical therapist with Kitsap Physical Therapy who treated her at the Bremerton location. "In addition to fractures, she had pretty significant soft-tissue damage and major swelling. Her hand was so tight and taut that it looked like it was made out of plastic."

Schindler would end up in physical therapy for about six months, initially visiting the office three days a week. In addition to the sessions with Richards, she followed a home program that included exercises and other techniques.

"It took a very long time to get the swelling under control and get the mechanics of the fingers back," Richards says. "She powered through it, even through pain, and never lost sight of what she was trying to achieve. As a result, she had great outcomes."

She estimates having about 60 sessions at Kitsap Physical Therapy. By the end of physical therapy last June, Schindler had regained 88 percent function. Today, she feels she's closer to 95 percent. She's resumed her regular work schedule and doesn't have any restrictions in daily activities.

"My hand is great," she says. "My right wrist doesn't move like my left hand but as far as recovery goes, I feel great."

Schindler recalls breaking into tears when Richards cleared her to end office treatments. It was a bittersweet moment because Kitsap Physical Therapy had meant more than just physical recovery.

"It was a hard, dark time for me. Coming to physical therapy helped me mentally," she says. "The entire staff were welcoming and kind, and they helped me through that time. I think Scott and his staff helping me recover and seeing me two to three times a week was a safety net. You could just tell they enjoy being there and they love their job. They care about their patients."

Richards says he didn't expect the result to be as successful due to the extent of the damage, and credits Schindler for willing to do whatever it took. He says that the home program plays a big role in outcomes not only in trauma cases like Schindler's, but also in treating chronic conditions.

"Being consistent with the home program is an important component of every hand therapy because there's a limited amount of time the patient is working with us one-on-one in the office," he says.
He notes that hand therapists can treat a variety of cases, including arthritis and carpal tunnel syndrome.

"Many people have arthritis in their fingers, thumbs and wrists and think there's not much they can do about it," Richards says.

Arthritis and other nontraumatic joint disorders, in fact, are the five most costly conditions among American adults, according to the Arthritis Foundation. The foundation conservatively estimates that 45 million adults in the United States have arthritis that's been diagnosed by a physician.

Richards says he would like to see more physicians tell their patients with arthritis that physical therapy could be a good option for them.

"We can't change the fact they have arthritis in their joints but through certain techniques and education, we can help reduce the pain and improve the range of motion and function for everyday activities," he says. "We can help them gain a higher-function lifestyle."

KPT has hand therapists at 5 clinics: Bremerton, Port Orchard, Silverdale and both Poulsbo locations.

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