I worked with victims of Hansen’s Disease many decades ago when there were still lepers and leper colonies around the world. Leprosy is a biblical disease completely eradicated now, although Central Florida is a hot spot for leprosy, report says | CNN, it seems to spring up occasionally. I wouldn’t worry about it much, it is treatable. Leprosy is caused by Mycobacterium leprae, and if I recall it right, it is treated with a course of drugs: Rifampicin, Lamprene and Dapsone. Once it is treated it becomes non-infectious and the infection requires skin to skin contact. What I recall about this disease are the deficits and deformities it causes. Most of these deformities are due to the damage caused by the bacteria to superficial nerves and cartilages. They include - foot drop due to involvement of the peroneal nerve. Multiple hand deformities ranging from claw hand to ape hand to mallet finger to wrist drop. The most common superficial nerves are the ulnar nerve leading to the paralysis of the ring and little finger, forming the Jesus Christ Benediction ( I wonder if Leonardo Da Vinci recognized the impact of the nailing of Jesus wrists that could have damaged the ulnar nerve to draw what we all know as Christ with that deformed hand).
claw hand
mallet finger
radial palsy + wrist drop (usually)
Ulnar Claw hand or Benediction
claw hand/benediction
ape hand
In the rehab and hospital where I used to work, hand problems were predominantly treated by Occupational Therapists. Occasionally I was assigned a hand or a shoulder in outpatient settings.
Hand therapy remains one of the most important components of rehab. Imagine losing the functions of your hands if you were a pianist, a surgeon, a mason, a writer, a painter, a cabinetmaker, a computer repairman, a sportsman and many other professionals. Imagine placing food with the aid of a fork in your mouth with shaking hands. How would you comb your hair, send a text, brush your teeth, button shirt, tie shoelace, hold a cane or walker, shower, dress, put shoes on, and the tasks go on and on and on?
Opening a door
Using a scissor
Combing hair
Eating with spoon or fork
You may take your hands for granted until they fail to move no matter how much you tell them to. You suddenly become dependent on someone else for these otherwise automatic and normal functions. Just to require somebody to clean you up after the bathroom and change you after the shower can pull a punch at your dignity and independence. I constantly dealt with previously independent people who woke up one morning without the ability to use their hands. The shock is often translated to the usual Denial, Anger, Bargaining, Depression, Acceptance stages of grief. Some can be stuck with Anger; some can get stuck with Depression. None of them are acceptable to the patient most of the time. They do accept the disability eventually but would not be happy.
What are the events leading to loss of hand functions today? In my experience, the major debilitating causes are neurological and orthopedic. Neurological damage transitions the muscle tone: Flaccidity, Emerging Spasticity, Dominating Spasticity, Start of complex movements, Waning of Spasticity, Normalization of movements. These were first described by Brunnstrom.
This website tries to simplify discussions so it would seem to be a layman talking to another layman, spasticity is the tightening of the muscles because the brain loses control over them. The muscles are in a contracted state. Flaccidity on the other hand is absence of tone in the muscles rendering them paralyzed. Once again, some patients may get stuck with flaccidity or spasticity. A few lucky ones can jump from flaccid (absent tone akin to paralysis) to normal. A lot of these outcomes depend on the severity of the neural damage. Or how long the recovery is. The most common stage that require extensive Rehab is the spastic stage of a stroke with a flexion synergy pattern. Near drownings could also result in brain anoxia (or lack of oxygen in the brain) leading to catastrophic damage to hand functions. The victims shake in tremors every time he tries to use his hand. Drug overdose is also an increasing menace that leads to brain damage that causes hand dysfunctions. Others to consider are bleeding of the brain, either subdural or subarachnoid, tumors, nerve damages such as radial, ulnar, brachial plexus etc. Same thing with temporary (or not) paralysis from Guillain Barre Syndrome.
Typical Hemiplegia after stroke. Notice the position of the arm.
Orthopedic causes are usually accidents (vehicular, falls, physical altercations, being battered are examples) that lead to spine and other bony part damages. There are a few rheumatoid arthritis sufferers. Carpal tunnel and its post-surgical rehab land on my treatment table. Same thing with Colles fractures from a fall landing on an outstretched hand. Spinal cord injuries, especially the high levels involving the neck and thoracic spine, are pretty much common in my rehab setting as well. Old age problems of neck spondylosis or compression fractures or simple wear and tear can cause hand problems. Hand burns.
Ok, before I get carried away and talk like everyone is a therapist here. PTs and OTs pretty much know what I am talking about, but they are not the target of this blog LOL. What I am driving at is this: the hand and its functions are necessary in our daily lives. It is important to take care of them.
If your job requires extensive use of hands, learn how to give them a rest. If you are a pianist, writer, surgeon, manual and massage therapist, a dentist, even a teacher who writes on chalkboard, or a driver, please take a few minutes now and then to rest your hands. The best way to relax the hands is to make them move in different directions including the fingers and wrists.
Gentle bending of finger joints until forming a fist
Digital Opposition
Abduction and Adduction of fingers and thumb
Thumb Opposition
Tubing Exercises for wrists, elbows (flex/ext, pronation)
Do hand and finger strengthening exercises. There are many tools from therapeutic bands and hand grips and small weights to help you in this. Examples:
