Vita Yu-Hsien TU, Occupational Therapist and Project Manager
Sunshine Social Welfare Foundation
In a previous blog post, we explored how scars not only affect single joints, but also have an impact on multiple joints. In the case of scars on the hand, functions like grasping may become limited. During grasping, the hand performs various combined movements. The fingers' multiple joints perform flexion, the thumb performs opposition, while the wrist performs moderate flexion and extension. Achieving these motions can be challenging if scars limit the hand's range of motion. To address these limitations, it is crucial to ensure sufficient stretching of the scars, from the fingers to the forearm. In this post, we delve into the concept behind the use of crepe elastic bandages to facilitate passive stretching, particularly for achieving combined flexion of joints for dorsal scars on hands.
How does bandaging for passive stretching work?
Passive stretching involves using external force to generate low-intensity and prolonged stretch on scars and soft tissues. This technique aims to improve flexibility of affected areas. While dynamic splints have been used for this purpose, they generally only stretch single joints. The use of crepe elastic bandages offers an effective and inexpensive alternative, in addition to also achieving combined stretching of multiple joints.
We will use the example of dorsal scars. When a patient makes a fist, involving simultaneous flexion of interphalangeal joints, metacarpophalangeal joints, and the wrist, it maximizes the stretching of dorsal scars. However, maintaining this position for an extended period can be difficult. Crepe elastic bandages offer a practical solution by providing constant tension and passive stretching without requiring the patient to exert effort continually.
Tension of the crepe elastic bandage is used to maintain the hand in a fist position for 15 minutes, keeping the interphalangeal joints and metacarpophalangeal joints in flexion to stretch dorsal scars, as shown in Picture 2. If a wedge is also used, passive flexion of the wrist can be achieved, as shown in Picture 3.
Are there any contraindications?
Crepe elastic bandages are recommended for wrapping the hand into a fist when dealing with hypertrophic scars on the dorsal side that lead to restricted finger flexion, thus requiring passive stretching. However, caution is advised when the limitation of metacarpophalangeal (MP) flexion exceeds 45 degrees. In such cases, forming a fist with the bandage may exert excessive force on the middle phalanx, primarily affecting proximal interphalangeal (PIP) flexion without significant improvement in MP flexion, as illustrated in Picture 4. Therefore, using crepe elastic bandages for passive flexion is contraindicated when MP flexion is less than 45 degrees or if other conditions hinder passive stretching, such as wounds on the dorsal side of the fingers. Appropriate evaluation of the patient's condition is essential to determine the suitability of using crepe elastic bandages for effective and safe hand rehabilitation.
How long can the hand be bandaged?
Although wrapping the hand in a fist with crepe elastic bandage will temporarily affect blood circulation and the patient may feel tingling in the hand, it is basically safe. It is recommended to leave the hand bandaged for 15 minutes per session, but each session should not exceed 20 minutes.
How to choose the type of elastic bandage?
Crepe elastic bandage with good elasticity should be used. Do not use elastic gauze, which can excessively restrict circulation. Crepe elastic bandages that have lost their elasticity will not only fail to achieve the desired stretching effect, but they will end up restricting blood circulation like a tourniquet.
Are there any special considerations?
In some cases, the range of motion for MP flexion may vary among the fingers. One common issue is hyperextension of the little finger. When utilizing crepe elastic bandages, therapists have the flexibility to wrap the second, third, and fourth fingers while excluding the little finger, or they may choose to wrap only the second and third fingers, depending on the specific situation.
As for the thumb, it can be wrapped in opposition with the four fingers, or it can be left out of the bandage altogether. In Picture 2, the thumb is shown unwrapped. However, if the thumb can be aligned with the palm, it can also be incorporated into the bandaging process, as demonstrated in Pictures 5 and 6. Alternatively, wrapping the thumb alone is also a viable option, as shown in Picture 7.
Watch a video demonstration showing how to use crepe elastic bandage to stretch scars on the dorsal side of the hand.
Incorporating crepe elastic bandages into hand rehabilitation can significantly improve the passive stretching of scars and joints, promoting better flexibility. This method allows for a controlled, low-intensity, and prolonged stretch, which aids in the recovery process. By adopting this approach, patients can experience enhanced hand mobility and a more effective rehabilitation journey.