Vita TU, Occupational Therapist and Project Manager
Sunshine Social Welfare Foundation
In a previous article, we talked about how crepe elastic bandage can be used to achieve simultaneous and continuous passive flexion stretching effect over scars on multiple joints of the fingers. In this article, we will specifically discuss the considerations for use of crepe elastic bandage for wrist flexion passive stretching.
When is the right time to start enhancing wrist flexion?
Before you take out the crepe bandage and start wrapping it around your patient’s wrist, we should first answer this question: under what circumstance is it NOT RECOMMENDED to enhance wrist flexion?
The answer is: when MP flexion limitation is greater than wrist flexion limitation.
In the second article explaining what makes the anti-contracture safe position safe, we explained how the tenodesis effect affects the wrist and the other joints. Wrist flexion creates more tension on the extrinsic extensor muscles, which will pull the MP joints into extension. On the contrary, wrist extension will cause passive flexion of the MP joints of the four digits. Therefore, when MP flexion limitation is greater than wrist flexion, enhancing wrist flexion will only promote MP extension, and is detrimental to promoting MP flexion.
In this context, when is the right time to start strengthening wrist flexion? It is usually recommended that MP flexion be 45 degrees or even above 60 degrees before starting to strengthen wrist flexion.
Can I only focus on stretching the wrist in flexion?
Stretching the wrist flexion alone without clenching the fist is usually only used when MP flexion range of motion is good and wrist flexion range of motion is poor. The reason is the same as what we mentioned above: we do not want to over-strengthen wrist flexion and promote MP extension due to the tenodesis effect.
What are the considerations for wrist position during wrist flexion extension?
When using crepe elastic bandage to make a fist and promote wrist flexion stretching, a triangular wedge is usually used as a support for the forearm to allow the wrist to flex and be stretched. A problem that easily occurs is that the position of the wrist is not close enough to the edge of the wedge, and wrist flexion will be limited by the wedge.
The correct position should ensure that the wrist joint protrudes from the edge of the wedge, so that the movement of wrist joint is not restricted by the wedge.
What are the range of motion considerations for wrist flexion stretching?
Normal wrist flexion is about 0 to 80 degrees, but when the hand is in a fist and performs wrist flexion, even a person with an uninjured hand will feel tightness when 80 degrees flexion is reached. Therefore, in the case of a burned hand, when using crepe elastic bandage for multiple joints passive stretching, be aware that insufficient range of motion is acceptable. When multiple joints are stretched at the same time, more skin and scars will be recruited than with a single joint. When using elastic bandage to make a fist and promote wrist flexion passive stretching, the pain felt by the patient will be greater. In addition, it is necessary to avoid creating excessive pressure over the median nerve of the wrist. The idea is not to achieve full range through stretching, but instead to produce a tolerable stretching effect over scars to promote moderate wrist flexion.
Watch this video demonstration on how to correctly use of crepe elastic bandage for wrist flexion passive stretching.