Outcomes and indications for early hand therapy after multiple concomitant elective hand procedures

• Published in: Journal of hand therapy Vol. 32; no. 4; pp. 457 - 462
• Main Authors: Parker, Amber M., Greyson, Mark, Iorio, Matthew L.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2019; Elsevier Limited
• Subjects: Carpal tunnel; Carpal Tunnel Syndrome - rehabilitation; Carpal Tunnel Syndrome - surgery; Comorbidity; Comparative studies; Complications; Diabetes; Disability Evaluation; Edema; Family medical history; Female; Finger; Hand; Hand pain; Hand therapy; Humans; Identification methods; Male; Medical records; Middle Aged; Mortality; Pain; Patients; Physical Therapy Modalities; Postoperative Care; Referral and Consultation - statistics & numerical data; Retrospective Studies; Soft tissues; Stiffness; Subpopulations; Surgery; Therapy; Trigger finger; Trigger Finger Disorder - rehabilitation; Trigger Finger Disorder - surgery; Trigger finger; Hand therapy; Hand pain; Carpal tunnel
• ISSN: 0894-1130; 1545-004X; 1545-004X
• DOI: 10.1016/j.jht.2018.04.004

Retrospective comparative study. Trigger finger and carpal tunnel surgery are common, but not without complications including pain and edema, which are treated with hand therapy (HT). There are limited data for the outcomes of multiple trigger finger releases (MTFRs) or combined trigger finger and carpal tunnel surgery and the subsequent need for HT. Based on our hypothesis that patients with more than 1 procedure may benefit from an early HT visit, we performed this study to compare the frequency of HT orders after single trigger finger releases (STFRs) and MTFRs and determine the reasoning for variation in the rate of HT orders after releases. Subjects receiving either an STFR or an MTFR were identified. Patient-reported outcomes were recorded preoperatively and 2 weeks postoperatively. One hundred fifty-nine eligible subjects were identified; 33 MTFRs and 126 STFRs. MTFR subjects were prescribed postoperation HT at a higher rate compared with STFR subjects (66.7% vs 34.1%; P < .001). Of the HT subjects, MTFR subjects received prescriptions for edema management at a significantly higher rate compared with STFR subjects (P = .02). Patients with soft tissue dissection, edema, and stiffness would most likely benefit from HT services. It is important to identify these at-risk subpopulations to potentially alter their postoperative trajectories and improve outcomes. Higher rates of referral to HT occur when there are multiple concomitant hand procedures. This suggests surgeons triage HT services based on need. Policies that disallow postoperative therapy will have a greater impact on patients with these indications. •This observational study compared hand therapy (HT) referral patterns based on whether a single trigger finger release or multiple trigger finger release was performed.•Multiple trigger finger release patients were prescribed postoperative HT at twice the rate compared with single trigger finger release patients.•Referral to HT appears to be dependent on surgical indications and clinical presentation, with more complex patients being referred for services.•Evidence-based referral algorithms may enhance the efficiency or outcomes of care.