Assessments and treatment methods
Oedema/Swelling assessment
It is necessary to treat swelling (oedema) in the hand and forearm as soon as possible, as swelling causes pain, limited movement and scar adhesions. Assessing the amount of swelling (oedema) in the hand and forearm measured in millimeters as compared to the opposite hand and forearm gives us a realistic idea of the amount of swelling present. This assessment allows us to set realistic goals and priorities of treatment.
Range of motion assessment
With this assessment technique our therapists determine the amount of movement or amount of stiffness in the hand and wrist. The measurements are taken in each joint of the hand and wrist using a goniometer (see picture). A goniometer is an instrument that measures movement in degrees and allows us to determine if the movement is improving by re-assessing the range of motion with consecutive therapy sessions.
Grip strength assessment
Our practice is equipped with a Jamar Handheld dynamometer, to assess the amount of grip strength or loss of strength in the hand. The measurement is taken in kilograms and the injured hand is compared to the non-injured hand. We also take into consideration whether the injured hand is the dominant or non-dominant hand as the dominant hand is usually the stronger of the of the two hands.
Sensation assessment
When a nerve has been injured or is being impinged, it usually results in impaired sensation in a specific area of the arm and hand (numbness, pain, or pins and needles in the hand). In our practice, sensation is assessed by various tests, including the Semmes Weinstein Monofilaments, Ten test, Two-point discrimination test as well as the Tinel test. With these tests we determine where there is nerve impingement, the level of nerve regeneration, or if a nerve is adhered to scar tissue as a result of a traumatic hand injury.
The Minnesota dexterity and in-and manipulation assessment
Our practice uses a reputable standardized test to assess dexterity and in-hand manipulation called the Minnesota manipulation and dexterity test. While a standardized score is calculated with the test results, our experienced therapists are also able assess fine co-ordination, compensatory techniques used, endurance, and other important factors of hand function. Dexterity is also assessed using the Purdue Pegboard standardised test.
Purdue pegboard test
The Purdue pegboard test is used in our practice to assess dexterity and observe gross motor coordination, fine motor coordination, bilateral integration after a serious hand injury. Through clinical observations made while performing this assessment, our therapists gain valuable insight into the hand function of an individual as well as compensatory methods used after a serious hand injury.
Pain assessment
Most hand injuries or other hand conditions, such as arthritis is associated with a painful hand. We use the Visual Analogue Scale to determine the amount of hand pain a person experiences during rest and activity performance. This enables us to determine the level of task performance on which the individual would be able to function, and assists us to determine the priorities of each individualised treatment program.
DASH (Disabilities of the Arm, Shoulder and Hand) Questionnaire
Scar assessment
Scarring affects movement, hand function as well as nerve regeneration and is therefore an integral part of the assessment procedure in our practice. The assessment of scar tissue includes the area of scar tissue on the hand and forearm, the thickness of the scar tissue, the sensitivity of the scar tissue, the extent of the adhesion of underlying muscles and nerve to the scar tissue, as well as possible contracture of a joint in the hand and forearm due to the surface area covered by the scar.
