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Expected Rehabilitation Times for Common Upper Extremity Injuries Gordon Iiams, MD.

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Presentation on theme: "Expected Rehabilitation Times for Common Upper Extremity Injuries Gordon Iiams, MD."— Presentation transcript:

1 Expected Rehabilitation Times for Common Upper Extremity Injuries Gordon Iiams, MD

2 What constitutes a common upper extremity injury?

3 A Review of One Hand Surgeons Workers Compensation Case Load: Time Frame 19 Months From September 2008 ToMarch 2010

4 Surgical Case Log Review of Workers Comp Cases Total # of WC Patients 49 Total # of WC Surgeries 66 (9.6%) All Surgeries688


6 Body PartsTotal Finger Tips6 Hand/Finger21 Wrist16 Forearm2 Elbow8 = 53

7 Are there any really simple injuries? Laceration Fracture Crush Soft tissue Bone Everything

8 Even a simple cut is usually complex M.T.: 32 yo WM RHDBox cutter laceration L Hand/ Index Finger Multiple Structures:Flexor Tendons RDA, RDN, FDS, FDP

9 R.T.:42 yo WM RDH L Wrist Laceration-Jigsaw (jagged/ugly)No functional structures injured

10 Recovery Times MMI M.T.1 yrND 8 day RD 11 wks SSLT 2 pt 80% 6 mm R.T.5 ½ weeksRD 1 Week Jagged skin scar

11 Is it fractured or just broken? Its just a fractured finger.



14 What constitutes a Boo Boo?

15 6 Finger Tip Crush Injuries (12%) Open Tuft Fx Nail Bed Laceration Nerves & Small Vessels of Finger Tip Pulp



18 Summary of Finger Tip Crush Injuries Full Duty – 3 to 9 weeks MMI months AgeMMI No Duty (days) Restricte d Duty (wks) Full Duty (wks) JJ58 M HLF35 F GR69 M EC21 M4678 CG37 M GM48 M

19 Distal Radius Fractures (18%) Extra Articular Intra Articular Comminuted Displaced




23 Summary of Distal Radius Fracture Patients Full Duty 7 wks-6.5 mo MMI 8 mo- 18mo AgeMMIFull DutyJob DL38 F186.5 moStore Mgr SP59 M14Const. Acute-on Chronic CR63 M613 wksMail Carrier JL26 M-Fisherman RSD EH66 F85 moCook RSD RH24 M- MJ45 M-M. Seaman Non- union JV57F7 wks OR RN- Colles JS52 MDOS Electrician






29 13 other Hand/Finger Crush Injuries = 26%

30 Hand Crush Patients Ages: Male/Female: 10/3 Return to Full Duty: 3 to 20 weeks Permanent Impairments: 3 MMI: 4.5 to 18 months

31 Office Evaluation Tools A. B. C. D. A.Goniometer B.Grip Dynamometer C.Pinch Discriminator D.2 Point Discriminator E.ROM F.Grip Strength G.Pinch Strength H.Sensation










41 Sample Impairment Rating G.M 51 FRHDFx-Dx Lt. 5 th CMCJ 1 yr = MMI L SF ROMMP % PIP % DIP zero

42 Sample Impairment Rating Grip StationRightLeft% SLI I II III IV V654531

43 Sample Impairment Rating G.M. Grip

44 Other Cases Not Discussed Nerve Repair/Decompression Elbow Fractures +/or Dislocations Global Extremity Injuries Ex: Brachial Plexus RSD

45 Reflex Sympathetic Dystrophy Causalgia: Chronic Regional Pain Syndrome Fracture Disease

46 Conclusion Simple or uncomplicated injuries Are not so common

47 Conclusion Recovery times for upper extremity injuries Take 6 months to 1 year Sometimes longer

48 Mitigating Circumstances Crush component RSD Nerve Involvement Elbows Intra-articular Extension Smoking Medical Conditions (ex Diabetes)

49 Thank You!

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