Dr. João Paulo Sousa

Specialist in Orthopaedic Surgery and Traumatology

Terapeuta Rosário Simões

Occupational Therapist

Hand Surgery and Therapy
The art and science of the upper limb

HPA Magazine 7

The hand is one of the most complex structures of our body; a means of touch, expression and beauty, a symbol of strength and skill, but whose main function is to grip. It accompanies the human being on all of its activities and undertakings, with its demands and diversity of different gestures, in function with each activity at the socio-professional level; strength work, precision work or repetitive work are the categories where we find necessities and specific qualities.

The hand is therefore quite exposed and often suffers injuries, be they more or less complex. Fully re-educating an injured hand, with or without surgery, requires solid knowledge in its structure and specific know-how. Clinical rationale and scientific and technical abilities, associated with communication skills, are the foundation of the entire process. In this context, a new specialty arose a few years ago: Hand Therapy, which according to the definition in 2008 of the Hand Therapy Certification Commission is “The art and science of rehabilitation of the upper limb: hand, wrist and shoulder”.
A hand therapist is an occupational therapist or physiotherapist who, through advanced training and clinical experience, acquires skills for the treatment of conditions of the upper extremity resulting from traumas, illnesses or congenital deformities. In order for this to happen, the therapist has a variety of techniques and means available with the objective of maximising the function of the hand and consequently promote the rapid return to socio-professional activities.
The Hand Therapy Sector of the Hospital Particular do Algarve receives patients from the various medical specialties (general surgery, plastic surgery, physiotherapy, orthopaedics, rheumatology), for assessment, treatment or crafting orthoses for the upper extremity, either in pre- or post-surgical situations, planned or emergency. The communication between the various members of the team, as well as the active participation of the patient in the rehabilitation process, are respected and fundamental requisites throughout the intervention procedure; the best results are always obtained as a group effort, Doctor/Therapist/Patient, where each element underscores and facilitates the action of the others.
Innovation and continuing professional updating, associated with the installations and care adapted to the specific requirements of each situation allow this service to have innovative materials and equipment available to treat a diversity of clinical situations, the most frequent being: 
> Fractures, Sprains, Strains;
> Carpal Tunnel Syndrome;
> Dupuytren’s Contracture;
> Epicondylitis;
> Amputations;
> Rheumatoid Arthritis;
> Injuries to tendons and nerves;
> Repetitive stress injuries and specifically sports and muscle injuries;
> Oedemas;
> Neuropathic pain;
> Arthrosis and inflammatory processes.

Hand surgery is one of the areas most sensitive to coordination and synchronisation of everyone involved; the result of a “perfect” surgery can be compromised by delayed or poorly conducted rehabilitation. Some of the most specialised centres in the world refuse to operate on patients who can not undertake specialised, and properly timed, rehabilitation. 
The HPA has created a coordinated team of professionals with vast experience, where there is strict daily contact that allows for the discussion of clinical cases and the constant adjustment to treatment; the skills, cohesion and complementary relationship of the Surgeon/Hand Therapist are predominant and decisive in this process. The accompaniment begins at the pre-operative stage, where the Hand Therapist makes an objective assessment and explains the whole course of treatment to the patient. Afterwards, during the hospitalisation and in the post-operative stage, the team constantly assesses the results as they are acquired, clarifying, guiding and motivating the patient, while they are determinant factors of the success of the functional recuperation.

For the recuperation process of these situations, a wide range of techniques is available, some of which are innovative and unique in Portugal, such as the case of Re-education for Sensory Pain:

>PRODUCTION OF ORTHOSES (SPLINTS)
Heat-moulded and made-to-measure. Generally used to substitute a plaster cast, for rest, to help with day-to-day chores or to increase movement and strength.

>ACTIVITIES FOR FUNCTIONAL TRAINING AND ACTIVITIES FOR DAILY LIFE

>TEACHING JOINT CONSERVATION
We have materials specific for promoting teaching the patient, mainly in rheumatology cases, in how to best to spare joints in order to prevent worsening of the situation, and to get rid of pain.

>PRESSOTHERAPY

>ELECTROTHERAPY

>TREATMENTS AND SCAR MOULDING

>RE-EDUCATION FOR SENSORY PAIN
The HPA is a pioneer in this type of treatment, as it has available a unique therapist who is certified in Re-education for Sensory Pain by the Pain Centre of Friburgo, Switzerland, and is skilled at re-educating neuropathic sensory pain. This method treats not only the allodynia (pain when touched), but other alterations to sensitivity, such as, for example, hypoesthesia (reduced sense of touch). Both situations provoke extremely intense pains, which can appear incessantly or intermittently 24h a day.

>MANUAL THERAPY

>MIRROR THERAPY