- The patient is a 14-year-old male who injured his right index finger during a kabaddi match. He underwent surgery for an avulsion fracture but developed stiffness after one month. - On examination, the patient had tenderness and edema around the index finger MCP joint with limited range of motion and muscle weakness. - The diagnosis was post-traumatic stiffness. Physiotherapy management included scar tissue massage, joint mobilization, and exercises over 3 weeks to improve range of motion and strength. Follow-up showed significant improvement in all areas.

1. POST OPERATIVE INDEX FINGER
STIFFNESS
CASE PRESENTATION
Presented by:
Dr. Priya Maurya
MPT (Sports Physiotherapy)

2. Demographic details
Name:- Lucky
Age:- 14year
Gender:- Male
Dominance:- Right handed
Occupation:- Student
Address:- Defence School, Kalpi
Date of assessment:- 28th September 2021

3. Chief complaint
Not able to make fist, and unable to write and lift heavy weight

4. History of present illness:
• On 26th August 2021 while playing a kabaddi match player got injured
in the hand, about which he came to know after the match, following
which he immediately visited MMSH emergency, where he was
primarily treated with analgesics and was straight away taken for an
X-ray, which revealed avulsion fracture in the index finger for which
he went under a surgical procedure??? on the same day
• On 28th September 2021, which is approximately after one month
after the surgery, patient visited the Physiotherapy department of
Maharishi Markandeshwar University, MM (DU) with the complaint of
not able to make fist, write and unable to lift heavy objects

5. Pain history
• Side:- Right
• Site:- Index Finger
• Onset:- Gradual
• Duration:- Felt during activity
• Type:- Non Radiating
• Aggravating factors:- During movement
• Relieving factors:- During hot water fomentation
• Intensity:- 4/10 NPRS

6. History of past illness
• Patient had no similar kind of event or injury reported in the past
Medical History
• Not relevant
Pharmacological History
• Patient had taken analgesics in initial 10 days of surgery
Surgical History
• None

7. Personal History
• No history of drug abuse and alcohol intake
Family History
• Not relevant
Socio-economic History
• According to Modified Kuppuswamy Socio-economic Scale (MKSS),
score is 12 which belongs to lower middle socio-economic class

8. On Observation
• Swelling: Not present
• Any scar: Present 4cm long
• Deformity: Not present

9. On Palpation:
• Tenderness: Grade 1 (around the metacarpophalangeal joint of the
index finger)
• Edema : Present (around the metacarpophalangeal joint of the index
finger)

10. On Examination
Motor:
Range of Motion: (Left)
Metacarpophalangeal Joint Range of motion Endfeel
Flexion 0- 60 degree Empty
Extension 0-30 degree Empty
Abduction 0-20 degree Empty
Adduction 20-0 degree Empty

11. Manual Muscle Testing:
Muscle Grade
MCP flexion Grade 2 (Poor)
Flexor digitorum superficialis Grade 2 (Poor)
Flexor digitorum profudus Grade 2 (Poor)
MCP extension Grade 2 (Poor)
Extensor Digitorum Grade 2 (Poor)
Extensor Indicis Grade 2 (Poor)
Reference:- Helen J. Hislop, Dale Avers, Marybeth Brown, Techniques of Manual Examination and
Performance Testing, 9th edition page no- 165-182

12. Sensory:
Superficial- Intact
• Pain
• Touch
• Pressure
• Temperature

13. Outcome measures
1. Numeric Pain Rating Scale (NPRS)
2. Range of Motion
3. Manual Muscle Testing

14. Numeric Pain Rating Scale
Current pain: 4/10

15. Investigation
Plain Radiograph: AP view

16. Findings:-
• Anterior-Posterior view
• Displaced avulsion fracture
• K- wire fixation between
metacarpal and phalanges
D’Arienzo M. et. Al. Management of Distal Radius Fractures in the Elderly Patients. Austin J Musculoskelet Disord. 2015; 2(3): 1025.

17. Diagnosis
Post trauma stiffness

18. Problem list
• Adhesion due to scar
• Pain around the metacarpophalangeal joint of the index finger
• Limitation in movements around the joint
• Decreased muscle strength

19. Goals
Short term:-
• Remodelling of adhesion
• To decrease pain
• To improve ROM
Long term:-
• To restore strength

20. Physiotherapy Management
Week 1:
• Hydrocollator pack- 15 min (around MCP joint)
• Soft tissue release near the scar area on dorsal, as well as
palmar aspect
• MCP joint Maitland mobilization ( anterior posterior glide)- 30
glides, 2 sets (Grade 1)
• MCP mobility exercises (within available ROM)
Samdrala S et. al. Outcome of active mobilization after tendon repair: A study in a tertiary care centre .
IJOS 2020;6(3):242-246

21. Week 2:
• Hydrocollator pack- 15 min
• Soft tissue release
• Hold relax technique to improve range
• MCP joint mobilization (anterior glide)- 30 glides, 3 set
(grade 3)
• MCP joint mobilization (posterior glide)- 30 glides, 3 set
(grade 3)
• MCP joint mobilization (transverse glide)- 30 glides, 3 set
(grade 3)

22. Week 3:
• Hydrocollator pack- 15 min
• Soft Tissue release
• Agonist contraction
• MCP joint mobilization (anterior glide)- 30 glides (grade 4) (alternative
days)
• MCP joint mobilization (posterior glide)- 30 glides, 3 set (grade 4)
• MCP joint mobilization (transverse glide)- 30 glides, 3 set (grade 4)
Hall & Brody: Therapeutic Exercise: Moving Toward Function, 2nd Edition © 2005, Lippincott Williams
and Wilkins

24. Follow up:
Range of Motion:
Metacarpophalangeal Joint Range of motion Endfeel
Flexion 0- 80 degree Firm
Extension 0-30 degree Firm
Abduction 0-25 degree Firm
Adduction 25-0 degree Firm

25. Manual Muscle Testing:
Muscle Grade
MCP flexion Grade 5 (Normal)
Flexor digitorum superficialis Grade 5 (Normal)
Flexor digitorum profudus Grade 5 (Normal)
MCP extension Grade 5 (Normal)
Extensor Digitorum Grade 5 (Normal)
Extensor Indicis Grade 5 (Normal)

27. Home exercise protocol:-
• Moist Heat
• Scar tissue massage
• Squeeze stress ball
• Finger lifts
• Finger Pinch
• Finger squeeze (Adduction)
• Finger spread with rubber band
• Cloth wringing
J Gulke et. al, Postoperative treatment of metacarpal fractures classical physical therapy compared with a
home exercise program. Journal of hand therapy. 2017 1-8

28. THANK YOU