What is the best treatment for a patient with a history of hand amputation and contracture requesting a wrist brace?

Wrist Brace for Patient with Hand Amputation and Contracture

A wrist brace is strongly recommended for this patient with a history of partial hand amputation and contracture to improve function, provide stability, and reduce pain.

Assessment of Current Condition

The patient presents with:

• History of left hand partial amputation (2014)
• Right hand contracture with almost complete closure
• Functional limitations due to bilateral hand impairments

Rationale for Wrist Brace Recommendation

Benefits of Orthotic Support

• Orthoses are strongly recommended for symptom relief in patients with hand dysfunction according to the 2019 American College of Rheumatology/Arthritis Foundation guidelines 1
• The European League Against Rheumatism (EULAR) guidelines provide a strong recommendation (Grade A) for orthoses to improve function and provide symptom relief 1
• Wrist braces can help stabilize the wrist joint, reducing pain and improving functional capacity in patients with limited hand function

Post-Amputation Considerations

• Prostheses and supportive devices have been used successfully following limb amputation, with appropriate care to minimize trauma to the residual limb 1
• Lightweight materials and soft padding (e.g., silicone inserts) are recommended to reduce trauma to amputation sites 1
• For patients with hand amputations, supportive devices can enable better function for activities of daily living 1

Implementation Guidelines

1. Type of Brace:

   • Choose a lightweight wrist brace with adjustable straps
   • Consider silicone padding for comfort and to prevent skin breakdown
   • Select a design that allows for maximum function while providing adequate support

2. Wearing Schedule:

   • Start with shorter wearing periods (2-3 hours) and gradually increase as tolerated
   • Monitor for skin irritation or pressure points
   • Long-term use is advocated for optimal benefit 1

3. Functional Training:

   • Provide education on proper application and removal of the brace
   • Demonstrate how to perform daily activities while wearing the brace
   • Education and training in ergonomic principles should accompany brace provision 1

Additional Supportive Measures

1. Exercises:

   • Prescribe gentle range of motion exercises for uninvolved joints
   • Consider strengthening exercises for remaining functional muscle groups
   • Exercises to improve function and muscle strength should be considered for every patient 1

2. Assistive Devices:

   • Evaluate need for additional assistive devices to complement the wrist brace
   • Consider adaptive equipment for activities of daily living

3. Pain Management:

   • Topical NSAIDs may be considered for pain relief if needed 1
   • Oral analgesics may be considered for short-term symptom relief 1

Follow-up Recommendations

• Schedule follow-up within 2-4 weeks to assess fit, function, and comfort of the brace
• Adjust brace as needed based on patient feedback
• Long-term follow-up should be adapted to the patient's individual needs 1

Potential Pitfalls and Considerations

• Monitor for skin breakdown, especially at pressure points
• Avoid overly restrictive bracing that might further limit function
• Be aware that the contracture in the right hand may limit the effectiveness of the brace
• Consider that the patient may need different types of braces for different activities

The wrist brace should be viewed as part of a comprehensive approach to improving this patient's hand function following amputation and contracture. Regular reassessment of the brace's effectiveness and the patient's functional status is essential for optimal outcomes.