Highlights
• Severe flexion contractures of the hand cause profound functional deformity
• The Inflatable carrot is a cone shaped orthosis placed with minimal discomfort.
• Improves pulp to palm distance, hand hygiene, nail and soft tissue architecture.
• The inflatable carrot is an alternative non-surgical solution for hand contractures
Abstract
Study Design
Case report
Introduction
Severe flexure contractures of the hand secondary to upper limb spasticity (ULS) cause pain, palmar hyperhidrosis, ulceration and nail plate deformities. Non-operative management includes traditional orthotic devices that can be very painful for severe contractures and Botox injections, which provide a temporary solution. Surgical treatment comprises of soft tissue releases, tendon transfers and release of the flexor and intrinsic muscles, which can cause permanent functional problems.
Case Description
In a 28 year old, unfit for surgery, we present the first documented case report in literature of flexion contractures of the hand secondary to ULS managed using the ‘Inflatable Carrot’ orthosis, where other conservative measures failed.
Results
At 4 weeks, the pulp to palm distance improved from 0-2cm. At 3months, the patient regained normal nailplate architecture, improved hand hygiene, reduced infection and pain. The patient reported improved psychological wellbeing and motivation to engage further with our therapists.
Conclusions
The inflatable carrot provided an alternative non-surgical solution for management of flexion contractures of the hand when surgical intervention was not considered in the patient’s best interests. Awareness of this orthosis among hand therapists and surgeons will broaden our armamentarium for this challenging clinical problem.