Fingertip Injuries: “I Can’t Look at It!”
What is it about fingertip injuries that causes such an adverse reaction in patients when it comes to looking at or using the affected digit? And why is treating a fingertip injury a challenge—even with extensive hand therapy experience?
The management of fingertip injuries poses several significant challenges for both you and your patient. Unlike a shoulder, elbow, or wrist injury, fingertip injuries completely alter the way a person interacts with their environment. Even as I type this now, I intermittently glance down at my fingertips to make sure they are hitting the correct computer keys.
Now consider the impact if injured. Every glance is a reminder of a table saw cutting the finger or a door slamming on the finger.
Fingers are intimate. We use them to explore our world, to communicate, to touch those we love. We often decorate our fingers with rings or nail polish.
Injury replaces those positive images with the urge to avoid looking at the affected digit.
Fingertip injuries are also especially painful because of high density of sensory receptors, so patients often avoid using their injured fingers. Though this is initially convenient for the patient, it results in changes in the brain mapping of the hand in the somatosensory cortex and can prolong dysfunction and disability.
These injuries present unique challenges to help patients decrease pain, restore normal movement patterns, and improve aesthetics.
Acute Phase: Encourage Patient Involvement
When patients are tentative to participate in treatment, look for opportunities to assist with wound care, dressing application, and light prehension activities. Even patients who have difficulty looking at an injured fingertip will often help hold a piece of gauze in place while wrapping. Those with hypersensitivity will engage in prehension tasks with soft objects such as cotton balls or foam.
If the injured digit must be immobilized or is not engaging in even simple activities, consider graded motor imagery to preserve somatosensory cortex representation.
Intermediate Phase: Include Purposeful Tasks
As wounds heal, start encouraging activity participation. Select activities that assist with finger movement and hand engagement with objects in the environment. Purposeful tasks that require visual integration with hand motion will also help the patient get more used to any altered appearance.
Involving your patient in shaping and wrapping for edema control and scar management will also help the patient restore ownership of the injured digit.
Some suggestions for clinic activities:
- Draw numbers on a soft ball and have the patient manipulate the ball with their digits, touching each number with the affected digit.
- Have the patient gather soft small objects in their hand—pick up one at a time and then store as many as possible with the other digits.
- Have the patient gather a towel using two hands on the table by gently walking their fingers along the surface.
Late Phase: Make the Finger Functional
Now it’s time to prepare for impact and make function and finger use automatic. Normally, in the late phase of treatment, people often think of strengthening activities. In these cases, however, consider finding ways to increase the speed of tasks. Whether typing on a keyboard, playing an instrument, or performing assembly line work, our fingertips are most involved in more rapid, dexterous fine motor movements.
Some suggestions for clinic activities:
- Have the patient rapidly snatch a small soft ball or object.
- Upgrade your patient’s previous tasks with harder surfaces, such as gathering coins or turning bolts.
- Patients who have a specific work tool or task they are concerned about should bring the objects to the clinic.
If your patient is still experiencing residual hypersensitivity, consider protective measures such as a gel cap to facilitate return to work and activity. Make it clear, however, that desensitization is a process and they should continue consistent performance.
Know Your Patient
Before judging or pushing a patient to “look at it,” take some time to understand what it is about the appearance of the finger they are most concerned about. Help explain the timelines of wound healing and nail growth and remember—while the finger may look fine to you, being empathetic and assisting with strategies to improve healing and cosmesis helps facilitate a more positive outcome.
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