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Introduction

In physical setting, Therapist need to assess client everyday to obtain the progress of different clients. This is a very challenging task since assessing real client is very different from assessing classmates in the role play situations. This case study is designed to help students strengthen their clinical reasoning in conducting basic hand assessment to clients with hand injuries. Various components of hand assessment are demonstrated by the lecturer and the former students. Students are to critique the assessment techniques and procedures shown. Before going into this case study, students are encouraged to go through the website of hand function assessment manual & Physical Assessment in Rehabilitation Sciences to familiarize with the various hand assessment.

Mr. Leung

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Client Information

Name of client: Mr. Leung

Age/sex: 54 / M (at 2001)

Diagnosis: Partial amputation of right forearm

Hand dominance: right

Occupation: Senior carpentry worker

Medical history:

Mr. Leung was injured at work in 1996 while trying to hook up the suspension mobile trolley system in a construction site to transfer a pile of wood. His right hand was caught by the machine and his right forearm was forcefully pulled away towards the direction of the machine. The traumatic pull and stretch had forcefully torn nearly two third of his right forearm resulting:

1. Partial amputation of forearm near the radial side;

2. Comminuted fracture of the radius and ulna,

3. Ruptured tendons, nerves and vessels of the forearm

4. Dislocation of the wrist joint.

5. Open wound injuries at medial side of the forearm

He was fully alert despite the severe pain from the injury and was sent to A & E Department of a general hospital. Emergency operation was conducted to repair the forearm, including:

1. Internal fixation of radius and ulna to stabilize the fracture site

2. Revascularization of the radial and median arteries

3. Repairs of the long flexors and the long extensors of forearm

4. Reduction of the wrist joint 

5. Repair of the radial and median nerves

6. Skin grafting to cover the massive wound on radial side of the forearm

 Mr. Leung was put on an external cast after the surgery to protect all the repaired tissues for three weeks. There was subsequent edema and pain after the surgery. Mr. Leung was put on bed rest and pain relieving agent.

After three weeks of immobilization, a resting splint was fabricated to replace the cast. He was referred to PT and OT for active mobilization. He received inpatient treatment for nearly 8 weeks and then discharged as outpatient OT and PT regularly for further rehabilitation.

 Three months post-operation, it was found that there were severe adhesion over long flexor tendon and the surgical tenolysis of the long flexors and reconstruction was conducted. However, the results were not satisfactory.

 After tenolysis, he has been referred to Occupational Therapy for further hand rehabilitation. He has regained certain hand functions. He has already discharged during the time of interview.

Client's summary:

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