Rehabilitation of Hand Burns

Improved survival after major burns has increased the importance of rehabilitation, particularly for hand burns.¹ A successful outcome requires a thorough understanding of patient needs and an individually tailored plan that begins at admission. This plan includes mobility, immobilisation, functional activities and modalities, and is developed further during the acute phase and the months following injury.¹

Hand burns are complex and contractures are a frequent complication. Such injuries often reduce hand function—especially finger flexion and extension—and diminish quality of life, particularly after larger burns.² The goal of physiotherapy and splinting is to maintain mobility, prevent contracture, and promote function and cosmetic outcome.³

Complications

A detailed understanding of the effects of hand burns is essential for successful rehabilitation.⁴ Common complications include:

• Oedema

• Joint deformities

• Claw deformity

• Palmar contractures

• Scar contracture

• Hypertrophic scarring

• Reduced hand function

• Syndactyly (webbing of fingers)

• Amputation

Post-Burn Oedema

Thermal injury causes major tissue changes with swelling, blistering and epithelial loss, leaving moist, exudative areas. This can lead to hypovolaemia and circulatory compromise.⁵ Deep, circumferential burns may produce significant oedema, reduced venous and lymphatic drainage, and impaired arterial inflow.⁵ Overhydration of tissues increases the risk of ischaemia and infection.⁵

Superficial burns cause only mild, transient oedema, whereas deeper burns produce persistent and more severe oedema.⁴

Joint Deformities and Contractures

The hand is among the three most common sites for scar contracture.⁶ This often develops early due to oedema, scarring or tendon involvement.¹ To prevent flexion contracture, a volar splint is recommended with the IP joints in extension, the MCP joints in 60–90° flexion, the wrist in neutral, and the thumb in 20–30° abduction. The splint is worn continuously for 6–7 weeks, then at night only up to 3 months.³

Scar Contracture and Hypertrophic Scars

Hand scar contracture grading:⁶

• Grade I: Tightness without ROM limitation; normal anatomy

• Grade II: Mild ROM limitation without significant functional loss

• Grade III: Functional loss with emerging deformity

• Grade IV: Marked deformity with loss of hand function

Role of Physiotherapy

Goals and treatment

Physiotherapy and splinting aim to reduce oedema, prevent contracture, maintain movement, minimise keloid, strengthen musculature and secure functional recovery.³

Oedema management

• Acute phase: Elevate the hand above heart level for 24 hours; passive mobilisation of affected joints

• Post-acute phase: Retrograde massage three times daily; compression bandaging; active/passive movement 10–20 repetitions; continued elevation³

Prevention of joint deformities

• Splinting as above, combined with passive/active movements and stretching.³

Contracture management

• Optimal positioning, stretching, massage and passive/active movements.³,⁹

• In the chronic phase, use gel (e.g., Contractubex, Dermatix) and stretching 2–3 times daily.

• Patients should use pressure gloves as required.³

Reduced hand function — Training programme

• Passive/active movements begin after 3–5 days (conservative care) or one week (post-surgery).

• Active mobilisation continues for 4–6 weeks.

• Static and dynamic strengthening to counteract atrophy.³

• Home exercises are taught to patients and caregivers.³

Role of Occupational Therapy

Function and goals

Occupational therapy restores daily functions such as grasping, opening doors, writing and dressing.⁹ Early intervention yields the best functional results, as the hand is particularly prone to contractures.⁹ The goal is to train activities of daily living (ADLs) with minimal difficulty.⁹,¹⁰

References

1. Moore ML, Dewey WS, Richard RL. Rehabilitation of the burned hand. Hand clinics. 2009 Nov 1;25(4):529-41.

2. Cowan AC, Stegink-Jansen CW. Rehabilitation of hand burn injuries: Current updates. Injury. 2013 Mar 1;44(3):391-6.

3. Rrecaj S, Hysenaj H, Martinaj M, Murtezani A, Ibrahimi-Kacuri D, Haxhiu B, Buja Z. OUTCOME OF PHYSICAL THERAPY AND SPLINTING IN HAND BURNS INJURY. OUR LAST FOUR YEARS’EXPERIENCE. Materia socio-medica. 2015 Dec;27(6):380. :https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4733548/

4. Moore ML, Dewey WS, Richard RL. Rehabilitation of the burned hand. Hand clinics. 2009 Nov 1;25(4):529-41.

5. Lund T, Onarheim H, Reed RK. Pathogenesis of edema formation in burn injuries. World J Surg [Internet]. 1992;16(1):2–9. https://pubmed.ncbi.nlm.nih.gov/1290261/

6. Sabapathy SR, Bajantri B, Bharathi RR. Management of post burn hand deformities. Indian journal of plastic surgery: official publication of the Association of Plastic Surgeons of India. 2010 Sep;43(Suppl):S72.

7. Gjennomgått - Trukket

8. Gjennomgått - Trukket

9. Rrecaj S, Hysenaj H, Martinaj M, Murtezani A, Ibrahimi-Kacuri D, Haxhiu B, Buja Z. OUTCOME OF PHYSICAL THERAPY AND SPLINTING IN HAND BURNS INJURY. OUR LAST FOUR YEARS’EXPERIENCE. Materia socio-medica. 2015 Dec;27(6):380.

10. Aghajanzade M, Momeni M, Niazi M, Ghorbani H, Saberi M, Kheirkhah R, et al. Effectiveness of incorporating occupational therapy in rehabilitation of hand burn patients. Ann Burns Fire Disasters. 2019;32(2):147–52.