Amputation, Finger or Thumb

Individuals who sustain amputation of a finger or thumb often begin rehabilitation immediately following surgery. Although there are various ways to medically and surgically manage digital amputations, the goals of rehabilitation remain the same: preserve the functional length, preserve useful sensitivity, prevent symptomatic neuromas, prevent adjacent joint contractures, achieve short-duration morbidity, and enable the patient to perform tasks of daily life as quickly as possible (Ware).

A hand, occupational, or physical therapist sees the individual approximately 2 to 3 times a week for the first 6 to 8 weeks. While the wound is open, the therapist monitors the wound, provides protective splinting, controls edema, and maintains range of motion for the uninvolved anatomical regions. The range of motion program for the involved digit at the amputation site adheres to and corresponds with the directives of the surgical plan and the stages of wound healing. The therapist and individual may passively stretch the involved thumb or finger joints to decrease the risk of a contracture. Individuals also perform active range of motion exercises to the uninvolved joints (Ware; Wilson).

Once the wound is closed, the therapist addresses desensitization/sensory re-education and scar management. Modalities such as heat and cold may be used to relieve pain and to relax the hand musculature at the outset of each treatment (Braddom). Strengthening exercises, crucial to restore hand function, are introduced once the amputation site is healed and follow the directives of the postoperative protocol and the stages of wound healing. For most surgical protocols addressing digital amputations, strengthening can begin at 6 to 8 weeks after surgery. Once the wound is healed, fine motor, functional, and work hardening activities are added to the therapy program.

A cosmetic prosthesis can be fitted once the amputation has healed and the residual stump is shaped. It is advisable for the prosthetist to be called in early during the stump-reshaping phase so that the therapy program may focus on the prosthetic goal. The prosthetic considerations directly relate to the level of the amputation. The digital prosthesis may be of considerable value aesthetically and can restore lost functional pinch (Bucchieri; Pillet).

If indicated, an ergonomist may be helpful in modifying the work environment to optimize employability. In some instances, a vocational counselor may be necessary, if the individual cannot return to the previous job secondary to this condition.