title: Case Report: The casting motion to mobilize stiffness technique for rehabilitation after a crush and degloving injury of the hand.
abstract: METHODS
  Case report.
  
  
  BACKGROUND
  This case report describes the use of the casting motion to mobilize stiffness (CMMS) technique in the management of a crush and degloving injury of the hand. The patient was unable to attend multiple hand therapy sessions due to geographic constraints. The CMMS technique involved the application of a nonremovable plaster of paris cast that selectively immobilizes proximal joints in an ideal position while constraining distal joints to direct desired motion over a long period. This uses active motion only. Traditional hand therapy techniques or modalities are not used. This treatment approach was beneficial to the patient as a minimum of 2 appointments per month were needed to regain functional hand use.
  
  
  OBJECTIVE
  To document the use of the CMMS technique as an effective treatment approach in the management of a crush and degloving injury of the hand.
  
  
  METHODS
  The CMMS technique was applied to the patient's left (nondominant) hand 8 weeks after injury. The technique's aim was to improve the 30° flexion deformity of the left wrist and flexion contractures of the index, middle, and ring fingers with a total active motion of 0°. Orthotic devices and traditional therapy were applied once joint stiffness was resolved, and a normal pattern of motion was reinstated.
  
  
  RESULTS
  At 6 months, substantial improvement was noted in wrist as well as metacarpophalangeal and interphalangeal joints. Total active motion exceeded 170° in all fingers excellent functional outcome resulted as measured with the upper limb functional index short form-10. The upper limb functional index increased from 0% to 55% of preinjury status (or capacity) over the 18 months of therapy.
  
  
  CONCLUSIONS
  Brief immobilization through casting causes certain functional losses, but these are temporary and reversible.
  
  
  CONCLUSIONS
  Finger stiffness, edema, and tissue fibrosis were successfully managed with the CMMS technique without the need for attendance at multiple hand therapy sessions.
  
  
  METHODS
  Level V.
authors: Hand Therapy Consulting, Bryanston, Johannesburg, South Africa. Electronic address: robyn@handconsult.com.
authors: Robyn
authors: R
authors: Midgley
mesh_terms: D000328:Adult; D002370:Casts, Surgical; D000071576:Crush Injuries / Q000175:diagnosis / Q000534:rehabilitation / Q000601:surgery; D000069836:Degloving Injuries / Q000175:diagnosis / Q000534:rehabilitation* / Q000601:surgery*; D005081:Exercise Therapy / Q000379:methods; D005384:Finger Joint / Q000503:physiopathology; D005500:Follow-Up Studies; D006230:Hand Injuries / Q000175:diagnosis / Q000534:rehabilitation* / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D011182:Postoperative Care / Q000379:methods; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D016038:Skin Transplantation / Q000379:methods; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology; D014955:Wrist Joint / Q000503:physiopathology
keywords: CMMS technique; Degloving injury; Joint stiffness; Rehabilitation