Ischaemic contracture of the intrinsic muscles of the hands a hazard of physical restraint

Abstract

A case is described of bilateral ischaemic contracture of the intrinsic muscles of the hands, presenting in a mentally-disturbed patient one year after a reported period of immobilisation in a physical restraint device. Involvement of the deep thenar muscles and the interossei on the radial side of the hand can be explained by consideration of the anatomy of the deep palmar arch. Division of the tendons of the contracted interosseous muscles proximal to the metacarpophalangeal joints and release of the left first web improved hand function. Those who supervise the use of physical restraint devices should be aware of the risk of intrinsic muscle ischaemia and of the need for prompt diagnosis and treatment.

Physical restraint use in a Korean ICU

“…The negative consequences of restraint use were not investigated in this study, but as 13.8% of the patients were continuously restrained for more than 24 hours, physical complications are possible, as have been reported in previous studies (McLardy‐Smith et al. , 1986; Lofgren et al.…”

“…Nurses are the primary decision makers in the use of physical restraints for patient safety. There have been many reports on the different types of complication resulting from the use of physical restraints: physical (McLardy‐Smith et al. , 1986; Lofgren et al.…”

“…• In conclusion, as the most discriminating factor of application or removal of restraints was the patient's restless behaviour, providing nurses with tools for the Introduction Nurses are the primary decision makers in the use of physical restraints for patient safety. There have been many reports on the different types of complication resulting from the use of physical restraints: physical (McLardy-Smith et al, 1986;Lofgren et al, 1989;Scott & Gross, 1989;Bromberg & Vogel, 1996), psychological (Strumpf & Evans, 1988;Mion et al, 1989;Tinetti et al, 1991) and social (Folmar & Wilson, 1989). Many studies have questioned the many strategies that have been developed for reducing the use of physical restraints, and the efficacy and benefits of applying restraints (Coppolo & May, 1990;Whelan et al, 1994;Grap et al, 1995;Snyder & Bender, 1995;Johnson & Beneda, 1998), but their use is still widespread.…”

Prevalence and Variation of Physical Restraint Use in Acute Care Settings in the US

“…Practitioners' use of physical restraints (PR) in healthcare settings is a controversial practice that occurs in developed countries worldwide (Choi & Song, 2003; Hamers & Huizing, 2005; Jehan, 1999; Karlsson, Bucht, Eriksson, & Sandman, 1996; Lee, Chan, Tam, & Yeung, 1999; Minnick, Mion, Leipzig, Lamb, & Palmer, 1998; Molassiotis & Newell, 1996; Werner & Mendelsson, 2001). Although intended to protect patients, physical restraint can have direct deleterious effects, e.g., pressure ulcers and death (Berrol & Berrol, 1988; Di Maio et al, 1986; Dube & Mitchell, 1986; Lofgren, MacPherson, Granieri, Myellnbeck, & Sprafaka, 1989; McLardy‐Smith, Burge, & Watson, 1986; Miles & Irvine, 1992; Miles & Meyers, 1994; Mion, Minnick, Palmer, Kapp, & Lamb, 1996; U.S. Department of Health and Human Services [USDHHS], 1992).…”

Locking of the Metacarpophalangeal Joint Caused by Idiopathic Intrinsic Muscle Atrophy of the Hand: Report of Three Cases

“…Atrophy of the intrinsic muscles causes the fingers to stiffen and the hand to become deformed and functionally disabled. Trauma limited to the hand, inflammation, spasticity, central nervous system disease, prolonged spasm, and excessive immobilization can cause such muscle contracture [1,2,4,5,[7][8][9]12]. Metacarpophalangeal (MP) joint locking is known to be caused by muscular contracture or trauma, collateral ligament, or volar plate tethering on a prominent MP head or osteophyte, a torn palmar plate, metacarpal head fracture, a loose body, or abnormal sesamoids [10,11].…”