Highlights
- •Severe flexion contractures of the hand cause profound functional deformity.
- •The inflatable carrot is a cone-shaped orthosis placed with minimal discomfort.
- •It improves pulp to palm distance, hand hygiene, nail and soft tissue architecture.
- •The inflatable carrot is an alternative nonsurgical solution for hand contractures.
Abstract
Study Design
Case report.
Introduction
Severe flexure contractures of the hand secondary to upper limb spasticity (ULS) cause
pain, palmar hyperhidrosis, ulceration, and nail plate deformities. Nonoperative management
includes traditional orthotic devices that can be very painful for severe contractures
and Botox injections, which provide a temporary solution. Surgical treatment comprises
of soft tissue releases, tendon transfers, and release of the flexor and intrinsic
muscles, which can cause permanent functional problems.
Case Description
In a 28-year-old male, unfit for surgery, we present the first documented case report
in literature of flexion contractures of the hand secondary to upper limb spasticity
managed using the “Inflatable Carrot” orthosis, where other conservative measures
failed.
Results
At 4 weeks, the pulp to palm distance improved from 0 to 2 cm. At 3 months, the patient
regained normal nail plate architecture, improved hand hygiene, reduced infection
and pain. The patient reported improved psychological well-being and motivation to
engage further with our therapists.
Conclusions
The inflatable carrot provided an alternative nonsurgical solution for management
of flexion contractures of the hand when surgical intervention was not considered
in the patient’s best interests. Awareness of this orthosis among hand therapists
and surgeons will broaden our armamentarium for this challenging clinical problem.
Keywords
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JHT Read for Credit
Quiz: # 899
Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.
- # 1.The study design is
- a.RCTs
- b.retrospective cohort
- c.case series
- d.case report
- a.
- # 2.The adjustable markings on the carrot are there to facilitate
- a.fisting
- b.carrot length
- c.proper inflation/deflation
- d.measuring ROM
- a.
- # 3.The larger end of the carrot is placed
- a.radially
- b.ulnarly
- c.centrally
- d.laterally
- a.
- # 4.The PIP flexion contracture was a result of
- a.flaccidity
- b.spasticity
- c.a primary volar plate laceration
- d.a failed flexor tendon repair
- a.
- # 5.This report is one a several similar published reports extolling the virtues of the Inflatable Carrot
- a.true
- b.false
- a.
When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.
Article info
Publication history
Published online: January 14, 2021
Accepted:
January 10,
2021
Received in revised form:
January 3,
2021
Received:
July 15,
2020
Footnotes
Conflict of interest: All named authors hereby declare that they have no conflicts of interest to disclose.
Funding: None.
Patient consent: Informed consent obtained.
Identification
Copyright
© 2021 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserved.
