Case Report| Volume 35, ISSUE 4, P665-669, October 2022

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The inflatable carrot—An orthosis for fingertip wound healing in flexion contractures of the hand: A case report

Published:January 14, 2021DOI:


      • 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.


      Study Design

      Case report.


      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.


      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.


      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.


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        • Porretta D.L.
        Cerebral palsy, traumatic brain injury, and stroke.
        Adapt Phys Educ Sport E. 2016; 6: 271
        • Black L.
        • Gaebler-Spira D.
        Nonsurgical treatment options for upper limb spasticity.
        Hand Clin. 2018; 34: 455-464
        • Bakheit A.M.
        The pharmacological management of post-stroke muscle spasticity.
        Drugs Aging. 2012; 29: 941-947
        • Tyson S.F.
        • Kent R.M.
        The effect of upper limb orthotics after stroke: a systematic review.
        NeuroRehabilitation. 2011; 28: 29-36
        • Dashtipour K.
        • Chen J.J.
        • Walker H.W.
        • et al.
        Systematic literature review of botulinum toxin A in clinical trials for adult upper limb spasticity.
        Am J Phys Med Rehabil. 2015; 94: 229-238
        • Van Kuijk A.A.
        • Geurts A.C.
        • Bevaart B.J.
        • et al.
        Treatment of upper extremity spasticity in stroke patients by focal neuronal or neuromuscular blockade: a systematic review of the literature.
        J Rehabil Med. 2002; 34: 51-61
        • Allieu Y.
        Surgical management of the adult spastic hand.
        Chir Main. 2011; 30: 159-175
        • House J.H.
        • Gwathmey F.W.
        • Fidler M.O.
        A dynamic approach to the thumb-in palm deformity in cerebral palsy.
        J Bone Joint Surg Am. 1981; 63: 216-225
        • Samilson R.L.
        • Morris J.M.
        Surgical improvement of the cerebral-palsied upper limb: electromyographic studies and results of 128 operations.
        J Bone Joint Surg Am. 1964; 46: 1203-1216
        • Bull P.C.
        • Thomas G.R.
        • Rommens J.M.
        • et al.
        The Wilson disease gene is a putative copper transporting P-type ATPase similar to the Menkes gene.
        Nat Genet. 1993; 5: 327-337
        • Ayse K.B.
        • Hakan G.
        • Duran A.
        • et al.
        Neurological features and management of Wilson disease in children: an evaluation of 12 cases.
        Turk Pediatri Ars. 2016; 51: 15-21
        • Gupta A.D.
        • Addison S.
        Healing hand ulcers caused by focal spasticity.
        Int Wound J. 2020; 17: 774-780
        • Navarrete-Opazo A.A.
        • Gonzalez W.
        • Nahuelhual P.
        Effectiveness of oral baclofen in the treatment of spasticity in children and adolescents with cerebral palsy.
        Arch Phys Med Rehabil. 2016; 97: 604-618
        • Verrotti A.
        • Greco R.
        • Spalice A.
        • et al.
        Pharmacotherapy of spasticity in children with cerebral palsy.
        Pediatr Neurol. 2006; 34: 1-6
        • Nair K.P.
        • Marsden J.
        The management of spasticity in adults.
        BMJ. 2014; 349: g4737
        • Monaghan K.
        • Horgan F.
        • Blake C.
        • et al.
        Physical treatment interventions for managing spasticity after stroke.
        Cochrane Database Syst Rev. 2017; 2017: CD009188
        • Jo H.M.
        • Song J.C.
        • Jang S.H.
        Improvements in spasticity and motor function using a static stretching device for people with chronic hemiparesis following stroke.
        NeuroRehabilitation. 2013; 32: 369-375
        • Gracies J.M.
        • Marosszeky J.E.
        • Renton R.
        • Sandanam J.
        • Gandevia S.C.
        • Burke D.
        Short-term effects of dynamic Lycra splints on upper limb in hemiplegic patients.
        Arch Phys Med Rehabil. 2000; 81: 1547-1555
        • Doucet B.M.
        • Mettler J.A.
        Effects of a dynamic progressive orthotic intervention for chronic hemiplegia: a case series.
        J Hand Ther. 2013; 26: 139-147
        • Orsini M.
        • Leite M.A.A.
        • Chung T.M.
        • et al.
        Botulinum neurotoxin type A in neurology: update.
        Neurol Int. 2015; 7: 5886
        • Hoare B.J.
        • Wallen M.A.
        • Imms C.
        • et al.
        Botulinum toxin A as an adjunct to treatment in the management of the upper limb in children with spastic cerebral palsy (UPDATE).
        Cochrane Database Syst Rev. 2010; : CD003469
        • Prashanth L.K.
        • Taly A.B.
        • Sinha S.
        • et al.
        Prognostic factors in patients presenting with severe neurological forms of Wilson's disease.
        QJM. 2005; 98: 557-563

      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 There is only one best answer for each question.
      • # 1.
        The study design is
        • a.
        • b.
          retrospective cohort
        • c.
          case series
        • d.
          case report
      • # 2.
        The adjustable markings on the carrot are there to facilitate
        • a.
        • b.
          carrot length
        • c.
          proper inflation/deflation
        • d.
          measuring ROM
      • # 3.
        The larger end of the carrot is placed
        • a.
        • b.
        • c.
        • d.
      • # 4.
        The PIP flexion contracture was a result of
        • a.
        • b.
        • c.
          a primary volar plate laceration
        • d.
          a failed flexor tendon repair
      • # 5.
        This report is one a several similar published reports extolling the virtues of the Inflatable Carrot
        • a.
        • b.
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.