Effect of Ultrasound and Exercise Therapy on Pain After Dorsal Hand Flap: A Case Report

Abstract

Background: Functional impairment following dorsal hand skin flap reconstruction commonly presents with pain, stiffness, and limited range of motion, which may interfere with daily activities, particularly in the chronic phase.

Objective: This study aimed to evaluate the effectiveness of ultrasound and exercise therapy in reducing pain and maintaining functional capacity in a patient with chronic post-operative hand contracture.

Methods: This case report was conducted in accordance with the CARE guidelines. A 27-year-old male with flexion contracture of the fourth and fifth proximal interphalangeal joints following dorsal hand flap reconstruction was treated at an orthopedic rehabilitation hospital in Surakarta, Indonesia. The intervention was administered once weekly for three weeks and included therapeutic ultrasound (continuous mode, 5 minutes), scar massage, active exercise, and activities of daily living training. Outcomes were assessed using the Numeric Rating Scale (NRS), goniometry, Manual Muscle Testing (MMT), limb circumference, and Wrist Hand Disability Index (WHDI).

Results: Movement-related pain decreased from 4/10 to 2/10, indicating a clinically meaningful improvement. Resting and pressure pain remained at 0/10. Muscle strength (MMT 3/5), range of motion (PIP flexion 45°–50°), limb circumference, and WHDI score (10%) showed no changes.

Conclusion: A short-term physiotherapy program may contribute to pain reduction and maintenance of functional status in chronic post-surgical hand conditions. However, it appears insufficient to improve muscle strength, range of motion, or overall functional outcomes, suggesting the need for longer and more intensive rehabilitation strategies.