© 2020 Matthew Freeman
Background and Purpose: Nonfatal gunshot emergencies occur regularly within the United States but do not often lead to patients entering outpatient physical therapy clinics for rehabilitation. The complex musculoskeletal injuries which result from gunshot wounds may require prolonged rehabilitative care to best achieve functional outcomes, but clinicians may find a gap in the current literature for guidance. The purpose of this case study is to describe the outpatient rehabilitation treatment interventions for a gunshot wound to the hand, including manual therapy, therapeutic exercise, therapeutic activity, and neuromuscular reeducation.
Case Description: The patient was a 34-year-old, left hand dominant, white male who presented to physical therapy after accidentally discharging his handgun on the ventral side of his left hand. During initial examination, the patient presented with gross dysfunction of the musculoskeletal, neuromuscular and integumentary systems which limited his ability to use his left hand while performing activities of daily living (ADLs) and work tasks.
Outcomes: The patient improved towards all set goals including strength, pain rating, and range of motion (ROM). AROM wrist flexion improved from 20 degrees to 70 degrees, PROM forearm supination improved from -45 degrees to 64 degrees and average PROM metacarpophalangeal flexion improved from 29 degrees to 75.8 degrees. Wrist extension remained highly restricted, limiting the patient’s ability to fully return to ADLs, IADLs, and all necessary job functions.
Discussion: The patient displayed improvements in ROM as demonstrated by handheld goniometry values, strength as demonstrated by MMT grades and dynamometry, and progressed exceptionally well towards all chosen goals. These outcomes suggest that a comprehensive approach to the PT rehabilitation of a gunshot wound to the hand appears to be successful in promoting functional patient gains.
Freeman, Matthew, "Physical Therapy Management Of Gross Function Loss Following Gunshot Wound To Left Hand: A Case Report" (2020). Case Report Papers. 118.