Hands Tightly Clenched

[shandy123]

Hi all,

My mother has had vascular dementia for 7 and a half years and is in last stages. Her hands have started to close and it's getting impossible to open them, I am quite concerned because the nursing home is not her cutting her nails regular enough and they are pressing on the palms of her hands, also they sweat and the hands get very smelly. I have tried to gently open her fingers from her palms but she looks as if it's painful so I have to stop.

I have tried rolls of sponge in her palms but she just keeps dropping them and it's really difficult to put them back. Has anyone experienced this and does anyone have any idea how we can help mum.

shandy x

 

[Noorza]

I haven't come across this has anyone tried oils and a gentle hand massage to the part that are still accessible, if opening her hand is painful I wouldn't do it either. Sorry I'm not much use.

 

[Mamsgirl]

I seem to recall a member, Padraig I think, writing about this.

Could you soak your mother's hand in warm, scented water to soften the nails, or perhaps slip something like gauze between nails and palm?

Very difficult time for you and your poor mother, take care, Toni.

 

[Gill1961]

Hi,

My Mum, who recently passed away, had the same problem. The care home staff would often place a wad of tissues of similar for her too grasp.

The care home arranged a visit, I think possibly from an Occupational Therapist, and Mum was supplied with some very soft splint like devices lined with medical quality sheepskin. Sorry to be a bit vague with the details but they did help.

Best wishes,


Gill

 

[lin1]

Hello
Yes I had this with my Mum.
It started with her right hand. her Gp at first wasn't much help, said nothing could be done.
So I used rolled large crepe (SP) bandages held in place with micropore
In retrospect I think this may have not helped things as Mum just held it and eventually could not move or flex her fingers, but this may have happened anyway, who knows.
Nail cutting, hand washing was a nightmare for both of us, as I am sure you can imagine.

physiotherapy may help but maybe too painful for her

Eventually the Gp realised the seriousness of the problems , and referred us to the OT when she came out , she explained it had gone to far for splints and provided Palm protectors for her hand.

when Her left hand started to clench up I bought a splint online

Sorry to be so long winded but wanted to let you know you are not alone and how I dealt with it.

I think your first port of call should be the Gp and get a referral to the OT (occupational therapist) and or physio. Bang on the table if you have to

 

[Saffie]

My husband is in a nursing home and is having dreadful problems with this. His right hand has been curled inwards for over a year now and he keeps having infections there. He has already lost a nail due to infection and has had quite a few courses of antibiotics. As he is an insulin-dependent diabetic, the main aim has been to stop the infection but he is in great pain with it. This has been helped by doubling the strength of his pain patch which does allow the nurse to open the fingers slightly so that his palm can be cleaned - sometimes. It still is far from easy though and he is very resistant to anybody going near the hand. As a result it does sometimes smell dreadfully and I know when a problem with infection is about to start as I can smell it.

Now the left hand has started and he has already had 2 pressure sores on his fingers there.
The nurse has tried to find a sheepskin protector for his hand but even the OT cannot trace one and the only one I can find in the net is in the US and I have no idea if it will help. An agency nurse said she had seen something on an a resident in another home but she said the OT would be the one to know - but she doesn't! The GP doesn't seem to either!
We have tried all sorts, from rolled bandages and lint to foam balls, so Izzy, if you know where we might find something suitable, we'd all be very grateful!
Pressure sore+infection+diabetes translates into gangrene and we've been there before.

 

[lin1]

Hi Saffie and Shandy

I can't find the site I used to get a totally different splint for mums left hand, they also had a good variety to choose from

This is what the OT supplied for mums right hand which was rightly closed up and nails digging in

http://www.mymobilityshop.co.uk/search/positioning+splint

Saffie I think it's dreadful that the OT doesn't know about these and other splints

 

[Soobee]

My mum also suffers from this and at her previous care home one of the carers said about another resident whose nails had started to get embedded into his hand. They didn't seem to know what to do about it.

Now she gets her hand cleaned daily I think. They put tissues or a squeezy ball in there. It is very painful for them to move the fingers but the ball does stop the hand closing completely and reduces the smell. She has a black fingernail but the GP is not worried about it. Nobody has ever mentioned splints or any other help for it.

Her remaining hand is starting to twist now. We are doing our best to ask her to keep moving it but it is getting harder.

 

[Saffie]

O gosh Lin, I am so sorry, I meant to write Lin, not Izzy and thank you for realising that, as well as what a numpty I am!
I've looked at the link - an NHS site, so how come nobody knows about that splint!
Also, it didn't come up with any of my weeks of searching either. Wrong words entered I suppose! Or maybe both the nurse, OT and I have been concentrating on the sheepskin aspect too much. I think that's because of the dampness issue as it keeps the skin dry I believe,
It looks to be a bit thick for Dave now as his hand is tightly clenched but is certainly worth a try.
Thank you ever so much for this. I will show it to the nurse and probabaly send for it anyway. It would do no harm to try.
Thank you again.

 

[nicoise]

My mum had this problem when her Parkinson's meds weren't working any more - so she was getting contracted and cramped muscles that seized up - it was called dystonia.

So the problem may be a neurological one (makes sense really) - that is part of the chemicals in the brain not working properly anymore.

I have read of botox being used to help relax the contracted muscles.

All I can suggest is you ask the physio or GP about this.

Here's a link which explains a bit more about dystonia:

http://www.dystonia.org.uk/index.php/about-dystonia

http://www.dystonia.org.uk/index.php/about-dystonia/treatments/botulinum-toxin-injections

 

[lin1]

Saffie No probs, I didnt notice till you mentioned it and even if I had I wouldn't have batted an eyelid

I know what you mean, I thought the same when I opened the pack.
They do pack down a little and soften a bit once washed.

Sounds like your Dave's hand is clenched as bad as my mum's were (fingers doubled up as much as possible and clenched tight)

I did have great problems inserting the palm protector, because I had to hurt mum to do it, I didnt do it daily

I found by liberally coating the inner and outer parts with vaseline helped to slide it between the fingers and palm
this did not affect mum's skin

you also have to check that all fingers are on top of it, which does mean lifting them slightly.
I too used to up mum's pain relief before I did mums hand, her teddy helped too

Nicoise Thanks for the links,I dont know if that was the cause of mum clenching her hands and her left arm or not/

Ps Saffie, If I remember right this palm protector is not real sheepskin, it does have the same qualities though and absorbs sweat.

 

[Saffie]

Sounds like your Dave's hand is clenched as bad as my mum's were (fingers doubled up as much as possible and clenched tight)

Yes Lin, Dave has a pit in his palm where his ring finger has been digging into it but oddly, the nail part is more flat, hence the pit. The nurse has to wrap cloth around her finger to clean inside as she can hardly lift the fingers at all. I'm wondering after what you've said, if the protector will be too thick. worth a try though. Thank you.

Nicoise - the GP has been involved from the start - it is she who has prescribed all the courses of ABs. I asked to speak to her some months ago as I was concerned about the outcome as Dave has diabetes and his skin is fragile. She said it was important that the hand is kept free of infection because of the danger of gangrene - which was why I was concerned in the first place and had asked to speak to her! - so it didn't really get me anywhere! I'm wondering if vI should ask for a hospital referral but would have thought the GP would have done this if she thought it would help!

 

[nicoise]

Hi Saffie,

As always, its just another idea which might or might not be appropriate, everyone's situation is specific to them ... No harm in running the idea past the GP if you think its appropriate.

I never got that far with mum as we were at the end of her struggle; we just tried giving her things to hold to try to keep her nails from digging into her palms all the time. She was in pain with the contractions though (just think what permanent cramp would feel like, let alone the cutting in and infection )

The splint/wrapping "glove" idea sounds a good solution as something to try.

 

[Cleo777]

The splints, sheep skin line or otherwise are what we use at work. To unclench the hand I've found that gentle massage using Vaseline or Epaderm works well if you have lots of patience and are not in a rush.

 

[Mamsgirl]

Lin and Saffie I'm speechless with indignation at your stories. How can the people entrusted with the physical care of vulnerable people let this happen?

Mil has Parkinsons and sometimes I think more could be done to help her day to day, but like many of her generation, faith in consultants and GPs is unshakeable. Will be keeping an eye out for this sort of thing and am quite happy to bang tables if necessary.

Shandy, hope you're as ok as possible,
Toni

 

[BeckyJan]

Is this link of any help:
http://ketteringsurgical.co.uk/shop/contractures/hand-wrist.htm

 

[Saffie]

Dave's remaining knee has been permanently bent for nearly 3 years too. I first commented on it when he was in the community mental health hospital. I thought the sister said it was rictus but I may have been mistaken. She said that nothing could be done about it and he was unable to walk by then after his amputation.

Mind you, they were useless at physical care there. He developed gangrene from a pressure sore on his remaining foot as they made him stand on it when the instructions were that no weight could be placed on it and he developed MRSA in his amputation wound when it had been perfectly healthy before. He had pressure sore and UTI s too. I have told my daughters never to allow me to go there!

His knee cannot straighten at all and I don't think his fingers will either, no matter how much we massage his hand. He wouldn't let us anyway as it is painful even to touch - but thankyou for the suggestion Cleo.
He is now holding his shoulder rigid, so the nurse has told me so where it will all end is quite frightening.

Thank you Jan. It looks interesting and a possibility if the fingers aren't too tightly clenched. I'll speak to the nurse about both sites.

 

[Saffie]

I mentioned the splints to the nurse this afternoon when I visited the nursing home and she asked if I would wait for a couple of weeks before ordering the one I from Lin's suggested site.(It was a lot cheaper than the others and so I though less of a waste of money if of no help.)

She said she wanted to speak to the GP today but the GP didn't visit the home as she usually does on a Monday. She intends to ask the GP to refer Dave to the Physio department at the small cottage hospital in the market town very near me. She said that the physio dept in the larger Southampton hospital won't do anything. I am really pleased about this as this hospital is lovely and I have been to their physio department for myself a few times over the years.Whether they can help is another matter but at least they are the people who should be able to advise. So I am hopeful.
She doesn't think that Dave's hand will open enough to place a splint in.

 

[shandy123]

Hi all, Thank you all so much for your replies and some really useful information. I mentioned moms hand to the duty nurse and the Dr has seen mom and referred her to an occupational therapist. The only problem now is they say it can take a while to get seen, so I will have to keep making sponge rolls until we hear something from the Therapist. The carer's have told me that a lot of residents have the same problem in the home - so why has nothing ever been done to help these poor people? words fail me at times !

shandy

 

[Saffie]

The nurse on Dave's wing phoned me tonight to say that she had spoken to the GP who happened to have the District Nurse with her. The latter said she knows of something they use in the community, costing £20. She is going to get the details of the company so that I can buy one. I asked if she could supply a picture too as I knew of one that was £14! She promised to ask her to do so. I'll post it on here when I have it as I hope thismight help you, Shandy, too.
The GP said there was no point in referring Dave to the Physio in the hospital and I confess I didn't see the point anyway as there is no way Dave is going to let her touch his hand!