Hand Therapy for Hypersensitivity

Brushes used as part of desensitization therapy for hypersensitive areas of the hand
Figure 1. Common desensitization therapy techniques for hypersensitive areas of the hand include massaging the affected skin with a hairbrush or other coarse material to provide constant stimulus for short, repeated intervals throughout the day.

The nerves supplying feeling to the skin of an injured or surgical area can become hyperactive. The pain nerve fibers may dominate all feeling in the area, and this pain may be higher in severity than expected.

Hypersensitivity causes pain, numbness, and a heightened response to touch. People with hypersensitivity may begin to limit use of the finger or hand, which can result in a longer recovery.

If hypersensitivity is not addressed, it can cause a pain loop. In this loop, pain causes further limited use of the injured area. The patient can get stuck in a rut and may not be able to improve pain or motion. This pain can be more intense and complex, and it can take much longer to go away.

Causes

Hypersensitivity can be caused by:

  • Injury
  • Casting
  • Laceration to skin resulting in a scar
  • Nerve irritation
  • Medications

Symptoms

Signs and symptoms of oversensitivity include:

  • Pain, which can be sharp, burning, or shooting
  • Inability to tolerate touch or pressure to the area
  • Adherent scar restricting nerve mobility
  • Nerve return following laceration or repair

Diagnosis and Treatment

History and physical exam are most important. Physical exam tests may include two-point discrimination or Semmes-Weinstein monofilament testing. It is helpful to rate pain on a similar scale at each visit to monitor progress.

These tests help identify possible sensation loss. Formal testing by a physician may include a nerve conduction test. It may also be important to identify any underlying nerve disorders, such as carpal tunnel syndrome.

The goal of desensitization therapy is to provide a constant stimulus to the affected area for a short period of time, repeated multiple times throughout the day. These periods of input try to stimulate the brain with input other than pain. The brain responds by adjusting to the input, which can decrease the heightened reaction.

Gradual introduction of light pressure or touch to the painful area over time decreases the pain response. When an unexpected pressure to the hypersensitive area occurs, desensitization therapy can make the event feel more normal and less painful.

Once the sensitive area becomes adapted to gentle stimuli, graded materials or textures may be used. For example, some programs begin with a cotton ball and gradually progress to Velcro or even sandpaper. The amount of force used to apply the stimulus can also be graded to increase the stimuli.

Suggested frequency: A therapy program may involve introducing stimuli to the affected body part for two to four minutes, five to eight times per day.

Home Desensitization Techniques

A home program can involve various techniques for desensitization. Examples include:

  • Rub the sensitive area with fabrics of various textures, beginning with softer fabrics and progressing to rougher ones. Examples include cotton balls, silk, paper towel, Velcro and loop, flannel, denim, and corduroy.
  • Tap along the sensitive area using a small eraser or your fingertips. Slowly increase the pressure. If your fingertip is the involved area, tap it onto a surface.
  • Use a hairbrush or a soft toothbrush to massage along the sensitive area in multiple directions and in circles.
  • Place your hand in a container filled with dry items such as rice, Cheerios, dry beans, sand, or corn. Open and close your hand in the container to get resistance. Make sure the container is deep enough to submerge past the affected area.
  • Place your hand in water of two different temperatures. Try to feel the difference between warm and cool instead of the pain. You can also focus on wet versus dry.

Using Vision and Mirror Feedback

Many of these techniques can be performed with eyes open and eyes closed. With eyes open, you use vision to add information you see to what you are feeling on the sensitive skin.

With eyes closed, try to concentrate on the sensation, such as rough, smooth, cold, warm, light, firm, clockwise circles, or movement left or right, rather than pain. Alternating eyes open or closed during therapy may help.

It can also be helpful to use a mirror. While applying different sensations to the sensitive skin, look at the area in the mirror instead of looking directly at the area that hurts. This can make the area seem like an image or video rather than your own body.

Source: American Society for Surgery of the Hand patient education material, adapted into a responsive format for web viewing.