Hypersensitive Scars


Hypersensitivity refers to a condition of extreme discomfort or irritability in response to a normally non-noxious tactile stimulation. It occurs at or near to the site of injury or surgical incision.


The symptoms can be reduced by Desensitisation


Desensitisation refers to the process of lessening reactivity to an external stimulus through the use of a graded series of modalities and procedures.


It aims to help the patient achieve their maximal level of function by increasing tolerance to touch in the hypersensitive area.


Indications

  • Neuromas
  • Hypersensitive amputated tips (stumps)
  • Nerve injuries with dysesthesia (a painful and persistent sensation induced by a gentle touch of the skin)

Precautions

  • Diffuse pain
  • Open wounds
  • Deep pain not remediated with desensitisation

Procedure


A) Testing

A base line assessment is performed to establish the individual’s sensitivity; this is used to direct treatment and to evaluate progress.


In the testing phase the patient is asked to rank a range of textures from the least to the most irritating.


  1. A number (5-10) predetermined textures and immersion materials that range from very little tactile sensation to those that give a significant amount of stimulation are randomly applied to the hypersensitive area.
  2. The patient is asked to rank a hierarchy of hypersensitivity for each texture or immersion material.
  3. The hierarchy is recorded.

B) Method

  1. After arranging the hierarchy the patient selects a tolerable but mildly irritating stimulus from each modality.
  2. Suitable textures and immersion materials, similar to the identified stimulus, are then selected for treatment. These are recorded. These materials are used to desensitise the affected area.
  3. A home programme of desensitisation is commenced.

(To be effective a desensitisation programme must be repeated several times a day, it is therefore not readily amenable to treatment in a therapy department; the thrust of treatment must be a home programme).


  1. The texture(s) are rubbed, tapped or rolled over the affected area or as close to the sensitive scar as possible.
  2. The hand is immersed and moved around in the identified immersion material.
  3. Treatment is performed 3 / 4 times a day for 10 minutes each session.
  4. The patient is re-evaluated in the therapy department. It is often 2-3 weeks before the first change is noted. When hypersensitivity to the texture / immersion material has decreased then the next material on the hierarchy is introduced.
  5. This process is repeated until the patient has progressed through the hierarchy and the sensitivity has reduced to a level that allows comfortable function and / or return to work.
  6. The average treatment time for scar sensitivity is 7 weeks.

Evidence

Allory.s.A. 1997. Desensitisation. In Clark, Wilgis, Aiello, Eckhaus & Eddingto (eds). Hand rehabilitation (sec ed) Churchill Livingstone, London

Barber L.M.. 1990. Desensitisation of the traumatised hand p.721. In Hunter J.M., Schneider L.H, Mackin E.J., Callahan A.D. (eds): Rehabilitation of the hand, Surgery and Therapy (3 ed). Mosby, St. Louis.

Barber L.M. 1978. Occupation Therapy for the treatment of reflex sympathetic dystrophy and post-traumatic hypersensitivity of the injured hand. In Fredricks S. and Brody G.S. (eds): Symposium on the neurological aspects of plastic surgery, St. Lois, Mosby

Hardy M.A., Moran C.A. & Merrit W.H. 1982. Desensitisation of the traumatised hand Va Med 109:134


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