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All Posts Tagged: hand recovery

Wrist Sprains: What You Should Know

Blog post by Erika Lassig

Picture your football final. The score is close, there’s less than two minutes on the clock and if your team makes one more try you’ll be the champions. You see an opening in the defensive line, a chance to make the winning try. Your teammate sees it too and passes you the ball. You make your play. You get tackled close to the line but make it over and get that winning try. But on your dive to the ground your stretch out your hand to brace your body against the fall. You feel something snap in your wrist when you hit the ground but at the first the adrenaline blocks out any pain.
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A few hours later the pain bites as your turn on the tap for the shower. It starts to ache and you can’t sleep. You take some Nurofen, ice it and go to bed. The next morning it’s a little bit swollen and sore but the pain is manageable and it only really hurts when you turn on a tap or grip something. You think “if it was broken it wouldn’t be able to move it at all, must be just a sprain”. After a supposed wrist sprain, many people ignore it and carry on, assuming it will heal. But wrist sprains can be serious. What you do next could be critical to the long-term health of your wrist joint.

Did you know that the wrist joint involves 15 bones with many ligaments joining these bones to each other? Ligaments are pieces of tough tissue that join bone to bone providing stability to joints. This makes the wrist arguably the most complicated joint in the human body. A sprain is an injury to one or more of these ligaments. A fall on an outstretched hand can cause a fracture to any one of these 15 bones, a sprain to some of the ligaments, and/or a dislocation to one of the joints. And the scary part is that a fracture or serious sprain doesn’t always hurt as much as you would expect.
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For this reason, if your wrist hurts after a fall, it’s vitally important to see a doctor to get an x-ray. A neglected injury can lead to an unstable or painful joint for years to come.  Apart from identifying any factures, x-rays can also show any unusual positioning of the bones that may indicate a torn ligament. While it’s encouraging if the x-ray comes back clear, it doesn’t mean you’re out of the woods. Some fractures of the small carpal wrist bones, particularly the scaphoid, are difficult to see on x-ray. Depending on the site of the pain, your GP may recommend another x-ray in a few days or a CT or MRI scan. These other scans can be expensive and not always required in the outset so don’t worry if your doctor doesn’t recommend one.

So, your x-ray shows no fracture, the swelling has gone but your wrist still hurts sometimes. Is it best to wait it out or get treatment straight away? My advice to you is that you should get treatment straight away, as you are likely to recover faster. But it’s important that you see the RIGHT person. Someone who knows wrist injuries and has lots of experience treating them. You can be sure to find someone with the appropriate experience if they are a member of the Australian Hand Therapy Association, soon to be known as an Accredited Hand Therapist. This is an occupational therapist or physiotherapist with additional training and extensive experience managing hand, wrist and elbow injuries. You can find an appropriate therapist here https://www.ahta.com.au/site/find-a-therapist.

Once you’ve booked an appointment with an experienced practitioner in hand therapy, ensure you take any x-rays or scans that you have to your appointment. At your initial appointment, you can expect a thorough wrist and hand assessment. This helps to identify which ligament you have injured and how severe the damage may be, particularly if you haven’t had an MRI. Correct diagnosis allows you and your therapist to develop an appropriate treatment plan. We can help you to understand the role of the injured structures in your wrist and why you should follow our advice for splinting, bracing or taping, activity restriction and therapy exercises.

The two most commonly injured ligaments in the wrist are the triangular fibrocartilage complex (TFCC) and the scapho-lunate ligament (SLL). These ligamentous structures have vastly separate roles and therefore they shouldn’t be treated in the same way.

The TFCC is a group of three ligaments and a cartilage pad. It plays a vital role in stabilising the part of the wrist that performs rotation of the forearm. An injury to the TFCC often causes pain on the little finger side of the wrist, particularly with twisting (such as turning taps) or gripping.

The scapho-lunate ligament has two parts and joins two of the small carpal bones of the wrist: the scaphoid and the lunate. This ligament is very important in making sure the wrist bones move the way that they were designed. An undiagnosed injury to the SLL may lead to serious wrist problems in the future. This injury causes pain in the middle of the wrist with gripping and when leaning on the hand.

After initial assessment to get a diagnosis, several therapy sessions will be required to monitor your recovery and progress your treatment. A custom-made orthosis or semi-rigid wrist splint may be required to rest the injury to allow healing. Gentle and very specific exercises will likely be started early in your rehabilitation and these will change and increase over time. You may also be given some unusual exercises such as using water in bottles or pipes or even rolling marbles on plates!

The most important thing is to get qualified treatment early, follow your treatment guidelines and commit to your recovery plan by dutifully doing prescribed activities and exercises or avoiding restricted activities.  It just might be the difference between a full recovery and partial recovery.  For more articles like this, like our Facebook page https://www.facebook.com/thehandrecoverycentre/ or visit our website for more details http://www.handrecovery.com.au/what-is-hand-therapy/ .

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It’s Not “Just” a Dislocated Finger…

Find out why a finger dislocation shouldn’t be treated lightly

Blog Post by Erika Lassig (BOcThy; MHSc(OT); Member AHTA)

If you follow the AFL, you’ll know that Brisbane Lions vice captain Tom Rockliff experienced a finger dislocation last month during their match against Richmond. But it’s no biggie because he won’t miss any matches, right? But hang on a second, the Lions team Head of Medical reported that the dislocation was accompanied by a small fracture near the joint and Rockliff has to wear a splint on the finger when he’s not playing. That sounds a bit more serious… but isn’t it just a dislocated finger?

Finger dislocations are extremely common in ball sports, in fact you may have had one or two yourself. All it takes is a fast-moving ball to hit the end of the finger and – ouch! It’s dislocated. Sometimes, it’s as simple as popping the finger back in, buddy strapping to the next finger and away you go. But often, it’s not so simple. It hurts. Ouch. The finger swells up. Gross. It becomes stiff. Uh-oh. You’re left with a permanently bent, clunky or stiff finger. What the?!. The more often you dislocate the same joint, the more easily it happens until it takes barely anything to pop it out of place. And then what? The only solution is surgical. Well that’s a real pain in the neck.

I’m here to give you some tips on why and how to prevent complications such as stiffness, deformity and recurrent dislocations. Because it may not be “just” a dislocated finger.

What to do – when it happens

When you or your team-mate dislocate a finger in a match, make sure it is only put back in by a qualified person. Jo Bloggs could cause more damage by reefing on your injured finger. If there isn’t someone qualified onsite, go to your local emergency department. An x-ray prior to popping the finger back in (known as reducing the dislocation) can actually be useful information for your treating therapist.

What to do – after reduction

It’s very important to get an x-ray after the dislocation has been reduced. This will tell you whether the joint is in the correct position, whether the joint is stable, and whether there had been any accompanying bony injury. Please do not skip this step! X-rays are bulk-billed so this will only cost you your time and may save you time, money, pain and a raft of problems down the track.

The finger should be splinted or buddy strapped to the neighbouring finger immediately after reduction. This is to prevent it popping out again as you may have torn some of the supportive tendons or ligaments.

What to do – week one

Armed with your x-ray in hand, visit your local hand therapy clinic as soon after your injury as you can, preferably within the first week. Be cautious of seeing other allied health or complementary medicine professionals. They do not have the in depth knowledge and experience for dealing with finger injuries. First and foremost, Hand therapy will arm you with information. It s so important for us to provide education about what has been injured, what to avoid to prevent further injury and what can be done to aid in a speedy recovery. A practitioner of hand therapy will be able to custom make a suitable splint to protect the finger from further dislocation, without immobilising any joints that do not need to be. A compression wrap to the finger will help to control the swelling, as persistent swelling is a major contributing factor pain and stiffness of the finger. Exercises. Yes, even though the finger will be painful, exercises are important in the first week. But not just any exercises, very specific exercises which are safe to do post dislocation, usually whilst wearing your custom-made splint.

What to do – week two and three

If you haven’t already, visit your local hand therapy clinic. Secondly, keep wearing your splint and complying with the prescribed treatment. This is an important time for the injured structures in your finger to keep healing. It’s normal for the finger to still be somewhat swollen and painful. This is important as swelling is part of the healing process and pain is an important reminder to be kind to your finger because it’s still healing.

What to do – Week 4

It’s likely that you will be able to stop wearing the splint most of the time but you still need to be careful with what you do as the finger is still healing. If you wish to play sport, you will need to strap the finger to the neighbouring finger to protect it from re-injury.

What to do – week 6 and beyond.

All being well your finger should be pretty much back to normal by this time. Some swelling and the odd twinge of pain may linger. Buddy strapping during sport is generally recommended until 12 weeks, but if you had some decent hand therapy and followed the expert advice, your injury will most likely be a distant memory from the time you had “just” a dislocated finger.

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Hollywood Hand Therapy

How to Get the Most Out of Your Hand Therapy

Blog post by Erika Lassig

Who doesn’t love a good flick? Action and thrillers are my favourite. My husband and I recently watched the latest Marvel instalment, Dr Strange. Have you seen it? Benedict Cumberbatch plays Dr Stephen Strange, an egotistical neurosurgeon who loses function in his hands following a horrific car accident. In his mind, Stephen is THE BEST at what he does. The loss of his ability to be a surgeon is so devastating that when he thinks medicine had “failed” him, he seeks to find healing from less conventional and bizarre sources. Thus ensues an entertaining film.  But haaaaang on! Stop the movie! Rewind! Let’s talk about this a bit more. As a person that manages hand injuries for a profession there are a few things wrong here. Some red flags. Let’s talk about how Stephen could have gotten better results out of his hand therapy.

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See a therapist who specialises in hand and upper limb rehabilitation

There was a therapy scene in the film. It was frightening, from a patient point of view and a therapist! What were those exercises? And that device he was using to exercise his fingers??? I have no idea. It’s certainly not what a hand therapy practitioner would prescribe. The hand is a very complex unit with many bones, ligaments, tendons, muscles, nerves and vessels. The function of the hand is also unique and remarkable and the best outcomes are achieved when your therapist has a thorough understanding of all of these factors. In Australia, to make sure your therapist has specialised training and experience in hand and upper limb rehabilitation, check that they are a full member of the Australian Hand Therapy Association (AHTA). Full membership can only be attained by an occupational therapist or physiotherapist with a minimum of 3000 hours experience and 500 hours training directly related to treatment of hand and upper limb injuries. A list of full members can be found at http://www.ahta.com.au/site/find-a-therapist.

Trust your surgeon and therapist

It was pretty clear that Dr strange didn’t trust his surgeon and therapist. He questioned everything. He gave them attitude. He was pretty unpleasant to be honest! I support patients asking questions, doing their own research and making an informed decision. It is a health care provider’s responsibility to explain to patients their options so that they can make their own decisions regarding health care. But keep in mind that we have a lot of knowledge and experience to draw on, have your best interests in mind and are doing our best for you. Find a surgeon and therapist that you like and trust and I promise you will get a better result.

Commit to your therapy for the long haul

I saw a lack of commitment from Dr Strange. It appeared to me he wanted a quick fix. The fastest route back to neurosurgery and his former life. Let me tell you a secret: there is no quick fix. No magic wand. No miracle pill. Sorry, but results come from commitment and hard work. Much like training for a marathon,  recovering from a hand injury is tough and sometimes painful. If you commit to doing your exercises several times a day, EVERY day, or as prescribed by your therapist, you can expect to see great results. The best way to remain motivated is to set goals. Goals that are specific, measurable, attainable, realistic and have a time frame. Have short term and long term goals. Also, find ways to fit your home exercise program into your daily schedule, make it a habit like your morning walk or taking your multivitamins. Schedule it in and set reminders on your phone. There’s a great App called RehabMinder that you can program to remind you to do specific exercises at specific times.

Keep a therapy diary

A therapy diary is a great way to document your goals and progress. When you become frustrated with your progress, look back to where you started to see how far you have come. This helps you to remain focused and motivated. I encouraged you to celebrate your successes, however small. For example, you can now hold a fork or no longer need your splint during the day. This will help you to remain positive when the obstacles seem too great to overcome.

Don’t get me wrong, I enjoyed the movie and if you’re a Marvel fan, you will too. It’s also a great lesson in what NOT to do when faced with a hand injury…

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