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All Posts Tagged: post surgical hand rehab

Don’t ignore a droopy finger. All you need to know about “Mallet Finger”

Blog post by Erika Lassig

A common fingertip injury occurs when something hits the end of a straight finger forcing it to bend. Often, it’s a ball when playing sport! Afterwards the end joint of the finger doesn’t straighten properly. The resulting drooping fingertip looks a bit like a mallet or hammer, so we call it “Mallet Finger”.

The fingertip droops because the tendon that straightens the end joint is no longer attached to the bone and can’t do its job. Mallet finger can be either a direct tear to the tendon or, more commonly, a piece of bone that is attached to the tendon fractures away. Unfortunately, the problem won’t fix itself and if it’s ignored it can cause long-term pain, stiffness and deformity of one or both finger joints.

 

If you have a suspected mallet finger injury the first step is to visit your GP for an x-ray. This helps to determine whether there has been a bony injury or tendon injury. In rare cases a relatively large piece of bone breaks off, disrupting the joint entirely and requires surgery to correct the joint alignment. In most cases, there is only a small piece of bone or a tendon injury and this can be treated very effectively with hand therapy. Results are always better if you get treatment as soon as possible. If treatment is delayed by more than three months, it may be impossible to correct the problem and the joint may have to be surgically fused.

Early treatment with hand therapy is very simple! A custom-made splint that holds the tip of the finger very still must be worn continuously for six to eight weeks. It is very important NOT to bend the fingertip at all, not even once, for at least six weeks. If you do, the immobilisation period is reset to day one and you will need to be held in the splint for a further six weeks. Your treating therapist will show you how to safely wash the finger and reapply the splint without bending the fingertip. You will also be given gentle exercises for the middle finger joint to prevent it from getting stiff.

After six to eight weeks in the splint full-time, a gradual weaning process occurs under the guidance of your therapist. It is important that you do not return to sport or manual work without the splint on for 12 weeks after treatment commenced or else you are at risk of re-injuring the finger.

Don’t ignore a drooping finger, the treatment is simple and very effective if started as soon as possible. So don’t delay, if you’ve got any of the above symptoms takes steps towards your recovery and book in with an accredited hand therapist today!

 

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Recovering from a Broken Wrist. Getting your plaster off is just the beginning…

Blog post by Erika Lassig

A broken wrist is a common childhood injury. Four weeks in plaster and then everything is ok again. Most of us think it will be the same story for an adult, however that isn’t true. Whilst a broken wrist is also a common injury for an adult, unfortunately the recovery is not so easy. After the initial six weeks in plaster, your wrist and hand need a lot more time and work to get back to your pre-injury activities.

A broken wrist is usually a fracture of the distal radius, that is a break in the end of the forearm bone on the thumb side at or near the wrist joint. In older people, this can be caused by a simple fall, whereas in younger people this is usually caused by motor vehicle or sporting accidents. An American study published in 2009 (Ehsan & Stevanovic) estimated women as having a 15% chance of having a wrist fracture in their lifetime, whereas men have a 2% chance of a wrist fracture in their lifetime. An Australian study published in 2001 (Nguyen, Sambrook & Eisman) reported women to be four times more likely to fracture their distal radius than men.

Stiffness and weakness of the wrist AND hand are the most common problems after coming out of plaster, whether the fracture was treated in a cast or required a surgical fixation. Most people also experience some degree of swelling and pain, but this varies greatly from person to person. It is also important to consider that in the early days after the plaster comes off, whilst the bone has healed enough to allow movement and some light everyday hand use, it hasn’t healed to it’s full strength and this is likely to take at least 3 months after the injury.

The therapist’s role is not only to prescribe exercises and materials for therapy but help you to understand the healing process and what activities are safe to commence at what time. This helps to prevent re-injury and unnecessary pain and frustration. It is a lengthy process the but investment of time and energy into your hand therapy regime will pay off in the future.

All images used in this post are courtesy of  www.meandmytravelbugs.com

References:

Nguyen, T.V., Sambrook, P. N., & Eisman, J.A. (2001) Risk factors for proximal humerus, forearm, and wrist fractures in elderly men and women: The Dubbo osteoporosis epidemiology study American Journal of Epidemiology, 153(5): 587–595.

Ehsan, A. & Stevanovic, M. (2009) Skeletally mature patients with bilateral distal radius fractures have more associated injuries Clinical Orthopaedics & Related research 468(1): 238-242.

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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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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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