Good Gardening Practices

With summer finally here, the urge to get outside to build and maintain our beautiful gardens is one that most British Columbians can’t resist.

However, it’s important to remember that many injuries can result from this favoured past-time. Naturally one thinks of back and knee pain that can arise from all the bending and pulling that is synonymous with gardening but in actuality many of gardening’s repetitive movements like raking, weeding, digging and pruning can cause stress to the smaller muscles of the hands, wrists and arms.

According to one American study by the Consumer Product Safety Commission (CPSC), over 400,000 outdoor garden-tool-related accidents are admitted into Emergency rooms every year.

Some of the more common hand, wrist and arm injuries that can occur from gardening are;

• Carpal Tunnel Syndrome – Hand numbness and pain result from increased pressure on the nerve.

• Dequervain’s Tendonitis – This condition is a painful inflammation on the thumb side of the wrist.

• Golfer’s or Tennis Elbow – A painful inflammation occurs in the inside (Golfer’s elbow) or outside (Tennis elbow).

Gardeners everywhere should take the time to practice these tips to ensure pain-free gardening and to keep their favoured past-time an enjoyable one.

• Stretch – You wouldn’t run a marathon without stretching or warming up and your hands, wrists and arms are full of muscles that deserve the same attention, so remember to take the time to stretch and warm-up pre and post gardening.

• Always Wear Gloves – Not only will wearing gloves reduce blistering, but gloves will also help protect your skin from the fertilizers, pesticides, bacteria and fungus that can often be found in soil. Even the smallest cut or lesion can develop into a major infection when exposed to soil. If leather gloves are worn they can also offer protection from insect, rodent, or snake bites, poison ivy etc.

• Take Frequent Breaks – The hands small muscles are easily fatigued so it is important to vary garden tasks every 15 minutes or so and to have a brief rest period in between so that the same muscles are not over used during repetitive movements such as raking, digging, planting or pruning. You can also try alternating hand use to relieve discomfort during some of the repetitive movements.

• Use the Right Tool – Hands shouldn’t be used in place of a tool. Use a hoe instead of your hand when digging, this will also help you avoid any sharp buried objects or debris that may cause a laceration or puncture to your hand. Avoid tools with form-fitting handles or finger grips molded into the handle. More often than not these “form-fitting” molds will only fit one size of hand perfectly and will lead to pain, soreness and calluses in larger hands and reduced grip strength and pressure in smaller hands.

• Use the Right Tool the Right Way – Practise good “posture” with your wrist/hand when using garden tools. Try holding tools with your knuckles parallel to the handles. Try to maintain a neutral position with your wrist, avoiding odd angles, awkward wrist motions and constant forceful gripping. Maximum grip strength occurs when the wrist is in a relaxed or neutral position and a recent study by Fiskars® showed that people lose up to 25% of their grip strength when the wrist is bent.

For an assessment or to meet with a therapist call 604-520-7375 or visit www.handtherapycentres.com

Hello Trevor

I know, it's been a long time since my last visit for my left hand therapy session with you. 

I am sneding this card to thank you for being so kind, caring, patient with me.  I don't think I properly thanked you for all your help.  So I am doing so now.

My left hand healed, it happened gradually, I can bend it and do everything now.  I can even play piano again.  When I look back, I cannot believe, I was in such a challenging situation, but I survived it and all that nightmare is over now. 

I thought, you would like to know.  So, again, thank you very much for being such a wonderful hand therapist, but most of all for being very kind and caring, you are a gift to all people who go to you for help. 

All the best to you with your work. 

Sincerely,

AH

Why Does My Hand Hurt?

Arthritis is a serious chronic disease affecting the health of Canadians. In BC it is estimated that more than 547, 000 people have arthritis, of which more than 85,000 are severely limited in their daily activities. By 2026 the number of people estimated to have arthritis was 874,000, of which 122,000 will be severely limited in their daily activities. Osteoarthritis (OA), also known as degenerative arthritis or degenerative joint disease, is the most common type of arthritis affecting 10 percent of Canadians.

In its more serious forms, osteoarthritis leads to the destruction of joints, such as hips and knees, which may require expensive joint replacement surgery. OA is often referred to as a ‘wear and tear’ disease, because over time cartilage can weaken and break down, sometimes developing cracks and holes. Pieces of damaged cartilage then can break off and irritate the joints or tissues nearby. The joint pain and swelling associated with OA can make it painful and difficult to move.

The most common site for osteoarthritis is at the Carpometacarpal (CMC) joint of the thumb – that is, the joint at the base of the thumb and the bone the wrist. The ends of these bones are covered with cartilage, which acts as a cushion and allows them to move freely. OA destroys the cartilage surrounding the joint, causing joints to become inflamed, resulting in pain and restricting movement of the thumb across the palm.

The actual degenerative process of CMC osteoarthritis is not completely understood. While it is primarily a “wear and tear” process, there are other factors that play a role in degenerative arthritis. These include previous trauma or injury, repetitive stress over long periods of time, laxity or looseness of the joint secondary to hormones or just the aging process. Muscle imbalance in the thumb may also be a contributing factor to CMC osteoarthritis. An imbalance can lead to poor control over the joint causing it to move at a slightly incorrect angle or rotation. If the joint is not stabilized properly it can rub or glide the wrong way causing the surrounding tissue to become inflamed and activate the degenerative process.

People developing osteoarthritis at the base of the thumb usually first notice pain associated with pinching activities such as turning keys or opening car doors. Simple activities such as holding eating utensils or a glass of water can be too pain to perform. Tenderness in the fleshy thumb muscle or over the joint may also be experienced and there may be an aching discomfort at the base of the thumb following heavy use or with weather changes.

As the disease progresses and more joint cartilage is lost, less stress on the thumb is necessary to produce pain. People will often avoid using the thumb for those activities that produce pain and over time this disuse can to lead weakness, muscle loss and a tendency to drop things. The pain can be so unbearable that it interferes with one’s quality of life at times indicating surgical intervention.

Fortunately, therapy has been an effective treatment for the relief of symptoms for CMC joint pain. Treatment initially begins with splinting the thumb in a comfortable position in order to put the thumb at rest and prevent the arthritic joint from moving. Splint treatment usually at night is often quite effective at decreasing the pain associated with CMC osteoarthritis. It is important that the splints used for this condition extend well up on the thumb as most commercially available, “drug-store” wrist splints leave the thumb free and may actually worsen the discomfort at the base joint. For this reason it is considered beneficial to have a custom made splint prepared by a trained health professional such as an occupational therapist or certified hand therapist.

Other conservative treatments include modalities such as ultrasound to reduce inflammation and pain, educating the patient on joint protection techniques, and work simplification. Anti-inflammatory medications may be also helpful, while a cortisone injection into the arthritic joint has been proven to be an effective non-surgical treatment in relieving pain.

When these conservative methods of treatment are no longer beneficial to the patient, surgery may be necessary. The most important goal of surgery is to eliminate the pain at the base of the joint of the thumb. Surgery may be performed in several ways according to the personal preference of the surgeon. In some instances, surgery is necessary to improve the position of the thumb, range of motion, and to improve strength for pinching and grasping.

Following surgery, patients are often referred to hand therapy for rehabilitation. Exercises designed to stretch and strengthen structures stabilizing the thumb is considered to be the best approach to treating post surgical pain, swelling, and movement limitations. As these restrictions gradually resolve within three to six months most patients experience complete, or near-complete pain relief along with recovery of range of motion.

For more information or to book an appointment with a Certified Hand Therapist, visit us at www.handtherapycentres.com or cal 604-941-3055.

Thank You Trevor & Monica

Thank you for giving me the opportunity to work here at Guildford Hand Therapy.  I appreciate the patience & advice you've granted me.  The challenges from working here have made this experience very rewarding.  Good luck with everything and the New West centre!

Liz

Sciatica

Leg Pain
The doctor of the future will give no medicine, but will interest patients in the care of the human frame, in diet, and in the cause and prevention of disease. – Attributed to Thomas Edison

What is Physiotherapy?
Physiotherapy is a natural method of healthcare that treats the causes of physical problems, such as low-back, hip and leg pain, rather than just the symptoms. Physiotherapy is based on a simple but powerful premise: With a normally functioning spine and nerves and a healthy lifestyle, your body is better able to heal itself. That’s because the spinal cord, which is protected by the spine, is the main pathway of your nervous system. The nervous system controls movement, feeling and function throughout your body.

What causes Sciatica?
Sciatica is an inflammation of the sciatic nerve, the longest nerve in your body. It runs from your lower spine, through your buttocks and into your leg and foot. When the sciatic nerve is inflammed it can cause numbness, tingling, pain or weakness in your lower back and leg.

• Inflamed Joint - If a bone (vertebra) in your lower back isn’t moving properly or is out of position, the joint can become inflamed and irritate the sciatic nerve.

• Bulging Disc - If one of the cushions (discs) between your vertebrae is bulging, it can irritate or put pressure on the sciatic nerve.

• Muscle Spasm - If a muscle in your lower back or buttocks is inflamed or tightening (in spasm), it can irritate or put pressure on the sciatic nerve.

Can Physiotherapy Care Help Me?
Your physiotherapist looks at your overall health – focusing not only on your sciatic but also on your lifestyle. This total approach to wellness helps determine the best treatment for your problem.

History
To help find the cause of your sciatica, you and your physiotherapist discuss your symptoms, such as where you feel pain. Your physiotherapist also asks about any prior injuries, your health history and your lifestyle, including work related and leisure activities.

Physical Exam
Physical, orthopedic (bone and muscle), and neurological (nerve) tests can help reveal the condition of the vertebrae, discs and muscles in your spine. Your physiotherapist gently touches and moves your spine to locate muscle spasms and pain and to see how well each vertebra moves.

Tests
X-rays may be done to reveal any problems with your vertebrae. If needed other imaging tests, such as an MRI (magnetic resonance imaging), may be used to show detailed images of discs, nerves and other soft tissue.

Diagnosis
Based on the results of your exam and tests, you physiotherapist may recommend a treatment program to relieve the irritation that’s causing your pain and other symptoms. If needed, your physiotherapist also consults with your referring or family doctor.

How Does a Physiotherapist Treat Sciatica?
Your physiotherapist is trained to restore the health of your spine and sciatic nerve. Special physiotherapy methods may relieve the irritation that’s causing your low-back or leg pain.

Spinal Adjustments
Your treatment depends on the cause of your sciatica. During a spinal adjustment, your physiotherapist gently presses on your spine to relieve irritated nerves and increase movement in your joints.

Related Treatment
Your physiotherapist may suggest other types of treatment to relieve irritated nerves. These may include electrical stimulation, ice or heat, massage, traction or ultrasound. Your physiotherapist can discuss these options with you.

What Can I Do to Keep My Back in Shape?
Whether you’re lying down, standing or sitting, keep your spine straight and well supported. Be sure to follow the exercise program your physiotherapist gives you.

To help mold and align your spine, lie down for 15-20 minutes a day with a small pillow or small rolled-up towel under your neck and lower back. Keep your knees slightly bent. Check with your physiotherapist before trying this.

Spinal Checkups
Just as you need regular dental exams, you also need regular spinal exams. Even if you don’t have symptoms, physiotherapy is one of the best ways to manage or prevent spinal problems and maintain a healthier lifestyle.

Call today to schedule your appointment 604-520-7375or visit our website to see all our locations http://www.physiotherapycentres.com/

The Right Posture and Position

Always be aware of how you’re sitting. If you slouch or you reach to far, you may start to feel stiff or sore. When a workstation is arranged to create a fit between you and your body (good ergonomics), using proper posture is easy. The right posture means sitting in a relaxed, well-supported position. Here’s how:

Start in the position described below. Then shift your position often by learning slightly back or forward with your lower back and feet supported.

1. Keep your head and neck upright.


2. Keep your wrists straight and your forearms parallel to the floor.


3. Support your lower back.


4. Keep your feet flat on the floor or support them with a footrest.

Comfort Tips

Adjust the chair’s height so your forearms are parallel to the floor as you work. Adjust the chair’s backrest until it fits snugly against your lower back. Or, use a small pillow, a lumbar roll, or a rolled towel.

Adjust the monitor so that it’s an arm’s length away and the top of the screen is just below eye level. Tilt it slightly down or sideways, if needed, to prevent glare.

Change your position often. Lean back or forward a little in your chair. Take breaks when you can to stretch or walk. Try not to spend more than 20 minutes in the same position.

TRIGGER FINGER FAQ

TRIGGER FINGER FAQ


1. What is trigger finger?

The first sign of trigger finger is a feeling of stiffness and difficulty bending the finger. There may be swelling in the palm, Later, as the symptoms increase, the finger may “get stuck” in a bent position and have to be straightened with the help of the other hand. When the finger does move, it may snap, as it becomes “unstuck.”

2. Why does it happen?

The tendon that bends the finger passes through a pulley, much like a tunnel. If the tendon becomes enlarged by inflammation, it cannot pass trough this tunnel freely. A nodule, or bump, may form on the tendon making it even more difficult for the tendon to glide and causing stiffness and pain. When the nodule must pass under the pulley, it may stop or stick. It can be compared to trying to pass thread that has a knot in it through the eyes of a needle.

3. What causes the tendon to be inflamed?

Repetitive use of the hands may make trigger finger worse, but it has not been proven to be a cause of the inflammation. The cause is not certain, though it is most common in middle-aged women. Diabetes and rheumatoid arthritis may increase the chance of getting a trigger finger.

4. What can be done to help?

With a mild case, simply resting the finger may relieve the symptoms. Grasping and other painful activities should be avoided. A splint can be used to keep the tendon at rest. Wearing the splint and avoiding grasping for a period of time may be enough to relieve the symptoms.


If the symptoms are more severe and the finger is frequently getting “stuck”, a physician may recommend a steroid injection. The steroid can decrease the inflammation and therefore, the size of the tendon and nodule. This allows the tendon to move through the sheath more freely.

5. What about surgery?

Surgery is recommended when injections and conservative treatments fail to relieve symptoms. In surgery, a small incision is made in the palm. The pulley is cut to allow the tendon to glide. The incision will be covered with a dressing for a few days. Full, comfortable motion is allowed. It is important during this recovery time to elevate the hand as much as possible to decrease swelling. There will be a scar on the palm. This can be softened and made more comfortable by massage.

Recovery form trigger finger surgery usually takes only a few wee

Common Indications for a Static 90 degree Elbow Splint

Static 90 degree Elbow Splint • Lateral or medial epicondylitis • Humerus/ foreman fracture • Repair of high median nerve laceration • Anterior transportation of the ulnar nerve • Elbow arthroplasty • Radial nerve repair (proximal to the elbow) • Ulnar nerve transposition • Repair of high ulnar nerve laceration • Elbow flexion contracture release (Often places volarly and increased serially into extension) • Ulnar neuropath • Radial-ulnar dislocation • Post nerve repair • Post trauma • Cubital tunnel release • Tendon transfer • Acute ulnar neuritis These suggestions are not meant to provide an absolute regimen for splinting. Each individual’s condition in unique, and each individual must be evaluated and treated based on his or her medical history and specific current condition.

Common Indications for a Anti- Spasticity Ball Splint

Anti- Spasticity Ball Splint • Upper motor neuron lesions resulting in mild to moderate spasticity Cerebral vascular accident Traumatic brain injury Cerebral Palsy

Common Indications for a Functional Position Splint

Functional Position Splint • Traumatic brain injury • CVA • Acute traumatic hand injury • Spinal cord lesion • Flaccid upper extremity • Brachial plexus injury • Arthritis

Common Indications for a Resting Pan Mitt Splint

Resting Pan Mitt Splint • Edema • CVA • Traumatic brain injury • Arthritis • Burns • Crash injury

Common Indications for Gauntlet Thumb Spica Splint

Gauntlet Thumb Spica Splint • Gamekeepers thumb • Sprain or dislocation • Injury affecting opposition • Degenerative rheumatoid arthritis or the CMC joint • Web spacer • Tenosynovitis

Common Indications for Wrist and Thumb Spica Splint

Wrist and Thumb Spica Splint • Scaphoid fracture • Radial or ulnar collateral ligament strain • Thumb replantation/revascularization • Degenerative rheumatoid arthritis of the joint • Reconstruction of the thumb MP joint • Gamekeeper’s thumb (Chronic ulnar collateral ligament injury) • Skier’s thumb (acute ulnar collateral ligament injury of the thumb MP joint) • Sprain or dislocation of the thumb • Tendon transfer • Trapezial replacement arthroplasty • Painful basilar joint arthritis • Web spacer

Common Indications Dorsal Wrist Cock-Up Splint

Dorsal Wrist Cock-Up Splint • Indications similar to those for volar wrist cock up splint • Patient with wound, graft, or sutures on volar surface • Patient who requires sensory surface free • Base for dynamic splint • C5-6 incomplete cord lesion

Common Indications for Static Splints

Volar Wrist Cock-Up Splint • Carpal Tunnel Syndrome • Synovectomy • Carpal Tunnel arthroplasty • Tensynovitis • Carpal implant arthroplasty • Post fracture • Ganglion cyst • Radial nerve palsy • Non-displaced metacarpal fractures (proximal base) • Post Colles’ fracture (6 weeks) • Post Carpal fracture • Extensor tendinitis • Lateral epicondylitis • Post wrist fusion • Wrist muscle weakness • Arthritis • Wrist sprain

Why Does My Hand Hurt?

Have you ever felt pain when you performed everyday activities such as turning keys or opening car doors? Ever wonder why simple activities such as holding eating utensils or a glass of water too painful to perform? Or have you felt tenderness in the thumb muscle or over the joint and an aching feeling at the base of the thumb following heavy use or with weather changes? One common cause of such pains is osteoarthiritis (OA) of the base of the thumb. This is called the Carpometacarpal (CMC) joint, which is the joint between the base of the thumb and the wrist. OA destroys the cartilage surrounding the join, causing it to become inflamed, resulting in pain and restricting movement of the thumb. The actual degenerative process of CMC osteoarthritis is not completely understood. While is it primarily a “wear and tear” process, there are other factors that play a role in the degenerative arthritis. These include previous trauma or injury, repetitive stress over long periods of time or just the aging process. Muscle imbalance in the thumb may also be a contributing factor to CMC osteoarthritis. An imbalance can lead to poor control over the joint causing it to move at a slightly incorrect angle or rotation. If the joint is not stabilized properly it can rub or glide the wrong way causing the surround tissue to become inflamed which stimulates the degenerative process. An exercise program designed by a certified hand therapist may be helpful in restoring muscle balance of the CMC joint. An osteoarthritis progresses and more joint cartilage is lost, less stress of the thumb is necessary to produce pain. People will often avoid using the thumb for those activities that produce pain and over time this disuse can lead to weakness, muscle loss and tendency to drop things. The pain can be so unbearable that it interferes with one’s quality of life at times. Fortunately, therapy has been an effective treatment for the relief of symptoms of CMC joint pain. Therapy may include ultrasound to reduce inflammation and pain. Patient education about joint protection techniques helps one to resume favorite sports and hobbies. For the acute joint, splints in addition to anti-inflammatory medications may be helpful. Splinting the thumb in a comfortable position can be helpful to put it at rest and alleviate the pain associated with CMC osteoarthritis. Certified hand therapists are trained to assess your hand and determine the most appropriate splint for your particular problem. Although there are several style of commercial designed splints available, they often don’t fit “quite right” and the cost is not usually covered through Extended Health Care Benefits (EHC). A custom splint, fabricated by your certified hand therapist is designed to fit your particular hand, and is reimbursable through EHC. Any additional cost may also be used as an income tax deduction. When these conservative methods of treatment are not longer beneficial to the patient, surgery may be necessary. The most important goal of surgery is to eliminate the pain at the base of the joint of thumb. Surgery may be performed in several ways according to the personal preference of the surgeon. In some instances, surgery is necessary to improve the position of the thumb, range of motion and to improve strength for pinching and grasping. Following surgery, patients are often referred to hand therapy for rehabilitation. Exercises designed to stretch and strengthen structures stabilizing the thumb is considered to be the best approach to treating post surgical pain, swelling, and movement limitations. As these restrictions gradually resolve within three to six months most patients experience complete or near complete pain relief along with recover of range of motion. For more information about osteoarthritis, please contact our one of our clinics, you will find out locations at www.handtherapycentres.com. We will be happy to arrange a clinic tour or to provide you with more information about our services.

Dupuytren’s Contracture

Introduction Dupuytren’s contracture is a thickening of deep tissue (fascia) which passes from the palm into the fingers. Shortening of this tissue causes “bands” which pull the fingers into the palm. The cause of this is unknown but it tends to run in families. The condition is progressive and the only treatment is surgery. If untreated, the fingers will be gradually pulled into the palm. Fasciectomy Your Dupuytren’s contracture will be corrected by removal of the abnormal fascia and relaxation of the overlying skin. The entire wound is stitched up in a zigzag manner which lengthens it but occasionally, a segment of the wound in the palm is not stitched, being left open to heal by itself (open-palm technique). Dermofasciectomy In some situations it is necessary to also remove the overlying skin if it is affected by the disease or previous operation. Amputation Very rare in unoperated cases but may be preferred in a finger in which the bands have returned many times and where there has been previous nerve and vessel damage. Post-Operative Care  Hand elevation is important to prevent swelling and stiffness of the fingers. Remember not to walk with your hand dangling, or to sit with your hand held in your lap.  You will be initially placed in a bulky dressing consisting of gauze, plaster of paris and tensor bandage to rest the hand. The dressing will be removed after 3-5 days and then be left open at this stage, if possible, to allow mobilization of the fingers. The open-palm technique usually requires dressing to be applied to the palm for 2-3 weeks while mobilization is performed in the usual way.  At this time, you will see a hand therapist who will fit you with a splint and give you specific exercises to perform. The splint is to be worn at night for 6-12 weeks to keep the finger straight. During the day, the hand should be exercised and you should perform normal light activities. You may require ongoing therapy for range of motion and strengthening.  Your stitches will be removed one to two weeks after the operation. Following this the scar will be somewhat firm to touch and tender. This can be helped by firmly massaging the area with moisturizing cream. At this stage it is safe to get the hand wet in the bath or shower. The scar and the surrounding skin often become very dry and will be more comfortable if a moisturizer is applied, including the scar itself.  A Hand Therapist will see you for scar management. It is often not possible to fully straighten fingers that are very bent at the time of the operation, particularly if much of the bend occurs in the middle joint of the finger. This can sometimes be improved with splinting and exercise later after the operation. Duputren’s contracture can return either at the site of surgery or else where in the hand.  You can usually drive a car a couple of weeks as long as you are comfortable and have regained good finger movements. Timing of your return to work is variable according to your occupation and this should be discussed. Please call the Office or your Family Doctor if:  The prescribed medication does not provide adequate pain relief  The dressing/cast is too tight or uncomfortable  Numbness persists  You have a fever Risks of Surgery Nerve Damage The nerves running to the fingers can be damaged during the surgery and cause numbness in part of the finger. This complication is unusual in unoperated areas but becomes more common during repeat operations. If this occurs the nerve would be repaired immediately, if possible. Infection Any operation can be followed by redness and tenderness which may indicate infection. Do not apply antiseptics. It would be treated with antibiotics.