Wednesday, September 28, 2011
Introduction to Pain
No-one really wants pain. Once you have it you want to get rid of it. This is understandable because pain is unpleasant. But the unpleasantness of pain is the very thing that makes it so effective and an essential part of life. Pain protects you, it alerts you to danger, often before you are injured or injured badly. It makes you move differently, think differently and behave differently, which also makes it vital for healing. It is usually really sensible to hurt.
Wikipedia describes Pain as:
" Pain is an unpleasant sensation often associated with damage to the body. It is the feeling common to such experiences as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone" and is caused by activation of specialized pain-signaling nerve fibers or by damage or disease affecting the somatosensory nervous system."
www.handtherapycenters.com
Wednesday, September 14, 2011
Mallet Finger
The extensor tendon of the finger can become injured, usually through a sudden forced flexion of the distal interphalangeal joint (DIP), for example, when a ball hits the tip of a finger.
The common presentation of this injury is an individual who can not straighten (extend) the DIP joint of a finger. There may or may not be associated pain and swelling at the DIP joint. In fact, it is not uncommon for a person to remark how they didn’t know the finger had been injured until it was noticed that it could not be fully straightened.
On x-ray, there may be an associated avulsion fracture where the terminal extensor tendon joins onto the distal phalanx, known as a “bony mallet”. When there is no fracture, it is referred to as a “soft tissue mallet”.
The accepted treatment for either a bony or soft tissue mallet injury is positioning of the DIP joint of the finger in slight hyper-extension for a minimum of 6 uninterrupted weeks, but optimally 8 weeks uninterrupted. This is best achieved through provision of a custom fitted thermoplastic splint. Although the “stax splints” are readily available, the fit is often not acceptable, not extending the DIP joint sufficiently, or interfering with full PIP joint motion. The alumifoam splints can position the DIP more carefully, but can create skin maceration from excess moisture collection.
The Certified Hand Therapists at the Hand Therapy Centres (www.handtherapycentres.com) treat many clients with mallet injuries. Evidence shows that the following needs to be in place to result in the best outcome from this injury:
1. If patients are sufficiently educated about their injury they will be more likely to comply with the exacting splinting regime.
2. Custom splints need to be comfortable, adequately position the finger and allow for the individual to participate in work and leisure activities.
3. Finally, monitoring of the patient while they are weaning out of the splint minimizes the risk of the extensor lag from re-occurring.
Secondary complications of poor management include:
• Swan neck deformity;
• Continued pain;
• Patient unhappy with range of motion;
The best results occur when treatment is started promptly, within a few days of injury. However, full functional range of motion of the DIP has been restored in some patients even when treatment has been delayed for several months.
On average, patients attend three sessions for treatment of mallet finger injuries, (once for the initial splinting and patient education; at 6 or 8 weeks of splinting to start the weaning process and final visit during the end of the weaning process to ensure an excellent outcome). The total cost of these visits is reimbursable from most extended care insurance plans.
If you have any questions in regards to the treatment of Terminal Extensor Injuries, pleas feel free to contact us and speak to one of our Certified Hand Therapists.
The common presentation of this injury is an individual who can not straighten (extend) the DIP joint of a finger. There may or may not be associated pain and swelling at the DIP joint. In fact, it is not uncommon for a person to remark how they didn’t know the finger had been injured until it was noticed that it could not be fully straightened.
On x-ray, there may be an associated avulsion fracture where the terminal extensor tendon joins onto the distal phalanx, known as a “bony mallet”. When there is no fracture, it is referred to as a “soft tissue mallet”.
The accepted treatment for either a bony or soft tissue mallet injury is positioning of the DIP joint of the finger in slight hyper-extension for a minimum of 6 uninterrupted weeks, but optimally 8 weeks uninterrupted. This is best achieved through provision of a custom fitted thermoplastic splint. Although the “stax splints” are readily available, the fit is often not acceptable, not extending the DIP joint sufficiently, or interfering with full PIP joint motion. The alumifoam splints can position the DIP more carefully, but can create skin maceration from excess moisture collection.
The Certified Hand Therapists at the Hand Therapy Centres (www.handtherapycentres.com) treat many clients with mallet injuries. Evidence shows that the following needs to be in place to result in the best outcome from this injury:
1. If patients are sufficiently educated about their injury they will be more likely to comply with the exacting splinting regime.
2. Custom splints need to be comfortable, adequately position the finger and allow for the individual to participate in work and leisure activities.
3. Finally, monitoring of the patient while they are weaning out of the splint minimizes the risk of the extensor lag from re-occurring.
Secondary complications of poor management include:
• Swan neck deformity;
• Continued pain;
• Patient unhappy with range of motion;
The best results occur when treatment is started promptly, within a few days of injury. However, full functional range of motion of the DIP has been restored in some patients even when treatment has been delayed for several months.
On average, patients attend three sessions for treatment of mallet finger injuries, (once for the initial splinting and patient education; at 6 or 8 weeks of splinting to start the weaning process and final visit during the end of the weaning process to ensure an excellent outcome). The total cost of these visits is reimbursable from most extended care insurance plans.
If you have any questions in regards to the treatment of Terminal Extensor Injuries, pleas feel free to contact us and speak to one of our Certified Hand Therapists.
Tuesday, August 30, 2011
Thank You Very Much
I'd like to thank you guys for taking me under your wing for the past 5 weeks. It's been a great learning experience in an incredibly interesting field. I'm sure I've seen some things I will never get a chance to witness again. But also, I've learned from the experts in the field how to manage some of the more common upper limb injuries I'll be sure to come across again. It was a challenging and rewarding placement, so I appreciate all of your time, effort and patience which helped make it so good. All the best to everyone on the team.
Joe
July 2011
Joe
July 2011
Wednesday, August 10, 2011
What is CMC Arthritis
In the thumb, the most common area of arthritis is at the base of the thumb, known as the CMC joint. Symptoms may include swelling, pain, redness, “crepitus” or creaking, and enlargement of the joint.
As the process progresses, the muscles may eventually overpower the weakening joint, pulling the thumb into the palm. This will decrease the ability to pinch, greatly affecting the function of the hand.
There are many hand therapy options including education, acute symptom control, chronic pain management, joint protection techniques, personalized exercises, and customized splinting. The combination of splinting, and learning management techniques will make a significant difference in functional levels.
A steroid injection to the joint may be recommended.
For badly damaged joints, remarkable surgeries are now offered which can rebuild the CMC joint. Therapy is offered following joint replacement surgery to protect the thumb during healing and to safely begin moving and strengthening.
www.handtherapycentres.com
As the process progresses, the muscles may eventually overpower the weakening joint, pulling the thumb into the palm. This will decrease the ability to pinch, greatly affecting the function of the hand.
There are many hand therapy options including education, acute symptom control, chronic pain management, joint protection techniques, personalized exercises, and customized splinting. The combination of splinting, and learning management techniques will make a significant difference in functional levels.
A steroid injection to the joint may be recommended.
For badly damaged joints, remarkable surgeries are now offered which can rebuild the CMC joint. Therapy is offered following joint replacement surgery to protect the thumb during healing and to safely begin moving and strengthening.
www.handtherapycentres.com
Tuesday, June 14, 2011
Continuous Education 4th WEEK for SOMATOSENSORY REHABILITATION 5-8 March 2012
4th Week for Somatosensory Rehabilitation
5th - 8th March 2012
Somatosensory Rehabilitation Centre
Switzerland, Europe
We have the pleasure to announce the 4th Week for Somatosensory Rehabilitation:
A course in English about the rehabilitation of the cutaneous sense disorders.
This rehabilitation is based on the principle that: most patients suffering from chronic pain have cutaneous sense disorders. A decrease in the hypoaesthesia will at the same time cause a decrease in their chronic neuropathic pain.
The course, which will be taking place in March 2012, in Switzerland, will consist in theoretical and practical aspect of the Somatosensory Rehabilitation. It has been taught for the past ten years in French and in German.
This course is opened to the graduate therapists (occupational therapists, physical therapists, etc.) and the medical doctors.
Yours sincerely
Claude Spicher, BSc OT, Swiss certified HT, Head & therapist in the Somatosensory Rehabilitation Centre, Scientific collaborator: http://www.unifr.ch/neuro/rouiller/collaborators/spicher.php
Rebekah Della Casa, OT, ST certified HELB, assistant manager and therapist in the Somatosensory Rehabilitation Centre
Isabelle Quintal, BSc OT, therapist in the Somatosensory Rehabilitation Centre
5th - 8th March 2012
Somatosensory Rehabilitation Centre
Switzerland, Europe
We have the pleasure to announce the 4th Week for Somatosensory Rehabilitation:
A course in English about the rehabilitation of the cutaneous sense disorders.
This rehabilitation is based on the principle that: most patients suffering from chronic pain have cutaneous sense disorders. A decrease in the hypoaesthesia will at the same time cause a decrease in their chronic neuropathic pain.
The course, which will be taking place in March 2012, in Switzerland, will consist in theoretical and practical aspect of the Somatosensory Rehabilitation. It has been taught for the past ten years in French and in German.
This course is opened to the graduate therapists (occupational therapists, physical therapists, etc.) and the medical doctors.
Yours sincerely
Claude Spicher, BSc OT, Swiss certified HT, Head & therapist in the Somatosensory Rehabilitation Centre, Scientific collaborator: http://www.unifr.ch/neuro/rouiller/collaborators/spicher.php
Rebekah Della Casa, OT, ST certified HELB, assistant manager and therapist in the Somatosensory Rehabilitation Centre
Isabelle Quintal, BSc OT, therapist in the Somatosensory Rehabilitation Centre
Tuesday, May 31, 2011
Clinical Tidbits
Clinical Tidbits
Studies show that hydrotherapy is a valuable tool in improving physical aspects (e.g., joint tenderness) of patients with rheumatoid arthritis.
Clinical studies of osteoarthritic knee patients reveal 20% to 40% relief of symptoms after only two to three clinical treatments of manual therapy and exercise.
Physical therapy may delay or defer the need for total joint replacement and represents a cost-effective way to improve patient function.
Studies show that hydrotherapy is a valuable tool in improving physical aspects (e.g., joint tenderness) of patients with rheumatoid arthritis.
Clinical studies of osteoarthritic knee patients reveal 20% to 40% relief of symptoms after only two to three clinical treatments of manual therapy and exercise.
Physical therapy may delay or defer the need for total joint replacement and represents a cost-effective way to improve patient function.
Wednesday, May 25, 2011
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 weeks.
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 weeks.
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