Tuesday, June 02, 2015 Specialists on Hand
Winter sports season is upon us and most sporting people will be familiar with the pain of a ball hitting their finger the wrong way! You may have bent it back into position, strapped it up and kept playing or left the field for the ice pack immediately. So what can you damage when a ball hits your finger and what should you do?
Finger and thumb sporting injuries can affect various structures in the finger; ligaments - which join bone to bone, tendons - which join muscle to bone; the bone itself, or a combination of these. Joint injuries can occur at either joint of the finger, the Proximal Interphalangeal Joint (PIPJ or middle joint) or the Distal Interphalangeal Joint (DIPJ or end joint). The middle joint of the thumb (MCPJ) is also commonly at risk.
The DIPJ has tendons inserting on both sides to flex and extend the fingertip. Injuries at this joint include:Mallet finger - This injury occurs when a ball hits the tip of the finger and the finger hyper flexes. It can avulse the bone or the tendon at top of the finger and the finger may present with a bent tip. Though not always painful treatment is essential to prevent deformity and includes 6 weeks at least in a splint.
Jersey finger - if the finger is struck in the other direction, or caught on a player’s shirt “Jersey finger” the tendon and bone on the volar or front side of the fingertip may avulse. This results in difficulty bending the finger tip. These injuries require surgery and therapy and must be commenced immediately thereafter.
At the middle of the finger is the Proximal Interphalangeal Joint. This joint is like a box surrounded by stabilising ligaments, a volar plate and dorsal tendon. If a ball hits this joint the surrounding structures can be damaged causing a range of potential fractures, deformities and instabilities in the finger.
Volar plate injury - This occurs when the finger is bent backward too far. You may or may not see it dislocate. The ligamentous structure on the front side of the finger is damaged perhaps with or without a bone avulsion. These injuries require therapy with splinting and specific targeted exercises for 6-8 weeks.
Central slip injury - If bent too far forward a central slip injury may result and you may not be able to straighten your finger. Splinting with your therapist is essential to prevent a deformity developing.
Gamekeepers/Skiers thumb – when the thumb is pulled to far away from the hand the ligament joining the bones may be damaged or ruptured. This was often seen in rifle shooters (gamekeepers) with skiers where the pole can pull their thumb out too far. A ligament injury at this joint can be of varying severity. If minor, a period of splinting will assist return of thumb function. If the thumb is dislocated the ligament may be ruptured and require surgical repair.
Many other combinations of ligament, tendon and bone injuries are possible in the fingers and thumb. Many fractures and bony breaks are possible in addition to these joint, ligament and tendon injuries and will require early management to prevent long term complications including pain, arthritis and deformity.
If you notice your finger dislocate with and there is an obvious change in shape do not keep playing. If you have a sharp pain do not keep playing. You have likely damaged one of the complex structures in the finger. Strapping it is not enough.
RICE: Rest the finger and apply and ice pack. Gentle compression will assist and elevation with aid resolving the swelling. Making a prompt appointment with your Occupational Therapist at Specialist on Hand will assist in evaluating the damage you have done to your finger. An X-ray may be required and your therapist can arrange this for you. You may also like to visit your GP for review.
Most finger injuries are managed in a splint to immobilise or protect the damaged structures for up to 6-8 weeks. Your therapist will progress a graded movement programme throughout this time to restore your movement and get you back on the sporting field.
Playing on, pushing through pain and leaving your finger injury untreated can result in a permanently painful, deformed or unstable finger.
Leaving you off the field for longer! If in doubt, make an appointment to see one of our hand therapists who will evaluate your injury and provide you with the appropriate treatment to get you back in the game as soon as possible.
Thursday, January 08, 2015 Specialists on Hand
At Specialists On Hand, we often have clients come to us and say “I’ve been told I have Tennis Elbow, but I don’t play tennis!” Tennis elbow is a broad and colloquial term used to describe pain at the outside bony prominence of the elbow. More specifically, this bone is the outside end of the humerus in the upper arm called lateral epicondyle. It can be sore to touch, or feel achy and warm after using your arm, wrist and/or fingers.
The pain is caused by damage to the common extensor tendon that originates at the lateral epicondyle. This is a blend of several tendons in the forearm that extend the wrist and fingers.
It is important to have the type of tendon damage correctly diagnosed by your GP or hand therapist, as pathology, prognosis and treatment are very different. The diagnosis of lateral epicondylitis or tendonitis denotes an acute injury, or micro-tears to the tendon. The tiny tears create an immune response as your body works to heal the damage. These are caused when the muscle is loaded with a tensile force that is too sudden or too heavy. Many people find taking part in an activity your body is not used to doing e.g. returning to sport (such as tennis or softball) after a long break, moving heavy furniture, spring pruning or digging in the garden, a fall or even car accident can result in lateral epicondylitis.
Tendonosis refers to the degradation of a tendons’ collagen in response to chronic overuse. There are cellular changes to the tendon tissue which weaken, thicken and alter the blood supply of the tendon. These changes occur over months (sometimes years) of repetitive movements conducted without allowing the tendon to rest and heal such as: typing, mousing, gaming, playing an instrument, sports, cleaning. Tenosynovitis and tenovaginitis are also diagnoses that fall under the umbrella of “tennis elbow”. These forms of tendon damage indicate inflammation of the fluid filled sheath (synovium) and /or mucous membrane that surrounds the tendon. Although less common, it is of value to differentiate the tissue pathology.
Treatment: Hand therapists are trained to treat all of the above forms of tendon damage. We are able to create a personalised treatment protocol that suits individual lifestyles and specific tissue pathology. Depending on injury history and diagnosis we utilise a variety of modalities to facilitate return to health:• Activity modification and ergonomic education
Monday, July 28, 2014 Specialists on Hand
Specialists On Hand are pleased to offer a comprehensive Handwriting Program including evaluation and treatment for those experiencing difficulties with hand writing tasks. This includes children in kindergarten and pre-primary through to high school and even tertiary (university) students.
Research indicates that examiners assign lower marks to written work which is poorly handwritten but contains content of equal quality to work which is attractively and legibly handwritten.
Children with conditions that affect their hands may find it difficult to keep up with schoolwork and start falling behind and becoming frustrated.
Specialists on Hand are now offering paediatric assessment and intervention for children with conditions which affect speed and legibility of their written work.
Experienced therapists will conduct thorough assessment to pinpoint areas for intervention and may use strategies to increase handwriting speed and/or legibility, adaptive equipment, or alternatives such as keyboarding.
Monday, July 28, 2014 Specialists on Hand
Many people assume that arthritis is a natural part of aging, however the reality is that arthritis can affect anyone of any age, including children!
Did you know that arthritis is a common term used to describe over 100 different musculoskeletal conditions and that only a handful of these conditions can be tested for? This means that arthritis is very common and can sometimes go undiagnosed for a long period of time. It is also very diverse and can impact on people in very different ways. Understanding the condition and how it affects you is the most important piece of the puzzle. Knowledge is power and prevention of further damage is the key.
Some of the more common symptoms associated with arthritis include pain, stiffness and inflammation. As the condition develops it can lead to weakness, instability and deformities that can inhibit your ability to do activities of daily living such as walking, preparing food, driving or brushing your teeth.
The earlier you learn how to manage your arthritis symptoms, the better equipped you will be to prevent further deterioration. A large part of managing arthritis involves education and examination on how you use your body, what difficulties you are having and where modifications can be made to improve overall function.
The key ingredients to successfully managing arthritis:
Wednesday, July 09, 2014 Specialists on Hand
Handwriting is an essential skill for both children and adults (Feder & Majnemer, 2007). Even in the age of technology, handwriting remains the primary tool of communication and knowledge assessment for students in the classroom. The demands for handwriting are great, whether in the classroom or beyond. A 1992 study (McHale & Cermak) found that 85 percent of all fine motor time in year 2, 4 and 6 classrooms was spent on paper and pencil activities. A more recent study (Marr, Cermak, Cohn & Henderson, 2003) noted that kindergarten children are now spending 42 percent of their fine motor time on paper and pencil activities, and that children spend up to 50% of their school day completing writing tasks.
Australian children spend approximately 1200 hours a year at school. Imagine if you had to spend 600 hours a year doing something that you found to be extremely difficult and caused you to have low self esteem! Attending school would be a real chore, and children may refuse to do school work or homework, or possibly become disruptive in class.Research literature extensively documents the consequences of poor handwriting on early literacy and academic performance. Children who experience difficulty mastering this skill [handwriting] may avoid writing and decide that they cannot write, leading to arrested writing development (Graham, Harris and Fink, 2000). Handwriting is critical to the production of creative and well-written text (Graham & Harris, 2005) affecting both fluency and the quality of the composition. Illegible handwriting also has secondary effects on school achievement and self-esteem (Engel-Yeger, Nagakur - Yanuv & Rosenblum, 2009; Malloy-Miller, Polatajko & Anstett, 1995).
Research indicates that examiners assign lower marks for written work that has poor legibility, even though it may contain equal quality of content compared to neat and legible work.Children need to be able to write automatically so that they can focus on other aspects of writing such as choosing words, spelling correctly, constructing sentences and composing written text.
At Specialists On Hand our therapists will provide a comprehensive assessment and treatment plan including activities or modifications the child can use or perform at home and in the classroom to improve their handwriting skills.
As a teacher if you have a need for pencil grips or other handwriting equipment you can contact Pencil Grips Plus