What is the Brachial Plexus?
The Brachial Plexus is the name given to the network of nerves as they leave the neck on the way to servicing the shoulder, arm and hand. These nerves are responsible for all shoulder, elbow, wrist and hand movements as well as feeling to these areas. Nerve also also have other functions such as sweating, getting goose bumps & hairs standing up when you are cold and knowing where your joints are positioned- even when you can't see them.
What is a Brachial Plexus injury?
Injury to the Brachial Plexus is when there is a change in the normal continuity of a part of a nerve or several nerves in the Brachial Plexus. The damage to the nerve results in disruption or stopping of the nerve messages as they travel from the spinal cord to the arm.
Symptoms of Brachial Plexus Injury
As a result of the messages being blocked or stopped the muscle will not get usual messages from the brain. And without the usual messages from the brain, the muscles will not be able to move properly; they may be weak or lack movement all together.
In the same way (but back to front) the messages that our skin give us about feeling; temperature, vibration, texture, will not get to the brain as usual. As the messages from the skin won't be able to travel along injured parts of the nerve where the damage has occurred. Therefore, following Brachial Plexus Injury a person will likely have altered, decreased or no feeling in the part of the arm that is usually serviced by the nerves that are damaged.
People may experience other symptoms as a result of nerve damage, including; decreased sweat, and therefore slippery hands which can lead to dropping items. Or when it is cold notice a lack of goosebumps and the hairs not standing up. Hair and nail growth in the injured arm and hand may change. And sometimes the involved hand can look a different colour to the other, for example a mottled appearance, or paler or more blue or red in tone.
Types of Brachial Plexus injury
Damage to the Brachial Plexus can occur due to a traumatic injury or non-traumatic damage;
Some injuries are transient, that is, symptoms are temporary and full recovery will be anticipated within weeks to months. Other injuries will result in permanent loss of movement and feeling to some or all upper limb muscles, leaving operation/s the only option to regain movement.
Operative Carpal Tunnel Release is the procedure used to relieve the symptoms of Carpal Tunnel Syndrome, that is releasing pressure on the median nerve at the level of the wrist. There are two types of surgery commonly performed; endoscopic and open. Both procedures involve cutting the roof of the carpal tunnel, the Transverse Ligament.
During Endoscopic surgery the surgeon sees and releases the ligament through a tube which is inserted through a small incision. Following the procedure clients are rarely referred for hand therapy.
Open Carpal Tunnel Release
Open Carpal Tunnel surgery involves release of the ligament through an incision at the wrist. Open Carpal Tunnel release is especially effective where there is a build up of synovitis or thick fluid or scarring in the carpal tunnel. The open approach allows the surgeon adequate access to the synovitis, such that s/he can remove it.
After your Open Carpal Tunnel Release
Following this open technique you may wake to find your hand heavily bandaged up, and you won'be be able to move your wrist much in these heavy dressings.
Stitches are usually removed 10-14 days after the operation. Some people find that their wound opens up in the days following the operation. It is best to discuss this with your surgeon or his/her nurse. If there is no infection present, some wound opening is not usually a concern. Your surgeon, nurse or hand therapist can help to assess and manage wounds.
Some people may notice bruising in their palm, this is not usually anything to be concerned about, gently massaging over the bruise may help to settle it.
Swelling is also not uncommon after an operation. Hand Therapy can help to manage swelling. Seeking hand therapy assistance early can help get on top of the symptoms early and get you back to using your hand in a timely fashion.
Wrist stiffness is also expected when you have been bandaged up. But if stiffness is present in the fingers, thumb, elbow or persists in the wrist- it is recommended you see a hand therapist for assessment of this and advice on how to regain movement.
As our hands play such an important role in performing everyday tasks, and many people require the use of their hands for work and hobbies, it can be daunting knowing when is the best time to get back to safely doing certain activities. Our Hand Therapists can help you to regain strength and advise on what tasks are safe to and best to avoid at different time frames following your operation.
We can also discuss strategies that can help when you return to work tasks and hobbies which require forceful gripping. We can look at adapting tools, use of specific gloves or splints, and altering the way your body is positioned or moves in specific activities to best protect the operation site. Some people find that they continue to use the strategies they adopt following carpal tunnel release, because they may help reduce recurrence.
Carpal Tunnel Release is a relatively common operation, and recovery is usually relatively smooth and straightforward. But if you require a helping hand getting back to doing the things that you most enjoy, a hand therapist can help get you back on track quickly.
The following are ways in which the young manual worker can help to manage symptoms of Carpal Tunnel Syndrome during everyday activities and work.
These steps don't offer the magic cure that is so commonly sought after. But those who employ the principals; may well find they are rewarded, and possibly avoid an operation.
Carpal Tunnel Syndrome occurs when a nerve (the Median Nerve) is compressed by the structures that surround it as it passes through the Carpal Tunnel (in the wrist). In younger clients who work hard with their hands this is due to;
Some ways to help manage these symptoms include;
Following operative release for Dupuytren's contracture it is not uncommon to experience; swelling, scars, stiffness and some pain in the operated hand.
Most surgical techniques for Dupuytren's Disease involve many precise surgical incisions to remove the diseased tissues. With this amount of work in the palm and fingers, it is not surprising the hand can be uncomfortable to move and use afterwards.
To get the best results from your operation, following these simple steps should help;
For the first 10-14 days following the operation most people will have stitches holding their skin together. Disrupting wounds early can result in infection, excess scaring and skin breakdown.
During this time, unless advised by your surgeon or hand therapist, it is best to keep your hand rested and dressings clean and dry.
For the swelling
To help bring down the swelling, try elevating your operated hand. It may also help to gently raising your heart rate (walking around the room lifting knees up) whilst raising your arm.
Your hand therapist may recommend a gentle form of pressure over the hand and fingers to help manage swelling, for example a lycra glove or compression bandage.
For some people, medications and the operative technique may direct how swelling is to be managed, it's best to ask your surgeon whether you have any special precautions.
Safe early movement under the direction and observation of the hand surgeon or therapist can help prevent finger joint stiffness. In the early stages try to regain bending and straightening with your own muscle power. Depending upon your operation, using your other hand to straighten the operated or adjacent fingers or thumb may not be advised.
Gentle night extension splinting can be used to help stretch out any tightness in the joints.
Once the wounds are dry and clean and the skin is held together, scar massage can start. Keeping the scars in the palm of the hand and fingers supple is essential to getting the best bending and straightening. Early gentle massage with oily cream over the scars and surrounding skin is often combined with the use of a custom made extension night splint. Your hand therapist may also recommend a compression glove and special silicon gel products to help flatten and smooth the scar.
Using the hand
Depending upon the climate where you live, your work and hobbies, there may be some activities that are best avoided for the first month to 6 weeks. An experienced hand therapist will be able to discuss with you your individual goals, and make suggestions to help get you back to your valued activities as safely and quickly as possible.
Please note; if you experience excessive pain or swelling, stiffness or numbness it is always advisable to seek prompt assessment from your surgeon or treating doctor. A small percent of clients will experience complications following operative management for Dupuytren's contracture. Any complication following hand surgery is best diagnosed quickly.
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It is important that any lump or bump in your hand or arm is investigated by your doctor.
Commonly, however a lump in the palm of the hand is nothing to be concerned about.
A lump in the palm can be the first symptom that people notice of Dupuytren's Disease. Dupuytren's Disease is not dangerous, but it can make using the hand difficult as the disease progresses.
Dupuytren's Disease is a condition where thick tissues (fascia) under the skin on the palm contract over time. Initially a lump or nodule in the palm develops, people might feel this or see the skin over the lump puckering. It may be painful to hold onto the golf club, but otherwise non problematic.
This may be followed by difficulty straightening the finger (usually the little or ring finger or the thumb). This difficulty is caused by further contracting of the fascia and development of cords or bands into the fingers. These bands make straightening the finger increasingly difficult. People of the say it becomes difficult getting something out of their pocket because the ring or little finger get stuck. Or they are embarrassed to shake hands as the fingers stay curled over.
The progression from lump in the palm to bent over fingers can occur rapidly or over several months or many years.
Dupuytren's disease is more common in men than women, and usually occurs in the sixth decade of life.
If you suspect you have Dupuytren's Disease, we recommend discussing your options with a Hand Surgeon. Hand Therapy can not help slow down the progression of the disease. We can, however, help you get the best outcomes following interventions from your Surgeon.
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