Osteoporotic fractures, particularly in aging populations, pose a significant public health challenge. With research projecting the incidence of osteoporotic fractures expected to increase by 25% over the next decade.
Physical exercise has been proven to reduce the risk of low-trauma, major osteoporotic fractures—without adverse effects.
Recent research, including systematic reviews and meta-analyses, provides strong evidence that exercise reduces fractures by approximately 23%, particularly in older adults.

The benefits of a targeted upper limb program includes;

• Fracture Prevention: Exercises tailored to reduce low-trauma arm and wrist fractures in those with osteoporosis.
  
• Personalised Intensity Progression: Adaptable to each client's capacity, applying the overload principle to ensure continuous bone adaptation.
• Comprehensive Protocols: Designed to focus on both bone strengthening and fall prevention, addressing two key areas of fracture risk.
  

We offer safe, targeted, personalised strengthening programs which are simple to replicate at home. One on one sessions with our fully qualified staff.
With the ultimate aim of preserving the independence and quality of life of older members in our community.
 

Focal dystonia is a neurological condition that causes involuntary muscle contractions in a specific area of the body. When it affects the hands, it can significantly impact the fine motor skills needed for activities like writing, playing an instrument, or even everyday tasks like typing or cooking. Hand therapists play a crucial role in helping individuals with focal dystonia regain function and manage symptoms.

What is Focal Dystonia?
Focal dystonia is often referred to as "task-specific dystonia," meaning it usually occurs when performing certain tasks. For example, a pianist may experience cramping or uncontrollable movements in their hand only when playing the piano, while a writer might struggle when holding a pen. The exact cause isn’t fully understood, but it’s believed to involve abnormal communication between the brain and the muscles, leading to misfiring of motor signals.

Types of focal dystonia that affect the hand include:

• Musician’s Dystonia: Common in musicians, this affects the muscles used for playing specific instruments.
• Writer’s Cramp: Affects people who write frequently, leading to cramps and spasms when holding a pen or pencil.
  

How Hand Therapists Help Treat Focal Dystonia
Hand therapists, who specialize in treating conditions affecting the hand and upper extremities, use a combination of techniques to manage focal dystonia. While there’s no cure, therapy focuses on retraining the muscles, improving coordination, and reducing discomfort.
Here’s a look at the approaches hand therapists use:

1. Sensory Retraining
One of the primary issues with focal dystonia is the miscommunication between the brain and the affected muscles. Sensory retraining involves exercises that help to “reset” or retrain this communication pathway.

• Tactile Stimulation: This involves stimulating different areas of the hand with textures or light touch to increase sensory awareness.
• Proprioception Training: Therapists may guide the patient through movements without using vision to help reconnect the brain’s sense of the hand’s position in space.
• Mirror Therapy: The patient performs movements with the unaffected hand while watching it in a mirror, which tricks the brain into thinking the affected hand is moving properly.
  
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2. Task-Specific Training
Since focal dystonia is often task-specific, a major part of treatment involves relearning the affected task in a controlled, step-by-step process.

• Breaking Down the Movement: A therapist may break down the problematic movement into smaller, manageable steps. For example, if writing triggers dystonia, they may start by practicing holding a pen correctly before progressing to more complex movements.
• Graded Motor Imagery: This technique involves mentally practicing the task without physically performing it. Visualization helps the brain reestablish proper motor patterns before attempting the movement again.
• Constraint-Induced Movement Therapy: In some cases, therapists will restrict the use of the unaffected hand to encourage the use of the affected hand and gradually retrain the muscles.
  
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3. Strengthening and Stretching Exercises
Muscle imbalance is common in focal dystonia, and hand therapists often prescribe specific exercises to strengthen weak muscles and stretch overactive ones. These exercises help improve overall hand coordination and prevent further complications like muscle stiffness or atrophy.

• Strengthening Exercises: Therapists may use small hand weights, therapy putty, or resistance bands to help build strength in weaker muscles.
• Stretching: Gentle stretches target overactive or tight muscles, helping reduce cramping and spasms. This can be done with the assistance of a therapist or through self-guided exercises at home.
  

4. Splinting and Adaptive Devices
For some patients, the use of splints or other adaptive devices can help temporarily alleviate symptoms.

• Splints: A hand therapist may create custom splints that help keep the fingers and hand in a more functional position, especially during tasks that trigger dystonia.
• Adaptive Tools: For activities like writing, therapists might recommend tools like specially designed grips that make it easier to hold a pen or utensil without triggering symptoms.

5. Biofeedback and Neuromodulation
Biofeedback is a technique that helps individuals become more aware of their muscle movements and control.

• Biofeedback Devices: These devices measure muscle activity, providing real-time feedback to the patient and therapist. The patient learns to control and adjust muscle contractions during specific tasks, which can be incredibly helpful for relearning proper motor patterns.
• Neuromodulation: In some cases, therapists might work alongside neurologists to incorporate neuromodulation techniques like electrical stimulation to alter abnormal muscle activity.

6. Behavioral and Lifestyle Modifications
Focal dystonia can be triggered by overuse, stress, or fatigue. A hand therapist may provide guidance on how to modify daily habits and routines to minimize these factors.

• Ergonomic Adjustments: Simple changes, like adjusting the height of a desk or the positioning of a musical instrument, can help reduce strain on the hand muscles.
• Activity Modification: Therapists often recommend taking frequent breaks during repetitive tasks to prevent overuse and give muscles time to rest and recover.
  

Conclusion
While focal dystonia can be challenging to manage, hand therapists offer a range of treatments that help patients improve muscle control, reduce symptoms, and regain function. By focusing on sensory retraining, task-specific training, strengthening exercises, and behavioral adjustments, hand therapists can help individuals lead more comfortable and productive lives despite this condition. If you or someone you know is experiencing focal dystonia, reaching out to a hand therapist can be a crucial step toward recovery.

Mallet finger is a common injury that affects the finger’s extensor tendon—the one responsible for straightening the fingertip. This injury usually happens when the fingertip is suddenly jammed or bent forcefully, like when a ball hits an outstretched finger. It's also known as "baseball finger" because it often occurs during sports, but it can happen in other everyday activities as well.

What is Mallet Finger?
Mallet finger occurs when the tendon that straightens the tip of the finger (called the extensor tendon) is torn or stretched. In some cases, a small piece of bone is pulled away with the tendon. This results in the fingertip being unable to straighten on its own.

Causes of Mallet Finger
Mallet finger is caused by direct trauma to the tip of the finger, forcing it to bend more than it should. This can result from trauma (e.g. a ball banging onto the tip of the finger), or in simple daily tasks (e.g. pushing sheets under mattress or pulling on socks).

Symptoms of Mallet Finger
The key symptoms include:

• The fingertip droops and cannot be straightened.
• Swelling near where your finger nail grows.
• In some cases, bruising may occur.
• The finger may feel tender when touched.

Treatment Options:

1. Non-Operative Treatment
Non-surgical treatment is often the first step in managing a mallet finger injury, especially if the tendon is torn without a significant fracture.
Splinting

• The most common non-operative treatment is wearing a splint. This holds the fingertip straight (in extension) to allow the torn tendon to heal. Custom made splints are more comfortable and effective.
• Duration: The splint is usually worn full-time for about 6-8 weeks. It's essential not to remove the splint, as even a slight bend can re-injure the tendon.
• After 6-8 weeks, the splint is gradually worn less, but continued part-time use (for example, at night) is often recommended for an additional few weeks.
• Pros: This method has a high success rate, especially for simple mallet finger injuries. It avoids surgery and complications.
• Cons: It requires strict compliance. The splint needs to stay in place, even during bathing or other activities, to ensure healing.

What to Expect: Swelling and tenderness may gradually improve with time. Although the finger may not look exactly the same as before, most people regain normal function.

2. Operative Treatment
Surgical intervention is considered if:

• There is a large fracture that involves a portion of the bone where the tendon attaches.
• Non-surgical treatment fails to correct the finger after the splinting process.
• There is an open wound or the joint is misaligned.

Surgical Procedures There are several techniques used, depending on the injury's severity:

• Pinning the Joint (K-wire): This involves placing a small pin to keep the joint straight while the tendon or bone heals.
• Tendon Repair: In cases where the tendon is severely damaged, the surgeon may stitch the tendon to the bone.
• Bone Fragment Fixation: If a bone fragment has been pulled off, the surgeon may reattach it with tiny screws or wires.
• Pros: Surgery can fix more severe injuries, particularly those that involve fractures or tendon ruptures.
• Cons: There are risks associated with surgery, such as infection, stiffness, or complications with the pin or wire.

Recovery and Rehabilitation

• Non-operative Recovery: After wearing the splint, some stiffness is normal, but hand therapy or exercises may be recommended to regain motion.
• Operative Recovery: Depending on the procedure, hand therapy may be necessary to restore movement and strength. Recovery time may be longer than non-operative treatment, depending on the injury's complexity.
  

Conclusion
Mallet finger, is a reasonably common finger tip injury which can usually be treated successfully with non-operative methods like splinting. However, for more severe cases, surgery may be necessary to restore function. If you suspect a mallet finger injury, seek prompt medical attention to ensure the best outcome, whether through splinting or surgery.

Following on from our Hand Therapist Jo Marsh's attendance at the recent Australian Hand Therapy Conference (August 2024); we have been contemplating how our new learnings might impact upon our management of hand osteoarthritis with our clients. Our team has come together and are considering the following and discussing how these concepts might alter the way we help our clients deal with the symptoms of their hand and upper limb OA.

• We understand that there are currently no disease modifying drugs for  osteoarthritis. Several drugs, which are designed to help other conditions (such as Rheumatoid or inflammatory Arthritis's) may have a beneficial impact, however none are designed specifically for osteoarthritis. There is currently no evidence to support complimentary medications for OA.
  
• We understand that possibly a subterranean diet (low inflammatory) may help to manage symptoms of OA.
  
• We also understand that if a person does not have symptoms of OA before the age of 55 years, they are unlikely to develop osteoarthritis at all.
  
• Pain in hand OA is now thought to have a central sensitisation component. This is also a new concept to our therapists, although it makes total sense. Why do we see two clients with the same looking scans, however two totally different pain experiences? This concept will inform the way we discuss with and guide our client in managing symptoms.
  
• An option for the treatment of hand osteoarthritis, which we at our clinic have not implemented in the past, is resistance training for hand osteoarthritis. Trials are underway to assess the impact. Early feasibility trials seem to support resistance training in this group. Following careful consideration- this useful new knowledge is challenging and changing the way we prescribe exercises, and we are changing our practice.
  

As always, attending our national AHTA (Australian Hand Therapy Association) conference provides our staff with the latest research and innervation in hand therapy. We are excited to share with our community the learnings and look forward to helping our clients as best we possibly can!

If you’re experiencing pain at the base of your thumb, you are not alone: Osteoarthritis (OA) at the base of the thumb affects 1 in 3 women and 1 in 4 men.

What is Osteoarthritis?
Osteoarthritis is a common condition that often begins in middle age and affects various joints in the hand. The base of the thumb, is the most frequently impacted.
OA develops when the cartilage protecting the joint wears down. This can lead to:

• Bony Growths: Small growth forming around the joint.
• Joint Compression: The joint surfaces move closer together.
• Lax Ligaments: Supportive ligaments become loose.
• Joint Instability: The joint becomes unstable, making movement painful and functional use unreliable.

How Hand Therapy Can Help
Hand Therapy can be effective in managing osteoarthritis pain and improving joint function:

• Acute Pain Relief: Splinting can provide immediate relief of pain.
  
• Long-Term Stability: Targeted stretching and strengthening exercises can help stabilise the joint. We know through cavaderic studies which muscles stabilise (n 4) and which muscles destabilise (n 2) the base of the thumb. Our program is graded, and works to stabilise the thumb for function.
  
• Education, small aides and equipment: Learn how to use your hands in daily activities to prevent aggravation. Our Occupational Therapists can guide you through the myriad of options of aides and equipment which can help you decide what you might need to help managing with less pain in your daily tasks.
  

If you're dealing with thumb base pain, don't hesitate to seek our professional help. Proper treatment can make a significant difference in managing your symptoms and improving your quality of life. 8339 4263

Our fascination with nerves is well-justified given their complexity and the multitude of ways they can become compressed. In the arm alone, there are three main nerves and over 30 potential sites where these nerves can experience compression.

What is Nerve Compression?
Nerve compression occurs when one or more nerves are pressed or squeezed by surrounding soft tissues or bones. In the upper limb, this can happen anywhere along the nerve’s pathway—from the neck and shoulder to the arm, elbow, forearm, wrist, or hand. Compression can occur at multiple points along this path, making it a complex issue to address.

Symptoms of Nerve Compression
When a nerve is compressed, you might experience various symptoms, including:

• Pins and Needles: This sensation often occurs at night or during specific activities or postures.
• Loss of Strength or Dexterity: You might find it difficult to hold or manipulate objects, or you may drop things more frequently.
• Changes in Finger Tips: They may lose their typical shape or produce less sweat, making gripping challenging.
• Color Changes and Discomfort: Some people notice their hand’s color changing or experience a burning or heavy sensation.

Causes of Nerve Compression
Several factors can lead to nerve compression, such as:

• Posture: Poor sleeping or resting positions can contribute.
• Repetitive Movements: Holding your arm or hand in one position for extended periods or performing repetitive tasks can cause compression.
• External Pressure: Pressure from tools or even jewelry can compress nerves.
• Anatomical Factors: Sometimes, nerve compression is related to how your body is structured or moves.

How We Can Help
Hand Therapists play a crucial role in diagnosing and managing nerve compression. Here’s how we assist:

1. Assessment: We evaluate where the compression might be occurring, often using diagnostic tools like ultrasound or nerve conduction studies for confirmation.
2. Diagnosis: By analyzing your body mechanics and daily activities, we can pinpoint the likely causes of compression.
3. Treatment: We provide advice, exercises, and sometimes recommend supportive splints for daytime or nighttime use to alleviate symptoms.
4. Specialist Referral: When necessary, we can guide you to other specialists to ensure comprehensive and timely care.

If you're experiencing symptoms of nerve compression, we can help. Early intervention can make a significant difference in managing and resolving the issue. Call us today to make an appointment 8339 4263.