We all have a scar somewhere on our body.
Scarring is a natural process that the body undergoes when healing from a wound. On the skin, scar tissue is mostly made of collagen. The collagen is a protein which is produced to close the edges of a wound to protect us from infection. Hypertrophic and keloid scar tissue sometimes forms when wound healing is delayed and / or excessive collagen is produced. This more likely occurs when there is damage to the deeper layers of skin or following an infection. The excess collagen production results in a scar becoming raised, thick and often darker than the surrounding skin. These scars are not dangerous, however can cause discomfort and limit movement. And for some people had a negative psychological impact. Hypertrophic scar Hypertrophic scars are thick, hard, raised, can be smooth or rough and are frequently darker than the surrounding skin (pink to deep purple). They often occur following a deep cut (laceration), surgical scar or burn. Hypertrophic scars are most likely to form over mobile joints where the skin is required to stretch and move as the joint below changes position. Keloid scar A keloid scar differs from other scars in that it exceeds the border of the original wound. That is, it grows larger than the initial area of injury. These scars are always dark, raised and thick, they can be rubbery, shiny and may be itchy and are sometimes even painful. Keloid scars often result from the site of a pimple, insect bite or piercing. The good news is that there are strategies to help manage the way a scar grows and matures. Seeking guidance from a professional who has experience in burns & scar management will get you set with what you can do to help minimise the appearance of your scar.
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We know that elbow pain can result from common causes such as a broken bone, tendinitis and arthritis. But when a child or teen report having a sore elbow after sport, without incidence of sudden trauma - the cause may not seem so clear. It is worth investigating whether they have developed Osteochontritis dissecans.
What is Osteochondritis Dissecans? Elbow Osteochondritis dissecans is a condition at the elbow joint, where bone under the cartilage dies due to lack of blood flow. The bone & cartilage become damaged which results in pain and decreased movement at the joint. This may result sudden injury and fracture (like a fall on the outstretched hand). Or from damage to the bone from repetitive trauma (for example during participation in sporting activities particularly involving throwing actions). Symptoms of Osteochondritis dissecans include:
Diagnosis of Osteochondritis dissecans: If you think you or your child may have developed Osteochondritis dissecans it is best to book an appointment to discuss with your doctor. As diagnosis is usually made from reviewing x-ray or MRI of the involved elbow. Treatment for Osteochondritis dissecans: Treatment is determined by the degree of damage to the bone. In some instances, symptoms can be managed without operation with hand therapy alone. However often surgical advice is recommended, as an operation may be required to remove any bone fragment from the joint. Many physios, hand therapists and surgeons recommend an elbow strap or counter-force brace to help manage the symptoms of Lateral Epicondylitis or Tennis Elbow.
But does an elbow strap actually help Tennis Elbow? The simple answer is yes, it can. And there is research to back this up, click here to read. This article published in the Journal of Orthopaedic & Sports Physical Therapy 2009 concludes that use of an elbow strap produced 16% more pain-free grip strength when compared with the use of a placebo or a wrist splint. How does an elbow strap work? Wearing an elbow strap just below the elbow, in theory, takes some of the load off the damaged tendons at the elbow. Put simply;
But be warned... There is no guarantee that using an elbow strap for tennis elbow will help! The overall resounding message from the research surrounding non-operative treatment of tennis elbow is- that there is no consensus about what works and does not work! And, in fact, if used incorrectly or for prolonged periods of time, counter-force braces can cause unwanted issues, including compression of the Radial Nerve. So, whats the take home message? Taking load off the tendons will decrease symptoms in tennis elbow- now that's the golden nugget! For other golden nuggets - follow this blog space! 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.
Endoscopic Release 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 may not 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; Rest 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. Move early 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. Scar management 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. Call us 08 8339 HAND 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 often 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. Call us 08 8339 HAND 'Golfer's Elbow' or Medial Epicondylitis, is a musculoskeletal condition which causes pain on the inside of the elbow.
This pain usually starts around the bony bump which is where the muscles that bend your wrist and fingers come from, and can progress into the forearm muscles. The pain is due to damage to the tendons which attach the muscles to the bone. This damage can be degenerative, in that it can occur over several years, or due to a sudden injury. However is more often due to a change in load to the tendons, for example you decide to take up a new hobby or sport which involves more gripping or wrist bending, and this overloads the tendons. Golfer's Elbow is often confused with Tennis Elbow. Tennis Elbow is a very similar condition, which occurs on the outside of the elbow. Both conditions can be see together, and they are not limited to playing golf or tennis. Golfer's elbow is most often seen in working aged people who have work tasks or hobbies which involve repetitive or prolonged clenching of the fist (gripping) and bending and straightening of the wrist. Some activities which can cause Golfer's Elbow include; painting, hammering, using power tools, playing tennis and golf, even knitting. Symptoms include;
If you think you have Golfer's Elbow, come and see us. We won't give you 'passive' treatments week after week. We will educate you how to manage the symptoms yourself, so that you can spend your time doing the things you enjoy pain free. Our hands are the tools through which most of us feel and explore the world. Yet, like so many things, most of us take our hands for granted. That is, until they hurt, or stop working properly. That’s when we come to appreciate how precious they are. And when you discover the value of hand therapy. Because of the incredible complexity and importance of the hand; specialty fields of hand surgery and therapy have developed. Most people have never heard of a ‘hand therapist’ before meeting one. But when they need one, and they meet one to know one, they tend to be glad they have. Hand therapists know all about hands, and their job is to get them working again. What is Hand Therapy? Hand Therapy is the rehabilitation of the upper limb, that is, from the fingertip to shoulder and everything in between. Therapy is aimed at reducing symptoms and increasing function, using non-invasive techniques. Meaning therapists don’t operate or prescribe medications. However, they work closely with doctors and surgeons in a team approach. Therapists use specialised tests to assess their clients’ symptoms and determine what the cause may be. They take a history, read any reports and observe the limb, before commencing hands on assessment. Assessment includes feeling (palpating) the skin and underlying muscles, bones etc., and getting the client to perform specific movements. Together this information helps the therapist determine what their symptoms mean. They then work together with clients to set treatment goals, and use specific techniques to help achieve these goals. These include the use of heat and cold, massage, compression, splinting, exercises, education, advice, small aides & equipment, activity and environmental modifications. Who is a Hand Therapist? A Hand Therapist is a registered Occupational Therapist or Physiotherapist who has honed their clinical skills through on the job work. They will have completed extra study, and undertake ongoing professional development to keep abreast of developments in the field. Many countries have a professional association that recognises and represents practitioners. In Australia, we have the Australian Hand Therapy Association (AHTA). Becoming a member of the AHTA is a stringent process. This ensures members are highly skilled in their craft and our profession is respected. Experienced therapists may choose further acknowledgement of their knowledge and obtain the Certified Hand Therapist (CHT, USA) credential. This is an American certification, but highly recognised internationally. Being a CHT demonstrates the practitioner has substantial clinical experience, and advanced theoretical knowledge in hand therapy. Who can Hand Therapy help? Anyone who has had an injury, deformity or disease, in their hands or arms can benefit from hand therapy. Following and injury or operation, hand therapy can assist to manage swelling and scars. Therapists help protect injured structures to optimise healing, before safely working to restore movement and strength. They work with clients to guide them back to using their arm as best they can for work and daily tasks. Hand therapist also help clients who have chronic and degenerative conditions to manage their symptoms. They understand how different diseases effect the body, and how to work with this to maximise participation and independence in valued daily activities. After all, for most of us, our hands play a vital role in enabling us the achieve and enjoy what we most want to from life. So, protect and respect your precious dextrous tools. And in the event, they let you down, rest assured, there is “such a thing as a hand therapist” who can help you get them working again. It might seem unbelievable, but gaming can result in injury! Hand injury that is. And most commonly to the thumb.
When players become engrossed in a game, it is easy to loose track of time, and become oblivious to strain that play might be having on the body. Injury can result from prolonged play; holding the device in the fingers & thumb for long periods of time, straining the neck and shoulders. Or from rapid & repetitive movements needed to manipulate the console. These actions, over time, take their toll on the tendons which control the thumb. Most commonly resulting in a condition called DeQuervain's tenosynovitis. The tendons at the base of the thumb become swollen and painful, in sometimes can 'creak' or catch during thumb & wrist movement. The sheath surrounding the tendon can also become swollen. People describe a burning pain over the back of the wrist and thumb, often accompanied by swelling. Rest is initially recommended to decrease load on the tendons and reduce swelling. Reducing play or taking a break from gaming will almost certainly help. A splint will support and decrease load on the tendons; allowing for healing. Sometimes a cortisone injection or anti inflammatory drugs are recommended. And in some cases surgery will be required to reduce pressure on the tendons. To prevent Gamer's Thumb, taking regular rest breaks and reducing the time played each session is recommended. Try setting an alarm to remind yourself to stop, rest and stretch- and get in the habit of doing so. Take care of your thumbs, after all, it is said "the thumb is half the hand!" A break in the little finger (5th) metacarpal (hand bone) is often coined a Boxer's Fracture. This is because a common mechanism of injury is from a punching a hard surface with a clenched fist. The bone is usually broken at the neck (close to where the little finger joins the hand) or the base (back of wrist on little finger side of hand).
Pain surrounding the break in the bone and swelling in the region usually occur directly after the blow. However it is important to get an x-ray early, because if the bone has shifted in position it may need an operation to fix it. There is a real chance, that if the bone is left to heal in an incorrect position, that permanent changes in the way the little finger moves will result. A Hand Therapist will make a custom fit thermoplastic splint to protect the bones as they heal, whilst allowing for maximal safe use of your hand. As swelling over the back of the hand is common with Boxer's Fractures, managing swelling is critical, as is getting the healing fracture moving as soon as it is safe to do so. An experienced Hand Therapist can help guide you through this process. Strain to the neck, shoulders, forearms, wrist and hand is not uncommon for musicians who play for prolonged periods of time each week. This usually results from awkward arm or body positioning in handling the instrument or sitting to play. Or overuse of different muscles or tendons from playing for long periods. And can result in aches, pain & swelling in the wrists, forearms and shoulders. In some cases compression on a nerve can cause pins & needles or tingling in the hands can be experienced during or after play.
To help prevent upper limb strain from prolonged play there are some simple and effective things you can do. 1. Warm up before you play Before picking up your instrument or sitting down to play, stretch the muscles of your fingers, wrists, forearms, shoulders & back. By gently stretching the muscles we increase blood flow, this will warm & lengthen the muscles & joints- and help prevent strain. Always move into stretches slowly, and try to hold them for at least 10 seconds each. TIP It can help to start by playing familiar & easier pieces before leading into complex ones. 2. Set a timer, check your posture Getting into the routine of regularly checking your posture can help to prevent strain. Consider setting a timer as a regular reminder. As a general rule it is beneficial to engage your core, relax shoulders, keep neck upright, and relax tight muscle groups. 3. Take a break Factor in regular short rest breaks throughout practice. It is easy to get caught up and concentrate on playing and loose track of time. Taking regular breaks, pause, move, stretch, drink water and take note of any built up tensions. Resting and changing position will help prevent nerve compression & tendinitis. 4. Strengthen up It is beneficial to strengthen particular muscles which work to position the arm and hold the instrument with aim to preventing injury. Bring your instrument into clinic (if possible), and we can customise a strengthening program to suit you and how you play. Carpal Tunnel Syndrome is the name given to a condition where the nerve that travels through the wrist (the Median Nerve) is compressed. The tunnel in the wrist that the nerve travels through is called the Carpal Tunnel.
The nerve can be compressed by surrounding soft tissues (such as swollen tendons), a tight 'roof' to the tunnel (ligament or retinaculum), or a build up of pressure in the tunnel (fluid) due to hormone changes or other reasons. When there is pressure on the nerve, messages can not travel along the nerve as normal. And this is what results in the symptoms associated with carpal tunnel syndrome. Dec 2017 Carpal Tunnel Syndrome is the most common nerve compression that we see in the hand therapy clinic.
Symptoms of Carpal Tunnel Syndrome include;
Hand Therapy can help to manage symptoms of Carpal Tunnel Syndrome with excellent outcomes. We will discuss different treatment options available to you. And communicate with your GP our recommendations- which may include referral to a surgical specialist for their opinion. Nov 2017 Trigger finger is most commonly noticed as clicking or catching of the thumb or finger joints when trying to straighten the finger, commonly first thing in the morning. Often accompanied by pain at the base of the fingers / into the palm. And in some cases the inability to straighten their joint without the help of the other hand.
It occurs due to swelling of either of the finger or thumb flexor tendon sheath +/- pulley. Usually in the palm. Usually occurring in females 50-60 years of age and children under 6. The thumb & ring finger of the right hand are the most common digits affected. Trigger finger can be associated with other conditions including; rheumatoid arthritis, osteoarthritis in the hand, diabetes and hypothyroidism. And can be caused by prolonged gripping of hand tools. Trigger fingers are classified depending upon symptoms. Treatment will be determined by severity of symptoms and may include;
Cortisone injection benefit many people with Trigger Finger. When symptoms are severe, referral to a hand plastic or orthopaedic surgeon for an opinion is recommended. The shoulder is the most frequently dislocated joint; most commonly occurring in 20-30 year-old men, followed by elderly women.
The shoulder joint is design to allow for maximal movement, however this makes it vulnerable to dislocation. And once it has popped out of joint, it is 50% likely to again. To prevent shoulder dislocation, it is important to strengthen the 4 muscles which maintain shoulder stability; the Rotator Cuff muscles. Their main role is to work together to hold the humeral head (ball) in the shoulder socket. Exercises using a resistance band can be very effective in strengthening the Rotator Cuff, these can be done at the gym (cable tower) or at home (1meter loop of resistance band attached to door knob). Shoulder internal & external rotation as well as abduction exercises should be completed with each arm, 10-15 reps, 3-5 times per day. If you have sustained a shoulder dislocation in the past; taping or bracing can assist to prevent it happening again. Stretching before 'at risk' sports can be beneficial. And we can always assess the quality and strength of scapula movement and muscles, and provide exercises targeted at any specific instabilities that may have occurred. FOOSH or 'fall on the outstretched hand' is a common mechanism for hand & upper limb injury.
The injury sustained will depend on many factors. Age for instance; children are more likely to sustain an elbow dislocation, adults a scaphoid fracture and the elderly a distal radial or Colles fracture. Some injuries which can be sustained from a FOOSH, include; Hand - soft tissue bruising, laceration, swelling Wrist - fracture (Scaphoid, Colles, Smith's, Barton's) - ligament (scapho-lunate, dorsal carpus, TFCC) - dislocation (lunate, perilunate) Elbow - dislocation (Essex-Lopresti) - ligament (medial collateral, lateral collateral) - fracture (radial hand & neck, olecranon, coronoid process) Arm - fracture (distal or proximal humerus, radius, Monteggia, Galeazzi) Shoulder - dislocation (A/C joint) - rotator cuff or labral tear - fracture (clavicle) Treatment will depend upon the injury. In the early stages there may be the need to immobilise or keep still using a splint or sling. Managing swelling & pain is important to prevent unnecessary stiffness. Movements are incorporated when safe. Strengthening and advice to assist getting back to normal hand and arm use ensure the best outcomes. The difference between a good and an excellent outcome following wrist injury comes down more than rest & repair.
Wrist function involves a complex interplay between wrist ligaments & stabilising muscles. And we increasingly understand that proprioceptive ability plays an important role in hand control and injury prevention. Proprioception is the sense of joint position in space. For example; knowing where your is hand even when you aren't looking at it- when you catch a ball or tuck your shirt in. It involves complex communications between the sensory, motor & central nervous systems. And the ability of specific nerve endings to sense & react to different loads, tensions, speed & degrees of movement in our joints. Following injury we usually rest to recover. During this time normal proprioceptive messages are not sent & received, and proprioceptive ability decreases. When movements and use are reintroduced, the wrist can feel uncoordinated. Specifically designed exercises can be used to improve proprioceptive feedback. Exercises we like to use include; balancing a marble on a plate, juggling, throwing a ball against a wall and balancing a slosh pipe. There are also some great apps available. These exercises give immediate feedback and are fun to do! Hagert, E. Proprioception of the Wrist Joint: A Review of Current Concepts and Possible Implications on Rehabilitation of the Wrist. J Hand Therapy. 2010;232-17. It's a bumper season in the Aussie Alps. But along with snow come sprained thumbs, coined Skier's Thumbs, which account for around 10% of all skiing injuries.
The sprain usually occurs at the base of the thumb (the MCPJ), caused by the stock hyperextending the joint usually during a fall. The ligament injured is the ulnar collateral ligament (UCL). In some cases the UCL will pull off a small bony 'avulsion fracture'. The UCL at the MCPJ is essential in providing stability to the thumb. Without it even holding a pen is difficult! A skilled hand therapist or specialist can determine stability by stress testing the joint. And it is always advisable to have an x-ray or diagnostic ultrasound, to determine whether there is a fracture. The severity of the injury will determine the course of treatment. In some cases a fracture might have moved and an operation will be required. In most cases a hand therapist can fix Skier's Thumb by making a thermoplastic splint that will hold the joint in a safe position whilst the ligament +/- bone heals. Taping techniques can also be used during the splint weaning phase, to help get you back to work / sports quickly & safely. And we will always give you exercises to stabilise the soft tissues around the injured, and surrounding joints. Keep those thumb tips safe! I set about pruning my roses yesterday, and so it should not have been a surprise to wake up this morning with pain on the inside of my elbow!
With so many gardening enthusiasts in the hills - at this time of year we tend to see an influx of gardening associated injures. Especially due to pruning and chopping wood! I was quick to realise that I had symptoms indicative of Golfer's Elbow (or Medial Epicondylitis); an overuse injury to the muscles and tendons that bend the fingers & wrist. People experience pain near the bony bump on the inside of the elbow. This pain is usually associated with resisted gripping or wrist bending. In young people, Golfer's Elbow can occur from an injury during club, racket or throwing sports or weight lifting. Or from work duties including hammering, painting & cooking. The symptoms of pain & weakness in gripping result from damage to the muscles and tendons involved. Chronic Golfer's Elbow is far more common, usually occurring in 35-60 year olds following a period of increased use. The involved soft tissues have age and use-related degeneration, making them susceptible to injury. We provisionally diagnose Golfer's Elbow by taking a history of symptoms and conducting clinical tests. Diagnostic ultrasound and MRI are the best tests to confirm diagnosis. We are always mindful to rule out neck issues in diagnosing Golfer's Elbow. As for Tennis Elbow (Lateral Epicondylitis), the best course of treatment is hotly debated in our professional literature. At AHHOT we focus our treatments on decreasing symptoms, whilst maintaining balanced muscle and tendon load in a graded & safe manner. Taking the time to discuss how each individual uses their body in everyday activities, helps us to customise treatments. We even look at work tools or sporting form to assist getting the best outcome from treatment, and with aim to prevent recurrence. So for now, I will take a bit of my own advice, and finish the pruning next weekend! One of the most common finger injuries to occur during ball sports is Mallet finger.
This is when the finger tip is forcefully bent forwards. The tip then doesn't straighten, because the extensor tendon to the finger has become detached. This may or may not include a small bony fracture (avulsion). Mallet finger can also occur without direct force to the tip, which also is not uncommon. Mallet finger injuries are often treated effectively by splinting the tip of the finger straight for 6-8 weeks. Splinting is most comfortably achieved with a small custom made plastic splint which a hand therapist can make. These splints are safe to wear for most work duties and during game play (when covered with firm tape). It is always recommended that an x-ray is taken to see whether there is a bony fracture. When there is a fracture present, which often occurs in ball v's tip Mallet injuries- the splinting time frames may be shorter. Following the period of immobilisation, movements & use of the finger are gradually introduced. We can teach taping techniques for work and sport to support the tendon in this phase. The tendon injury can remain weak for some time, and it is therefore important that movement and use is introduced safely and gradually. If left untreated the Mallet finger may develop what we call a fixed flexion deformity- meaning that the finger permanently becomes stuck in a bent position and can no longer be straightened. The inability to control a finger like that can be annoying; many men complain it gets in the way when reaching to get their wallet out of their pocket. And a permanently bent tip can become a safety risk- as it is not so easy to get it out of harms way. The art and science of hand therapy really come into play treating Mallet finger injuries! "It's just my finger, don't worry about it, it will get better in a few days..!"
A common (and painful) injury in ball sports is the sprained, dislocated and or fractured finger. In the hills we also see these injuries in people working with horses and cattle, when the finger is forcefully pushed against a gate, or in people falling over on slippery paths in winter. Dorsal PIPJ dislocation usually occurs from hyperextension of the middle bone of the finger- stretching the ligaments on the palm side of the joint. In some instances, middle bone of the finger is pushed right out of joint and becomes stuck on top of the longer finger bone. People are often tempted to put their finger back into place themselves. But DIY relocation could harmfully move a fractured bone, or entrap a surrounding tissue in the joint space (e.g. a ligament, nerve or artery). This may lead to longer term pain, stiffness & deformity. We don't need to look far to see examples of retired football players with fingers riddled with arthritis! A sprained finger will be painful, swollen, and discoloured. Applying ice and compression as soon as possible and buddy taping to a neighbouring finger may assist with continued game play. However if the finger is not sitting straight or moving normally it is best to get it x-rayed, as there is likely ligament +/- bony damage. And if left untreated or not treated correctly and early, this injury can get worse over time and result in repeat dislocations, painful joint deformities and possibly surgery. So please don't ignore that finger sprain- it might not get better in a few days! Biceps tendinitis is when the long head of the biceps tendon, located at the front of the shoulder, becomes swollen and irritated. This often causes pain that can radiate down the arm. You might notice the pain most at night or during overhead activities like:
Who is at Risk? Biceps tendinitis can affect athletes, especially football and tennis players, particularly if there’s a muscle imbalance, joint instability, or weakness in the rotator cuff. It also affects older clients, who have Rotator Cuff or other shoulder damage. Preventing Biceps Tendinitis
Managing Symptoms If you’re experiencing symptoms:
Seek Our Professional Help Biceps tendinitis is often associated with other shoulder issues. If you’re having shoulder problems, it’s best to get a thorough assessment from a specialist to ensure you receive the right treatment. Feel free to reach out if you need more advice or assistance! 8339 4263 |
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February 2025
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Adelaide & Hills HAND THERAPY. Hand & arm rehabilitation in Adelaide and the Adelaide Hills SA.