Tendinopathies are common in the upper limb; despite lower force generation, there are more sustained levels of activity and higher repetition tasks than in the lower limb. Muscle-tendon units in the leg are subject to higher forces, often against total body weight, generating high-velocity movements. Translating research findings from the lower limb to the arm is not straightforward however, there are similarities in tendinopathies occurring where there is an element of compression, such as over the radial head in elbow extension and pronation. Wrist and finger tendinopathies also occur under retinacular structures at the wrist and the pulleys of the fingers.
"A tendon transfer procedure relocates the insertion of a functioning muscle-tendon unit in order to restore lost movement and function at another site.”
We occasionally get a referral through for a child with a trigger digit – frequently thumbs. Paediatric trigger thumb, also known as paediatric acquired thumb flexion contracture, occurs in children aged between 1 and 4 years of age, has an incidence of 1-3:1000, and has been linked to a genetic predisposition.
Taping is one of the strategies we may employ in hand therapy to manage scar formation. Early management is targeted at reducing local mechanical stimulation, so more rigid tapes such as paper tape or Hypafix may be used
Volar plate avulsions and central slip avulsion fractures.
Ironically, when thinking of ideas for this blog, a quote from one of our orthopaedic hand surgeons, Ram Chandru, came to mind… “little bone, big problem”, so the focus was intended to be on avulsion fractures.
Thumb IP flexion splint – spending time with a gentle stretch at end range, made possible with this small device
Thimble and saddle splint for end range finger flexion – gradually tightening on the elastic gives the patient control over how much stretch is comfortable, best followed with strengthening exercises at end range to use the regained movement.
Beaded splint for fine tuning motor control – sometimes you just need to see it! By giving visual cues to slide the beads, this splint guides the movement of thumb opposition, often lacking with CMC OA, but also for patients recovering from median nerve injuries.
Phantom limb pain (PLP) affects a significant number of patients (50 – 85%) following amputation. A degree of non-painful residual tingling or squeezing is described as a phantom sensation, in contrast to phantom limb pain when the missing part becomes painful, cramping or being altered in size or shape.
SPECT CT combines nuclear medical imaging (such as bone scans) with CT and gives a colourful image representing tissue metabolism. Problem areas are identified as anatomically precise ‘hot spots’.
Delivering hand therapy via Telehealth has been a refreshing new “norm” for us and our patients during the lockdown period. Despite the many ceilings, internet crashes and “can you please close the curtain behind you” prompts, it has brought with it many new positives: