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:
Although rare – Anterior Interosseous Nerve (or Kiloh-Nevin) Syndrome is said to make up less than 1 % of all upper limb neuropathies - we have recently seen two cases of this condition in the clinic.
Devised by an American hand therapist, Julie Ann Howell working with the hand surgeon Wendell Merritt, a Relative Motion Splint is a small ingenious device which maintains the metacarpal phalangeal joint of the injured finger in either flexion or extension relative to the other digits. Due to the delicate muscular balance of the intrinsic muscles around this joint, when the MP joint is held flexed in relation to the other fingers it can facilitate active PIP extension in cases of central slip injury, PIP extensor lag or small flexion contractures. Alternatively, when the MP is held in extension relative to the other fingers , the splint will allow PIP flexion whilst protecting healing extensor tendon structures post repair.