Category Archives: Hand

FOOSH

FOOSH – Silly Name, Serious Injury

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FOOSH

One of the most common mechanism of injury from falls is called a FOOSH (Fall on an Out Stretched Hand) injury. Don’t let the funny name fool you. A FOOSH injury is one of the most debilitating ways to injure your upper extremity and cause a significant loss of function. A Foosh occurs when a person is on their way down during a fall and tries to brace for impact using their hands. This is a natural response to falling and is difficult to try and prevent. The resulting impact of the hand and wrist on the ground can cause varying types of injuries from strains and sprains to fractures of the hand, wrist, elbow or shoulder.

What to look for if you experience a FOOSH Injury

1. Fractures: Typically, the fractures of the forearm from a FOOSH are the easiest to spot. They become swollen and bruised very rapidly and are associated with a lot of pain. Often times they produce a visible bulging of the skin of the forearm which can even protrude outside of the body. Fractures of the wrist and forearm will need to be evaluated and often times re-set and casted. Following casting the person must regain strength and range of motion through a guided exercise program before normal function can return. These injuries may take as long as 12 weeks to heal, but as many as 20 weeks for return to normalcy. This process can be expedited significantly by a referral to a well-trained physical therapist.

2. Sprains: Sprains from a FOOSH are much more difficult to spot. A sprain is a common injury to a ligament that normally holds one bone to another as a part of a joint. It most likely causes moderate to severe swelling, bruising, and pain. The pain may occur both by moving the joint yourself or having someone else move the joint while you are relaxed. During a sprain, a non-contractile piece of tissue becomes torn partially or completely. The result is a joint that is too lax to allow proper joint stability. This can cause problems for years following the initial injury. Think of the brake system on your bicycle. If the brake cable becomes elongated the brake does not function correctly until it is repaired. An evaluation by a physical therapist is necessary to diagnose and treat a sprain correctly and to prevent further injury to the injury site as well as allow for speedy recovery.

3. Strains: Strains are also difficult to spot following a FOOSH. A strain differs from a sprain in that it occurs as a tearing of the tendon instead of a ligament. This can present like a sprain with swelling and bruising, but will have a few different characteristics. Tendons attach to bone on one side and a muscle on the other. Tendons therefore hurt with both passive motion, but also with active motion. Strains of the wrist and hand can cause a significant loss in function with things like writing, typing, or even just holding an object in your hand. Without intervention, this can lead to progressively worsening problems like tendonitis and carpal tunnel syndrome which may need surgical intervention if not attended to quickly.

No matter your age or fitness level please use caution to avoid these types of debilitating injuries. If you do fall, it is important to consult your health care provider. During rehabilitation we can help you reduce pain, increase strength and regain function. Please feel free to call us for more information or to schedule an appointment.

hand therapy week PTandMe

ASHT: Hand Therapy Awareness Week

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Prevent hand and wrist injuries while cooking. Professional hand therapists promote wrist and hand health in the kitchen.

USE THE RIGHT TOOL FOR THE JOB
Use easy-to-grip versions of tools like spoons, knives and bottle/can openers to decrease the stress on your hands and use scissors to open bags (or packages) instead of your thumbs.

SIT OR STAND UP STRAIGHT
Correct posture is important because the nerves that operate your fingers start in neck. During activities which require you to be looking down at what you are doing, like chopping vegetables, take a moment to stand up straight, turn your head side to side/up and down, and stretch your arms over your head.

SLIDE, DO NOT LIFT
When working in the oven, always slide the shelf out so you can get a good, safe grasp of the panhandles.

KEEP YOUR SHOULDERS DOWN
Your arms should be at your sides and the counters you work on should be waist high. Many kitchen counters are too high for the average person. As a result, you may be forced to raise the shoulder you are using to cut the food and lean to the opposite side of your body when preparing food. This causes increased stress on the neck, shoulder and arm muscles and nerves.

cracking knuckles

True or False: Cracking Your Knuckles Can Lead to Arthritis

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Cracking Knuckles Arthritis_FBsize

Crack. Pop. Click. These sounds jump from the joints of the many children and adults who are in the habit of cracking their knuckles.

If you cracked your knuckles as a child, you may have been warned that it could cause you to develop arthritis later in life. Is this true? Probably not, according to a handful of studies on the subject. While cracking your knuckles may not cause arthritis, some researchers believe that habitual cracking could create some problems later on. Not to mention that the incessant pops and clicks are likely to be a major annoyance to those around you.

Evidence for the Health Claim
Your knuckles are the joints in your fingers and toes. They are located where two bones meet, and they are bathed in a liquid called synovial fluid, which lubricates the joints. Sometimes a bubble of gas develops in the synovial fluid, and when the joint is manipulated in certain ways (eg, when a person is bending or compressing his or her hand), the bubble can burst, making an audible popping or cracking sound.

Arthritis is an extremely common problem for older adults, with the majority of people over age 65 having signs of the condition. There are two major forms of arthritis. Rheumatoid arthritis results from inflammation of the joints, and can cause pain, redness, swelling, and eventually deformity and loss of function. Osteoarthritis, the most common form, results from wear and tear on the joints over time, which is why it tends to affect older adults.

While there is no reason to believe that knuckle cracking would lead to rheumatoid arthritis, it makes sense that habitual trauma to a joint might eventually cause tissues to break down and wear away leading to osteoarthritis. In fact, some researchers have reported cases of people who habitually cracked their knuckles and went on to develop osteoarthritis or other joint problems. For example, in a case report published in the British Medical Journal, researchers report that a man who habitually cracked and popped many of his joints had damage in his right hand indicative of arthritis.

Another study published in the Proceedings of the Institution of Mechanical Engineers simulated the act of cracking knuckles and found that the energy used to crack your knuckles is enough to damage the cartilage in your joints.

Do these reports mean knuckle cracking can lead to arthritis? Or are they just chance findings, since so many people develop osteoarthritis whether they crack their knuckles or not?

Evidence Against the Health Claim
While individual reports may cite cases in which voracious knuckle crackers develop arthritis, other studies tell a different story.

In 1975, Dr. Robert L. Swezey and Stuart E. Swezey conducted a study of 28 nursing home residents who could recall whether or not they had cracked their knuckles earlier in life. After performing x-rays on the participants’ hands, the researchers concluded that there was no link between habitual knuckle cracking and arthritis.

Another study, published in the Annals of Rheumatic Disease, looked at a group of 300 habitual knuckle crackers. The researchers found that the participants who cracked their knuckles regularly did not experience more cases of osteoarthritis. Knuckle crackers, however, were more likely to have hand swelling and reduced grip strength in their hands. Whether the knuckle cracking caused the swelling and loss of hand function or those with hand problems were just more likely to crack their knuckles, the researchers could not say.

Researchers also compared a group of people with osteoarthritis in the hand with those who did not have the condition. The two groups were asked whether they cracked their knuckles and, if so, the duration and the frequency of this behavior. When the researchers analyzed the findings, they found no correlation between knuckle cracking and the development of osteoarthritis.

knuckles

Conclusion
Some people who crack their knuckles do it out of habit or boredom. Many others say it helps relieve joint pain and tension, and allows for greater range of motion in their joints. If you are in the habit of cracking your knuckles, the evidence available today suggests that it will not cause you to develop arthritis. While some insatiable knuckle crackers may go onto to develop problems down the road, the occasional painless cracking is probably harmless.

Keep in mind, though, that while cracking your knuckles seems like nothing more than an innocent, mindless habit, for the person sitting next to you, it may be just as irritating as the sound of fingernails on a chalkboard.

by Krisha McCoy, MS

More PTandMe articles about arthritis can be found here:

   

 

REFERENCES:

Brodeus R. The audible release associated with joint manipulation.J Manipulative Physiol Ther. 1995;18:155-164.

Castellanos J, Axelrod D. Effect of habitual knuckle cracking on hand function.Ann Rheum Dis. 1990;49:308-309.

Protapapas MG, Cymet TC. Joint cracking and popping: understanding noises that accompany articular release.J Am Osteopath Assoc. 2002;102:306.

Swezey RL, Swezey SE. The consequences of habitual knuckle cracking.West J Med. 1975;122:377-379. Available at: http://www.pubmedcentral.gov/picrender.fcgi?artid=1129752&blobtype=pdf. Accessed July 11, 2006

Watson P, Hamilton A, Mollan R. Habitual joint cracking and radiological damage.Br Med J. 1989;299:1566.

Watson P Kernohan WG, Mollan RA. A study of the cracking sounds from the metacarpophalangeal joint.Proc Inst Mech Eng. 1989;203:109-118.

3/17/2011 DynaMed’s Systematic Literature Surveillance DynaMed’s Systematic Literature Surveillance: Deweber K, Olszewski M, Ortolano R. Knuckle cracking and hand osteoarthritis.J Am Board Fam Med.2011;24(2):169-174.

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carpal tunnel

Carpal Tunnel Syndrome Causes and Treatment

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carpal tunnel

Carpal Tunnel: A Definition
The carpal tunnel is a small space at the wrist in which the median nerve and nine tendons pass through. The median nerve travels on top of the tendons through the tunnel. The tunnel itself is made up of your wrist bones and along the top of the tunnel is a thick fibrous ligament called the transverse carpal ligament. If the tendons become swollen (tenosynovitis) or if the tunnel size itself decreases because of injury, compression to the median nerve can occur. Symptoms may include: pain during pinching and gripping, a feeling of clumsiness – the inability to hold things, numbness in the fingers at night, or a radiating pain up the arm.

Risk Factors at Home and at Work
• Repetition – Overuse can occur with light forces. Irritation of the tendon can be caused by rapid, repetitive activity without a break. Decreased blood flow to the nerves and tendons may be caused by holding or gripping an object without relaxation.
• Force – The muscles of the hand and fingers are contracted when gripping or pinching. These contractions place stress on the tendons that go through the carpal tunnel. Higher forces are more likely to expose you to greater risks.
• Bending – The tendons in the carpal tunnel can be irritated by bending your hand. Bending your hand up, down, or sideways may inflame the tendons in the carpal tunnel.
• Vibration – Nerves are especially susceptible to vibration. Common causes of vibration of the nerves in the carpal tunnel are: power tools, steering wheels, or other mechanized equipment.
• Impact – Your hand is not a tool. Hitting, moving, or jerking objects may damage the structures of the wrist. Even using a hammer transmits sudden force to these delicate structures.

carpal tunnel

Practicing Prevention
The first line of defense against Carpal Tunnel Syndrome is reducing the risk factors that may lead to CTS. Look carefully at your equipment and tools and try to eliminate the forces that are risk factors – bending, vibration, impact, and repetition.
• Tool Handles – The handle should have an optimum grip span of about 2 ¼ inches.
• Gripping Surface – Use a rubberized coating or tubing on your gripping surface. This will decrease the grip strength required to hold onto the tool.
• Reduction in vibration – Place a rubber or gel material on the handles or utilize gloves with rubber inserts to reduce vibration.

Home Treatment
ICE – Use an ice pack on the palm and wrist area for 10 minutes after hand intensive activities or for the management of pain. This can be followed by the wrist stretches.
REST – Rest your hands after frequent, forceful, or repetitive activities that last 30 – 60 minutes. Try doing a different activity which is not as stressful to your wrist and hand.