Category Archives: Hand

Carpal Tunnel Causes, Relief, and Treatment

July 10, 2019 Teresa Stockton - Blog, Hand, Wrist

What is Carpal Tunnel Syndrome and Why Does it Hurt So Much?

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 of Carpal Tunnel Syndrome 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

There are many factors that can contribute to pain in the carpal tunnel, but these are some of the most common causes of Carpal Tunnel Syndrome.

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.

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. This can include bending, vibration, impact, and repetition.

Tool Handles – A handle should have an optimum grip span of about 2 ¼ inches.
Gripping Surface – Use rubberized coating or tubing on your gripping surface. This will lower 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 intensive hand activities. 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.

If your Carpal Tunnel Syndrome pain does not subside, call your physical therapist to schedule an appointment. Physical therapy may be able to reduce pain and remove the need for surgery.

PT News April 2019

April 24, 2019 Teresa Stockton - Blog, Hand, Shoulder, Wrist

This time in PT News we recap what our clinics have been posting throughout April 2019. We are excited to begin a new year of new posts featuring published articles from PTandMe partnering clinics!

1. The Truth Behind Shoulder Impingement
Written by Spectrum Physical Therapy with 3 physical therapy locations in Connecticut.

Shoulder impingement (Subacromial Impingement Syndrome) is a condition of the shoulder that results in pain felt at the front of the shoulder, under a bone called the acromion process, that is often worse with repetitive or frequent overhead activity. Read more

2. What is Certified Hand Therapy?
Written by the Therapy Team at Momentum Physical Therapy with multiple physical therapy locations throughout Greater San Antonio.

You may have heard of Certified Hand Therapists (CHTs) and wondered if they are the only therapists that can treat hand injuries. You may have also wondered why therapists needed a special certification to treat a specific body part. Read more

3. The Power (and Weakness) of the Wrist
Written by the physical therapy team at Cornerstone Physical Therapy with 5 locations in Ohio.

A wrist fracture has the potential to impact daily life for an extended period of time. Wrist fractures result from falls, sports activities, and improper lifting. Owing to the complex architecture of the bones, muscles, and ligaments in the wrist and hand, healing can take a while. Read more

PT News March 2019

March 27, 2019 Teresa Stockton - Arm, Blog, Hand, Neurological Rehab

This time in PT News we recap what our clinics have been posting throughout March 2019. We are excited to begin a new year of new posts featuring published articles from PTandMe partnering clinics!

1. What Triggers Trigger Finger?
Written by Rebound Physical Therapy with physical therapy locations throughout Bend, OR and the surrounding areas.

Trigger Finger seems to be a diagnosis many people are familiar with but not actually sure what the diagnosis entails and what can be done to prevent or treat it. Read more

2. Patient Regains Use of Arm After Biceps Tear Surgery
Written by the Therapy Team at Ability Rehabilitation with multiple physical therapy locations throughout Central Florida.

After his biceps tendon repair surgery, Rob’s right arm was in a fragile state; it was locked at the elbow and Rob was fearful of moving it and causing further injury. Read more

3. Physical Therapists Undergo Pain Neuroscience Education
Written by the physical therapy team at ARC Physical Therapy+ with locations across Kansas, Missouri and Iowa.

Evidence has shown that neuroscience educational strategies focused on teaching people in pain more about the biological and physiological processes involved in their pain experience, changes patient beliefs regarding their pain, thus reducing the threat of pain. Read more

Better Joints For A Better You

March 20, 2019 Teresa Stockton - Blog, Hand

Painful joints in your hand(s) can slow down how you function during the day. You may even be taking medication to control that pain. We would like to show you some joint protection techniques- this is one way to help decrease the pain, plus help protect your joints for the future. So what is joint protection? Joint protection is a simple way to change how you complete a normal activity to avoid putting stress and strain on the joints, causing less pain. Occupational Therapists (OT) have been teaching joint protection for over 20 years, by putting less force on the small joints in the hand; this can not only lead to pain relief, but also create less “wear and tear” on the joint. The next time you do an activity that results in pain to your hands, stop for a minute, and try to figure out what is causing the pain and what you can modify to make the activity less painful.

Here are some simple suggestions for changes to make to decrease the pain in your hand. This does not have to cost a lot of money. A little creativity can do the trick once you know what causes your pain. Many people complain of pain while writing, pinching, turning the key in the car, and can usually isolate the pain to the base of the thumb. One reason for this discomfort, for every 1 pound you pinch at the thumb tip, it delivers 12 pounds of force to the base of the thumb.

Most of the time the best way to modify your activity involves the slogan: “Bigger is Better”. The larger the pen, handle, key, utensil etc. the less force you apply to the joints in your hand. Regarding pens or pencils, especially if you write a lot, buy a bigger/wider pen, use a pen grip, or make your own using foam or soft tape. Below are some examples:

Using spring loaded scissors take a lot of pressure off the base of the thumb, for those who use scissors consistently, most fabric stores carry this type of scissors. No matter what your “tool of trade” is you can always make the handle bigger for paintbrushes, on your tooth brush, any handle that is difficult or painful to grip. When opening jars, use your palm to turn the lid instead of your finger and thumb.

Believe it or not some simple ideas for gadgets can also help ease the pain to your hands. Again think of the things around the house, kitchen in particular, that causes increase pain. Here are a few solutions to some common problems causing pain to the hand(s). These gadgets can be found from kitchen stores, to dollar stores, and medical companies specializing in adaptive equipment. Sometimes just knowing what to look for is half the battle. Again, sometimes you can use foam or tape to build up handles on your favorite tools.

Use an electric can opener, or at least a manual can opener with big handles (especially the handle you turn).
A wide variety of jar openers are available, some can even attach under the cabinet. If not you should at least use a non-skid rubber surface to open all jars so you apply less force with your hands.
Paring knives, regular utensils, potato peelers all come with extra wide firm handles – they are also dishwasher safe.
Big plastic spoons, spatulas, tongs are made with wide handles.
Apple slicers, ice cream scoopers, pizza slicers, garlic press all come with easy to grip handles allowing use of your arm versus the small joints of your fingers.

Hopefully this has given you some ideas to modify the tasks that are painful to your hand(s). Occupational Therapists in particular Certified Hand Therapists (CHT) are your best resource for any injury or condition to your hand or upper extremity. A CHT works with patients with a variety of upper extremity disorders, including but not limited to tendon/nerve disorders & lacerations, fractures, inflammatory disorders, and nerve compressions. Many patients seeking the care of a hand therapist also suffer from such chronic problems as arthritis or neurological conditions. A hand therapist works closely with the physician to provide a continuum of care for patients.

This article was written by Kingwood Occupational and Physical Therapy in the Houston, Kingwood area. More information about the physical therapy Kingwood location can be found at www.kingwoodotpt.com

FOOSH – Silly Name, Serious Injury

January 16, 2019 Teresa Stockton - Arm, Balance & Vestibular Rehab, Blog, Elbow, Hand, Shoulder

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.

ASHT: Hand Therapy Awareness Week

June 6, 2017 Teresa Stockton - Blog, Events, Hand

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.

True or False: Cracking Your Knuckles Can Lead to Arthritis

May 2, 2017 Teresa Stockton - Blog, Hand

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 have 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.

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 a 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 on 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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