As winter continues to embrace us, singlets and thongs are replaced with jackets and slippers. There’s a dense fog settling in through town and you’re dreading the cold commute into work- that icy steering wheel! The sudden cold snap can leave lots of us with joint aches and pains, slowing us down. Luckily there are lots of tricks of the trade to keeping your hands toasty warm and ready to brave the elements. 

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Pain is defined as an unpleasant sensory and emotional experience which we primarily associate with tissue damage. Pain is always subjective.  Each individual copes with pain differently.  Pain can be sharp, or dull.  It can come and go, or be a constant feeling.  Sometimes it can be worse following the use of the hand or wrist, and other times it can feel worse when resting.  No matter your circumstance, there are ways that pain can be managed. 

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De Quervain’s tendinitis occurs when the tendons around the base of your thumb become irritated. The irritation causes swelling and pain along the thumb side of your wrist. You have probably noticed the pain most when forming a fist, grasping objects, when turning your wrist or picking up your child, feeding your baby, or putting your seat belt on.  It can be a sharp grabbing pain at the base of the thumb, or a dull aching feeling - or you might experience both types of pain.  

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Cellulitis is a sudden, non-contagious infection of the skin, characterised by redness, swelling and heat, accompanied by pain and tenderness. People with lymphoedema are particularly susceptible to cellulitis because the lymphatic system is damaged or overloaded and does not function adequately to fight infection. What does it present like and what do we do about it?

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If you have a tendency to look at people’s hands when you meet them or pass them in the street like I do, then you may have noticed we all have different hands and may have experienced an injury. Amputated fingers are a common injury unfortunately.  We answer some of the common questions here.

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The use of compression garments is one of the cornerstones of lymphoedema treatment. They enable medically appropriate pressure to be applied to the swollen region. This means that the pooling of fluid can be reduced, the limb size and shape preserved and the lymphatic circulation supported and improved. Compression garments provide graduated compression and are available in a variety of styles, sizes, colours and grades of compression. Severe swelling usually requires stronger support than mild swelling. We get it though - it is often the last thing you want to be putting on when you get dressed in the morning. 

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A scar develops as part of the normal wound healing process.  Within 2-3 days of the skin’s surface being injured, scar tissue fills in the injured area to close the wound.  Scar tissue can continue to develop over many weeks or months.  What are problem scars and how can massage help? 

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We see a lot of clients needing casting and the great thing is there are different options to choose from.  Sometimes we meet very confused poeple who think they have a waterproof cast and do not. For those who are not sure what casting options there are available, here are the ones that are most common:

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There’s no need to not knit (can you say that 5 times quickly?) any more just because your hobby is causing you pain. In hand therapy, we see a lot of people with hands that are sore even though they haven’t had an injury. Particularly among our female patients, we regularly come across the complaint that hobbies such as knitting, crochet or sewing causes pain and sometimes people are forced to give up a favourite pastime.

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If you often wake with pain and stiffness in your fingers, we have 5 simple strategies that can help get you moving and reduce your pain.  It is not uncommon for finger joints to feel sore as we get older.  Old injuries, arthritic conditions, or simple wear and tear to joints can means the structures around the joints that give us stability and allow easy gliding, don’t work as efficiently. 

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A scar develops as part of the normal wound healing process.  Within 2-3 days of the skin’s surface being injured, scar tissue fills in the injured area to close the wound.  Scar tissue can continue to develop over many weeks or months.  The amount of scar that develops is dependent on the severity of the injury/surgery, the location of the wound, skin type and slow healing wounds. Scar tissue can become sensitive or painful however….. then what?!

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New technology has now allowed for increased assessment for this patient caseload. Lymphoedema is a condition that can cause significant swelling of the arm and hand due to excess lymph building up. This can occur when the lymphatic system, which is responsible for draining excess fluid, is damaged or altered by surgery and/or radiation therapy.  So how do we measure this swelling?

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This deformity results from an imbalance of forces in the finger. As stated in our blog about Boutonniere deformities, the various muscles and their tendons which act upon the fingers work in perfect equilibrium, balancing the forces which act to pull into flexion or extension. Disruption to this equilibrium results in changes in posture, movement and function. The swan-neck position is described as hyperextension of the PIP joint and flexion of the DIP joint and it results from a ‘collapse’ between the three phalanges of the finger. So how does this happen?

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In the forearm and hand there are three crucial nerves which deliver information about movement from the central nervous system (CNS), and deliver information about feeling and position back to the CNS. One that we will discuss is the radial nerve which is essential for you to give a thumbs up, extend your wrist and fingers to pick up a cup, and turn your palm over, eg to collect your change at the checkout. It also carries information back to the CNS about feeling and joint position.

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Paediatric trigger thumb is estimated to represent about 2% of all upper extremity abnormalities in children. The incidence has been reported to be between 0.5 and 3 per 1,000 children. The flexor tendons of the hand and wrist (the tendons that help us bend) move freely in sheaths. The flexor tendons are held in place by a system of pulleys. If there is swelling of the tendon or of the tissue surrounding the tendon, the movement through the A1 pulley may be painful and inhibited. When the tendon is inflamed (nodule) it becomes too thick to pass through the A1 pulley. This can cause the thumb to have a snapping or lock into flexion when the thumb is being mobilised.

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At the elbow, the radius articulates with the humerus and proximal ulna. These articulations allow flexion-extension of the elbow and pronation-supination of the forearm (rotating the forearm for things like holding your hand out to collect change).  The radial head is the end of the radius bone at the location of the elbow.   Radial head and neck fractures are common and account for one third of all fractures of the elbow and approximately 1.5%-4% of all fractures in adults (Kova, et al 2013).  How do they happen?

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We have all jammed our finger in the door at least once and know how much it can hurt!  The most common cause of nail bed injuries and deformities is trauma. Crush injuries, where the nail bed gets squeezed between the hard nail and the distal phalanx, are common. Other injuries to the nail bed include laceration, and avulsion injuries.  The anatomy of the nail is incredible and more complex that first thought.

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Carpal tunnel syndrome (sometimes called ‘carpet tunnel’ by accident!) is a common condition we treat at Riverina Hand Therapy. We see it in our adult patients of both genders, more commonly in the middle and later decades of life, though it can affect people of all ages.  People with carpal tunnel often experience tingling, pins and needles, numbness or pain in their hands. It is limited to the thumb, index, middle, and radial half of the ring finger and the palm, for this is the area which is powered by the median nerve, which passes through the carpal tunnel. People often complain that they wake up during the night or in the morning with numb, tingling hands.

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Oh dear. So your finger is starting to look bent? 

This position is known as a Boutonniere deformity (boo-ton-e-air), where the PIP joint becomes fixed in flexion and the DIP joint becomes hyperextended. The various muscles and their tendons which act upon the fingers work in perfect equilibrium, balancing the forces which act to pull into flexion or extension.

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Swelling, also known as oedema, is the accumulation of excessive fluid in the intercellular (between cells) spaces. The build-up of fluid involves a variety of factors. Our bodies undergo the inflammatory process virtually any time an injury or tissue damage occurs. Along with redness, heat and pain, swelling is a sign of the inflammatory process at work. When part of the body is injured, chemicals are released that act on our smallest blood vessels, called the capillaries. Why is this important?

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For those that love gardening, it shouldn’t have to be a painful activity.  Often, however, the onset of arthritis into our wrist, finger and thumb joints can create sharp pain during certain gardening activities such as weeding, or can result in an aching feeling even when you have finished gardening.  How to prevent this?  One of the best ways to prevent pain from arthritis is to adopt methods that protect the joints – that is doing things in a way that reduces the stress the joint has to endure.  Here are some tips for applying this to gardening:

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A common (and painful!) injury with ball sports is dislocation of the proximal interphalangeal joint (PIP joint). From the time pre-season training starts until after the grand final, we see increased numbers of people from all football codes and skill levels visiting our rooms with painful, stiff, swollen fingers. Of course this injury is not restricted to sports players; sometimes falling over, hitting a gate or the toss of a horse’s head while you’re holding the rope is enough to dislocate a joint. While dislocations can occur in many different joints, this blog will address dislocations of the PIP joint.

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A really common injury that we see is what’s termed a mallet injury. This occurs when the extensor tendon that attaches to the dorsal side of the distal phalanx of your finger (just before your fingernail) is no longer able to straighten the end joint, known as the distal interphalangeal joint (DIP joint). This can occur playing sport, such as Aussie Rules or netball, or even just at home. Some of our clients have sustained this injury by simply bumping their finger when drying off with a towel, or hitting their finger on the Christmas ham! Other times it can be more traumatic, such as sustaining a deep laceration across the back of the finger.

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As mentioned in a previous blog, dry needling is a useful tool alongside our regular therapeutic treatments for reducing tension in very tight tissues which may be causing pain or impairing normal movement and function. It stimulates your soft tissues – that is the muscles, tendons and ligaments – to improve their function. One of the issues that we incorporate dry needling as a treatment for is pain. There are many causes of pain in the upper limb; one that we often is encounter is pain which results from tight, inflamed tissues and nerves which are compressed by tight tissue.

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Radial tunnel syndrome (RTS) is the name given to a condition when the radial nerve is compressed in the proximal forearm, usually by muscle or ligament. It is sometimes called supinator syndrome.  If you have RTS, you are likely to experience pain in the proximal radial forearm, particularly in the muscles which supinate the forearm (rotate so the palm faces up) and extend the wrist and fingers. It is often aggravated with use of the hand and arm. Heavy gripping, working with the elbow extended, repetitive or prolonged positions of supination or pronation (palm facing down) often provoke symptoms. What about pain caused from RTS?

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Your wound requires proper care to ensure that it heals as quickly as possible. Healing it as quickly as possible reduces the risk of infection and reduces scarring. Minimising scarring is very important to prevent unnecessary stiffness and pain. Here at Riverina Hand Therapy we deal with wounds on a daily basis.  These can be from surgery, or from an accident, such as a crush, or laceration.  Here are some tips for managing your wounds.

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What is a normal lymphatic system like?                                                              

The lymphatic system is similar to the blood system and has just as many vessels - but they contain lymph, which is clear and so cannot be seen (unless a suitable dye is injected). The lymphatics differ from the blood system in that the blood continually circulates through each part of the body while the lymph just drains from each part. Lymphatics drain away the excess protein and water which continually escape from the blood in small amounts, plus some substances made in the tissues, and any foreign substances which enter them. Lymphatics start, in almost every tissue, as many tiny vessels which gradually join together into bigger ones. What else happens?

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At Riverina Hand Therapy it is important to us that we review how things are going with treatment.  Are things working?  Is pain being relieved?  Is movement and function improving?  Pain is often a large area that we work on in hand, wrist and arm injuries.  Having a way to measure pain, and its effect on how we use our hands, is essential in our practice. It can be hard to measure pain from a therapist’s perspective as we are not the ones experiencing it.  Everyone copes with pain differently, and it is very individual.  How do we capture this information? One way we do this at Riverina Hand Therapy is through a questionnaire called the Patient Rated Wrist and Hand Evaluation (PRWHE). 

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Hand and upper limb function can be greatly affected following neurological injuries such as stroke, brain injury or spinal injuries.  Traditionally there was little dynamic splinting available for regaining a grasp and release pattern that is required to do even the simple things such as picking up your wallet, holding onto a knife and fork, or even a cup to drink from.  Last year Amy our director undertook training in the prescription and delivery of therapy via Saebo (say-bo) splinting.  So what is Saebo all about?

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Injury or amputation of the fingertip can have a negative effect on the overall function of the hand. Fingertip injury and amputations are not uncommon.  These injuries can be very painful and debilitating and need to be properly cared for.  The fingertip is very sensitive and important to the function of the finger; it allows us to grip, feel and discriminate between different objects.  We often see finger tip injuries and know exactly how to get you back on track to using your hand quickly and effectively. Did you know the thumb and fingers on your hand have different and important responsibilities in the overall function of the hand?

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You might have heard of neoprene splinting before.  Neoprene splinting is an alternative to thermoplastic splinting, and has many benefits. It provides support to joints and structures of the hand, however also allows flexibility by giving movement to the area.  Neoprene is made up of an internal rubber layer used to an external nylon layer.  The neoprene used for making finger and hand splints is similar to the wetsuit material you might be familiar with.  So how is it used in hand therapy?

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Scarring can develop after surgery, or after an injury.  It develops once a wound starts to heal.  Scar tissue is formed when the wound closes and the body lays down collagen cells.  Collagen is a core ingredient in our body tissues as it gives strength.  Scar tissue is made up of a dense randomly aligned group of collagen cells.  It has a lot of strength, but not a lot of elasticity to allow movement. Scar tissue can also stick.  It can adhere itself to tissues under the skin.  Thick and adhered scar tissue can restrict movement or an ability to function well.  For example, a scar to the back of the hand, might then affect the ability to make a fist.  What to do about this?

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We get a lot of people present to us in hand therapy with tingling fingers. The good thing is, we can help with this. The little finger and half of the ring finger are innervated by the ulnar nerve. When patients report tingling in the little finger, it often indicates that the ulnar nerve is irritated somewhere as it makes its way down the arm. A common place for the ulnar nerve to become irritated is at the cubital tunnel.

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The thumb is a complex unit, and we use it so frequently in every day life.  In fact we take it often for granted, until an injury occurs which limits the use of the thumb.  Anatomically, the thumb has three joints. The carpometacarpal joint (CMC joint) which is right at the bottom where the thumb meets the wrist; the metacarpophalangeal joint (MP joint) and the interphalangeal (IP joint) which is the tip joint. The middle joint (the MP joint) can be injured in skiing activity, often when we fall over with a ski pole in our hands. It can also be commonly injured when the thumb receives a blow to the tip, such as during sporting games or from a fall on an outstretched hand.  So what happens in this situation?

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It wasn’t until we started to incorporate lymphoedema treatment into our existing practice, that we realised many at risk men and women do not know a lot about lymphoedema, and those that do, feel very anxious about what it involves and how it will impact their lives. 

Lymphoedema occurs when the body is not able to regulate its lymphatic system.  The lymphatic system is similar to the blood system with just as many vessels.  Lymph is a clear fluid which travels along the lymphatics and is filtered by the lymph nodes, which remove foreign matter needed for immunity.  Lymphoedema is due to a failure of the lymphatic system when the lymphatic’s capacity for transporting lymph is permanently overloaded.  It usually affects the limbs and can also involve the trunk, breast, neck or genital area.

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Let’s face it, in hand therapy, we see a lot of splints! Everyday, we deal with splints – different shapes, different colours, and different thicknesses. A static splint (also known as an orthosis) serves different purposes, and it is important for therapists to gain good clinical reasoning before applying splints/orthoses to any customer.  Thermoplastic splinting is very common in hand therapy, but there are some principles that need to be considered when deciding if this is the right support for each individual. Let’s have a look at these.

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We see many people through our clinic who have pain.  Pain from arthritis in the hands and wrists is more common that you think. Pain caused by osteoarthritis occurs from wear and tear to joints and joint structures over time. There are many reasons why your joints ache and hurt.  Some of these can include:

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For those that love a great app, I have sourced two of the best for anyone who has developed arm swelling or lymphoedema.  A large part of our service provision for lymphoedema clients is education: about risks, skin care, and management of swelling.  These following apps can be a really great addition to clients lymphoedema management, particularly if you are regionally based and the frequency of review appointments is limited due to distance.

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