It is common for patients to experience heightened sensitivity of the area following a hand injury or surgery.  It is thought to be the result of reduced sensory threshold to stimulus, or maladaptive central processing of incoming sensory information from the periphery. If the nerve tissues themselves are damaged, micro neuromas are another possibility (Rosen, 2012).  This hypersensitivity or hyperaesthesia may include allodynia (when pain results from stimuli which would not normally provoke pain) or hyperalgesia (an increase in sensitivity to tactile stimuli). Desensitisati ..read more

Common treatments for tennis elbow or lateral epicondylalgia (LE) are frequently combined in clinical practice. The use of corticosteroid injection (CSI) to treat LE is increasingly discouraged due to the lack of long-term efficacy and due to high recurrence rates. In a randomized controlled trial with 1-year follow-up, recurrence was evident in 72% of patients receiving corticosteroid injection compared with 8% after physiotherapy. A randomised placebo-controlled trial (Coombes et al. 2013) was conducted to investigate the effectiveness of CSI, multimodal physiotherapy, or both in patients ..read more

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 ..read more

At In Touch Hand Therapy, we have an ongoing interest in improving hand pain and function for people with OA hands, thumbs and wrists – it’s becoming an obsession! Arthritic joint pain in the hands and thumb has often seen as a right of passage for older adults, with few options in regard to treatment. From a hand therapy perspective, multimodal interventions for thumb OA have been shown to perform slightly better than unimodal therapy (Deveza et al 2021) with some uncertainty about the use of joint protection programmes which in the past have been a core component of management of hand OA. A ..read more

"A tendon transfer procedure relocates the insertion of a functioning muscle-tendon unit in order to restore lost movement and function at another site.” The science of tendon transfer is well developed – relocating a functioning muscle’s tendon to a paralysed muscle.  This is most commonly done in cases where the peripheral nerve supply has been permanently damaged in injury.  When the transferred muscle contracts, it pulls on the tendon it has been transferred to, creating a different movement than it used to.   Through years of development the muscles used in t ..read more

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.  ​ The pathophysiology is largely still unknown, however research has shown an anatomical mismatch of the flexor pollicis longus (FPL) tendon in the tendon sheath and fibrous tissue proliferation of the A1 pulley. The child often presents with a thumb locked in flexion at the ..read more

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 A 2005 study (Atkinson et al.) of 70 patients found that paper tape significantly decreased scar volume and was likely to prevent hypertrophic scarring.   In later stages we may use kinesiotape or similar to apply limited load to the scar for mobility, as well as a variety of silicone based tapes for scar softening and appearance ..read more

​Volar plate avulsions and central slip avulsion fractures. Volar plate avulsions These painful injuries usually occur with forceful hyperextension of the finger, frequently a ‘ball versus finger’ during netball, basketball, cricket or other ball sports. There is a characteristic bruising over the palmar aspect of the PIP joint, with rapid swelling. The volar plate is a thick ligament that spans the palmar aspect of each of the MCP and IP joints, providing a firm constraint to hyperextension. In volar plate fractures the avulsed chip of bone remains attached to the distal ligament insertion ..read more

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 ..read more

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. We also wanted to focus on the bigger picture approach in rehabilitation, of involving the sensorimotor system, movement patterning, emotions and beliefs when helping a person return to full function after a hand or wrist injury (little bone – big problem!). Then, the Covid-19 virus crisis hit, and the little thing became a big problem overnight. From Wednesday 25th March, In Touch sw ..read more