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Hand Therapy Consulting regularly shares current news and information on hand therapy practices from around the world, including information on common hand problems, trends in hand therapy exercises and treatment as well as updates and announcements on our own research and activities.

Scars from part of the normal healing process following an injury or surgery and can take up to two years to mature. Some scars have a tendency towards becoming hypertrophic. This can be problematic as the scar may shorten and contract, thereby limiting movement across a joint. In addition, patient's often feel self-conscious as a result of the appearance of a scar. Pressure therapy helps to improve the appearance and pliability of a scar, thereby giving the patient more confidence and freedom of movement.

The need for scar intervention is assessed on an individual basis by a qualified Occupational Therapist. A detailed history is taken and a treatment plan is determined. Treatment can include compression therapy, scar massage, moisturising, the provision of silicone and protection from sunlight in the early phase of wound healing. A referral may be made to a Plastic Surgeon for surgical management may be required for old and problematic scars.

Hand Therapy Consulting (HTC) has a special interest in scar management with all patients being assessed by Robyn Midgley, BSc (Hons) OT, AHT (BAHT), ECHT (EFSHT,).

HTC offers an in-house service where bespoke garments are designed, fitted, monitored and adjusted accordingly and is excited to announce that Penny Hannekom has joined the practice to assist with the measurement and fabrication of each compression garment. The compression garments are made from stretch knit polyester fabrics in skin tone colours. Penny is a highly experienced seamstress who has a passion for sewing and helping people re-gain their confidence after an injury.

Welcome to the practice Penny!

 

 

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Harvard Medical School released news of a study today suggesting that hand grip strength is a predictor of an increased risk of having a heart attack, stroke or early death.

Hand grip strength is assessed using a Dynamometer (image above) and is measured in Kilograms. An individual's results can be compared to normative data to ascertain if their strength lies within normal limits. Hand grip strength has been shown to reflect overall strength. Previous studies have shown that weak hand grip strength is linked to a higher risk of death compared to those who have a stronger grip. These studies were performed on an older population in Europe and North America.

The Harvard Medical School study analysed 140 000 individuals from 17 countries around the world, across a broad age group spectrum. The study linked poor grip strength with an increased risk of heart disease and death due to heart disease. The researchers suggest that a person with weak grip strength is more likely to die sooner if medical problems develop than someone who has a higher grip strength. Muscle strength can predict survival.

The good news is that a healthy diet, resistance training and quality sleep can build muscle strength and contribute to overall wellness.

For more information please go to https://www.intelihealth.com/article/grip-strength-linked-to-early-death-risk 

 

 

 


The hand surgery and therapy community all agree that a tendon laceration is best repaired as soon as possible. A delay of a week or two can be viewed as detrimental to the functional outcome of a repaired tendon. However, all too often patients that are involved in a traumatic injury to the hand are first assessed by Accident & Amergency staff who are not hand specialists and injuries such as tendon lacerations are frequently missed. It is never too late to repair a tendon and it is also never too late to change one's splinting practice in the rehabilitation of Zone II flexor tendon repairs.

I received a referral of a patient who sustained a crush injury to his dominant right hand 8 months ago. The phalanges of the index and middle fingers were fractured and immobilsed but the tendon lacerations were not identified until he was seen by a Hand Surgeon 8 months after the initial injury. The hand surgeon was able to perform a primary repair the FDP tendon to the index finger; however a 2 stage tendon reconstruction to the middle finger was required due to poor tendon integrity. 

For the first time in my practice I have opted to use the Manchester Short Splint as described by Peck et al, 2014 as opposed to a forearm-based Synergistic Wrist Splint. The Manchester Short Splint design permits maximal wrist tenodesis motion and facilitates interphalangeal joint flexion and extension through a combination of an early active motion and passive flexion exercises. According to Peck et al, this splint design demonstrates improved outcomes whilst preserving repair integrity and is an innovative development in the rehabilitation of repaired flexor tendons. The design is less cumbersome for the patient and is likely to improve patient compliance with wearing the splint. The FDP tendon of the index finger is functioning very well at present and I expect that he will have an excellent outcome.

 

 

It is well documented that when a finger is injured and not used functionally for a period of time, the motor representation of the finger on the brain is diminished. Trauma to a joint results in a normal tissue response of increased oedema, inflammation, collagen cross linking and poor movement between tissue planes. As the joint is unable to move, an abnormal pattern of movement develops, which results in re-patterning of the motor cortex.

When presented with a finger that has poor active flexion or extension, the natural response is to provide a splint to straighten the finger and to perform passive mobilisation exercises in order to reduce joint stiffness. This treatment approach may be effective, but improvements in active and passive range of motion are often short lived, with the need for frequent hand therapy sessions over a long period of time.

Judy Colditz, OT/L, CHT, FAOTA describes a method called Active Re-Direction whereby all forms of passive splinting and exercise are replaced with volitional active movement of the stiff joint. This is achieved through the use of a splint which blocks MP joint hyperextension and permits full active flexion and extension of the PIP joint repeatedly throughout the day. This concept simultaneously reduces oedema, accomplishes differential glide of tissue planes and ensures remapping of the motor cortex. The result is the achievement of full active flexion and extension of the stiff joint and improved use of the finger when performing functional tasks.

Active re-direction was recently applied to two of my patients with success:

PATIENT A

Nicky presented with poor active range of motion of the right little finger as a result of an old injury. The PIPJ was not stiff, but re-patterning of the motor cortex was preventing adequate control of the finger during finger flexion and extension. The Active Re-Direction Splint assisted with regaining a normal pattern of movement and cortical re-mapping.

          

Active Finger Extension Before Treatment           Active Re-direction Splint                                Active Finger Extension After Treatment

 

PATIENT B

Casey presented with a stiff PIPJ following a knife laceration to the joint. She was unable to flex or extend the PIPJ more than is presented in the first picture. An Active Re-Direction Splint was provided and Casey was able to regain full active flexiona nd extension of the PIP and DIP joints of the index finger.

          

Active Finger Extension Before Treatment           Active Finger Extension After Treatment             Active Finger Flexion After Treatment                                 

It is recommended that an active regime is used as opposed to a passive regime in order to ensure both cortical and mechanical stress is applied for optimum results.

For more information on the technique please click on the following link:

https://handlab.com/resources/active-redirection-instead-passive-motion-joint-stiffness/

 

 

 

February 2015 promises to deliver exciting courses and opportunities to network with Hand Surgeons and Therapists:

1. SASHT Gauteng Welcome Function: New Developments Regarding Consent & Confidentiality,   Matty Van Niekerk, 7th February 2015.

2. INSTOPP: ICD 10 Coding for Occupational Therapists, Discovery Health, 14th February 2015.

3. SASSH Refresher Course: Topics include Anatomy and Biomechanics, Congenital Abnormalities and Tendon Transfers. International Guest Speaker: Donald Summut from the United Kingdom and Jan Friden - Professor of Hand Surgery from Gothenburg, Sweden, 20-22 February 2015.

 

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