In January this year we updated our policy on hand hygiene following a detailed discussion in our monthly therapy in-service program. Posters were made for all of our consulting rooms on the “5 Moments of Hand Hygiene” and we ensured that hospital grade alcohol based hand rub (Avagard) was stocked and available to therapists and patients for use in all our rooms. This was very timely considering the unexpected pandemic that has followed.
We have been using any non-patient time to further our knowledge and expertise with some exciting professional development opportunities. A lecture series run by Roth / McFarlane Hand And Upper Limb Centre include; Therapeautic Management of Elbow Dislocations, Carpal Instabilities and Extensor Tendon Injuries.
In the treatment of lateral epicondylitis we use a multimodal approach combining elbow joint mobilisation and exercise. Current research supports the superior benefits of this approach when compared to other treatment options, with this approach patient's see a greater recovery of symptoms in the long term.
The Scapholunate (SL) ligament is the most injured carpal ligament accounting for 5% of all wrist strains and can also be present in approximately 40% of distal radius fractures, particularly those of the radial styloid. The SL ligament is richly innervated and provides important proprioceptive input for dynamic wrist stability.
The SL ligament can be torn when the wrist is loaded in extension and ulna deviation with the forearm supinated. Often SL ligament injuries present late, the patient may not be able to recall the injury mechanism and wrist ROM may be normal. They will, however, have dorsal wrist pain when the wrist is loaded and localized tenderness over SL interval, just distal to Listers tubercle. Useful imaging includes Xray of bilateral hands/wrists clenched fist view looking for evidence of Dynamic SL instability.
Thermoplastic wrist splinting will speed up healing time by protecting the wrist from axial loading (which can lead to further damage to the SL and secondary stabilizers). Early rehabilitation of these injuries decreases the risk of progression to more serious pathology. Early referral to hand therapy improves patient outcomes and facilitates earlier return to activities of daily living including work and sport.
Flexor pulley injuries make up the majority of all rock climbing injuries to the upper limb and are often the result of strong forces through the fingers in a challenging dynamic movement or if a climber slips from a foot hold. These injuries can vary in severity but conservative management is the preferred method of management, except in multiple pulley ruptures.Our hand therapists can assist to assess these injuries, facilitate referral for appropriate imaging or specialist review, fabricate custom-made thermoplastic splints and to assist with a graded return to daily activities and climbing.