News

7 July 2022

Updates & Communications
July 2022

  • What's New This Month:
  • Word From Jen
  • Skiing Injuries
  • Cubital Tunnel Syndrome
  • Fast Five with Lucy

WORD FROM JEN

Jennifer Mathias
MHT Director
Senior Clinician

It is a bittersweet July for all of us here at Melbourne Hand Therapy as we say goodbye to our current general manager, Steve Eagland.

In no surprise to any of us, Steve has been headhunted back to his old stomping ground in the car industry and we wish him a world of success.

As my right-hand man, Steve’s remarkable skills helped steer MHT through two years of Covid turbulence and his affable and calm manner was a Godsend for me during those times of high stress.

Good luck Steve. We’ll miss you.

Now for the sweet part. Welcome new general manager David Ratner.

David will start at MHT on July 11 and has over 15 years of senior management experience with a strong focus on finance, operations and service delivery.

He is a lovely, approachable man and very friendly and will fit perfectly into the MHT team. Of course, we’ll be throwing the Fast Five microphone over to him for the August newsletter just to check what is under the hood.

David has worked as a general manager in many family-based businesses and, importantly, believes passionately in the values, ethics and morals of a business, which align very well with MHT’s ideals.

He’s got two young children and coaches sports teams in his spare time.

In other news, we look at what happens when fun on the ski slopes takes priority over safety. Sixteen-year-old MHT patient Charlie was so excited to get going on his snowboard, that he "forgot" his wrist guards. It didn't end well.

And we analyse what happens when your “funny bone” is no longer a laughing matter. Physiotherapist Terri Stanley-Clarke takes you through Cubital Tunnel Syndrome - often a progressive condition that occurs over time resulting from the ulna nerve - known colloquially as the “funny bone” - becoming inflamed, swollen, or compressed at the inside area of the elbow as it travels through the cubital tunnel.

And as is tradition, we subject our newest member of staff, hand therapist Lucy Barrett to a grilling for Fast Five.

Fun on the slopes but safety first

The Victorian ski fields are open and calling. But before you start rummaging through storage for your long-lost ski gear, take a moment to consider how best to stay injury-free on the slopes.

By the MHT Team

After the two-year shutdown of the Victorian’s snowfields, it’s no wonder the rush is on to get back up the mountain among our skiers and snowboarders.

And who can blame them? An early dump of snow and continual fresh dusting makes for ideal conditions.

While it's hard not to have fun on the slopes – whether you are carving up the mountain or taking a more Après approach by an open fire in a lodge with a good book and glass of red - there is a serious side to skiing and snowboarding. Unfortunately, that's the side we at Melbourne Hand Therapy see all too often. And that is the injuries.

The injuries.

And the two main injuries that tend to result from fun on the slopes are distal radius fractures and skier’s thumb.

Distal Radius Fracture:

Sixteen-year-old Charlie, a first-time snowboarder, was so keen to hit the slopes with his flashy new board, he "forgot" his all-important wrist guards.

Wrist guards, along with helmets, are a vital safety feature for any snowboarder, as they stabilise and strengthen the wrist in an inevitable fall and help to absorb shock. 

Ten minutes into his first snowboarding experience, Charlie lurched backwards and instinctively threw out his hands to break the fall. Even though it was a low-energy impact - as he was on flat ground and had limited speed - it was enough to break his wrist.

The ski patrol was called, diagnosed a broken wrist (saying it “happened all the time”) and Charlie was sent to the local hospital.

Hospital x-rays revealed a distal radius fracture. Luckily for Charlie, he didn’t require surgery but was in a splint for six weeks and forced to miss his beloved basketball.

While wrist guards can’t always prevent such injuries, they can help mitigate against them in a majority of cases.

Skier’s thumb:

Ever heard of skier’s thumb? Yes, there is such a thing. Skier’s thumb is a ligament injury caused by falling while holding ski poles. Using your leashes incorrectly can pull the grip against your thumb, increasing the risk of injury. Instead, loop the leash over your wrist and bring the grip up from underneath, grasping both grip and leash in your fist - this allows the pole to fall away from your hand if you let go. Better yet, ski leashless!

When the thumb is overstretched away from the hand it may cause a sprain, partial or full tear to the ulnar collateral ligament. This ligament helps to stabilise the thumb and any injury to it will cause pain and instability. 

MHT’s basic tips for staying safe and injury-free in the snow:

Get your equipment right - make sure your boots and board or skis fit you well so that you’re comfortable. Ill-fitting equipment can lead to accidents. Always wear a helmet and consider goggles instead of sunglasses so that your vision is as good as it can be, even in bad weather.

Ski with friends - You want someone to be able to notify snow patrol if you get injured or disappear into a snowbank. If you are skiing alone, let someone know where you are going and when you will be back.

Take regular breaks and eat well - Accidents are more likely to happen the more fatigued you get. We all want to maximise our time on the slopes but don’t forget to take breaks throughout the day to rest, eat and hydrate! When you finish for the day have a big healthy meal and a good night’s sleep so your body is recovered enough to go again the next day.

Know your limits - Study the trail map and look out for signs which show the level of the runs. Remember that difficulty might change throughout the day or overnight, so approach runs with some caution the first time you attempt them. If you’re new to skiing it’s a great idea to sign up for lessons early on your first day - all those pros out there took lessons at some stage. At the end of your lesson, you can ask your instructor for tips on new runs to match your new skills.

Enjoy the slopes this winter. But remember, it's NOT cool to be injured.

When the Funny Bone Loses Its Sense of Humour

By Terri Stanley-Clarke

The cubital tunnel comprises muscle bone and ligaments. The Ulna nerve – what we all know as the “funny bone” - is both motor and sensory so provides feeling and function to the forearm and wrist. It provides sensation to the inside of your forearm and wrist and extends on the palmer surface of the hand through to the little finger and half of the ring finger, and to the tips front and back. It innervates the muscles involved in bending the wrist and fingers and adduction of the thumb

There are several ways that the nerve can be compressed or irritated 

  • Repetitive elbow bending or sustained elbow flexion. As we bend our elbow, the ulna nerve stretches and glides in order to travel around the medial epicondyle which can irritate the nerve. Sustained or repetitive bending can cause irritation to the nerve.
  • Repetitive overhead activities.
  • Leaning on the elbow.
  • Swelling in the elbow may compress the nerve.
  • A decrease in the space/area of the tunnel itself such as space-occupying lesions- ganglions/ lipomas or structurally. anatomical irregularities or degeneration of the elbow joint, compromising integrity of the ulna nerve.
  • the ulna nerve for some people may sublux, move in and out from the medical epicondyle with movement, irritating the nerve over time.

Signs & Symptoms

Patients will usually present with a specific set of symptoms differing based on the length and how far the condition has progressed. It can loosely be classified as mild, moderate and severe

Mild- pain and pins and needles that come and go.

Moderate- pain and pins and needles with measurable weakness.

Severe – Constant pain, pins, and needles with measurable weakness.

Main symptoms can include pain around the inside area of the elbow or pain extending down the forearm with numbness and tingling in the ring, little finger and associated areas down into the hand. There may be reported snapping or popping with bending of the elbow. As the condition progresses, weakness is observed – in grip strength, pinch strength - and the little finger may stick out to the side due to weakness. There may be atrophy of the muscles in the hand and in the 1st webspace in the thumb. The little finger and ring finger may be resting in a claw position due to weakness.

Assessment

Studies may be done to identify if the nerve is working properly. This test measures the time it takes for the electrical signal of the nerve to go from one point of the ulna nerve to another. Several points on the nerve are tested and an increase in time can identify where the nerve may be compressed. 

Electromyogram EMG- this tests muscle response and is often done in conjunction with nerve conduction studies. Electrodes are placed on the muscles corresponding to the ulna nerve and measure the electrical activity of the muscle as it contracts. With these studies, they can also determine if there is associated muscle damage indicating a severe condition.

An X-ray may be done and while the ulna nerve can’t be observed, this may give information regarding any bone spurs or arthritis that could potentially be compressing the nerve.

Treatment

Depending on the severity and the timeframe of progression of the condition, treatment might vary.

Initially, in particular, with mild conditions, conservative treatment would be the first line of call.

Conservative 

  • rest and cessation of aggravating activities.
  • night brace to limit sustained flexed postures.
  • nerve gliding exercises.
  • posture and ergonomic setup.

If the condition doesn’t improve or gets worse, surgical intervention may be required.

Surgical

There are different types of surgeries for this condition. The surgeon will decide on an appropriate surgical course based on the severity of the symptoms.  

This can include Cubital tunnel release where the ligament roof of the cubital tunnel is cut and divided, increasing the size of the tunnel.

It can also include an Ulnar nerve transposition where the nerve is moved from its normal place behind the medial epicondyle to somewhere else. Moving it takes away the ability of the nerve to have to stretch around the medial epicondyle and therefore reduces irritation. It can be moved in front of the epicondyle (anterior transposition) or even moved under the skin and fat (subcutaneous transposition). A surgeon might also decide to move the nerves within the muscle (intermuscular transposition); or under the muscle (submuscular transposition).

In other cases, surgeons can decide on a medial epicondylectomy. This is where part of the medial epicondyle is removed. This prevents the nerve from getting caught/stretching around the medial epicondyle.

How to Prevent Cubital Tunnel Syndrome?

There are some known risk factors associated with cubital tunnel syndrome. By being aware, identifying early signs and symptoms and adjusting our daily lives to avoid aggravating factors, this condition can be partly prevented. Risk factors include

  • Prior fracture or dislocation of the elbow
  • Bone spurs/arthritis of the elbow
  • Swelling of the elbow joint
  • Cysts near the elbow
  • Age – over 40
  • Overhead (especially throwing) activities
  • Work or activities that involve prolonged or repetitive elbow flexion
  • Resting on elbows
  • Obesity
  • Can be associated with other diseases like diabetes, RA, OA

How Melbourne Hand Therapy Can Help

  • With accurate assessment and diagnosis of condition and help identify the severity
  • Aid in appropriate conservative treatment by identifying aggravating factors, and help formulate a plan to limit the stress and compression of the nerve
  • Issue with an appropriate brace for night
  • Appropriate nerve gliding exercises
  • Help in timely referral to surgical team if needed

FAST FIVE WITH LUCY

This month, Fast Five cornered MHT’s newest therapist Lucy Barrett to find out what lies beneath the surface of our new highly credentialed colleague.

Other than having many years of experience as a hand therapist in sunny Darwin, Lucy has a special interest in post-operative rehabilitation. Could that possibly have come from the 388 episodes of Grey’s Anatomy this superfan has watched?

What football team do you support and why?

West Coast Eagles. No reason aside from being from Perth and not wanting to support the Freo Dockers. 

What are you reading at the moment?

Nothing, I don't read at all and haven't picked up a book in about 10 years.

What is your guilty streaming pleasure?

I'm a big Grey's Anatomy fan! I've watched all 388 episodes, some more than once! (Editor: 🧐)

What do you do to relax?

I love to run so will always go for a jog if I'm ever feeling stressed.