Chronic Regional Pain Syndrome can be a challenging condition to treat and requires a Multidisciplinary Team approach. At Melbourne Hand Therapy, if we identify that CRPS symptoms are present or developing, we liaise closely with the referring doctor and primary medical provider regarding medical management and recommend referrals for additional input such as involving a Pain Management Specialist and a Psychologist where indicated. Hand Therapy management includes some or all of the following interventions:- Education on pacing and activity modification Desensitisation exercises- Range of Motion exercises- Taping techniques- Graded Motor Imagery (laterality, imaged movements, mirror box)- Education on “pain and the brain” and nerve hypersensitivity utilising patient friendly terminology.
Buckle fractures of the distal third of the radius are very common in children between the ages of 2-12. Simple dorsal buckle fractures with minimal displacement/angulation can be managed in a thermoplastic wrist splint for 3-4 weeks. The benefits of a Thermoplastic splint compared with a cast include being lightweight, breathable, remouldable to allow for swelling and comfort, removable, waterproof- no need to worry about keeping it dry in summer!
We have a new off the shelf splint available for use with our patients. The NeoG wrist and thumb support is made of a soft, flexible and breathable fabric and is great for supporting and compressing the wrist and thumb while still allowing function. The NeoG can be used for ulnar or radial sided wrist pain or as a lighter option while weaning from one of ourcustom made thermoplastic splints. Slimline, lightweight and washable, it will work well for our patients returning to sports such as tennis and golf post Melbourne lockdown.
Much has been learnt about wrist mechanics in recent times, and in particular the presence and role of mechanoreceptors within the wrist ligaments and how this influences injury rehabilitation. Elizabeth Hagert’s paper “Proprioception of the wrist joint” 2010 explores the role of the mechanoreceptors and proprioception. She identifies the importance of a dynamic rehab program rather than the traditional table-top exercises. This has influenced how we practice, and the types of exercises used at Melbourne Hand Therapy.
Our wrist program includes comprehensive assessment and prescription of dynamic exercises. Many of these exercises demand a lot from the wrist and often require activation of more proximal postural muscles eg. pelvic floor or the rhomboids. Each exercise is progressed from easy to hard with increased weight bearing and core strength required. Weight bearing scores, pain assessments and questionnaires on functional performance are regularly conducted and help monitor progress and guide treatment.
Our highly skilled occupational therapists and physiotherapists can assist in writing factual, objective and comprehensive medico-legal reports regarding our patient’s injury, treatment as well as the expected outcomes of their therapy. These reports may be requested by solicitors (with patient’s consent) or by other nominated third parties (e.g. WorkCover/TAC) requesting further information regarding a patient’s injury and treatment. Our therapists will develop this report through review of a patient’s ongoing therapy notes as well as conducting additional relevant assessments that may assist in providing an impartial and accurate report.
