26 October 2023

Updates & Communications
October 2023

  • What's New This Month:
  • Word from Jen
  • Working Towards Full Accreditation
  • Lymphodema Management by Jana Van Der Merwe
  • Tendon Compression in the Hand by Alison Butler


Jennifer Mathias
MHT Director
Senior Clinician

This month we welcome Jana Van Der Merwe to the hand therapy team. Jana is a South African Occupational Therapist who has spent the previous six years specialising in hand therapy. She completed her studies at the University of the Western Cape in Cape Town, South Africa in 2017. She has worked in various hospitals and clinics and moved to Melbourne in 2022. She has completed many additional courses including obtaining her full accreditation in Lymphodema management with the Lymphodema Training Academy in 2021. Jana is an awesome catch and we are privileged to have her as part of our team. We know patients will love her with her kind heart and clinical knowledge of the upper limb.

  • What's New This Month:
  • Word from Jen
  • Working Towards Full Accreditation
  • Lymphodema Management by Jana Van Der Merwe
  • Tendon Compression in the Hand by Alison Butler

We also welcome Kate Rayner back after her nine week trip around Europe. Jaime has been holding the forte at Latrobe Private Hospital very competently, but we know he is happy to have Kate back!

Working Towards Full Accreditation

This coming weekend sees three of our hand therapists completing another AHTA course. This is the closed trauma course open to hand therapists with a minimum of two years experience. It will be an action packed three days of anatomy, biomechanics, and tissue injury and repair. Specifically they will come away with a more in-depth knowledge of scaphoid lunate ligament injuries, posterior interosseous nerve injuries, radial head fractures and shoulder impingement. We look forward to hearing back from Jaime, Lucy and Morgan with their further training. The course will also assist the three therapist is obtaining their full accreditation for the AHTA. They might be back on Monday for a rest!

Lymphodema management by Jana Van Der Merwe

The lymphatic system is part of the body’s circulatory system and functions as its sanitation system. It helps move waste and debris from the tissues; protects the body from infection; and helps return fluid and proteins from the tissues back into the circulatory system.

Lymphoedema is an abnormal, long-term swelling of parts of the body caused by a collection of lymphatic fluid build-up in the tissues below the skin. You may have lymphoedema after surgery, after some cancer treatments, due to poor circulation or you could have been born with it.

Some symptoms of lymphoedema may include:

  • A feeling of heaviness or tightness
  • Swelling of a body part/s
  • Difficulty moving
  • Pain or discomfort
  • Skin hardness or tightness

There is no cure or quick fix for lymphoedema. It is managed through:

  • Manual lymph drainage (MLD)
  • Lymphatic taping
  • Compression garments
  • Prescribed exercises

If you are struggling with stubborn swelling, you may benefit from seeing Jana who is a certified lymphoedema therapist.

Tendon Compression in the Hand by Alison Butler

Tendon compression in the hand can cause inflammation, pain and restricted movement. Tendons attach muscle to bone and so issues with tendons can restrict function in daily life, and if left untreated can result in joint stiffness, reduced strength, and contractures.

There are two common conditions associated with tendon compression pathology, De Quervains tenosynovitis and trigger finger. Sometimes, these conditions can arise from an injury or repetitive strain, there also may be a biological predisposition to develop these conditions, but often there is no obvious cause. Our therapists at Melbourne Hand Therapy can assess for these conditions, and advise treatment options.

De Quervains tenosynovitis results from compression of the tendons at the thumb and wrist junction. It involves inflammation of two main tendons of the hand: abduction pollicus longus and the extensor pollicis brevis. Both these tendons travel from their associated muscle to the thumb through a compartment or tunnel known as the first extensor compartment at junction of the thumb and wrist. This compartment containing the tendons is surrounded by a sheath or protective casing that protects and nourishes the tendons. This sheath sits underneath the extensor retinaculum, which is a horizontal band of tissue at the back of the wrist that holds the tendon compartments and other structures in place and prevents what is called a ‘bowstringing’ affect. De Quervains tenosynovitis occurs when the affected part of the extensor retinaculum becomes markedly thickened, causing friction with the tendon compartment, aggravating the two named tendons. This thickening can cause a palpable, and often visible, slightly tender lump.

Pain is often experienced with activities that result in the wrist bending towards the little finger direction, and the thumb squeezing towards the palm, such as when lifting a small child underneath their shoulders. This is one reason parents or grandparents caring for young children often experience DeQuervains.

Trigger finger is caused by inflammation of the tendon site at the base of the thumb of finger. The result is that the affect finger often gets ‘stuck’ when it bends, and becomes stiff in flexion and difficult or painful to straighten. It occurs during inflammation most commonly at the A1 pulley, one of the most important structures that keeps the tendon in place at the base of the thumb of finger. The inflammation at this site causes the tendon to become compressed, resulting in poor gliding of the tendon when the finger of thumb is bent. Many patients feel the site of abnormality is at the middle joint or proximal interphalangeal joint of the finger as this is where the movement abnormality occurs. In some cases, there also may be swelling at the base of the affected finger associated with inflammation at the A1 pulley.

For both De Quervains and Trigger finger, the most affective analogy is the tendons affected act like a rope that has a knot in it, and just as the rope may get damaged passing through a narrow pipe, then tendon becomes inflamed as it passes through the surrounding structures. For both DeQuervains and trigger finger, often these conditions can be resolved by conservative management, such as by wearing an appropriate splint that allows rest and healing of the site of inflammation, for a period of time. In more severe cases, surgical intervention is sometimes required to create more space around the tendon so that it is no longer compressed. Your therapist can help evaluate and discuss treatment options during your session.

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