Hand Therapy

By ASHT (American Society of Hand Therapists)

What is hand therapy?

Hand therapy is the art and science of evaluating and treating injuries and conditions of the upper extremity (shoulder, arm, elbow, forearm, wrist and hand). Hand therapy uses a number of therapeutic interventions to help return a person to their highest level of function. It evolved from the need for a specialist with the knowledge and experience required to manage the challenging recovery of complex hand and upper extremity injuries

What is a hand therapist?

A hand therapist is an occupational or physical therapist who, through advanced continuing education, clinical experience and integration of knowledge in anatomy, physiology and kinesiology, has become proficient in treatment of pathological upper extremity conditions resulting from trauma, disease, congenital or acquired deformity.

What does a hand therapist provide?

Hand therapists bridge the gap from medical management of upper extremity conditions to successful recovery, allowing individuals to function normally in their daily lives. Hand therapists provide non-operative interventions, preventative care and post-surgical rehabilitation for a wide variety of upper extremity disorders, from simple fingertip injuries to complex replanted extremities. Patients with chronic conditions, such as arthritis, or neurologic conditions, such as a stroke, can benefit from hand therapy through education on joint protection and energy conservation, and with recommendations for adaptive equipment or devices to improve function. A hand therapist employs a variety of techniques and tools, including activity and exercise programs, custom orthotic fabrication, management of pain and swelling and wound and scar care. A hand therapist can also be a consultant in the industrial world, training employees and recommending modifications of workstations and alternative work methods to help ensure healthy work styles of all employees.

Where do hand therapists work?

• Hospitals

• Rehabilitation centers

• Industrial medicine facilities

• Privately owned therapy clinics

• Sports medicine facilities

• Academia

Why APTSM?

At Advanced Physical Therapy & Sports Medicine we have a dedicated team of Occupational Therapists who specialize in hand therapy. Our hand therapists offer a variety of treatments to develop or maintain functional living in those with certain physical conditions or musculoskeletal disorders.  They focus on the client, placing a paramount focus on client goals. If you or a loved one suffers from hand-related aches and pains, call us today and set up a free, 15-minute consultation to receive expert advice from one licensed hand/occupational therapists… 920-991-2561

Start the Year Right, Prevent and Treat Shoulder Pain

Phil Sorensen, PT, CSCS

From Thanksgiving through Christmas & New Years I have had more friends and family members ask me about their painful shoulders than any other body area. Not one had a specific injury. Pain developed with use/reaching, exercise, work and in most cases was interfering with their ability to sleep. The good news for them was their condition is very treatable and responds well with physical therapy. The longer you ignore symptoms and the repetitive pain with daily use, reaching, etc. the more challenging it can become to relieve. Structure of the Shoulder: In most parts of the body, the bones are surrounded by muscles. In the shoulder region, however, the muscle and tendons are surrounded by bone. If you tap the top of your shoulder, you can feel bone immediately under the skin, this is called the acromion of the scapula. Directly under this bone is the rotator cuff, a group of four muscles and tendons. In the image below, the supraspinatus is one of the tendons that are most commonly involved. It along with the bursa (a fluid-filled sack) is positioned right between the humerus (upper arm bone) and the acromion that you tapped. This structure of muscle-tendon between bones is a contributing factor to the development of impingement syndrome (shoulder bursitis, rotator cuff or biceps tendinopathy).

Muscles of the Shoulder: Proper rotator cuff (RC) and scapular muscle strength is critical in both preventing and treating shoulder pain/impingement. The RC role is to keep the ball of the humerus in the correct position with the scapula. The rotator cuff enables the other major muscles of the arm, the deltoid and Latissimus dorsi (“lats”), to properly perform their job during reaching, lifting, pushing, or pulling. Balanced strength around the shoulder blade, in the lower & middle trapezius, rhomboids & serratus anterior (scapulothoracic) muscles, is crucial for shoulder blade movement and shoulder mechanics. Weakness and imbalance in these muscles and/or the RC is another primary factor with impingement syndrome, shoulder bursitis & rotator cuff tendinopathy. Corrective Measures: Learning proper technique to balance the previously mentioned muscles in various positions then progressing to movements can be complex and is where the skills of a PT are of great benefit to optimize your time and efforts. Below is a link to a video demonstrating a great shoulder stability exercise that engages these muscles using a small looped band while doing a small forward reach. CLICK HERE

In addition to developing proper rotator cuff & scapulo-thoracic muscle strength, it’s important to address adequate shoulder, rib cage & thoracic (upper back) mobility. Your physical therapist will assess, treat and instruct you in things you can do to improve your mobility. In most cases, shoulder impingement, bursitis, &/or rotator cuff tendon injuries can be completely rehabilitated and should leave no residual effects once a person has recovered. Shoulder pain can be debilitating by limiting your ability to exercise and perform daily tasks. Start the year out right, be proactive in the care of your shoulder. Call and set up an appointment to see a PT today. The longer a condition is left untreated, the more potential for harm and tissue damage which may lead to a longer recovery process.

The American Physical Therapy Association (APTA) is an excellent resource for learning more about physical therapy as well as locating a physical therapist in your area.

Osteoarthritis of the Thumb CMC Joint

Written by: Tammy Vanevenhoven PT, DPT, CHT

As the season of fall hovers over us and the leaves begin to fall, the temperatures outside continue to fall as well. For those who suffer from arthritic hands stiffness and pain, it can quickly be felt by the changes in the temperature. Osteoarthritis is the most common of all joint diseases. It often affects the larger weight-bearing joints of the hips and knees, but it also commonly affects the smaller joints of the hands; especially the base of the thumb called the CMC joint (carpometacarpal joint). The CMC joint of the thumb is considered a saddle joint that allows the thumb its vast ability to grasp objects of various shapes and sizes, to open doors, jars, and packages, etc. It also allows pinching-- a more precision type movement for writing, buttoning, using scissors, picking up small objects or turning a key. We need our thumbs as they contribute to 60% of our hand function.

Signs and Symptoms of CMC joint arthritis are:

*pain at the base of the thumb after activity

*pain with active movement of the thumb especially with pinch

*morning stiffness

*joint tenderness to palpation

*crepitus (crunching noise in the joint) with thumb movement

*joint deformity with bony nodules felt at base of thumb

*weakness of hand grip (opening a jar, sealed packages, etc.) or with pinch (writing, buttoning, turning a key, etc.)

How is CMC joint arthritis diagnosed?

Usually a standard radiographic x-ray will show joint space narrowing, bony changes such as spur formation, and joint erosion. Based on the x-ray, the arthritic changes are usually classified as mild, moderate, or severe joint destruction.

What can be done non- surgically to help the painful arthritic thumb?

A certified hand therapist (CHT) or an occupational therapist can be of great help in alleviating pain in the arthritic thumb by fabricating a thumb spica splint that stabilizes the base of the thumb while still allowing use of the thumb tip for light pinch and grip activities. Stiffness can be reduced by using a paraffin bath that is composed of paraffin wax and mineral oil which is then melted to a therapeutic warm temperature which molds around the bony prominences of the hand to help soothe pain and improve movement of the joint. Your hand therapist will also educate you on joint protection by recommending built up handles on objects that are difficult to grip such as tools, scissors, writing and eating utensils. Key adapters can also be placed on your keys to allow ease with key pinch. An electric can opener can also be used to avoid stressing the arthritic thumb with a manual can opener. Protecting the hands from the cold weather is very important. Wearing mittens and using warming packs if you like to be outdoors will help keep your hands from getting stiff and painful while you cross country ski, ice fish or while taking a winter hike.

What does the surgery for CMC joint replacement entail?

CMC joint arthroplasty is the most common joint replacement of the arthritic hand. The beak ligament reconstruction, or the LRTI, is the most common surgical procedure performed. The hand has, thankfully, many muscles that perform the same function. They are called “spare parts.” The eroded CMC joint is removed and one of these extra tendons of the hand/wrist is sacrificed and bundled up to fill in the joint space at the base of the thumb. Patients are placed in a cast and often external pins are inserted for extra immobilization.  At four weeks the cast and pins are removed, and the patients are placed in a forearm-based thumb spica splint and sent to therapy to see a certified hand therapist or an occupational therapist that specializes in treatment of the hand. Therapy includes gentle progressive range of motion to restore normal movement of the thumb, fingers and concurrent wrist; which becomes stiff from being in the cast. Swelling control and pain management are treated by working on scar mobility to avoid tendon adherence. Hypersensitivity often occurs from the surgeons having to retract the superficial radial nerve to perform the operation. Therapists can ease this sensitivity by performing desensitization exercises to calm the nerve pain. Restoring functional hand strength while appreciating joint protection and education of patients for life-long care for the arthritic thumb are just some of the various ways your hand therapist can help.

If you would like more information in treating your arthritic hands you can call Advanced Physical Therapy and ask to speak to a certified hand therapist or occupational therapist that can assist you in answering your questions. APTSM New London phone: (920)982-0100.

The 4 P's of Energy Conservation

The 4 P’s of Energy Conservation

Laura Johnson, PT, DPT

Has it been exhausting for you to complete your typical morning routine, or maybe you are having shortness of breath while grocery shopping?  When individuals have a diagnosis of Chronic Obstructive Pulmonary Disease (COPD), Multiple Sclerosis (MS), or Congestive Heart Failure (CHF), or are recovering from a recent illness or surgery, it can be difficult to complete daily chores due to fatigue and decreased activity tolerance.  Your lungs and heart may not be working as efficiently as they should, so it is important to conserve energy throughout the day.

In order to succeed, there are 4 simple steps to consider, and we are going to refer to these as the 4 P’s of Energy Conservation

1.     PRIORITIZE: Decide what needs to be done today, and what can wait for a later date.  Try to scatter your household chores throughout the week.  One day for laundry, next day for vacuuming and another day for grocery shopping.  If you are partaking in a social engagement, plan to skip some daily activities to reserve some energy before the fun begins! A good quality rest period each day is best!

 2.     PLAN: Plan ahead to avoid extra trips.  Gather supplies and equipment needed before starting an activity.  For example, before showering, make sure your towel, clothes and necessary daily items are all located in the bathroom area.  Also have a chair available to provide yourself a seated rest break if needed.  Another technique is to plan to alternate heavy and light tasks.  Find a good balance between work, rest and leisure.

3.     PACE: Slow and steady pace, never rushing!  Some individuals try to complete as many tasks as possible, as quickly as possible.  Unfortunately, this leads to complete exhaustion, and inability to perform tasks later in the day.  This can also lead to a greater chance of falls due to increased fatigue: We all know a fall can be extremely traumatic.  Plan to rest before you feel tired. Provide yourself with enough time to take short, frequent rest breaks. 

4.     POSITION: Think about your body position while completing tasks throughout the day.  Bending and reaching can cause fatigue and shortness of breath.  There is adaptive equipment available to make some daily tasks less stressful on your body.   Examples are: 1) Use a reacher to grasp the cleaning supplies in the low cupboard, 2) Use elastic shoe laces to avoid bending over to tie your shoes, or 3) Use a sock aid to get your socks or compression stockings on.  Eliminating some strain when bending or reaching will allow your lungs to expand more fully, which in turn helps get more oxygen into the body. 

Conserving your energy can allow you to complete the tasks you want to complete throughout the day.  You do not want to run out of energy before the day is through and we definitely do not want you to entirely stop your activity for constant rest.  Get moving, but move smarter!

Image by Pavlofox from Pixabay