Wrist fractures
Wrist fractures should be referred to a hand therapist as the mechanism of injury that causes wrist fracture typically causes some soft tissue injury as well.
Complications following wrist fractures can include instability between carpal rows, between radius and ulna, or between the distal aspect of the radius and ulna and the proximal aspect of the carpal bones. More complicated wrist fractures require a thorough understanding of wrist and hand anatomy as well as an understanding of more conservative protocols. Hand therapists also have skills to fabricate protective upper extremity orthotics as well as progressive orthotics to improve wrist and forearm rotation when needed.
Dislocations, sprain and strains, and ball jamming injuries
The PIP and DIP joints are very commonly injured in sports requiring throwing and catching of balls. The mechanism of injury is often related to the finger being struck by a moving ball, another player, or an awkward landing during play. These are often splinted by primary care physicians, buddy taped by athletic trainers, or ignored until weeks later when the finger has become problematic.
When identified early, a hand therapist can often treat these conditions with minimal visits by initiating the use of the correct orthosis and appropriate range of motion exercises to promote proper balance of the affected tissues. Identification of the correct structures involved and the pattern of deformity are important for the fabrication of the proper orthosis in order to minimize deformity and facilitate the best possible hand function.
Not all finger injuries are created equal and an over-the-counter box splint that maintains PIP joint extension does not always effectively address the involved structures and deforming forces. When an orthosis is custom-fabricated, the client is immobilized in the correct position to restore balance to the involved tissues while maintaining or regaining the necessary range of motion of the surrounding joints.
Ulnar sided wrist pain
Ulnar-sided wrist pain can be an acute or chronic problem involving the triangular fibrocartilage complex (TFCC), Extensor Carpi Ulnaris (ECU), distal radial-ulnar joint, and/or the ulna. A fall on an outstretched hand often causes wrist fractures, but it may also cause some damage to the TFCC and surrounding structures.
Ulnar-sided wrist issues are typically problematic with weight-bearing and rotational movements. Understanding the anatomy and functionality of the TFCC and ECU and imbalances that occur when these structures are not functioning properly is key to proper rehabilitation pre and postoperatively.
In many cases, acute ulnar-sided wrist pain can be managed well with a conservative ulnar-sided wrist program, appropriate immobilization, and activity modification. Hand therapists have a vast knowledge and understanding of these structures and their relationship to a range of motion and function.
Elbow fractures
Elbow fractures can be stubborn, and regaining range of motion can be a lengthy, frustrating process for both the client and the therapist. Hand therapists have a slight advantage as they can fabricate orthoses designed to provide prolonged end range time in desired motion throughout the night or during prescribed exercise periods during the day.
Custom orthoses can be modified as the client’s elbow range improves, applying the same principles as serial casting in a more convenient, removable application. These can be more effective at gaining that pesky last 10-15 degrees of elbow extension or flexion than your typical turn-buckle device.
Turn to a hand therapist!
The listed conditions are in no way the only conditions you should or could consider referral for your patients. Hand therapists tend to consider function first and can be a great resource for other clients who need less aggressive programs emphasizing functional usage.
Next time you’re struggling with an upper extremity client, or feel an individual could benefit from custom immobilization to provide rest and balance to affected tissue, consider referral to a hand therapist. Their outlook and skill set may be just what the doctor ordered.
A hand therapy specialist provides:
- Accurate assessments, immediate care, and effective treatment to reduce treatment time
- A continuum of care eliminating the need for multiple medical providers
- Faster recovery results in decreased medical costs
- Functional outcomes ensuring a faster return to work and a productive lifestyle
- The most comprehensive care for their patients
Diagnoses Hand Therapists Treat:
- Amputations
- Arthritis
- Carpal Tunnel
- Cubital Tunnel
- DeQuervain’s
- Dislocations
- Dupuytren’s
- Fractures ~ Humerus, Elbow, Radius, Ulna, Wrist, hand and fingers
- Ganglion Cysts
- Lateral Epicondylitis (“tennis elbow”)
- Ligament injuries
- Mallet finger
- Medial Epicondylitis (“golfers elbow”)
- Nerve lacerations
- Repetitive Strain Injuries
- Shoulder injuries – frozen shoulder, instability, impingement, rotator cuff
- Sprains/Strains
- Stiffness
- Tendinitis
- Tendon laceration/rupture
- Trigger fingers
