QUESTION: A 51 year old female office worker tripped over at home and landed on her hand, sustaining a broken wrist. It is swollen and painful. What should she do?
What Is a Broken Wrist?
A Distal Radius Fracture is a fracture of the end of the radius near the wrist, and is commonly referred to as a broken wrist. It mainly occurs when you fall on an outstretched hand.
Broken Wrist Treatment
An undisplaced or mildly displaced fracture can be managed by a hand therapist. Different immobilisation options are available including a waterproof fibreglass cast, EXOS brace and thermoplastic splint.
Your therapist will determine the appropriate for of immobilisation for you depending on the severity of the fracture, amount of swelling and whether the fracture is being managed non-operatively or after surgery. You will also be provided with:
- Education about appropriate care of your swollen hand
- Provision of a splint suited to your needs
- Exercises to non-involved joints
- Graded strengthening and proprioceptive exercises when appropriate
Surgical review may be required if there is multiple fragments or any displacement. Your hand therapist will be happy to discuss with you and your GP whether referral to a hand surgeon is appropriate.
QUESTION: A 58 year-old right hand dominant admin officer complains of pain at the base of her thumb when opening jars, turning keys, writing and knitting. She is worried that she is developing arthritis, and remembers how debilitated her mother was with arthritis in her hands. Is there a role for hand therapy?
What is it?
Osteoarthritis at the base of the thumb is a degenerative condition, which may be associated with pain, stiffness, weakness and increasing deformity. Symptoms can be aggravated by activities requiring strong pinch or sustained gripping activities. The thumb may look swollen and be tender to touch, and ache after prolonged activities. Particular aggravating activities include opening jars, turning keys, writing, pinching pegs or leaning on an extended wrist.
An X-Ray may be helpful to determine the degree of degenerative change, although symptoms don’t necessarily correlate with severity of X-ray change.
Most people with arthritis at the base of the thumb will respond well to a custom made splint, and instruction in various self-help strategies with an appropriate exercise program. Your hand therapist will provide you with:
- Education about appropriate care of your painful thumb
- Appropriate exercises to improve your movement, control, and ability to perform activities of daily living
- A supportive splint to rest the thumb, to allow you to perform activity without pain. The splint may be made from a soft neoprene material or custom made out of thermoplastic materials
- Neuromuscular and graded strengthening exercises when appropriate
- Neural glides
Surgical review may be required depending on your response to conservative treatments. Your therapist will be happy to discuss with you and your GP whether referral to a hand surgeon is appropriate.
QUESTION: A 16 year old girl was playing basketball at school and injured her finger when trying to catch the ball. Her finger was pushed back into hyperextension. The middle knuckle is now swollen and she cannot bend her finger into a fist. What is the problem?
What Is Volar Plate Injury?
A volar plate injury can occur when the finger is forced into hyperextension. It is very common in ball sports. The volar plate is a ligament which sits at the front of the proximal interphalangeal joint. It prevents the finger from hyperextending.
The volar plate is supported by a ligament on either side of the joint called the collateral ligaments, which prevent deviation of the joint from side to side. The ligaments can partially or fully tear and can avulse with a small fracture fragment when the finger is forced backwards into hyperextension. This can cause swan neck deformity of the finger.
Your hand therapist can assess the finger for stability, swelling and movement. An X-Ray or Ultrasound may be needed, your therapist will advise whether this is required.
Treatment of Volar Plate Injury
Your hand therapist will fabricate a thermoplastic finger splint to help protect the ligament whilst it heals. This is sometimes needed for 3-6 weeks. You will also be provided with:
- Education regarding joint protection, activity modification and techniques to reduce swelling.
- Active range of movement exercises will be commenced early. You will be encouraged to bend forward to the palm, and then straighten within the limits of the splint.
- It is important to attend for regular review to allow remoulding the splint and so prevent flexion contractors. You might also be provided with a small Figure of 8 style splint once your swelling has subsided. This will allow increased flexibility while still providing protection to the injured structures.
- Specific strengthening exercises can be commenced from 6 weeks.
- Splinting and buddy taping techniques may be required when returning to sports or heavy activities, once instructed by your hand therapist.
A referral to a hand surgeon may be required for large avulsion fractures or where the joint is unstable. Your therapist can assess your finger and in discussion with you GP arrange a referral if necessary.
If you have any questions regarding volar plate injury, please feel free to give us a call.