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First published March 26, 2020 12:40pm. Updated 29th June 10:00am AEST
All patients and visitors must be wearing a mask and sign in upon entry with a QR code.
New South Wales – From 6pm on Saturday 26 June 2021, if you have been in Greater Sydney, including the Blue Mountains, Central Coast, Wollongong and Shellharbour for any reason since Monday 21 June 2021, you must follow the stay at home rules and must continue to follow them for 14 days after you were last in Greater Sydney until 11.59pm on Friday 9 July 2021.
The requirement to wear a face mask in all indoor areas of non-residential premises that was recently applied in Greater Sydney has been extended to all of NSW.
Waking up with stiff fingers or achy joints is a common experience, especially for those recovering from hand injuries or living with conditions like arthritis. But why exactly do your joints feel stiff after a night’s rest?
Understanding Joint Stiffness
Between each of your joints lies a substance called synovial fluid. This fluid acts as a natural lubricant, allowing your joints to move smoothly and pain-free throughout the day.
However, during the night while you sleep, your body remains mostly still. This lack of movement slows down circulation and causes the synovial fluid to settle, rather than flow freely through your joints. When you wake up in the morning, it may take a bit of time and movement for everything to get going again.
Ehlers-Danlos Syndrome (EDS) and Hypermobility Spectrum Disorders (HSD) are connective tissue conditions that can have a big impact on hand and upper limb function. People with these conditions often experience joint instability, frequent sprains, pain, and difficulty performing daily activities. Fortunately, hand therapy can play an important role in managing symptoms, improving hand function, and preventing further injury.
Understanding Ehlers-Danlos Syndrome and Hypermobility
EDS and HSD are conditions that affect the collagen in the body, making connective tissues more elastic and less supportive than they should be. This can lead to:
Joint hypermobility – joints that bend beyond their normal range
Frequent dislocations or subluxations (partial dislocations)
Joint pain and fatigue
Early-onset osteoarthritis due to repeated micro-injuries
Grip weakness or difficulty with fine motor tasks
The hands are particularly vulnerable because of the many small joints and ligaments that rely on stable connective tissue for support. Tasks like writing, typing, buttoning clothes, or opening jars can become painful and frustrating.
How Hand Therapy Can Help
Hand therapists (occupational therapists or physiotherapists with specialist training) focus on preserving joint health, improving function, and reducing pain. Treatment is tailored to each individual but may include:
1. Joint Protection: Education & Splinting
Learning how to avoid positions that overstress the joints
Using ergonomic techniques and pacing activities to prevent flare-ups
Selecting adaptive equipment to reduce strain during daily tasks
Fabrication of splints and supports to aid joint protection and reduce discomfort with daily tasks
2. Strengthening & Stability Exercises
Gentle strengthening of the small hand muscles to improve joint support
Proprioceptive training (awareness of joint position) to reduce dislocations
Stretching (used cautiously) to maintain mobility without causing instability
3. Pain Management Strategies
Heat or cold therapy
Soft tissue techniques and mobilisation
Activity modification to reduce repetitive strain
The Role of Splinting in EDS and Hypermobility
Splints are a key tool for many people with EDS or HSD because they support unstable joints, reduce pain, and allow functional use of the hand without injury.
Types of Splints Used:
1. Custom Thermoplastic Splints
Fabricated by hand therapists
Provide targeted support to specific joints (e.g., thumb or wrist)
Often used temporarily during flares or recovery from injury – splints can be used long term but will need to be replaced periodically due to wear-and-tear.
2. Silver Ring Splints
Elegant, low-profile splints that look like jewellery
Commonly used for swan-neck or boutonniere deformities, or general finger/thumb hypermobility
Provide stability while allowing functional movement
Can be worn all day without restricting fine motor activities
Silver ring splints are particularly popular for people who need long-term joint support but want a discreet, durable solution that blends with everyday life. Your hand therapist will measure you for the splint, which is then ordered direct from the company. Customisation is often possible, and your hand therapist can liaise directly with their design team.
Why Early Intervention Matters
EDS and HSD cannot be cured, but early hand therapy can make a huge difference by:
Preventing repetitive joint injuries
Delaying or avoiding long-term deformities
Supporting independence in daily life
Reducing chronic pain and fatigue
Working closely with a hand therapist allows you to develop a tailored plan for joint protection, strengthening, and splinting, giving your hands the best chance to stay strong and functional for as long as possible.
Takeaway Message
If you live with Ehlers-Danlos Syndrome or Hypermobility Spectrum Disorder and struggle with hand pain, frequent sprains, or joint instability, you don’t have to just “put up with it.” Hand therapy, including the use of custom splints or silver ring splints, can help you protect your joints, regain confidence in hand use, and keep doing the activities you love.
Ulnar neuropathy is inflammation or compression of the ulnar nerve – if there are sensations of pins and needles, numbness with or without tingling along the ring and little fingers, there could be an element of ulnar neuropathy.
The ulnar nerve is one of the three main nerves of the forearm. It originates from the neck, passes through the axilla, goes around the medial epicondyle/ “funny bone” of the elbow, and travels towards the ring and little fingers.
This nerve gives sensations to inner half of the hand, as well as muscle power to half of the forearm, part of the thumb, ring and little fingers. When the ulnar nerve is irritated or compressed, it is called ulnar neuropathy. The most common point of ulnar nerve compression is at the elbow and this condition is called Cubital Tunnel Syndrome.
A mallet finger is when the terminal extensor tendon comes away from the distal phalanx with or without a piece of bone, resulting in an inability to straighten the tip of the finger.
A mallet injury can be classified as the following:
A bony mallet – when the tendon comes off attached to a bony fragment called an avulsion fracture.
A tendinous mallet – where the tendon pulls off its point of bony insertion.
What are the symptoms?
Inability to straighten the tip of the finger (the distal interphalangeal joint – DIPJ)
If you straighten the fingertip up but cannot manage to keep it straight, then it is likely that you have sustained a mallet injury.
There can be subsequent swelling to the injured finger, most commonly overlying the DIPJ.
A mallet injury can be painful to touch and when moving or using your hand
You will still be able to bend (flex) the joint as the flexor tendon is not interrupted in a mallet finger injury.
What Causes a mallet finger?
Mallet finger injuries usually occur when the tip of the finger is forced to bend, and most commonly occurs during impact and ball sports. Some individuals with connective tissue disorders will be at higher risk of tendinous mallet injuries.
How is a mallet finger treated?
For both types of mallet injuries, patients are placed into a splint that holds the fingertip straight or in slight hyperextension. The splint is worn strictly full time for 6 to 8 weeks. Following this period of immobilisation, the bone and tendon will be assessed for stability and healing and will then be weaned accordingly.
Mallet splints can come in a range of designs and materials and depending on your functional needs and lifestyle – your hand therapist will discuss and recommend the most appropriate splinting design for you and fabricate a custom-made splint to wear. Your hand therapist will provide exercises for the uninvolved joints, monitor the skin and oedema whilst ensuring that the splint remains a good fit to ensure optimal positioning while healing. Better outcomes are associated with early referral. If you suspect a mallet finger, see your family doctor for an x-ray and book an appointment with a hand therapist promptly.
Winter is coming and so are those dreaded winter sport injuries……
Do you have pain on the inside of your thumb?
Do you have pain on the inside of your thumb? The pain could be from an injury at the ulnar collateral ligament (UCL) of the thumb metacarpal phalangeal (MCP) joint.
What is the UCL?
The UCL is a ligament located at the inside border of the thumb metacarpal phalangeal joint. It is an integral structure for stability of the thumb, preventing excessive sideways movements, especially during pinch and grasping objects.
How is the UCL injured?
An injury may involve the ligament itself in isolation, or the ligament may pull off a bony fragment at the site of ligament attachment; this is known as a UCL avulsion injury. The mechanism of injury can be from a traumatic event involving sudden, forceful pulling of the thumb away from the fingers, known as Skier’s thumb. Although it is less common, repeatedly stressing the UCL over a long period of time may also lead to weakening and instability, referred to as Gamekeeper’s thumb.
Ligament injuries are graded into categories dependent on severity of the ligament instability. Your hand therapist can assess the injury and recommend appropriate treatment.
How do I treat my UCL injury? Your hand therapist will fabricate a custom-made thermoplastic thumb orthosis to optimise ligament healing, reduce oedema and relieve pain.
When the ligament is deemed stable, your therapist will prescribe specific exercises to regain your thumb range of motion and strength to enable return to your previous level of function.
If the UCL ligament is assessed as unstable, your hand therapist will also appropriately refer you to a hand surgeon for surgical opinion. Unstable UCL injuries may require surgical repair. If you suspect you have an injury to your thumb, please don’t hesitate to call us.
The proximal phalanx is one of the three bones that make up your finger. It is the first bone in your finger after your palm. Fractures of this bone are particularly common in children and we treat lots of them in the clinic.
Common causes, signs & symptoms of injury
A proximal phalanx fracture often occurs during contact sports, from a ball hitting the finger or a collision with another player. A fall or an accident, such as getting the finger caught in something, can also cause this injury.
Signs & symptoms to look out for are swelling and tenderness at the base of the finger. There may also be bruising in the area. An x-ray is required to diagnose the fracture.
Common treatments
A fracture that is non-displaced or minimally displaced can usually be treated conservatively. Your hand therapist can fabricate a custom-made thermoplastic splint to immobilise the fingers and allow for appropriate healing.
Here are some photos of a splint for a ring finger proximal phalanx fracture.
If the bone is fractured in a way that there are many pieces or the bone is displaced, this may require an appointment with a surgeon. Your hand therapist can also discuss this with you.
Exercises and recovery
Range of motion exercises are included as part of the recovery process. These are usually finger flexion and extension exercises. It is important to complete your exercises within a pain-free range. Exercises should be completed regularly throughout the day and light use of the hand can also aid in recovery.
Yourhand therapist can create an exercise program that is tailored to your injury and difficulties. If you have broken your finger, please don’t hesitate to book an appointment. We’d be more than happy to help.
A distal radius fracture refers to a broken wrist – they are one of the most common fractures sustained around the world. Wrist fractures often happen due to falling over, sport accidents or during high impact situations like car accidents. There are many different ways that the distal radius can fracture – sometimes they are simple breaks, but sometimes they go into the joint, have multiple fragments, or can be displaced. A distal radius fracture can be diagnosed with an x-ray however additional imaging may be required to rule out other injuries or to assist with planning surgery.
Why do I need surgery?
A hand surgeon will recommend surgery if the fracture is complex or unable to maintain correct alignment within a cast or splint. A distal radius ORIF (Open Reduction Internal Fixation) involves the application of plate and screws over the fracture site to correct the position and increase the stability of the fracture.
Fingers going numb? Dropping things? Feeling weak?…..Have you considered that you may have Carpal tunnel?
What is carpal tunnel Syndrome (CTS)?
Carpal Tunnel Syndrome is a condition that affects the hand and wrist causing a range of symptoms including pain, weakness, numbness and often pins and needle sensations in the thumb, index, middle and the radial side of the ring finger. These symptoms occur when the median nerve is compressed or injured at the level of the carpal tunnel.
The Median nerve originates at the neck, travels through the axilla at the brachial plexus, descends through the forearm then enters the hand through the carpal tunnel at the wrist level. The carpal tunnel is a narrow space in which accommodates the Median nerve, all the flexor tendons to the fingers and the small lumbrical muscles. As the fingers bend to achieve a fist position, the flexor tendons and lumbrical muscles are dragged into the carpal tunnel which can also place further compression on the median nerve subsequently causing the above mentioned symptoms.
Archibald finalist Tsering Hannaford’s self-portrait ‘Meditation on time’, showcases the subject wearing a wrist brace, and facilitates a discussion on the importance of braces & splinting.
Hannaford’s artwork portrays herself wearing a wrist brace following an undescribed wrist injury. In her artwork, she details the reasoning and consequences of wearing a brace; moreover, her artwork highlights that splints & braces remain a pillar of hand therapy and are crucial in the treatment of wrist injuries.
Tsering Hannaford, Meditation on time (a left-handed self-portrait), oil on canvas. Photo: Jenni Carter / Art Gallery of New South Wales
Clicking and locking of a finger or thumb is generally known as a “Trigger finger” or “Trigger thumb.” This is a common condition involving inflammation or thickening of the tendon that bends your fingers or thumb. The tendon passes through a pulley in the palm of the hand, however when the tendon is inflamed, it can catch or lock as you make a fist or grip items.
