June 2nd 2010
Excellent article on proprioceptive re-education and core stability
Every hand therapist must see their fair share of wrist related problems. There are a wide and varying range of clinical diagnoses that may fall into the “wrist patient” bracket from distal radius fracture, ligament disruption, OA, RA, tendonitis or those with an undiagnosed source of symptoms despite numerous examinations and investigations. With this sort of potential patient volume you would think treating the wrist would have become easier over the years but to many it remains a bit of a mystery.
For those of you who are fascinated by the wrist you may have noticed a trend towards exercise prescription as a means of improving patient outcomes over the last few years. The inclusion of eccentric loading programmes is just one example of this but the more recent trend in my own practice has been towards proprioceptive re-education and core stability. If you’ve not stopped reading already have a look the reference below for an article published in The Journal of Hand Therapy January/March 2010 edition by Elisabet Hagert.
Hagert, E. (2010) Proprioception of the Wrist Joint: A Review of Current Concepts and Possible Implications on the Rehabilitation of the Wrist, Journal of Hand Therapy, 23, 1, 2-16.
If you can have a favourite article of all time this would be mine as the narrative review perfectly illustrates many of the treatment principles I use in my own wrist rehab programmes. Enjoy the read those of you who dare to tackle some of the neurophysiology!
January 16th 2010
Professional Sports – do protocols apply?
The majority of patients who sustain a thumb fracture requiring surgical fixation would be given advise by their hand therapist to avoid contact sports for roughly 12 weeks. Does this apply to the professional sports person? Would the answer be the same for all forms of sport?
Clinical reasoning would suggest sports involving the greatest load/force through the thumb or those with a high risk of a direct blow would require the longest period of time away from the sport.
Given this information how would you treat a 6’ 8’’, 280lb, American football player? The team are due to play a wild card playoff game that weekend that would end their season should they not win, the stakes are pretty high. Have a look at the image below of Calais Campbell, defensive end for the Arizona Cardinals playing last weekend against the Greenbay Packers.
Analysis of playing position and use of the hand during a game allows a suitably functional cast to be applied. His particular playing position means this treatment option is viable. Risks are still present with this treatment strategy but these are weighed up against longer term career ending injury prospects and the importance of one particular game. Had this been a regular season game when the team had already qualified for the playoffs the weight of risks and benefits may have swung towards resting the player.
The risk paid off. The Cardinals won and I’m now watching him play in the next round against New Orleans Saints. The cast is still in place, doing its job to protect his thumb without limiting his playing ability.
December 21st 2009
IFSHT Conference 2010
After attending the 2007 International Federation of Societies for Hand Therapy (IFHT) conference, held in Sydney, I have been keenly awaiting the programme for the 2010 conference due to be held 24-26 June in Orlando. Unsurprisingly the programme seems to be packed with a wide range of different aspects of hand therapy to suit a variety of hand therapy backgrounds.
The conference appears to have an emphasis on interactive sessions with a mixture of panel discussions, workshops and free papers. So far the stand out sessions I am hoping to get my name down for are The Perceptive Wrist and Paediatrics. The opportunity to listen to the three speakers on The Perceptive Wrist panel is an exciting one particularly as the detail in the programme states they will be discussing proprioception which is the basis for much of my wrist rehabilitation work. A certain proportion of my NHS work covers paediatric hands which is a subject so rarely covered in any course or conference that I will hopefully be snapping up this opportunity.
There are no details regarding the free papers at this stage but you always pick up a few great tips and insights during those sessions.
Conferences always offer a great opportunity to keep up to date with the latest research but they also give you the chance to catch-up with colleagues from around the world who you don’t get to see very often.
December 6th 2009
A Perfect Gift For A Hand Therapist
Fingerprint Portraits and Precious Imp Print
For those of you with a bit of cash in your wallets take a look at Fingerprint Portraits by DNA 11. A truly original gift for a hand therapist or something to put up in your private practice as a talking point.
DNA 11 send you a fingerprint kit for you to capture your perfect print and send it back to them with your selection of colours and framing options. As a piece of artwork this has to be as unique as they come.
If you’re more interested in jewellery Precious Imp Prints take casts of finger prints and turn them into a range of jewellery items.
Happy Christmas shopping!
December 1st 2009
Hand Dissection Course
For those hand therapists who want the chance to brush up on their anatomy a fairly rare opportunity has come up at Guy’s Hospital in London. A 3 hour cadaveric dissection of the hand and wrist lead by an anatomist is due to be run on 8th February 2010 from 2pm. Not only is this a rare opportunity but is at the bargain price of £45.
Although there are many great diagrams, photographs, websites and DVDs available to describe and recreate hand anatomy you can’t really beat dissection views or time in theatre. For me it is the only way you can truly understand how complex extensor anatomy within the digit is, particularly around the MCP and PIP joints. It certainly made me appreciate the amazing job hand surgeons do, not only identifying the structures but then actually repairing them.
For more info on the course contact Kerry Sinclaire on 0203 299 9000 extension 2466.
November 17th 2009
Scaphoid Mechanics
For all those who struggle to understand, or describe, the position and motion of the scaphoid check out this website wikiradiography.com:
A friend and fellow hand therapist sent this link through to me. The general info regarding the scaphoid is useful but the highlight has to be the animations of specific scaphoid movement and general carpal movement during ulnar and radial deviation. For those of you who request imaging this page also gives you an insight into the way in which radiographers take scaphoid views and why.
September 25th 2009
British Asssociation of Hand Therapists (BAHT) Conference
The BAHT conference was almost a month ago now but I thought I would write a quick review. The packed programme had a nice mix of therapy, surgery and research related to nerve injury and repair in the upper limb.
The stand out session for me was the keynote lecture from Dr Christina Jerosch-Herold which was moved from the Monday morning to Sunday afternoon. The reason I mention the change in programme is the fact the presenter was completely ready to go with only 20mins notice and a full 17hrs earlier than planned! The review of sensory assessment techniques with the most up to date literature available was presented in an extremely useable format for all hand therapists in attendance. Controversially, some might say, I disagreed with the section on motor assessment in the hand as the idea that gravity eliminated and gravity assisted muscle work did not really apply to muscles within the hand and forearm. I tend to use gravity as an assistive or resistive technique within exercise prescription, particularly wrist rehab, and have found it a really valuable tool progressing patients.
The conference was my last one as Chair of BAHT and was a good way to finish. There was a great atmosphere amongst the over 100 members in attendance and I think everybody was able to take something useful away from the day and a half.
Next year will be the joint BAHT and BSSH (The British Society for Surgery of the Hand) to be held in London. I look forward to being there as a delegate rather than an organiser for the first time in a few years!
October 23rd 2009
The British Association of Hand Therapy Conference 2009
This weekend is the BAHT 09 Conference – the only annual UK conference aimed specifically at hand therapy specialists.
The conference is being held at the Ramada Jarvis Hotel, Leicester on Sunday September 27th – Monday September 28th 2009. I am pleased to say that the conference is fully booked and we have over 100 delegates. As the current chair of BAHT I’m a little bit on the busy side fine tuning (or should I say starting) my welcome and introduction.
It’s a great event, even if it is a bit busy with my chair hat on, to catch up with hand therapists that you don’t get to see all year, a real networking and learning experience. The BAHT committee are a fantastic group of professionals all running BAHT on a voluntary basis and give hours and hours of their time building the reputation of the charity and putting on events such as these.
At this years conference the keynote speakers are:
Mr Stewart Watson (Plastic, Hand & Microsurgeon) talking about – Techniques and Timing of Surgery for Brachial Plexus and Peripheral Nerve Injury
Dr Christina Jerosch-Herold (Occupational Therapist and Chief Editor of the BAHT Journal) who’s topic will be – Current Concepts in Assessment and Treatment of Nerve Injuries
Mr Andrew Hart (Hand and Plastic Surgeon) talking about – Free Functional Muscle Transfer in the Management of Brachial Plexus Injury
The workshops will be:
Workshop 1. EMG Interpretation (Duncan Farrell, Neurophysiologist)
An in depth look into EMG investigation covering method of assessment and interpretation of findings.
Workshop 2. Dynamic Splinting of Peripheral Nerve Injuries (Nick Gape, Karen Murray, Judith Wood)
This practical workshop will take a problem solving approach to dynamic splinting of peripheral nerve injuries and associated problems. A variety of materials and products from kitform to bespoke splints will be used in addressing these.There will be flexibility within the workshop to meet all levels of experience and participants are encouraged to bring their own experiences and scenarios to the session.
Workshop 3. Sensory Re-education (Sarah Turner)
This workshop will cover the principles of sensory re-education and demonstrate practical techniques using equipment that is both available commercially and that can be sought out by the patient or therapist. It is pitched at a basic level for therapists with no or limited experience in sensory re-education, but with knowledge of the clinical signs and symptoms of nerve injuries
Workshop 4. Tendon Transfers (Zoe Clift)
This workshop will cover the clinical reasoning process behind tendon transfers from a therapy perspective. Pre-operative and post-operative assessment, decision making and rehabilitation techniques will be discussed in detail with an emphasis on exercise prescription and functional re-training.
The conference this year is being very generously sponsored by Promedics
For those unaware of British Association of Hand Therapy (BAHT), is a registered charity whose aim is to advance and promote the study and general knowledge of the treatment of the hand.