Another question for the PT's out there...

[beccaB]

My husband has a wrist injury that's more related to a tendon connected to his thumb. He's had as much PT as our insurance will allow. He's debating having surgery and the orthopedist says it's an easy recovery, about 3 weeks. I'd have to dig for the paperwork to be specific about what his injury is called, but he turns a wrench for a living. The PT seems to think the surgery isn't as easy to recover from as the Orthopedist is telling him. My husband has been biking all along and says it doesn't hurt to do that, but he's pretty much given up on his weight training, which he misses a lot. My question is to anyone familiar with this injury-is it as easy to recover from as the orthopedist is telling him?

[KnottedYet]

Do you have a hand therapist near you?

They are Occupational Therapists with advanced training in hands (essentially hand PT... but don't tell any OT's that I said that! )

PT's are faaaaabulous, of course, but if I had a hand injury or was contemplating hand surgery, I'd find a certified hand therapist for a pre-surgical consult.

If you have a hard time finding one, try calling the OT department of the hospital, ask if they have (or can recommend) a certified hand therapist.

[beccaB]

Actually yes, she is that kind of occupational therapist. I went with my husband during one of his sessions and talked to her quite a bit. I'm considering going back to school at some point for Physical therapy assistant, even though I'm middle aged crazy. I'm going to have to wait a while though because I'm getting ready to have 3 kids in college with in a year. Yikes. The part I'm worried about with my husband is if the recovery takes longer that he was told he will be so frustrated. He's already had to give up some of his workout routines and we have some pretty nice fall centuries around here that he doesn't want to miss, and I don't want to go without my training partner. He was hoping to get more improvement from the therapy, but he's still in pain. He has another condition that makes it not feasible to take cortisone injections as well. I don't think he has any more options than the surgery, but we're wondering when to do it.

[KnottedYet]

Hey, I went back as almost middle-aged, and I wasn't even the oldest person in my class! (the oldest was 52) Go for it!

Did the hand therapist have any suggestions for splinting? Silver ring splints are popular for people who work with their hands. Totally depends on what is going on with the hand, of course.

If the hand therapist says it takes time to recover, I'd go by what she says.

[beccaB]

What is the silver ring splint you're talking about?

[KnottedYet]

Kind of like a thumb spica, but you can still use the thumb for work.
There are a gazillion different kinds of silver ring spints for all kinds of hand and thumb issues. http://www.silverringsplint.com/prob...-mcp-problems/

[Cataboo]

Mild thread hijack since PTs & wrists are being discussed in here... I've had tendonitis or something in my right wrist for years. I've gotten all my bikes adjusted so that I can ride without my hand going numb. I had my wrists checked last year for carpal tunnel by EMG - no carpal tunnel showed. I'm usually very careful about keeping my wrist position neutral no matter what I do. Whenever I go to a doctor, I get either told carpal tunnel or tendonitis - and there's no getting someone back who has already decided wrist pain + sometimes numbness = carpal tunnel.

But all of a sudden this year (and this may be entirely unrelated to all the issues I've had with the right wrist), my right hand has been going numb paddling - it starts off with the thumb going numb, and the tips of the middle & 3rd fingers... and then progresses to the entire hand. Using a smaller paddle blade helps, but it still goes numb. I just spent entirely too much on a paddle with an oblong shaft that it takes about 10-15 miles before I start getting the numbness in the thumb & other fingertips and the numbness doesn't progress much beyond that... Which is a huge improvement. I've had several people that teach kayaking, race, whatever look at me while paddling to try to figure out if I'm doing anything wrong - my wrist is definitely neutral while paddling, and I open my hand/fingers when pushing the blade away from me - so I don't have a death grip and I'm constantly opening and closing my hand. Someone suggested more torso rotation would help...

Any other suggestions?

[OakLeaf]

FWIW ... you're not specific what his injury was, but a few years back I bruised a tendon and a nerve right near the base of my first metacarpal (could never figure out whether to call it a hand, thumb or wrist injury ). Had all kinds of PT (which my insurance pre-approved and then wouldn't cover because it was done by an OT ), had an ortho immobilize it for a while (big mistake), eventually the only thing that healed it was TIME. Eight months of agonizing, frustrating time.

[beccaB]

Mild thread hijack since PTs & wrists are being discussed in here... I've had tendonitis or something in my right wrist for years. I've gotten all my bikes adjusted so that I can ride without my hand going numb. I had my wrists checked last year for carpal tunnel by EMG - no carpal tunnel showed. I'm usually very careful about keeping my wrist position neutral no matter what I do. Whenever I go to a doctor, I get either told carpal tunnel or tendonitis - and there's no getting someone back who has already decided wrist pain + sometimes numbness = carpal tunnel.

But all of a sudden this year (and this may be entirely unrelated to all the issues I've had with the right wrist), my right hand has been going numb paddling - it starts off with the thumb going numb, and the tips of the middle & 3rd fingers... and then progresses to the entire hand. Using a smaller paddle blade helps, but it still goes numb. I just spent entirely too much on a paddle with an oblong shaft that it takes about 10-15 miles before I start getting the numbness in the thumb & other fingertips and the numbness doesn't progress much beyond that... Which is a huge improvement. I've had several people that teach kayaking, race, whatever look at me while paddling to try to figure out if I'm doing anything wrong - my wrist is definitely neutral while paddling, and I open my hand/fingers when pushing the blade away from me - so I don't have a death grip and I'm constantly opening and closing my hand. Someone suggested more torso rotation would help...

Any other suggestions?

I work at a Curves women's workout club, and I went to convention right after I was hired. I had been a Curves member for 6 years. I was opening and closing my hands on a few of the machines, and when I went through the circuit workout at convention, someone from corporate told me not to open and close my hands on the grips because I was setting myself up for injury that way. They said to keep a solid grip. I don't know anything about kayaking, but maybe the movements are related.

[beccaB]

Oakleaf-did you have to stop biking? I hope you will tell me no....

[OakLeaf]

Oakleaf-did you have to stop biking? I hope you will tell me no....

At the time I wasn't bicycling, but because they kept prescribing rest, rest, rest, I had to stop motorcycling, and yeah, that was awful.

BUT. The pain wasn't so bad that it would've interfered with my ability to brake, steer or pull the throttle, and in retrospect I don't think rest accelerated the healing at all. Even though I told every health care practitioner I saw how the injury occurred, I think the treatment they prescribed was more appropriate to a strain or sprain and not a simple bruise, and I don't think they ever really isolated how much of my pain was from the nerve and how much was from the tendon.

JME, with a really freakish sort of injury (picked up a stepladder the same way I'd always done, and the edge of the step put the full weight of the ladder right onto that soft tissue). Even touching a ladder totally freaks me out, now, never mind I have a phobia of falling!

I have a strong suspicion that some of the PTs didn't believe that resting was a good idea, but were deferring to the orthos. And in turn, because it wasn't a surgical injury, the hand surgeons basically didn't even want to know me. I've had that experience before - if it's not surgical, the orthos just say "no activity outside of PT," when that turns out to be really damaging, and the best thing is to keep the muscles strong and the joints loose by normal activity. Hopefully I've learned my lesson about that if I get another injury.

Still, I think the possibility that time alone will heal - and rest may not - is something to be discussed frankly with practitioners. Especially with something like a hand, which not only is a MAJOR interference with ADLs, but wound up causing tendinitis in elbows and wrist because of shifting all the work of that hand to other joints, doing things backwards and upside down, etc. Probably didn't help my TMJ either, because of all the stuff I had to hold with my teeth.

I recommend everyone going without one hand for three hours, just once, just to see what it's like.

[KnottedYet]

I have a strong suspicion that some of the PTs didn't believe that resting was a good idea, :

... we don't let anyone rest....

Just kidding, actually we want people to rest during the inflammatory phase, about a week post injury. Once the tissue leaves the big inflammatory phase and enters the repair phase we start kicking 'em in the heinie to begin gentle motion, progress to tissue loading after that during the tissue remodelling phase (stop kicking and start using the whips and chains), etc.

If someone is repeatedly injuring themselves (RSI or the like) we do intervene then. "It only hurts for a week after I juggle bowling balls, the rest of the time I'm fine, really!" Call a halt to the bowling ball juggling, let the tissues get over the inflammatory phase, then begin specific strengthening and body mechanics education until the patient can handle the weight of accelerating bowling balls without tearing something.

(two of my more unusual patients were circus performers. not jugglers, though, that's just my hypothetical patient for my illustration here)

[beccaB]

It's De Quervain's syndrome. He has a consultation with the surgeon at the end of this month.

[snowroo]

I have that. For me it was brought on by kayaking. It got so bad I couldn't use my hand or even turn my wrist a tiny bit without excruciating pain.

For me, a thumb wih half wrist splint worked (half longitudinally). I had to wear it for months. I now wear a full rigid wrist/thumb splint for kayaking and the half wrist if I feel it flaring. The little pica splint did nothing.

I'd have the surgery if they'd offer it to me.

[Reesha]

I may get some flack for this because I know the md vs. chiropractor argument is alive and well, but my cousin had some major problems with his hand/wrist (he's a drummer) and went to an ART certified chiropractor. POOF, wrist/hand problems subsided during/after the therapy. It might be worth checking into. If something wasn't obviously torn, I would consider a non-invasive solution first before resigning to surgery. If it works, hurrah! And no surgery.