HANDS UP OCCUPATIONAL THERAPY
Your Hands are in Good Hands
Ulnar Gutter Splint
😮 Sounds Complex‼️
Triangular Fibrocartilage Complex or TFCC Injuries can be quite complex‼️ The triangular fibrocartilage complex (TFCC) is a load-bearing structure located between the lunate, triquetrum, and ulnar head. The TFCC is a stabilizer for the ulnar aspect of the wrist and is frequently at risk for either acute or chronic degenerative injuries. Injury to the TFCC can lead to pain and difficulty with daily activities such as opening a jar, turning a door 🚪 knob or even tying up ones hair. Conservative treatment includes splinting and immobilization. The Hand Therapist @handsupot fabricated this comfortable light weight ulnar gutter splint for this active NYU student who enjoys taking dance 💃🏼 classes. Due to the frequency of weight bearing tasks with dance and all daily activities, she was instructed to wear her splint to protect her wrist to decrease pain and symptoms. If you are experiencing ulnar sided wrist pain, this splint may be perfect for you! Call ☎️ and make an appointment with your OT today‼️
Relative Motion Orthosis
Beach Football 🏈 anyone❓This patient sustained an acute sagittal band injury while playing 🏈 football 🏈 and was referred to OT. Patient presents with snapping and subluxing of the extensor tendon of his 3rd digit. The sagittal band is the primary stabilizer of the extensor tendon at the metacarpal phalangeal joint. The Hand Therapist @handsupot fabricated a relative motion orthosis that prevents full composite flexion of the metacarpal phalangeal joint (MCP) joint of his 3rd digit 👊🏾This splint maintains the MCP joint of the affected digit in approximately 15* of extension. For acute injuries splint wear is recommended for 4-6 weeks🗓 . The splint is comfortable and easy to wear and patient is able to return to most daily activities while wearing the splint‼️ Patient can continue to enjoy the rest of his ☀️ summer
Repetitive Stress Injury
Are you experiencing pain in your forearm ❓❓Forearm flexor pain due to overuse can be quite limiting impacting grip and all daily activities. This patient was referred to @handsupot Patient presents with increased pain and inflammation in bilateral forearms due to Repetitive strain injury (RSI). RSI is a general term used to describe the pain felt in muscles, nerves and or tendons caused by repetitive movement and overuse‼️This patient is presenting with myofascial pain in bilateral forearms. The therapist fabricated bilateral wrist cock up splints for night 💤 use and as needed during the day for pain control. However to increase function and decrease pain the hand therapist applied Rocktape @rocktape to bilateral forearms as photographed here. The patient was 😃 happy 😃 with the results and was able to use his arms with less pain for increased time!
PIPJ Flexion Contracture
🌀Serial casting 🌀for PIP joint flexion contractures❓
Proximal interphalangeal (PIP) joint flexion contractures are a common clinical problem and are frequently treated by 🤚🏻hand therapists and orthopedic surgeons after various types of injury to the finger. Conservative treatment is preferable over surgery. A variety of pre-fabricated and custom-made orthoses are available for treatment. Depending on the presentation, acuity, and nature of the injury your hand therapist will determine what is best for you‼️The hand therapist @handsupot opted for serial casting with this patient. Serial casting is frequently used to treat even the most resilient PIP joint flexion contractures. Serial casting allows for maximal 🔘 Total-End-Range-Time 🔘(TERT) that has been proven to increase ⬆️ the passive range of motion (PROM) of a stiff joint. Patient is complaint with wearing schedule and precautions have been reviewed. Stay tuned to see the outcome‼️
An ongoing series of informational entries #HUOT
New Moms - January 2021
Mommy Thumb - De Quervain's Tenosynovitis
For most new moms it's impossible to avoid picking up their new born. Unfortunately, holding an infant for prolonged periods can take a toll on your wrists and thumbs. For example, improper positioning over extended periods of time can lead to a condition commonly known as Mommy Thumb or De Quervain’s Tenosynovitis. Fortunately, there are some adjustments that a new mom can make to safely hold her baby while protecting her hands.
De Quervain’s tenosynovitis is a common condition that affects the Abductor Pollicus Longus (APL) and Extensor Pollicis Brevis (EPB) tendons, that run through the first dorsal extensor compartment of the wrist. Symptoms can exacerbate during the later months of pregnancy due to increased swelling in the wrist and hand and can further increase postpartum due to lifting and carrying a newborn.
Can I do anything to prevent this from getting worse ?
Activity Modification and Proper Body Mechanics is crucial to prevent and or decrease exacerbation of symptoms.
Modifying the way you hold the baby while nursing or feeding.
Using a nursing pillow alleviates the added stress and weight of the baby in your hands and wrists and allows you to rest the baby on the pillow while the baby is in a proper position.
HUOT Highly recommends My Brest Friend Deluxe Nursing Pillow.
This nursing pillow is a 2019 What to Expect Award Winner! It is known for its wrap-around design that stays secure with an adjustable belt and has a flat surface to prevent the baby from rolling - making it easy for both nursing and bottle feeding moms!
Modifying the Bottle
The shape and size of the bottle nipple can significantly impact flow which is critical for the baby. But, the shape and weight of the bottle is critical to your hands. The smaller the circumference of the bottle and the lighter the weight, the less stress on moms' hands. Thus, when selecting a bottle it is important to be mindful of one that requires a wide grip and increased thumb extension that can be painful when holding for a prolonged period.
HUOT recommends Thinkbaby All-In-One Bottle
This baby bottle is perfectly shaped for moms that are experiencing hand pain while feeding. Its narrow waist prevents hyperextension of mom’s thumb, additionally it is light weight prevents forceful grip and pinch that tend to be painful.
Modifying the way you pickup your baby
Holding your baby is a great bonding time for mom and baby. When holding your baby pay attention to your wrist position while making sure your little one is safe and secure. The optimal wrist position while holding an infant is with the wrist in neutral or as straight as possible. Bending the wrist in either direction for a prolonged period of time can lead to various wrist issues and pain, numbness and or tingling in your hands. Moreover, when picking up your baby try and and avoid hooking your thumb under the baby's arms, rather scoop up the baby in the palm of your hand to more evenly distribute the weight and the pressure on your thumbs.
Take breaks! (Yes, you read that correctly)
In order to properly care for your newborn you need to stay healthy. Whenever possible take short breaks and complete some light wrist stretches in both extension and flexion. Stretches can be performed several times a day. If sore, apply ice to affected area for approximately 5 min to help decrease inflammation.
Perform stretches in a pain free range and contact your therapist if symptoms exacerbate and or persist.
Do you have De Quervain’s?
A quick test that you can do at home to help determine if you are presenting with De Quervain's is the Finkelstein test. In order to complete this test you bend your thumb across the palm of your hand and bend your fingers down over your thumb and move your wrist toward your little finger. Pain with this movement in the radial aspect of your wrist may be a symptom of De Quervain's tenosynovitis.
OK, so you already made all the recommended modifications and you are still in pain? What's next?
There are various treatment options available for patients presenting with De Queurvain's.
A Forearm Based Thumb Spica Splint to immobilize the wrist and thumb and allow the tendons to rest by avoiding repetitive movements is recommended for treatment.
Your doctor may recommend over-the-counter anti inflammatory/ pain relievers. Additionally depending on the symptoms, your physician may recommend injections of corticosteroid medications into the tendon sheath to reduce swelling.
In acute cases where treatment is initiated within the first 3-6 months patients respond well to conservative treatment.
Depending on the severity of your symptoms, your doctor may recommend surgery. A De Quervain's release is an outpatient surgical procedure in which the surgeon identifies the tendon sheath of the first dorsal compartment and then opens the sheath to release the pressure so your tendons can glide freely.
Post-operatively your surgeon may refer you to therapy. Your occupational therapist will work with you to regain your range of motion, complete scar management techniques as well as strengthening exercises to help you resume your daily activities symptom free.
Fortunately, there are a variety of options available. If you have any questions or would like to schedule an appointment with the HUOT Team please contact us today. We treat patients at all stages from acute exacerbation to post-surgical cases and fabricate same day light weight custom orthotics/splints. We are looking forward to working with you so that you can resume holding your little one pain free!
The information provided above by no means replaces the evaluation of a skilled therapist & physician. These are general recommendations. If you have symptoms and can benefit from a formal evaluation please contact Hands Up Occupational Therapy.
Wrist Weights - February 2021
Pandemic Workouts - Safe, Virtual & Fashionable
With the current pandemic, living rooms across NYC have been transformed into work out studios. For most New Yorkers working out, going to the gym and taking classes is an essential part of our daily routine. Thankfully many fitness studios and instructors have created virtual platforms giving us the opportunity to exercise safely in the comfort of our homes.
The Centers for Disease Control and Prevention (CDC), recommends 30 minutes of exercise 5 days a week, including 2 days of muscle-strengthening and building routines. Workouts such as yoga, Pilates, sculpt, HIIT and many others have been transformed to create routines that you can follow along virtually wherever you are while maintaining your exercise goals. Many virtual fitness classes provide the option to exercise with or without equipment depending on your preference. If you are using equipment during workouts, it’s important to maintain proper form, use the correct resistance and select the appropriate weight to prevent injuries and overuse.
Upper extremity strengthening is an important aspect to many exercises routines. For upper extremity strengthening and endurance building HUOT recommends wrist weights for safe and effective exercise programs. Wrist weights provide the resistance required to safely increase strength and endurance without added stress to the digital/grip flexors. Traditional dumb bells all though excellent exercises equipment (we use them regularly in the clinic) require continuous grip in that can lead to repetitive stress injuries to the flexors if used for prolonged periods during daily work out routines. Conversely wrist weight are worn or strapped securely around your wrist avoiding any added stress from gripping. This allows you to focus your routine on the muscle you are targeting. Luckily there are several types and styles of wrist weights that one can choose from.
Our favorite wrist weight at HUOT is the Bala Bangle. For fashion forward New Yorkers these wrist weights are just as stylish as they are an excellent accessory to add intensity to any work out. on each wrist The Bala Bangle comes in an assortment of soft pastel and vibrant colors made of easy to clean silicone- coated cast iron bars and a stretchy elastic band that fits all sizes. The recommended weight is 1-2 lb on each wrist.
Order your Bala Bangle Today!
Another HUOT Fan favorite wrist weight is the popular Tracey Anderson Wrist Weight. These weights are 1.5 pounds and is designed with iron seed fill, coated nylon casing. The adjustable Velcro strap makes them easy to put on and to adjust for comfort.
Order your TA Weight Today!
Depending on your exercise needs and aesthetic desire you can select the best wrist accessory for you to work out safely and with style. If you have any questions regarding which wrist weight would be the right option for you contact your therapist or fitness trainer.
Some amazing virtual classes that we highly recommend that you can safely incorporate your fashionable new wrist weights are:
Tracy, founder of TA Method, has transitioned workouts from her NYC studio to virtual platforms. She adds rhythm and flow to her workouts, helping boost endorphins and performance. TA Method provides a holistic approach promoting fitness, nutrition and lifestyle changes to feel the best version of yourself!
This fabulous duo Elizabeth and Dale have put together a work from home road map that features and collaborates with various instructors for in-person, virtual and outdoor workout classes!
Megan is the founder of The Sculpt Society. She provides a virtual platform, allowing viewers to subscribe and workout anywhere. Megan also provides pre-natal education and fitness options as she shares her experiences and pregnancy journey. Congratulations Megan!
Melissa is the creator of The MWH method. This super mom is an amazing a fitness instructor providing virtual platforms to her audience bringing top notch virtual work outs to your living room!
Musicians Hands - March 2021
Many musicians have been significantly impacted due to the pandemic. With the unfortunate closure of performance venues such a Broadway, Carnegie Hall, and some of my local personal favorites Rose Bar, Flatiron Room, and Rockwood Music Hall in the LES, musicians have had the opportunity to focus on self-care and improvement (which could equate to hours of increased practice time). At Hands Up OT seeing that many musicians are taking this time to focus on recovery and rehabilitating their hand related injuries that resulted from overuse, we decided to share some tips and pointers to help the amazing musicians of NYC decrease their symptoms and prevent further injuries (as we eagerly await the re-opening of our favorite NYC music venues).
Musicians use their hands daily and are vulnerable to musculoskeletal injuries that can be career ending or that may even result in the unfortunate loss of enjoyment in performing. The highly repetitive nature of the movements required to play instruments such as the piano, the flute or violin, along with the sustained arm, hand and neck positions may lead to nerve compression's and muscular tightness or inflammation.
Common Conditions that Impact Musicians
Carpal Tunnel Syndrome: compression of the median nerve at the wrist level, resulting in numbness, tingling and weakness in the fingers and thumb
Cubital Tunnel Syndrome: compression of the ulnar nerve at the elbow level, resulting in numbness, tingling and weakness at the pinky side of the hand
Lateral/ Medial Epicondylitis: Pain and tenderness to palpation in the elbow with active wrist movement
Trigger Finger: increased pain, tenderness and possible locking of the finger with making a fist
CMC Joint Arthritis: joint inflammation at the base of the thumb can result in increased pain with movement and sustained pinch
IP Joint Arthritis: joint inflammation in the fingers and hand can lead to pain, stiffness and potential deformities in the digits
I have pain and symptoms…. What can I do?
Number one Rule! (If you take away one thing from this article)
Musicians tend to present with a limited awareness of the extreme stress they endure physically due to their passion for making music. Pain however, is your body's way of communicating with you that there is something wrong.
How Can OT help me?
Having a thorough evaluation by your physician and occupational therapist can determine the cause of your specific symptoms and detect various differences in technique that can impact your ability to play symptom free. The occupational therapists will evaluate your posture and positioning, as well as likely recommending you bring your instrument to your therapy session to assess your body mechanics. Once identified, your therapist will determine a treatment plan that is appropriate to address your specific needs.
Your OT will incorporate treatment techniques such as manual therapy including soft tissue massage and joint mobilization as well as the use of, modalities, postural awareness and endurance training. Additionally, the OT will fabricate customized splints you can don while playing or resting. During therapy you will complete proper stretching, and strengthening exercises of supporting muscles. Your OT will also educate you on activity modification and joint protection techniques you can incorporate while playing your instrument of choice.
Tips for a Successful Recovery
Beyond diagnosis, through the understanding of anatomy and mechanisms of injury, following treatment, the therapists also help musicians develop warm-up and post-performance routines that can prevent injuries from recurring .
Proper form when playing your instrument is key. Making sure that your set up is ergonomically correct with proper body alignment.
Proximal strengthening. Proximal strengthening decreases the stress on the distal joints.
Protect your hands! In order to prevent adding additional stress to your hands and joints be selective of what activities you complete at home or work using your hands and makes simple modifications.
A well-balanced diet provides the nutrients you need for growth and repair
Stretch and change positions. Set an alarm and take a break from playing to complete simple stretches for your upper extremities and neck.
HUOT Success Stories!
At HUOT we have had the pleasure of working with many talented musicians over the years helping them return to playing! We have shared some of our success stories and photos!
To all my Guitarists
Osteoarthritis can be quite limiting when it comes to being a musician. This talented guitarist presents with increased pain when holding a guitar pick. He has several upcoming gigs and needs to play for extended periods.
In conjunction to skilled OT we highly recommend a 4mm thick guitar pic that decreases the force on the finger joints while pinching and 1mm pic.
“This pick has really helped me, it makes playing less painful!”
Joe from NJ
HUOT Favorite 4mm Guitar Pick : Gravity Picks Axis Guitar Pick - Standard, 4mm
To all my Drummers
In this case the talented drummer presents with CMC joint osteoarthritis in her thumbs. Her OT has fabricated bilateral thumb Spica splints as well as recommended Vic Grip Drum sticks that provide an anti-slip finish decreasing the stress on her joints.
HUOT highly recommends : AMERICAN CLASSIC® 5A VIC GRIP
Audrey : Thumb OA
“The custom splints and the coated drum sticks have allowed me to play drums with less pain.”
Hannah’s story: This amazing and talented singer, song writer , pianist and guitarist is eager to return to live performances ASAP. She started attending HUOT in the midst of the pandemic and has implemented multiple strategies including activity modification techniques, upper extremity and postural strengthening techniques as well as skilled OT to return to playing and live performance!
Hands UP OT has had the pleasure of working with several music schools in NYC recently and providing tips on joint protection and activity modification techniques to help reduce and prevent hand related injuries. Many musicians experience various repetitive stress injuries to their hands that can impact their ability to play their instruments. The Occupational therapists at Hands Up OT work with these musicians to educate them on various preventative strategies.
At Hands Up Occupational Therapy, we provide thorough evaluations and customize treatment plans for all musicians. Please contact us today to set up an appointment and get back to pain-free performance!
Cycling Season is Around the Corner!