tag:blogger.com,1999:blog-21940631060534730262023-11-16T02:47:19.247-08:00Sporting Hands Hamishhttp://www.blogger.com/profile/13296725506088769035noreply@blogger.comBlogger41125tag:blogger.com,1999:blog-2194063106053473026.post-48112895896553120122022-02-08T23:12:00.000-08:002022-02-08T23:12:58.726-08:00Following the Black LineOf the three disciplines in Triathlon, swimming is the one I like the least. I've already mentioned that I was the 4th last person out of the water in my first tri. In my most recent one, I was mid-pack in my age group so not quite as bad! But it's swimming you say, surely your hands are safe in the water? And you'd be mostly right.<br />
<br />
The vast majority of upper limb injuries in swimming are to the shoulder. More than 90%. Then the elbow, then the wrist, and then the finger. Usually wrist injuries are due to overuse or poor technique. Finger injuries occur when hands get smacked against the edge of the pool or hyper-extended in that last desperate lunge to the wall. The trick comes in how to manage these, especially in someone who needs to swim regularly.<br />
<br />
It all starts, as it always should and especially with overuse injuries, with a detailed history. If a swimmer is compensating for shoulder pain, extra strain can be felt through the wrist. If a swimmer has had a different injury like a fractured distal radius, then her return to the pool can be compromised not necessarily just by a loss of motion, but more likely due to a loss of forearm strength. A lack of strength can then be exacerbated when swimming equipment like hand paddles are utilised, and wrist stability is compromised. Having said that, if you are sensible, the training aids like fins or paddles can actually help offload an injury. There is almost always a way <div>
to stay in the water.</div><div><br />
<a href="https://eliteclubs.com/wp-content/uploads/2018/06/Muscles-Used-in-Backstroke-300x246.png" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="Image result for body shapes freestyle vs backstroke" border="0" height="262" src="https://eliteclubs.com/wp-content/uploads/2018/06/Muscles-Used-in-Backstroke-300x246.png" width="320" /></a>Consider different strokes. It is obvious, or at least should be once you stop and think about it, that breaststroke utilises different muscles to free style. Just have a look at the body shapes of Olympic swimmers. The demands the strokes place on the wrist will change as shoulder position changes. Feathering of the hand through the water will also alter. Use this to your advantage. If one style is inflammatory, can you integrate another so that swimming fitness is maintained throughout recovery? There will be a way.<div><br /></div><div>If you have been told to wear a splint or brace, can you swim with the splint on without posing a risk to how that injury will heal. Paddles can actually help protect a hand fracture, but need to be got used to. I have seen a couple of mallet finger injuries of late caused by hitting the wall too hard. One patient opted not to swim and COVID-19 closing the pool helped with that. The other was a keen open water swimmer. Stupidity personified given it is winter here and the bay sits at around 14 degrees Celsius. However, I'm not judging, really.</div><div><br /></div><div>The answer here was working out a solid taping protocol both over and under the splint. We also spent some time discussing skin care as the risk of maceration and subsequent skin breakdown was high. Finally, we practiced donning and doffing the splint in the clinic until it could be done confidently without me saying a word.</div><div><br /></div><div>Water exercise is important for so many reasons. The act of immersion itself can be healing, offering pressure differentials and sensory stimulation, that can reduce oedema, sensitivity, and pain. If you need to get back in the swim, I'm pretty confident that with the right advice, you can.</div><div><br /></div><div>Look after those fingers,</div><div><br /></div><div>Hamish <br /><div><br /></div><div><br /></div></div></div>Hamishhttp://www.blogger.com/profile/13296725506088769035noreply@blogger.com0tag:blogger.com,1999:blog-2194063106053473026.post-29874685401645132702020-09-08T20:28:00.001-07:002020-09-08T20:28:46.759-07:00Iso's in Iso: Beyond the Ball<div class="separator"><span style="font-family: arial;">If this isn't the best title for a blog piece on grip strengthening this year the</span><span style="font-family: arial;">n I'll give it all up. I actually don't have much more than the title actually. Sorry. I've spent most of the morning thinking about how I help patients regain hand strength. What special tools do I utilise and what is the science behind these unique methods? Sorry again. I've got nothing for you beyond gut although I'm sure there is some science out there. <div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5de_5PK-AntqrKIkcl_woVy03BebTru5apER2vmsQhUZaBTuiqGePWIwit19oqXj9DALtiMvtfaRaIYEK8kxOdDqzhp6q_lKx0ByF2abNjuByvtFJOmsFIXyd1Ozbdmtxu47h5-fpZPU/s263/Grip+types.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="263" data-original-width="191" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5de_5PK-AntqrKIkcl_woVy03BebTru5apER2vmsQhUZaBTuiqGePWIwit19oqXj9DALtiMvtfaRaIYEK8kxOdDqzhp6q_lKx0ByF2abNjuByvtFJOmsFIXyd1Ozbdmtxu47h5-fpZPU/s0/Grip+types.jpg" /></a></div><br /></span></div><div class="separator"><span style="font-family: arial;"><br /></span></div><div class="separator"><span style="font-family: arial;">When we talk grip strength, much of the conversation is based around differentiating between power grip and precision grip. Both types then get torn up into even more specifics. Power grip has 4 forms apparently. There's cylindrical grasp, ball grasp, hook grip and lateral prehension (thumb adduction). Pinch also has 4 forms, precision, oppositional, key pinch and chuck grip <span style="font-size: x-small;">(1,2)</span>. So when I get a patient referred for rehab </span><span style="font-family: arial;">with the suggestion tha</span><span style="font-family: arial;">t "maybe </span><span style="font-family: arial;">a stress ball woul</span><span style="font-family: arial;">d help", it's hard n</span><span style="font-family: arial;">ot</span><span style="font-family: arial;"> to feel a little superior. </span></div><p></p><div class="separator" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em; text-align: center;"><img border="0" data-original-height="1200" data-original-width="1800" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjonJ9bT1TdygHlXqfd4fQvAmwRPtuHU9uJ4tL42yJyoCJ_btPAE8OkSoJ1oA0aBdJnMX0otpY9EvJbrPNcJKi_jzluSBGa5z70EgXzhyZ92tKNm78GFAg0lcJjMVhGlCAFwy5Cxb2dYDw/s320/Grip+Ball.jpg" width="320" /></div><span style="text-align: left;"><span style="font-family: arial;">We can do better than a stress ball because rebuilding a functional hand requires more than 10 repetitions of a ball grasp 3 times a day. In fact, if I'm speaking plainly, I almost never prescribe stress ball squeezes. I find that often this type of grasp neglects to include the long flexors and the ulnar digits. Instead, I'll find strengthening exercises that replicate most what that patient needs to do and then build from there. If that's swinging a hammer, the initial focus may be on cylindrical grip. If that's holding a football, then working on a more open, ball grasp with its emphasis on intrinsic stability. If it's climbing a wall, then hook grips and flat pinch come into play. <br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEioJniL5KvTL7d9FTxq2erqZpevGSBBxxINDGdloacaPvSXSicZbW2hU1w12Fo5Fph16LJmXpn6w7o7rqS_r-iBEnOqftLliJQ_shStCb9k7IgYIWVPLlCC04I2nyrsGdpRnrv1njpL_Xc/s299/Grip+Rice.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="Not my arms, those who can do etc" border="0" data-original-height="168" data-original-width="299" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEioJniL5KvTL7d9FTxq2erqZpevGSBBxxINDGdloacaPvSXSicZbW2hU1w12Fo5Fph16LJmXpn6w7o7rqS_r-iBEnOqftLliJQ_shStCb9k7IgYIWVPLlCC04I2nyrsGdpRnrv1njpL_Xc/w320-h180/Grip+Rice.jpg" width="320" /></a></div></span></span><p></p><p><span style="font-family: arial;">My current favourite is the rice bath. It encourages composite wrist and hand movement, it facilitates all grip and pinch types, and there's a sensory component to it as well which may assist with proprioceptive feedback. The key is variation regardless of what you prefer. Use a ball, but also use a rope, or encourage wringing of a wet towel. Isometric holds of a barbell will build hook grip strength, but hanging from a chin up bar will encourage cylindrical grip. Remember that there is a clear correlation between grip strength and shoulder stability<span style="font-size: x-small;">(3)</span>. Work in pronation and supination, sitting and standing, shoulder abduction and flexion. </span></p><p></p><div class="separator" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em; text-align: center;"><img border="0" data-original-height="190" data-original-width="265" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjo8w-dcRccPwWFnpY4ytHe6aZTo5D9-ezhrP-NMcZE23cZkEK_hlXTYVkUO6w0Y3YuXqUYpddl-u4XhdMMmiR_tgQZ1_IWl8UXrDMH-a9Sd5OtdU7TZmRzl8knVp_dCjSMGIqbFy8Fs98/s0/Grip+Stress.jpg" /></div><span style="font-family: arial;">So, no science, but some sense. Have a look at how your patient grips. Use a rolled up bandage instead of a ball. Use a pillow or a handle. Empty 5 kilos of rice into a bucket. Look at what's not working, at what they need to do, and go from there. "Isos in iso", brilliant. Should have been in advertising! <br /></span><p></p><p><span style="font-family: arial;">Look after those fingers,</span></p><p><span style="font-family: arial;">Hamish</span></p><p style="text-align: left;"><span style="font-family: arial; font-size: x-small;">(1) Duncan S. et al. Biomechanics of the Hand, Hand Clinics 29 (2013) 483-92</span><br /><span style="font-family: arial; font-size: x-small;">(2) Landsmeer J. Power Grip and Precision Handling, Ann Rheum Dis 21 (1962) 164 <span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span></span><span style="font-family: arial; font-size: x-small;">(3) Horsley I. Do changes in hand grip strength correlate with rotator cuff function? Shoulder Elbow 8-2 (2016) 124-9</span></p>Hamishhttp://www.blogger.com/profile/13296725506088769035noreply@blogger.com1tag:blogger.com,1999:blog-2194063106053473026.post-60037482323348600922020-08-18T22:45:00.000-07:002020-08-18T22:45:05.332-07:00Ways around a problem. Getting into Hands.<div class="separator"><p style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="font-family: arial;">Greetings from lock down. Over the past coupl</span><span style="font-family: arial;">e of weeks I have listened to a number of webinars and participated in two. A quick shout out to the team at HandSpark, Beth and Ngaire for their initiative in creating the hand therapy sum</span><span style="font-family: arial;">mit with 9 speakers </span><span style="font-family: arial;">over 3 days. It has been well worth tuning </span><span style="font-family: arial;">in to. </span></p><table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4Egl9n5BFYvpPv_gW7ib4JPLik5J06t2Zw3HOgpseG5dWV6EU_e6HGpKPy9nKlNf47Qui4grPIQ_8eT9Q3b6jdD2LNqW-tGiRXo5jCCLWNVQ3tP2mSnGZrh4DgqtEzWwVg2WV38He5mI/s318/Aug+Beth+%2526+Ngaire.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="159" data-original-width="318" height="199" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4Egl9n5BFYvpPv_gW7ib4JPLik5J06t2Zw3HOgpseG5dWV6EU_e6HGpKPy9nKlNf47Qui4grPIQ_8eT9Q3b6jdD2LNqW-tGiRXo5jCCLWNVQ3tP2mSnGZrh4DgqtEzWwVg2WV38He5mI/w398-h199/Aug+Beth+%2526+Ngaire.jpg" width="398" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Beth & Ngaire from HandSPARK<br /></td></tr></tbody></table></div><p><span style="font-family: arial;">I have also been involved with an Introduction to Hands webinar that the Australian Hand Therapy Association did last weekend, and also one on Hand Injuries to the musician and Athlete that I did with Karen Fitt from Melbourne Hand Rehab for the students group at the Australian Physiotherapy Association. Whilst both presentations provoked a range of questions from the participants, a common one was "how do I get into hands?". </span></p><p><span style="font-family: arial;">It's a tricky question to give an answer to as there is no consistently direct pathway. We no longer have a post graduate course in Australia due principally to bean counters at the universities, not due to lack of support from potential teachers or students. Several private groups have stepped into the breach, and alongside the education offered by the AHTA, there are now private graduate fellowships and workshops available. Travelling overseas was how I found my way in, but will that be an option for others? Maybe not for a while. What else... <table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6drHp3E91iiaGQYf41bZFGcT17y1stTFFpzmO4tyf-mt5e8p72pKA7ho9SUOCm0mcQRah-1JT-Uyw8qjq3CVGXs-SXpuLxTYTVFXc7HbdrVM1iBldxbKRBgrEmppgjdU0RGxjIcaduog/s304/Aug+AHTA+Intro.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="166" data-original-width="304" height="208" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6drHp3E91iiaGQYf41bZFGcT17y1stTFFpzmO4tyf-mt5e8p72pKA7ho9SUOCm0mcQRah-1JT-Uyw8qjq3CVGXs-SXpuLxTYTVFXc7HbdrVM1iBldxbKRBgrEmppgjdU0RGxjIcaduog/w380-h208/Aug+AHTA+Intro.jpg" width="380" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Lots of great courses here...<br /></td></tr></tbody></table></span></p><p><span style="font-family: arial;">In a flash of laziness, I remembered the podcast I did with Jack Williams some months ago now in pre-COVID days. He had followed up with a summary of our conversation with an emphasis on that very question that I always intended to publish, but never did.</span></p><p><span style="font-family: arial;">Here then is a guest piece by Jack Williams. Please do have a listen to his pod</span><span style="font-family: arial;">cast especially if you are a young therapist on the cusp of, or just starting your career because he talks a lot about opportunity and how you can shape your direction and path. Thank you Jack...</span></p><p class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;">Hello
Sporting Hands readers...<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;">I first
came across Hamish's blog in 2017 as a student physiotherapist and thought it
was a great learning resource which really helped me whilst I was on a hospital
orthopaedic / hand therapy placement. <table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgImUQPzFsnE4AXMto1WdsSlAa91YQSLVh4IWF1XxUJUjXdepCS37sJmhCjjKYCe-dzlfNb0lJ1ihI8PcvxdiW1-4M2Zqze2J_i9C0hLL5y_lViA0aeNTAe3r_9kg9XxA7KZC-E2OUn4Fo/s259/Aug+Jack.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="194" data-original-width="259" height="243" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgImUQPzFsnE4AXMto1WdsSlAa91YQSLVh4IWF1XxUJUjXdepCS37sJmhCjjKYCe-dzlfNb0lJ1ihI8PcvxdiW1-4M2Zqze2J_i9C0hLL5y_lViA0aeNTAe3r_9kg9XxA7KZC-E2OUn4Fo/w324-h243/Aug+Jack.jpg" width="324" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Hard to find a photo of Jack<br /></td></tr></tbody></table><o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;">I really
enjoyed our chat and I promised Hamish to make a contribution to t</span><span style="font-family: "Times New Roman", serif; font-size: 12pt;">he blog which
has proved very helpful over the y</span><span style="font-family: "Times New Roman", serif; font-size: 12pt;">ears! I thought I would leave </span><span style="font-family: "Times New Roman", serif; font-size: 12pt;">the sporting
injuries to the experts and write about getting experience in hand therapy as I
recen</span><span style="font-family: "Times New Roman", serif; font-size: 12pt;">tly hosted a podcast with Hamish talking about this very subject...</span></p>
<p class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;">You can
listen in to the podcast here...<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;"><a href="https://linktr.ee/Healthlinkd" target="_blank">https://linktr.ee/Healthlinkd</a></span></p>
<p class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;">I am
fascinated with Hand Therapy for many reasons...<o:p></o:p></span></p>
<ul type="disc">
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;">Did you know Brian Mulligan’s
“apple on the head” moment for the development of his mobilisation with
movement manual therapy techniques occurred when he was working with a
stiff PIPJ?<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;">Splinting is widely
considered the defining factor of a hand therapist - but as Hamish says -
splinting skills constitute a very small proportion of the job!<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;">Hand therapists have a
specialised knowledge of physiology, anatomy, neuroscience and orthopaedic
knowledge which is unrivalled by other spheres of OT and physio.<o:p></o:p></span></li>
</ul>
<p class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;">Maybe
this is why getting a position in hand therapy is so competitive... these
skills are not taught at university and private practise educators and mentors
are hard pressed for time to impart such knowledge...<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;">Which
brings me to the point of this article…<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;">What are
some things a student or new graduate OT/PT can do to get a training position
in Hand Therapy?<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;">The AHTA
runs a number of special interest groups in each state, getting along to as
many of these as possible is a fantastic learning opportunity and also good for
networking... as a student it is recommended that you find out where your
nearest SIG group is and get along!<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;">Approaching
a private practise as a student and doing some observation is a good way to get
your foot in the door and learning about what is required for a private
practise role. If you are volunteering for a period of time - this should not
exceed more than a few months and be sure to make yourself a part of the team’s
professional development in-services and other learning opportunities.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;">There are
also a lot of overseas training in hand therapy available in the UK. Hamish
first started working in NYC as a hand therapist and also notes that many early
career and experienced OT / PT's are able to find hand therapy training
positions and work in London and other parts of the UK. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;">The AHTA
also runs a number of courses for OT/PT's who are interested in training in
hands - they are for people looking for professional development in hand and
upper limb MSK and students and new graduates are welcome to attend - even without
much experience in hands... getting started early with one of these courses
will stand out on your resume - particularly with the new pathways for
'Accredited Hand Therapist' come into play and both private practise and public
employers value this certification for leadership positions for hand
therapists.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;">The are
many exciting prospects in the future for Hand and it is certain that this area
will remain distinct moving into the future... Hamish also talked about what is
in store for hand therapy on the podcast as well as 3D printing of splints and
places for hand therapists in professional sports... You can listen in here...<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><a href="https://linktr.ee/Healthlinkd">@Healthlinkd |
Linktree</a><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;"><o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;">It was
great to visit the Heidelberg Repatriation Hospital and put a face to a
familiar blog... <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;">Thanks
again for coming on the podcast Hamish!<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;">Jack<o:p></o:p></span></p>Hamishhttp://www.blogger.com/profile/13296725506088769035noreply@blogger.com0tag:blogger.com,1999:blog-2194063106053473026.post-57229756206753722322020-07-09T22:19:00.000-07:002020-07-09T22:19:44.331-07:00Just When I Think I'm Out...<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEifSgGfbj5yE6ngJq6Bdti182KG1ajfeqCVEPY_0ZgcSt6egrNMmBTqLFyu9nZ08_zGcYwTCOk-P1K-Rx4UO_6t1rQrpNqtizd3w0ct5kDEJ2cA8-hRtVOrlTXjMJbbaCe_u5_eNH-CqdI/s1600/July+20+Al+Pacino.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="307" data-original-width="400" height="245" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEifSgGfbj5yE6ngJq6Bdti182KG1ajfeqCVEPY_0ZgcSt6egrNMmBTqLFyu9nZ08_zGcYwTCOk-P1K-Rx4UO_6t1rQrpNqtizd3w0ct5kDEJ2cA8-hRtVOrlTXjMJbbaCe_u5_eNH-CqdI/s320/July+20+Al+Pacino.jpg" width="320" /></a><span style="font-family: Arial, Helvetica, sans-serif;">So close. There was always talk about a second wave, but we all thought we'd be right. Well I did. So did, obviously, those who started to flout sensible advice like washing hands and social distancing. The result is that the city I live in has gone back into lockdown. I can't escape to the beach for a surf this time either. It's a hardcore lockdown. Not that the idiots running around the park this morning in packs of 4 to 8 seemed to think anything of it. I didn't say anything; just crawled into my little car and screamed at the world. </span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjEBaOLKNVGViZyA2k0FxaQF91-Eeh-uG4JrESVmyu-dJSJKIZHgGF2f-lQwpO4eLRiWumz7an0c35UzJy6xW5xwtdC40UPvpXEX-Ow46owT0aUHhidd3m7paFQA51wGzZt6-zumtIHhjc/s1600/July+20+Raynauds.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="230" data-original-width="220" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjEBaOLKNVGViZyA2k0FxaQF91-Eeh-uG4JrESVmyu-dJSJKIZHgGF2f-lQwpO4eLRiWumz7an0c35UzJy6xW5xwtdC40UPvpXEX-Ow46owT0aUHhidd3m7paFQA51wGzZt6-zumtIHhjc/s200/July+20+Raynauds.jpg" width="191" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Raynauds, keep it simple.</td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif;">It's hard to build back into the mindset I had for the initial lockdown. I was pretty productive then. Updated website, updated protocols, video consults, research paper, a bit of learning. Even made a street library and stocked it with old books. The patients that did come through got extra attention and great results. Numbers started to climb and so did my confidence in myself and my clinics. Then everything stopped again. Just, like, that.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">A full session yesterday was cut by 75%. I was so cranky. Then Carol bought me a croissant. Then Antonio walked past the clinic with wave and a ridiculously big grin on his face. He does that every day at 9:15am. He said his hands were cold. I couldn't understand much else given the mask and his Italian English, but the fact that his fingers were white meant he was probably a bit uncomfortable. I grabbed a pair of arthritis gloves, put them on him and sent him on his way back down the road with his wheely walker and his smile. </span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhdRoyIn3x0aOfoFqYJV7IDYN4lkjINk9nRSYfErvDfCuOzwO6V2DBeRuwGTD-KrBvzNO4SW13pASa1nT_JJVE6Sj4dDy4RLxHaGPAsEdZUWrO8HjE6nouo8bSyiiS1m3zkPY09ksTbsyM/s1600/July+20+Croissant.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="845" data-original-width="700" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhdRoyIn3x0aOfoFqYJV7IDYN4lkjINk9nRSYfErvDfCuOzwO6V2DBeRuwGTD-KrBvzNO4SW13pASa1nT_JJVE6Sj4dDy4RLxHaGPAsEdZUWrO8HjE6nouo8bSyiiS1m3zkPY09ksTbsyM/s320/July+20+Croissant.jpg" width="265" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;">And then I had a young patient who had never had any help following a traumatic elbow fracture dislocation whilst playing footy ten months ago. He'd regained full movement, but it was a bit clumsy, his strength was off and his sensation was messed up. All he wanted to do was to play footy again, and get ready for the cricket season. Given the fact that he was pretty much an open book, the question was where to start. </span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdjjsUDmRDysH8mdJtaagKw_O4TFSndxaW3CTYq7D0-XaAzfc5Tp4B9Jm7RLPzUmgijsW4l6VyhqGBvt37ZOJJU8iMAqZJH8JzGKOg_sw8XKw6HUqFAPpax8dhMes8YTgDXp6qd1IcxKM/s1600/July+20+Ali.jpeg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1076" data-original-width="900" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdjjsUDmRDysH8mdJtaagKw_O4TFSndxaW3CTYq7D0-XaAzfc5Tp4B9Jm7RLPzUmgijsW4l6VyhqGBvt37ZOJJU8iMAqZJH8JzGKOg_sw8XKw6HUqFAPpax8dhMes8YTgDXp6qd1IcxKM/s320/July+20+Ali.jpeg" width="267" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Thank you Alison #walkadifferentdirection</td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif;">We did a lot of talking. He asked a lot of questions, I offered reassurance and something different for me, Kinesiotape. Now, I'm not going to say that Alison Taylor is a genius, even if she wanted me to and even though it may be true. I missed her presentation at the Asian Pacific Hand conference due to COVID so have been looking at and trying to work out some of her treatment methods online. I must admit, much of it I don't yet understand. I do understand and appreciate her primary message though. That message is that she gives us all as clinicians, the power to say "I'm going to have a crack at that", even if we haven't tried it before and even if it's not at the top of our usual toolbox of techniques. So I taped.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Ulnar to radial dorsal glide just distal to Guyon's canal. It worked. Not exactly sure why, but I think I know, and I know I'll work it out. I'll definitely try it again. Thank you Ali, thank you <a href="https://www.handtherapyed.com/#/" target="_blank">www.handtherapyed.com</a> Tape may not be the answer next time, but something else will be. The sun will come up tomorrow everyone. Keep trying new things, keep smiling and eating croissants, because being cranky helps no one.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Stay safe and look after those fingers,</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Hamish</span><br />
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Hamishhttp://www.blogger.com/profile/13296725506088769035noreply@blogger.com0tag:blogger.com,1999:blog-2194063106053473026.post-85633698544965568342020-04-28T19:29:00.000-07:002020-04-29T16:08:11.684-07:00Corona Resolution #1: Learn stuff<br />
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<tr><td class="tr-caption" style="text-align: center;">One cannot climb in isolation...</td></tr>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">My big Corona virus resolution was to formalise my ulnar sided wrist pain rehab progression. As I worked on this, much like a lot of my thinking, the initial concept I had morphed into something much bigger and more unwieldy. So often as hand therapists we talk about the need to assess and treat the whole arm, not just the end of it. There is no good having a wrist that works if the shoulder that is designed to put it into space can't do that. But, there is no point in having a shoulder that works beautifully, if the wrist lacks coordination and stability. The problem with realising this, is that assessment of upper limb issues typically is done by examining each part individually, not as a whole. So are there measures that look at whole arm movement and function, not just bits? </span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgq6KLfMh4NuUW_UtIkDydPXWwG8oSVv1ofNj745rl1Jqvbrt29AoANjOdWYBWth8cdu2rne9_zIJppmarbIssfaM6DH1ujcNbX_8NUoi9-CWaDxM2itqb0szm9Hq9cfG-xi2-p9-vYOPc/s1600/Rafa+arms.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="202" data-original-width="250" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgq6KLfMh4NuUW_UtIkDydPXWwG8oSVv1ofNj745rl1Jqvbrt29AoANjOdWYBWth8cdu2rne9_zIJppmarbIssfaM6DH1ujcNbX_8NUoi9-CWaDxM2itqb0szm9Hq9cfG-xi2-p9-vYOPc/s1600/Rafa+arms.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Nice guns Rafa, shame about your wrists...</td></tr>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Screening tools used in elite sport include the 9+, the United States Tennis Association High Performance Profile, and the Functional Movement Screen. Unfortunately, these are all predominantly lower limb and balance related. The USTA one for example is made of of 10 tests. Three look at the shoulder in isolation. 6 look at the hip and legs, again mostly in isolation, and one assesses the core. There is no reference to anything elbow, wrist or hand related, and no way to even examine them even accidentally, in spite of the fact that injuries to these areas make up 10 to 24% of injuries within the sport(1,2). </span><span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span><br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhVf8ovm4945iECHVgDQEhAuV1bakOv7GfhX5I-qc5ZLZQ5vOOSmvrh6NEy7FddH0_6PJ6ciN-kAz4ztmcJZpgBO_ZSbYmtqOsxhAqU2TPa-kF2b7GUEIvXZ9Ys4g-z631_F74DkPdIzqI/s1600/medicine-ball-seated.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="208" data-original-width="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhVf8ovm4945iECHVgDQEhAuV1bakOv7GfhX5I-qc5ZLZQ5vOOSmvrh6NEy7FddH0_6PJ6ciN-kAz4ztmcJZpgBO_ZSbYmtqOsxhAqU2TPa-kF2b7GUEIvXZ9Ys4g-z631_F74DkPdIzqI/s1600/medicine-ball-seated.jpg" /></a><span style="font-family: "arial" , "helvetica" , sans-serif;">A bit more digging and I discovered some tests with potential. A bloke by the name of Matt Redshaw posted a presentation he had made that discusses assessment with a view to returning to play (thank you Matt)(3). Again, it is a shoulder heavy piece, but I couldn't help wondering if some of the tests could be used to look at whole arm performance. The two with the most promise are very similar in nature.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">The single arm seated shot put, and the seated medicine ball throw both measure the ability to push a weighted ball through the air. Distance is measured, the results are compared to norms and, in the case of the shot put, to the non-involved arm with an expectation of 90% symmetry. The test requires an extended wrist and hand that flexes as the arm extends in order to propel the weighted ball. Simple, sort of functional, providing immediate and relevant feedback to the patient and therapist (4). </span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEguHgiYmf0xuQJYdm9FLmDvDjr8GA-LfYgdUw5O33GAixOSFM9-O9f96i0pKzDE5GcqyclQwGtnne69H0w2X-QLROGLAtCfESLuMctvhU_M_RGsx4Sv7GhpdnkY3U5TTJDU4zxgqYzDP_A/s1600/Fibonacci+Hand.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="274" data-original-width="214" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEguHgiYmf0xuQJYdm9FLmDvDjr8GA-LfYgdUw5O33GAixOSFM9-O9f96i0pKzDE5GcqyclQwGtnne69H0w2X-QLROGLAtCfESLuMctvhU_M_RGsx4Sv7GhpdnkY3U5TTJDU4zxgqYzDP_A/s1600/Fibonacci+Hand.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fibonacci in the hand</td></tr>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Its application made sense to me as I wondered why I am seeing so many rock climbers with trigger fingers. Ben Cunningham, a local hand therapist whose wisdom I respect, reasoned that this is probably due to an intrinsic vs extrinsic muscle imbalance, and therefore a dysfunction of the Fibonacci sequence. Also known as the Golden Ratio, this famous sequence occurs frequently in nature and mathematics. It refers to a sequencing of numbers where each number is the sum of the two numbers that preceded it eg 0,1,2,3,5,8 etc.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Whilst the ratio has been disproven with regard to bone length in the hand (5), it still seems relevant when applied to hand movement. Here, it describes how during finger flexion, the motion paths of the digits form an equiangular spiral. Ben's argument is that this predictable & balanced progression of angles, whilst applicable to full grasp, is disrupted during specific climbing holds like the crimp. This then exaggerates the forces, disrupts the relationship between muscle groups, and leads to overload and failure. </span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEaWce-XjrEYJ4QYTLZRz5IVc4bra3iSuch7QUsswPNGP1UpezbfbTLeOocSIssGUzYfQvrXdFw75IA7XxZIeGco7zkO5XtGD3zp41bdWd0WSm1kP-X3YQ4FTBnzRRc8MnK1tOvb96I-I/s1600/Washing+hands.png" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1194" data-original-width="1202" height="317" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEaWce-XjrEYJ4QYTLZRz5IVc4bra3iSuch7QUsswPNGP1UpezbfbTLeOocSIssGUzYfQvrXdFw75IA7XxZIeGco7zkO5XtGD3zp41bdWd0WSm1kP-X3YQ4FTBnzRRc8MnK1tOvb96I-I/s320/Washing+hands.png" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Not true. Just keep doing this. Stay safe & well.</td></tr>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Now Ben is a very wise man, and whilst he possibly has something there, could it also be the result of a more proximal deficiency? Either way, hand and wrist pain in climbers is usually the result of overload causing poor technique, and subsequent biomechanical failure. Establishing a baseline of whole arm power might prove useful even if the assessment itself is not as obviously applicable as a timed hangboard test. My suggestion is that in addition to examining individual parts, we test muscle power and efficiency with whole arm active testing. Dynamic tests like the seated shot put or medicine ball throw might be part of the answer. I'll keep playing around with things, but in the meantime I would love to know what others are using. </span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Look after those fingers,</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Hamish</span><br />
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<ol>
<li><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: xx-small;">Targett, S. <i>Periodic medical assessment of athletes</i>. In Brukner & Khan, Clinical Sports Medicine Ch 46. 5th Ed. 2017. McGraw-Hill.</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: xx-small;">Abrams,G. E<i>pidemiology of musculoskeletal injury in the tennis player</i> BrJSpMed 2012</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: xx-small;">Redshaw, M. <a href="https://www.manchester.edu/docs/default-source/fort-wayne-docs/neisms/2017docs/matt-redshaw.pdf?sfvrsn=2">https://www.manchester.edu/docs/default-source/fort-wayne-docs/neisms/2017docs/matt-redshaw.pdf?sfvrsn=2</a></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: xx-small;">Riemann, B.L., <i>A bilateral comparison of the underlying mechanics contributing to the seated single-arm shot-put functional performance test. </i>Journal of Athletic Training 2018;53(10):976–98</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: xx-small;">Park, A.E.,<i>The fibonacci sequence: Relationship to the human hand</i> JHand Surgery, 2003 <a aria-label="Persistent link using digital object identifier" class="doi" href="https://doi.org/10.1053/jhsu.2003.50000" rel="noreferrer noopener" style="box-sizing: border-box; color: #0c7dbb; margin: 0px; padding: 0px; text-decoration-line: none; word-break: break-word;" target="_blank" title="Persistent link using digital object identifier">https://doi.org/10.1053/jhsu.2003.50000</a></span></li>
</ol>
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<br />Hamishhttp://www.blogger.com/profile/13296725506088769035noreply@blogger.com0tag:blogger.com,1999:blog-2194063106053473026.post-60197601346297989652020-04-21T20:16:00.000-07:002020-04-23T01:17:28.203-07:00Telehealth; the New Normal? <table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdn1lKo4c2KrhC_6qPvKbJVbqW3mBT2tpyPV4QOGCJPlzoyFYzVs8uS1ZXfIvhLA7GaNEjXTIeAwM3xuZ_pKDoZXmgHyxMVR6DMFh5gF0-TyG6VpNjqreNFqWD73hsYVwZCTyuDl_tiVw/s1600/Telehealth+Lauren.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto; text-align: center;"><img border="0" data-original-height="225" data-original-width="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdn1lKo4c2KrhC_6qPvKbJVbqW3mBT2tpyPV4QOGCJPlzoyFYzVs8uS1ZXfIvhLA7GaNEjXTIeAwM3xuZ_pKDoZXmgHyxMVR6DMFh5gF0-TyG6VpNjqreNFqWD73hsYVwZCTyuDl_tiVw/s1600/Telehealth+Lauren.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Lauren Miller, amazing what a deadline can do!</td></tr>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Telehealth can be awesome but has inherent limitations. Like so much of what I do, it requires practice and it also requires a buy in from both therapist and patient. I spent a bit of time helping Lauren Miller out with a review paper on telehealth and hand therapy she punched out for the AHTA. I've pasted the introduction below. The paper demonstrated that there is established proof that telehealth can be a viable and effective treatment modality. I would agree with this, albeit we need to recognise that it does have limitations. I'll let you read Lozza's work first, then I'll add my 5 cents. </span><br />
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<span style="background-color: white; color: blue; font-family: "helvetica"; font-size: 13px;"><em><strong>Evidence of clinical effectiveness of telehealth consultations by Hand Therapists: for the consideration of Private Healthcare Australia, </strong></em>Lauren Miller, PhD<sup>1,2</sup>, Hamish Anderson<sup>3,4,</sup> Andrea Bialocerkowski, PhD <sup>5,6</sup></span><br />
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<span style="background-color: white; color: blue; font-family: "helvetica"; font-size: 13px;">Hand Therapy and Coronavirus (COVID-19)</span><br />
<span style="background-color: white; color: blue; font-family: "helvetica"; font-size: 13px;"><br />Hand Therapy is the science and art of rehabilitation of the upper limb from the shoulder to the hand. It involves the assessment, using standardised tests, of the injured limb from which a specific treatment program is designed (Australian Hand Therapy Association, 2020). A variety of specialised treatment techniques are used to achieve client goals. Hand Therapy is practiced by occupational therapists and physiotherapists, and traditionally occurs in the face-to-face delivery mode.<br /><br />However, in the wake of the coronavirus (COVID-19) pandemic, measures aimed at controlling the spread of the virus within our community have been introduced. These include social distancing of at least 1.5 metres between individuals, advice for people to stay at home (particularly those aged over 70, or over 65 with pre-existing conditions, or Indigenous people aged over 50 with pre-existing conditions) and self-isolation for those who have recently returned from overseas, tested positive, or been in contact with someone who has (Australian Government, 2020).<br /><br />These important measures present significant challenges to the traditional face-to-face model of care. Telehealth consultation provides an alternative and in many cases adjunct option that enables continued access to Hand Therapy services and prevents unnecessary delays in receiving care while minimising risk of coronavirus (COVID-19) disease transmission. Telehealth consultation may become even more crucial in the event of more restrictive lockdowns, such as those being enforced in other countries.<br /><br />Fortunately, the Australian Hand Therapy community is well placed to introduce safe and effective telehealth consultations. The use of telehealth has been repeatedly shown to be efficient, cost-effective, and able to deliver the results that Australian Hand Therapy consumers demand, and deserve. It is the strident view of the Australian Hand Therapy Association that to enable privately insured patients to access appropriate and effective health care during the restrictions of this pandemic, hand therapists need to be able to bill private health insurers for teleconsultations.</span><br />
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<tr><td class="tr-caption" style="text-align: center;">Ordinary meme, but pickings were slim</td></tr>
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<span style="background-color: white; color: #606060; font-family: "arial" , "helvetica" , sans-serif; font-size: 13px;"><span style="color: black; font-size: small;">The issues I have faced are mostly addressed in the article. They include poor display quality that means I can't tell if a wound is infected or just angry, reluctance on behalf of patients to actually pay for my time, and the inability to repair a splint over the internet. The evidence does exist to justify telehealth as a modality. My immediate problems are twofold. </span></span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="background-color: white; color: #606060; font-size: 13px;"><span style="color: black; font-size: small;">Number one is that with no one playing sport or doing risky things, with no elective surgery, and with no one visiting a GP for anything other than a fearful sniffle, I don't have patients knocking on my door at the moment. I do want to utilise telehealth but I don't currently have a patient population to use it on. Bigger practices, those associated with trauma surgeons, and those who pre-pandemic had established exercise classes may be different. Good luck to you all. Also what can't be effectively addressed is a perceived inability on my part to translate what the patient needs to do without being able to physically put my hands on them. I'll learn that if I get the chance to persist, perhaps in the post COVID-19 world. </span></span><span style="background-color: white;">Ultimately, the valuable lesson for us all is that it is an option, and is likely one that should be be added to most therapy tool kits from here on. So well done Lozza, and thank you.</span></span><br />
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<span style="background-color: white; color: #606060; font-family: "arial" , "helvetica" , sans-serif; font-size: 13px;"><span style="color: black; font-size: small;">Look after those fingers,</span></span><br />
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<span style="background-color: white; color: #606060; font-family: "arial" , "helvetica" , sans-serif; font-size: 13px;"><span style="color: black; font-size: small;">H</span></span>Hamishhttp://www.blogger.com/profile/13296725506088769035noreply@blogger.com0tag:blogger.com,1999:blog-2194063106053473026.post-31722129358310280762020-03-31T17:51:00.002-07:002020-04-21T17:28:27.717-07:00Madness in the Time of Corona<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4pOtZyqj_XvB7F_oh8OG9DWxJrTPiDl8CZhV3tRxahtanCUS1m8SYEh5KQAbk57o2a1FhyphenhyphentFOw3c4p7i9Udeh51NPkFtnRcEd0A8B1lulq8F9y1xAmdu9ZZGfsEQdZwGFTXC1Yur953Y/s1600/Corona+Hamish.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="242" data-original-width="325" height="238" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4pOtZyqj_XvB7F_oh8OG9DWxJrTPiDl8CZhV3tRxahtanCUS1m8SYEh5KQAbk57o2a1FhyphenhyphentFOw3c4p7i9Udeh51NPkFtnRcEd0A8B1lulq8F9y1xAmdu9ZZGfsEQdZwGFTXC1Yur953Y/s320/Corona+Hamish.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Hates a microphone!</td></tr>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Six weeks ago, I wrote about how things change. I was diving back into private practice after 3 years of mostly working at a public hospital. The Corona virus was on the radar then, but it didn't appear to be influencing anybodies plans unless they lived in Wuhan, and it certainly wasn't shaping mine. For me it was full steam ahead. Loving being back at the Hawthorn footy club, and relishing the challenges associated with working with the Carlton AFLW team. I was also at the pointy end of having been the co-convenor for the, wait for it, triennial combined meeting of the Asia Pacific Society for Surgery of the Hand, and the Asia Pacific Federation of Hand Therapists here in Melbourne. </span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrxtslW7PA5HAD9E_njQJn4a8I55m18lWspaFc8NIPHqsFedPJbO84kMiishPOrfcNQ9FTdtXJepmCQCz9YR0VBK84j2AzSkOYzEYKIrll8aNs2zdt0M7wvFsgcw5VOcAC2DVamLI9ROE/s1600/Corona+Sad+Hawthorn.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="594" data-original-width="392" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrxtslW7PA5HAD9E_njQJn4a8I55m18lWspaFc8NIPHqsFedPJbO84kMiishPOrfcNQ9FTdtXJepmCQCz9YR0VBK84j2AzSkOYzEYKIrll8aNs2zdt0M7wvFsgcw5VOcAC2DVamLI9ROE/s320/Corona+Sad+Hawthorn.jpg" width="211" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Do they miss me as much as I miss them?</td></tr>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">We were expecting well over a thousand registrants for this conference. As we got closer to the event date of March the 10th, those numbers started dropping. First the Chinese delegation pulled out, then Singapore, Korea, and much of Japan. When the Grand Prix wasn't cancelled, we took this as a green light to continue. At the same time, we spent a lot of time arranging video presentations, and the schedule took a massive hit. </span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">The conference went extremely well. Minimal contact, but not nearly to the extent we have now. A challenging program amidst a backdrop of impending doom. The call to cancel the final day was made at three o'clock on Friday the 13th. Apt perhaps. There was disappointment, but no complaints that I was aware of, and I can only thank the delegates for that. The gala dinner went ahead, and as Alison Taylor said, it was kind of like the last party on the Titanic. It was certainly the last party I'll be at for a while. </span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh5S9maZ0otMzJskqLQoJIUz6jZ1SjdzXzaPV1Ejw9upsh9FiYTKF-38QDSt9-8fBwVO7XGqaU5KjqNdt4fe4zDLClE5G3Z5IfvLdSatIgOjYXq4V8IklhaINhzBN035SD-J4SYeXTeADI/s1600/Corona+Saw+Doctors.png" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="696" data-original-width="522" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh5S9maZ0otMzJskqLQoJIUz6jZ1SjdzXzaPV1Ejw9upsh9FiYTKF-38QDSt9-8fBwVO7XGqaU5KjqNdt4fe4zDLClE5G3Z5IfvLdSatIgOjYXq4V8IklhaINhzBN035SD-J4SYeXTeADI/s320/Corona+Saw+Doctors.png" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Ripping tune</td></tr>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">I've now lost my contract at the footy clubs and my practice has shrunk to half of what it was. I still have people coming through the door, but I'm restricting that as much as possible to post-operative cases. I've read comments about how we should shut our doors completely or just offer tele-health, and I can appreciate where they are coming from. However closing the door on a person just after surgery and having them rely on surgical advice to "just start moving when you feel like it" is likely condemning them to a crap result. Tele-health is great for some and I've used it to reinforce & adjust programs, but it can't work for everyone. So I'm still open. </span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">But it's weird isn't it? It's surreal. Streets are empty. Toilet paper has made a return, but you can't buy more then two tins of vegetables even if you mix the types, and there's nothing in bulk. Spotify is chockers with Corona Isolation playlists. The memes that are flying around are mostly hilarious, although I get the impression that the edge to them is getting darker and nastier.</span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJ0WEX1lyYwQCKXD4H-NUP9PHlT4YGgdWq3iceidcdLaGUfCfFWFXWQpHpHDaeYBnjm9kOHso6DHUZDyTPuaSBWQ0PXyWlwbW25KHaN9d2tNV7_ykaTgxy5g9gqJ4_Nh_uMra7JtJ8LQs/s1600/Corona+Podcast.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto; text-align: center;"><img border="0" data-original-height="225" data-original-width="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJ0WEX1lyYwQCKXD4H-NUP9PHlT4YGgdWq3iceidcdLaGUfCfFWFXWQpHpHDaeYBnjm9kOHso6DHUZDyTPuaSBWQ0PXyWlwbW25KHaN9d2tNV7_ykaTgxy5g9gqJ4_Nh_uMra7JtJ8LQs/s1600/Corona+Podcast.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">For a positive sporting fix</td></tr>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">When I'm not working on the business I'm watching anything on Netflix I can that's sport related. Just finished "The English Game". Acting was ordinary, but the story was fascinating. There's a series of ESPN documentaries called "30 on 30" that I'd love to work through, and I've found several podcasts one of which, "The Howie Games" is a surprising stand out. I'll do some exercise, go for a run, hit the lonely speed ball, and have a kick with my son. I'm also working on a passable version of "I Useta Love Her" by the Saw Doctors. Classic happy space song. It could be worse, and so it's not me I'm worried about. </span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Here's where a blog that is determinedly light-hearted and irreverent becomes sombre. I worry for those who don't have my resources. I worry for Mum and Dad. I worry for the mental health of so many. I worry for the long term implications of this virus: socially, financially, and physically. I worry for my friends working on the front-line in public health both here and overseas. I don't worry for the dickheads who think they are above it all and can do whatever they want. Karma will get them.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">So stay safe, look after your fingers, and I'll see you on the other side of this madness. </span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">H</span><br />
Hamishhttp://www.blogger.com/profile/13296725506088769035noreply@blogger.com0tag:blogger.com,1999:blog-2194063106053473026.post-40219135334238678142020-02-17T22:07:00.000-08:002020-02-17T22:07:04.577-08:00It's all about me now!<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2WauC3_smAjICtba5mB9xbR9b-n-afDPqmOu1Qre92oqgE-q0o8hvbvMBZJSmF7XTNoLaXBJBXuNPVP1YolvVAgEzoWVm7bkF1L8IF0WnrHJLjGBSZBNSVjYPgf-ewkp_l8ms6eJzswA/s1600/Beckworth.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="225" data-original-width="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2WauC3_smAjICtba5mB9xbR9b-n-afDPqmOu1Qre92oqgE-q0o8hvbvMBZJSmF7XTNoLaXBJBXuNPVP1YolvVAgEzoWVm7bkF1L8IF0WnrHJLjGBSZBNSVjYPgf-ewkp_l8ms6eJzswA/s1600/Beckworth.png" /></a><span style="font-family: Arial, Helvetica, sans-serif;">So as you may have noticed, I never fulfilled that promise
to complete the triathlon series, nor did I update the blog as regularly as I
should have. 2019 was a year of massive upheavals for me and mine, and things
certainly got away from me. I did however complete the same triathlon this year.
I was faster this time, and I’ve emailed the race organiser Adam Beckworth (<a href="http://www.beckworthracing.com/">www.beckworthracing.com</a>) to get his
10c worth on triathlon and hand injury. Hopefully that will all work out! <o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">In the meantime, with the unashamedly self-centred goal of
self-promotion, I’m going to use this blog to discuss my rationale associated
with diving back into the perils of full time private practice after three
years of working predominantly in the public sector. <o:p></o:p></span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-Us_eqVFwDFPXSAuKJq4r4QXA0IqAu9z18SL9a5ZzC4GAr2vEwGPfBZMwGqgLj-o48urLV1l4a_J3F-sRvElZYrqF-MrAFnlcg-wJ4gdNSyFstNd6F11sO95C9ai8u7qDOMnMFH5HWLI/s1600/aht_logo_colour.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="886" data-original-width="886" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-Us_eqVFwDFPXSAuKJq4r4QXA0IqAu9z18SL9a5ZzC4GAr2vEwGPfBZMwGqgLj-o48urLV1l4a_J3F-sRvElZYrqF-MrAFnlcg-wJ4gdNSyFstNd6F11sO95C9ai8u7qDOMnMFH5HWLI/s320/aht_logo_colour.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Thanks again to Hoggie of Andrew Hogg design</td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif;">When you are solely responsible for bringing food to the
table and can’t just expect to be paid for showing up, a whole host of issues
aside from the ability to fix fingers arise. You have to understand marketing.
You have to understand budgets. You have to understand relationships with
referrers. You may not want to admit it, but because your relationship with
your patients is fee for service, sometimes your role becomes mercenary. These
conditions are what you sign up for. The reason I went to work at Austin Health
as their senior clinician in hand therapy, was because 15+ years of mostly independent
private work had worn me out. <o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">At Austin Health I had a great team of therapists to lead
and teach. I also learnt from them all, regardless of their experience. I got
paid regardless of whether a patient showed or not. I could manage my time to
include extra projects and research and was supported to do so. I enjoyed my
three years there because of the people, both the other therapists, and the
patients. Ultimately, the reason I left the financial safety of a permanent
position, was because Austin Health could never give me the career control I
had when I was my own boss.<o:p></o:p></span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhO6saE_TjaHkqrVVJZ7PtCqs58qncNl6VMwn8HuorAnE3c7Tu2k7rQi62h3Xpteg4d5BySOCHA0zKqaccuUn9eNUoRD6IkDRDo5McXIzq8W60i56h9FyaXxMh6_t5eKpJeYqzSwAnYi4E/s1600/Tayla.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1024" data-original-width="768" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhO6saE_TjaHkqrVVJZ7PtCqs58qncNl6VMwn8HuorAnE3c7Tu2k7rQi62h3Xpteg4d5BySOCHA0zKqaccuUn9eNUoRD6IkDRDo5McXIzq8W60i56h9FyaXxMh6_t5eKpJeYqzSwAnYi4E/s320/Tayla.jpg" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Go the Blue Baggers!</td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif;">Within two weeks of leaving Austin Health, I was consulting with
a wheel chair athlete at the Australian Open. I also took the opportunity to
work directly and regularly with the Carlton AFL womens team, in a very similar
role to what I do at the Hawthorn footy club. I got busy establishing three new
clinics. Two of these are in busy sports physio practices; one is in a rock-climbing
gym! I am chasing provider numbers, new equipment, and new stationary, not to
mention new patients. I am writing to potential new referrers. I am working on “establishing
a social media presence”. I am getting control back. <o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">I am getting control back by doing what I love to do, in the
manner in which I love to do it. Yes there is a financial risk; I don’t
anticipate I’ll be flying first class anywhere anytime soon. But I’m
challenging myself again much as I challenged myself in the Barwon Heads
triathlon last weekend. Life is simply too short to doubt yourself or your
ability to do what you want to do. <o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: small;">Until next time, look after those fingers,</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Hamish<o:p></o:p></span></div>
<br />Hamishhttp://www.blogger.com/profile/13296725506088769035noreply@blogger.com0tag:blogger.com,1999:blog-2194063106053473026.post-8681670316470586162019-05-23T17:52:00.001-07:002019-05-23T17:52:39.363-07:00Triathlon & Hands<div class="MsoNormal">
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<tr><td style="text-align: center;"><img alt="Image result for matt hopkinson physio" height="180" src="https://cdn.newsapi.com.au/image/v1/67b43572b362040bcf9b695fe97790ed" style="margin-left: auto; margin-right: auto;" width="320" /></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Matt Hopkinson. Ordinary triathlete, elite dancer!</td></tr>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">I was recently chastised in a nice way by my “landlord” Matt
Hopkinson. Matt is the owner and principle physiotherapist at “Glenferrie Sports
and Spinal” which is where I work every Monday afternoon. Matt, and Ben
Holland the peoples’ podiatrist, had just returned from a weekend in Sydney on
practice management, and in particular, the use of social media. Matt had a
crack at me for not keeping my presence on social current. He’s right of
course, it has been 10 months since my last blog, and so I promised him I would get something down. <o:p></o:p></span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">The something that has been buzzing around in my head is the
result of a triathlon I completed in February. Around the same time, I saw an
elite triathlete, who had had an extremely nasty injury to her wrist after a
fall from her bike. The injury, whilst it didn’t necessarily stop her from
training, certainly impacted on how she trained and what she could do. <o:p></o:p></span></div>
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<a href="http://clipart-library.com/image_gallery/585390.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="Image result for clip art triathlon" border="0" height="105" src="http://clipart-library.com/image_gallery/585390.jpg" style="cursor: move;" width="320" /></a><span style="font-family: "arial" , "helvetica" , sans-serif;">Triathlon is a sport that demands different things from the
body at specific times. There are things that are similar between the disciplines,
eg cardiovascular fitness; and there are things that are different such as the demands
on upper body in swimming that are not there in running. I would argue, and I
will argue, that a wrist or hand injury can impact all three; swimming,
cycling, and running. <o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="line-height: 107%;">I first saw
triathlon on the Saturday afternoon TV show “Nines Wide World of Sports”. The
Hawaiian Ironman. This race began in 1978 when </span><span style="line-height: 107%;">Judy and John Collins proposed combining the three toughest endurance
races in Hawai’i—the 2.4-mile Waikiki Roughwater Swim, 112 miles of the
Around-O’ahu Bike Race and the 26.2-mile Honolulu Marathon—into one event. 15
people raced that year, 2400 last year in what is now a qualification only
event (1).<o:p></o:p></span></span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYk4b0cXIAmqwjh2t1T1lUP4wvHQ7VqFUpLwf3VacS69Bauok51MOA_P9mvVaCFE-1KkBESpAAvd7tLGrXBbantrgcLDZV0fKdXHKvfPB7lBKxL41wAF-s7f0Ep5TGPdfLjuJlwAwwwb0/s1600/Kew+2.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="610" data-original-width="1600" height="151" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYk4b0cXIAmqwjh2t1T1lUP4wvHQ7VqFUpLwf3VacS69Bauok51MOA_P9mvVaCFE-1KkBESpAAvd7tLGrXBbantrgcLDZV0fKdXHKvfPB7lBKxL41wAF-s7f0Ep5TGPdfLjuJlwAwwwb0/s400/Kew+2.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">It really is that colour. Swimming through goose poo.</td></tr>
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<span style="line-height: 107%;"><span style="font-family: "arial" , "helvetica" , sans-serif;">My
first triathlon was in 1985 around the Kew Boulevard. We swam in the Yarra
River which is revolting now I think about it, and I was 296<sup>th</sup> out
of the water in a field of 300. Jumped on my trusty but rusty 10 speed Lawrencia bicycle
with its pack rack still attached and rode my guts out. Did okay in the run and
ended up in the First Aid van with cramp at the end. A fantastic morning and
whilst the experience never led to a lifetime of racing, I’ve always loved the
sport. <o:p></o:p></span></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif; line-height: 107%;"><span style="font-family: "arial" , "helvetica" , sans-serif;">In the
next blog (and it will be up very soon), we’ll talk about swimming, my least favourite leg but an important one for fingers!!</span></span></div>
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(1) </span><a href="http://ap.ironman.com/triathlon/events/americas/ironman/world-championship.aspx#ixzz5onGPe21q" style="font-size: 10pt;"><span style="color: #003399;">http://ap.ironman.com/triathlon/events/americas/ironman/world-championship.aspx#ixzz5onGPe21q</span></a></span>Hamishhttp://www.blogger.com/profile/13296725506088769035noreply@blogger.com1tag:blogger.com,1999:blog-2194063106053473026.post-9027325636709588862018-07-19T20:13:00.000-07:002018-07-19T20:13:27.152-07:00One screw or two?<span style="font-family: Arial, Helvetica, sans-serif;">It's getting towards the end of the Australian rules football season. It always seems around now that I see more people with hand and wrist fractures than I did at the start of the year. maybe it's the cold, maybe it's fatigue, maybe it's that the games become more desperate with finals around the corner. Surely someone knows?</span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjInpAgB-IBvtbhuprgn2SU__7_eU45G2O_GjmiI6mHVdT-lMLxyGPtmf28klCmlLrFUjljMMUXYUXRuacb3qViaZ9l-lCR7hEe1Y4Y20TFjbotiNNEDqzCIXDSC1g9stQ378ePsDZodKw/s1600/Brad-Hill.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="366" data-original-width="624" height="187" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjInpAgB-IBvtbhuprgn2SU__7_eU45G2O_GjmiI6mHVdT-lMLxyGPtmf28klCmlLrFUjljMMUXYUXRuacb3qViaZ9l-lCR7hEe1Y4Y20TFjbotiNNEDqzCIXDSC1g9stQ378ePsDZodKw/s320/Brad-Hill.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Better in brown & gold! Scaphoid 2016.</td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif;">In any case, this week I have seen 4 footballers with scaphoid fractures. All were simple non-displaced waist fractures. Two were casted, two had surgery. One of these had one screw inserted to repair the bone, the other two. A physio I really respect asked whether the two screw thing was new, and why would the surgeon opt for what appears on the outside to be much more difficult surgery to a small bone that already has a poor reputation for healing. The surgery and the science weren't new to me, but a translation of their impact was obviously required so let's start at the start. </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Facts about the Scaphoid <span style="font-size: xx-small;">(1,2)</span></span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgoEAUIc6mm4ngTd-TMggus2NiS84wU7MUK33__UWSBBNkJBZdqO9in_W9ZUcHnYQUmOWxLhS9brY-keVO1tzKwfbWajX9ksuYlmf8YBMHHzAgEbWaWu9nNc5MsZ8gGP7Wr0UV5J26CJdI/s1600/Scaph+%2523.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="379" data-original-width="650" height="232" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgoEAUIc6mm4ngTd-TMggus2NiS84wU7MUK33__UWSBBNkJBZdqO9in_W9ZUcHnYQUmOWxLhS9brY-keVO1tzKwfbWajX9ksuYlmf8YBMHHzAgEbWaWu9nNc5MsZ8gGP7Wr0UV5J26CJdI/s400/Scaph+%2523.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Scaphoid fracture through waist. One screw, result at 4mths. Not my patient.</td></tr>
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<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Most commonly injured carpal bone</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Frequently diagnosed late if at all, with high rates of bone non-union</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Best assessment indicator remains pain on palpation of scaphoid in radial snuffbox (below thumb)</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">The part nearest your wrist (proximal) has poor blood supply, often lost with a fracture of the middle section (waist)</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Casting can be required for 2-6 months</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Surgery appears to have better outcomes in the short term</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">It appears thumb immobilisation is unnecessary in a cast <span style="font-size: xx-small;">(3)</span> (but I still include the thumb at least initially because I definitely don't trust young, male footballers!). </span></li>
</ul>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjitfe8DUHM_k26LIyxKvvC4mxABkiEFnuSeofuqwd6MBjB_g-9m-chm_TWow6215fTsEFR2cJS5RL2K5t8KXaNKH9W1P1RqQAxlkV3E9qIPbBBSm8IWG6Bdmw4mAvj0w6-8YGmawSQyfc/s1600/NFL+cast.jpeg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="821" data-original-width="630" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjitfe8DUHM_k26LIyxKvvC4mxABkiEFnuSeofuqwd6MBjB_g-9m-chm_TWow6215fTsEFR2cJS5RL2K5t8KXaNKH9W1P1RqQAxlkV3E9qIPbBBSm8IWG6Bdmw4mAvj0w6-8YGmawSQyfc/s320/NFL+cast.jpeg" width="245" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Not an option in Aussie rules footy!!</td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif;">If I am just talking about athletes, then they are looking at the quickest possible return to their sport. This makes a fracture during the season more likely to be addressed with surgery in spite of the real risk of complications. There remains a risk though. Surgery will ensure good bone compression and stability, but the bone still requires protection in a splint, and active movement outside of the splint is not always encouraged such is the reputation of this poor little bone <span style="font-size: xx-small;">(1,2)</span>. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">The reason surgeons started looking at two screw fixation was that they wanted earlier movement at the wrist to reduce concomitant weakness, and there have been significant improvements in available hardware since development of the Herbert screw in 1984<span style="font-size: xx-small;">(5)</span>. There was also a recognition of the potential benefit of permitting controlled stress across the joint to augment bone growth. </span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEicpeJ3DmQmk6f6oKwWdfZeli0rKnCl3jJcUeXKn1Us4H-RX0AYXps9TklYePG9KWB2MgFseeF3dZX7jmKYb-I1u9DB4T_6ac_vqzrbV7naDh5nb8gKYlhTHYGsPCWq-ZE-bkYCY1F0yrA/s1600/Cupcake+tower.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="439" data-original-width="651" height="215" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEicpeJ3DmQmk6f6oKwWdfZeli0rKnCl3jJcUeXKn1Us4H-RX0AYXps9TklYePG9KWB2MgFseeF3dZX7jmKYb-I1u9DB4T_6ac_vqzrbV7naDh5nb8gKYlhTHYGsPCWq-ZE-bkYCY1F0yrA/s320/Cupcake+tower.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Cupcake bouquets. Who knew they were a thing?</td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif;">Keen students of previous blogs will be aware that the scaphoid is a tricky little beast, not always moving in a singular plane. The problem with a single screw, was that it still permitted rotation of the scaphoid. Proponents of the two screw method argued that torsional stability of the bone would be enhanced with two points of fixation <span style="font-size: xx-small;">(4,5)</span>. This makes sense to me. One toothpick in a cupcake bouquet and the cupcake will slide off. Two toothpicks and it can't. Simple! </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Obvious complications are that inserting two screws is technically very difficult, it effectively doubles the likelihood of malpositioning, and it is more expensive <span style="font-size: xx-small;">(4)</span>. It is a new technique; one that is not available to all patients, and one that is not yet supported definitively. Rehabilitation protocols specific to this surgery have not yet been established. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div>
<span style="font-family: Arial, Helvetica, sans-serif;">Notwithstanding the risks, and relative newness of the research, the biomechanical theory comparing one vs two screws is promising. Both lab based and clinical results do indicate a better stability, stiffness and energy absorption compared to a single screw. Whilst these studies concentrated on scaphoid fractures involving non-union or displacement, the implications are that an earlier introduction of mobilisation, loading and strengthening may be tolerated <span style="font-size: xx-small;">(4,5)</span>; possibly even an earlier return to play... just in time for finals!</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Look after those fingers,</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Hamish</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">References</span></div>
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<ol>
<li><span style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">Rambau GM et al. Evaluation & management of nondisplaced scaphoid waist fractures in the athlete. Operative Tecniques in Sports Medicine 2016 24:87-93</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">Winston, M., Weiland AJ. Scaphoid fractures in the athlete. Curr Rev Musculoskelet Med 2017 10:38-44</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">Buijze, GA. et al. Cast immobilisation with and without immobilisation of the thumb for nondisplaced and minimally displaced scaphoid waist fractures: A multicentre, randomised, controlled trial. JHS Am 2014; 39(4):621-627</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">Mandaleson, A. et al. Scaphoid fracture fixation in a nonunion model: a biomechanical study comparing three types of fixation. JHS Am 2018;43(3):221-228</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">Garcia RM. et al. Scaphoid nonunions treated with two headless compression screws and bone grafting. JHS Am 2014;39(7):1301-1307</span></li>
</ol>
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<br />Hamishhttp://www.blogger.com/profile/13296725506088769035noreply@blogger.com0tag:blogger.com,1999:blog-2194063106053473026.post-5675249109218517042018-01-28T21:14:00.000-08:002018-01-28T21:14:13.040-08:00Low to High Hamma, Low to High<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi8jlTM7xkoxkHgr2chYq40kgxbWZDFfEdZ9yZXdlCkTsugax8P0WI4ATJa_dJMM3fkHxCRrrHHDOTGty0tBrSpTTnC00AIvarc-Ig0UQxh2jVRPlPo1xZslZX8JH8g848HxglMMqO4ruk/s1600/170px-Moorcroft_-_2001_mark.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="243" data-original-width="170" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi8jlTM7xkoxkHgr2chYq40kgxbWZDFfEdZ9yZXdlCkTsugax8P0WI4ATJa_dJMM3fkHxCRrrHHDOTGty0tBrSpTTnC00AIvarc-Ig0UQxh2jVRPlPo1xZslZX8JH8g848HxglMMqO4ruk/s200/170px-Moorcroft_-_2001_mark.jpg" width="139" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">John Egan; back 2 back 2 back winner of the <br />
Cannons Mark of the Year<br />
Gary Coleman Cup</td></tr>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">My mate Jumping Johnny Egan is one of the best marks of a
footy that I have ever seen. As he launches himself towards the ball, his hands
move from down by his waist into the air above his head before snapping open
with wrist extension just before the ball smacks into his palms. Conversely,
and keen readers of this intermittent blog will know exactly where I am going
with this, I am one of the worst marks of the footy I have ever seen. At least,
I used to be.<o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">The local junior footy club (Go Sharks) began to run training nights for
Dads. There was no game, just an excuse to run hard and do circle work. One
night, in the middle of another ball dropping performance beyond belief, the
bloke running the show pulled me aside and asked if anyone had ever taught me
how to mark a footy. Before I’d even had a chance to realise that he wasn’t
taking the piss, Jacko proceeded to outline exactly what I needed to do. I
needed to be more like Johnny. <o:p></o:p></span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2ceA-E8RwyEFMjYgAO_hpdVCeFxfddExi1CFHVLitiCDU3k0Csd-luv09lqMbg276sbZBBS8wSd7cHWKqQspOMnmywONiNurQznOwGIoHbU6WC7I9kHDQzrSsQ-Gtu1KthTORPG_xu4c/s1600/Poppy+low+to+high.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="421" data-original-width="316" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2ceA-E8RwyEFMjYgAO_hpdVCeFxfddExi1CFHVLitiCDU3k0Csd-luv09lqMbg276sbZBBS8wSd7cHWKqQspOMnmywONiNurQznOwGIoHbU6WC7I9kHDQzrSsQ-Gtu1KthTORPG_xu4c/s320/Poppy+low+to+high.jpg" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Talk about "Low to High" Poppy!!</td></tr>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">When Johnny marks the ball, his hands aren’t coming up from
below the ball’s trajectory. Instead they are coming towards the ball but in
such a way as to offset the trajectory and speed of the ball so as to give his
hands as much time as possible to grasp it. Now that’s not what Jacko told me,
but it is what he meant when he said “Low to high Hamma. Low to high mate”. It
is however what an Italian neuro-physiologist found in a mind numbingly
involved article with the disarmingly simple title, “Grasping and Catching” (1). <o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Catching is a combination of predicting the velocity and
path of the object, adjusting proximal structures in such a way that grasp of
the object is possible. Experience helps which probably is one reason the
recent explosion in girls playing footy has seen a similar explosion in finger
injuries within that cohort. What also helps is visuo-spatial ability, which is
a little more difficult to train up if you haven’t been gifted with it to the
same ability as Jumping Johnny. <o:p></o:p></span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhT5bAX0wqHHWFjIDstJMnGLczbG7mO_98QqVDuCWkrUFzz9JvFWtGHOO6kJueui3V_b5f9ctPt5XhiwA76m45nF0XiFGX0GgymzlYVmqpvHenVDfCDk-6zXDGyXVOkiXnuIaygmoUgblM/s1600/Sticky+glove+helps+too.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="187" data-original-width="270" height="137" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhT5bAX0wqHHWFjIDstJMnGLczbG7mO_98QqVDuCWkrUFzz9JvFWtGHOO6kJueui3V_b5f9ctPt5XhiwA76m45nF0XiFGX0GgymzlYVmqpvHenVDfCDk-6zXDGyXVOkiXnuIaygmoUgblM/s200/Sticky+glove+helps+too.jpg" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Above: Mind you, a sticky glove helps too... right Clokey?<br />
Below: I don't need one says Roughy!</td></tr>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhyphenhyphen6fbi_eNewSDE6mh6rV3ZH_3HrLhW_WIXmxIEqa5koHWbbb53BNbM2o-a14cWvKD3DRrVkqIvBNgXVAILyYxWX1ehrXE7byCBJVHOdP70EC4azqf28FrLtnLl4LPiNYCCp9xGXfqkMA/s1600/Rough+one+handed.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="576" data-original-width="1023" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhyphenhyphen6fbi_eNewSDE6mh6rV3ZH_3HrLhW_WIXmxIEqa5koHWbbb53BNbM2o-a14cWvKD3DRrVkqIvBNgXVAILyYxWX1ehrXE7byCBJVHOdP70EC4azqf28FrLtnLl4LPiNYCCp9xGXfqkMA/s320/Rough+one+handed.jpg" style="cursor: move;" width="320" /></a><span style="font-family: "arial" , "helvetica" , sans-serif;">Whilst the article is at pains to point out differences in catching ability between professional and amateur sports people, it does indicate that a combination of training, technique and experience can make a difference. It is all about maximising the time you have getting your hand into position before it needs to grasp the ball to hang on to it which may be why an over hand catching technique proved more reliable. This technique may not be transferable to Australia’s greatest game in every instance, but the concept is, and getting your hands into position is the best way to start. </span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Look after those fingers,</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Hamish</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif; font-size: xx-small;">(1) Cesqui, B. et al. Grasping in one-handed catching in relation to performance. </span><i style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">PLoS One</i><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: xx-small;">July 2016</span></div>
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<br />Hamishhttp://www.blogger.com/profile/13296725506088769035noreply@blogger.com0tag:blogger.com,1999:blog-2194063106053473026.post-31657367603228721022017-09-05T02:51:00.000-07:002017-09-05T03:10:43.416-07:00The Stress is Killing Me<div class="MsoNormal">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjn4bV9NUnY4cxkBlGtCpr2c3MpmeyNeGWCDL2BDNNFX1JsBEtJePpoJ3QJVbJ5rVYk6Y-X59IrYcCImi909jhkFbPZffxLhs7DQF1QQxqBvRNLP_ZHpanlWDIbgZRTJf5u6Qi2c9IWynw/s1600/Hand.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="640" data-original-width="640" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjn4bV9NUnY4cxkBlGtCpr2c3MpmeyNeGWCDL2BDNNFX1JsBEtJePpoJ3QJVbJ5rVYk6Y-X59IrYcCImi909jhkFbPZffxLhs7DQF1QQxqBvRNLP_ZHpanlWDIbgZRTJf5u6Qi2c9IWynw/s320/Hand.jpg" width="320" /></a></div>
<span style="font-family: "arial" , "helvetica" , sans-serif;">A lot of trees have been sacrificed in the name of better
understanding bone stress injuries to the lower limb. Brukner and Khan’s latest
edition of Clinical Sports Medicine devotes a whole chapter to their management...
in feet. Admittedly with good reason;
they are debilitating and difficult to treat.
However, at the risk of being seen to harp again on my favourite theme
of “what about the hand”, what about the hand? If B & K don’t mention them, and do they even exist? <o:p></o:p></span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">The answer is of course yes, it’s just that they are rarer. A
Spanish paper in 2010 reported that only 12 cases of stress fractures to the
metacarpals had ever been written up. The authors of that paper then published
a case series of 7 tennis players with stress fractures of a metacarpal. All
were adolescents, and all had altered their training or some aspect of their
game prior to this injury (1). Volker Schoffl, that rock-climbing, x-gaming
hand surgeon in Germany also published a paper on bony oedema in climbers (2). Aside from that there are a few case studies, but not a lot.<o:p></o:p></span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJJdFK-VTy8CRjircxKX-RbKOptB4Bm5UvftYAtjzWyIWYFT8vorfQjVgh9toOLrPosqdlPQltunFUGxozPUV2_FcWCRQOmxH0fK9ktF7WDYi5FJXc4Emu9eY15z5ektfPn6-MRcuRwkU/s1600/Stuart+Warden.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1024" data-original-width="793" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJJdFK-VTy8CRjircxKX-RbKOptB4Bm5UvftYAtjzWyIWYFT8vorfQjVgh9toOLrPosqdlPQltunFUGxozPUV2_FcWCRQOmxH0fK9ktF7WDYi5FJXc4Emu9eY15z5ektfPn6-MRcuRwkU/s320/Stuart+Warden.jpg" width="247" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">I've got almost too much in common with this guy!</td></tr>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">So if they’re not talked about much, are we talking about
the same thing? Well, essentially yes. B & K devoted a chapter to this
subject; I’m going to try to paraphrase them in 150 words. Actually, I’m just
going to copy what Stuart Warden wrote because it’s nice and succinct… (3) <i>“A bony stress injury (BSI)represents the
inability of bone to withstand repetitive mechanical loading, which results in
structural fatigue and localised bone pain and tenderness. It occurs along a
pathology continuum beginning with a stress reaction, which can progress to a
stress fracture, and ultimately a complete bone fracture”. </i>Thank you
Stuart. Of course there is a lot more too it, and his chapter is a good read so
get into it if you want to know more. <o:p></o:p></span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNYw57qxwonC6XgDxJznM07dXHC07-98UsLpScVt9D76zOvh4sOLDD-c-XOE5PWQKjOkDyhlKB21Tk7UvyZY19A5uggmHvTlCNmsT9HH3_2Vs0uF2-JSPafwmFd9YBKcJNKnnn9Io4NjY/s1600/Metacarpal+stress+%2523.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="654" data-original-width="226" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNYw57qxwonC6XgDxJznM07dXHC07-98UsLpScVt9D76zOvh4sOLDD-c-XOE5PWQKjOkDyhlKB21Tk7UvyZY19A5uggmHvTlCNmsT9HH3_2Vs0uF2-JSPafwmFd9YBKcJNKnnn9Io4NjY/s400/Metacarpal+stress+%2523.jpg" width="137" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Should be obvious.<br />
MRI stress #. Not my patient<br />
(4)</td></tr>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">“Treatment then is what?” I hear you protocol driven fiends
out there screaming. Rest and controlled load says Stuart, among other pearls.
But let me make this a bit more personal, this is what I did...<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">·</span><span style="font-stretch: normal; line-height: normal;"><span style="font-family: "arial" , "helvetica" , sans-serif;"> </span><span style="font-family: "arial" , "helvetica" , sans-serif;">T</span></span></span><span style="font-family: "arial" , "helvetica" , sans-serif; text-indent: -18pt;">ennis player, bone pain in second metacarpal,
had come on strongly over the period of a clay court tournament but had likely
been festering for some time. Essentially the pain was so severe he could no
longer hold his racquet and hit a forehand with any force. Stress reaction
confirmed on MRI, dorsal interossei inflamed also which made anatomical sense. </span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif; text-indent: -18pt;">·<span style="font-stretch: normal; line-height: normal;"> -</span></span><span style="font-family: "arial" , "helvetica" , sans-serif; text-indent: -18pt;">Weeks one to two, rest in hand forearm orthosis
overnight, hand based radial metacarpal joint immobilisation orthosis during
the day, coming out for gentle range, modalities and very light massage only.
Pain with turning on tap.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif; text-indent: -18pt;">·<span style="font-stretch: normal; line-height: normal;"> -</span></span><span style="font-family: "arial" , "helvetica" , sans-serif; text-indent: -18pt;">Week three initiate very light isometrics to the
interossei. Shadow racquet swings with large diameter light cardboard roll – NO
PAIN. Decreased splint use, taps almost ok. Continue overnight splinting, stop
day splint.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif; text-indent: -18pt;">·<span style="font-stretch: normal; line-height: normal;"> -</span></span><span style="font-family: "arial" , "helvetica" , sans-serif; text-indent: -18pt;">Week four introduce light grip vs theraputty,
continue to build load. Roll ball on racquet head. Grip rolled up towel.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif; text-indent: -18pt;">·<span style="font-stretch: normal; line-height: normal;"> -</span></span><span style="font-family: "arial" , "helvetica" , sans-serif; text-indent: -18pt;">Week five to six, continue to build load,
isometrics well tolerated now, introduce graded hitting ie soft balls, no
forehands just yet. Progress putty density, light gym weights.</span><br />
<ul>
</ul>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">At this point, I passed him back to the tennis physios as
the interossei were now pain free to heavy loading, although forceful grip was
uncomfortable especially when hitting, and he still had pain with palpation of
the second metacarpal. However my outcome measures had all been met, and it was
felt he needed to focus on the tennis side of things.<o:p></o:p></span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgavTbwkF4ElrR2YP2X6SPwa8YjwXlQQWpAXA3Ym246rrDRDx02fhdq-HUmnnAOhSnhN2Xf8sGvZiS849ESFmYlOgFc83iNan4xQXQI6YA5EJt4mGvjiPA5i03keQ4xtG_nIVF2dbwbt9E/s1600/Roddick.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="388" data-original-width="610" height="253" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgavTbwkF4ElrR2YP2X6SPwa8YjwXlQQWpAXA3Ym246rrDRDx02fhdq-HUmnnAOhSnhN2Xf8sGvZiS849ESFmYlOgFc83iNan4xQXQI6YA5EJt4mGvjiPA5i03keQ4xtG_nIVF2dbwbt9E/s400/Roddick.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Not my patient btw. Just a funny photo.</td></tr>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">It is now 4 months since he last hit a tennis ball in anger,
but he has finally been given the green light to resume competition. That’s a
long time off for something that was initially seen as a short term reaction to
increased activity. The time frame does does however, fit published case studies (1,4). It’s also likely that this stress reaction was in fact a
fracture. I can absolutely guarantee that if any of the team involved with this
injury come across any similar injury that occurs in another tennis players
metacarpal will be taken just as seriously as if it had occurred in a
metatarsal. “What about the hand” indeed! All part of my cunning plan. <o:p></o:p></span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Look after those fingers,<o:p></o:p></span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Hamish<o:p></o:p></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></div>
<div class="MsoListParagraphCxSpFirst" style="margin-left: 36.75pt; mso-add-space: auto; mso-list: l1 level1 lfo2; text-indent: -18.75pt;">
<!--[if !supportLists]--><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: xx-small;"><span style="line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-font-size: 9.0pt; mso-bidi-theme-font: minor-latin;">(1)<span style="font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="line-height: 115%;">Balius, R. et al. Stress fractures of the
metacarpal bones in adolescent tennis players: a case series. <i>American Journal of Sports Medicine</i> 2010
38:6 pp 1215-1220<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 36.75pt; mso-add-space: auto; mso-list: l1 level1 lfo2; text-indent: -18.75pt;">
<!--[if !supportLists]--><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: xx-small;"><span style="line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-font-size: 9.0pt; mso-bidi-theme-font: minor-latin;">(2)<span style="font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="line-height: 115%;">Hochholzer, T., Schoffl, V. Overuse bone marrow
oedema of the hands in sport climbers. <i>Sport
Orthop Traumatol </i>2013 29:3 pp 219-24<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 36.75pt; mso-add-space: auto; mso-list: l1 level1 lfo2; text-indent: -18.75pt;">
<span style="font-family: "arial" , "helvetica" , sans-serif; font-size: xx-small;"><span style="line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-font-size: 9.0pt; mso-bidi-theme-font: minor-latin;">(3)<span style="font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--></span><span style="line-height: 115%;"><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: xx-small;">Warden, Stuart. “Sports Injuries:
Overuse” in Brukner, P & Khan, K. <i>Clinical
Sports Medicine</i> 5<sup>th</sup> ed. 2017</span><span style="font-size: 9pt;"><o:p></o:p></span></span><br />
<span style="line-height: 115%;"><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: xx-small;">(4) Duarte, M. Metacarpal stress fracture in an amatuer tennis player; an uncommon fracture. <i>Revista Brasilera de Orthopedia </i>June 2017.</span></span></div>
Hamishhttp://www.blogger.com/profile/13296725506088769035noreply@blogger.com2tag:blogger.com,1999:blog-2194063106053473026.post-74601505162390520702017-01-18T22:04:00.001-08:002017-01-18T22:04:52.213-08:00If a tree falls in the forest...<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiWjVO59ozXSbxujDK9-cjwvg_tFf2BQqI75IYtOEUcB5p9G4Yb4KnKgRH7m4dKEypYvermFgw3OISFdkijO0-Jrbx6s_roJpjfYfHplFDBqI9uU5Xk_o2Fi_Nbe4njBNnbYguW0iFKa9o/s1600/dennis_lillee400x300_18t6o54-18t6o5e.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiWjVO59ozXSbxujDK9-cjwvg_tFf2BQqI75IYtOEUcB5p9G4Yb4KnKgRH7m4dKEypYvermFgw3OISFdkijO0-Jrbx6s_roJpjfYfHplFDBqI9uU5Xk_o2Fi_Nbe4njBNnbYguW0iFKa9o/s400/dennis_lillee400x300_18t6o54-18t6o5e.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Nothing wrong with those fingers Dennis</td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">I have often said in this forum and in others, that injuries to the hand are often neglected by patients, especially it seems, in an athletic population. For that I think we have only ourselves as therapists to blame. In spite of best intentions, these injuries are regarded as less important and less crucial. The only real way to change this perception is through researching the impact and incidence of hand injuries within a sporting population. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiGBXbe3A4GumwZaYidyAuphfi-4fHDUY3EcXoxzOsX5Z6V5LTov27JotTet9n8jG2F9xddDLkpZhhaGGR_CGpgPBdwt2O8LMRYxCRZZZcJFAMHz46LDYvv1oK1jCJUKWsrez-tfPj82YY/s1600/cricket_injuries.gif" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiGBXbe3A4GumwZaYidyAuphfi-4fHDUY3EcXoxzOsX5Z6V5LTov27JotTet9n8jG2F9xddDLkpZhhaGGR_CGpgPBdwt2O8LMRYxCRZZZcJFAMHz46LDYvv1oK1jCJUKWsrez-tfPj82YY/s400/cricket_injuries.gif" width="247" /></a><span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">For many years, Dr John Orchard has been compiling injury reports in elite cricket. On the back of these papers, a great deal of good work has been done to address hamstring, groin and back injuries at all levels of cricket, with particular attention to fast bowlers and the development of appropriate workloads. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">In a recent publication, Dr Orchard revisits injury incidence within an elite cricket population, and updates the injury definitions. The article is well constructed, discussing at length the most common injuries and whether rule changes might make a difference. What stood out for me having been alerted to the article via Twitter by Alex Kontouris, the Australian cricket team physio, was that in spite of ranking third for incidence and fourth for most affected body part over a ten year period, wrist and hand fractures were not discussed at all.</span><span style="font-family: Arial, Helvetica, sans-serif;">(1)</span><span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"> </span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKQMgbNuQ0Yhrh_KPFCIb2QTB8BvQ8CaaZJuhQC1KyQ2EbGjzvrGPv2e5nzji99v1B11KjzYQ-30PnlGwjf35kF_Ia_i2fJ8obQZS3xcpneKTNbUic3iPdrm8gd2jUyrc7eg0_U5xCiWk/s1600/s-cricket-shots-waitrose-he-is-out-of-the-tour-8238456.png" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKQMgbNuQ0Yhrh_KPFCIb2QTB8BvQ8CaaZJuhQC1KyQ2EbGjzvrGPv2e5nzji99v1B11KjzYQ-30PnlGwjf35kF_Ia_i2fJ8obQZS3xcpneKTNbUic3iPdrm8gd2jUyrc7eg0_U5xCiWk/s400/s-cricket-shots-waitrose-he-is-out-of-the-tour-8238456.png" width="337" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Does "!" make him soft?</td></tr>
</tbody></table>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">To be fair, the article was written to address the rise in hamstring injuries in connection with the rise in Twenty20 cricket becoming a the most popular cricket format. I also accept Alex's comment that most fractures occur in situations which cannot be controlled in the manner that a soft tissue injury can be. Yet if a maintained incidence rate at an elite level is not commented on, if those injuries aren't considered worth commenting on at an elite level then the perception of laypersons become that the injuries aren't worth taking seriously even though those of us who treat elite athletes know that isn't the case. </span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiyes-Ga3F75b0JptcQyo8ryW0em9sW9Ewz0dsIEUWiLpQMzk2IDW3U8zgp9jtvmAXMcAOSWeyWzlj17oNKJ0FPhFz9VYefFPcIPBmagzV00xYVmDpnnLEw5owbz-KMQo7RCv-bUzMBZfU/s1600/Indian-Cricket-Very-Funny-Picture.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="192" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiyes-Ga3F75b0JptcQyo8ryW0em9sW9Ewz0dsIEUWiLpQMzk2IDW3U8zgp9jtvmAXMcAOSWeyWzlj17oNKJ0FPhFz9VYefFPcIPBmagzV00xYVmDpnnLEw5owbz-KMQo7RCv-bUzMBZfU/s320/Indian-Cricket-Very-Funny-Picture.jpg" width="320" /></a><span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Getting amateur sports persons to take wrist, hand and finger injuries seriously before they become chronic is an issue I face every day in my clinic. I need someone to show me how to make Dr. Orchards' research have an impact in my clinic for the everyday athlete. Any takers? </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Look after those fingers,</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Hamish</span><br />
<br />
<span style="font-family: Arial, Helvetica, sans-serif;">Refs: (1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5167453/</span>Hamishhttp://www.blogger.com/profile/13296725506088769035noreply@blogger.com2tag:blogger.com,1999:blog-2194063106053473026.post-29971370170717458782016-12-22T00:05:00.001-08:002016-12-22T00:05:07.234-08:00Surf safe<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuT0n0CNOFuzXen8NIsfJ1n-xJFl1LqzYuAVatx8e0NmYfxjSuCLCp-QnDNHFQ7N39emgnYN3QX2xmHA9j5Yd5WhjTIrfIozdNuIcAZwaxW7e900rfFbR7tUbVUPd4A4AqwkoKM4gbZlo/s1600/Surf+wrist2.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuT0n0CNOFuzXen8NIsfJ1n-xJFl1LqzYuAVatx8e0NmYfxjSuCLCp-QnDNHFQ7N39emgnYN3QX2xmHA9j5Yd5WhjTIrfIozdNuIcAZwaxW7e900rfFbR7tUbVUPd4A4AqwkoKM4gbZlo/s320/Surf+wrist2.jpg" width="184" /></a><span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">I certainly haven’t been all over social media this year in
the way in which allied health marketing guru Amy Geach of @MaidaLearning tells me I should.
However, all good things take time and given that we are perilously close to
the end of the year, I thought I’d have a final crack at spreading the word
about the rehab of wrists and sport. Specifically a sport close to my heart,
surfing. <o:p></o:p></span></div>
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<tr><td style="text-align: center;"><br /><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgyFHnGzgCzrcC6F3bCvVsNtDDc5m8Ujf-UDYro9Tp9iA2uSFRAe2t-4w3EahWpgd8BLk3w_zmK8cm1PimZ7s3fIQNoFBbmaPmRFW2i0wuGHYKTVQ7Rf3E_OrfqZT_XQS1h7NoP_V10Xpg/s1600/Surf+wrist.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgyFHnGzgCzrcC6F3bCvVsNtDDc5m8Ujf-UDYro9Tp9iA2uSFRAe2t-4w3EahWpgd8BLk3w_zmK8cm1PimZ7s3fIQNoFBbmaPmRFW2i0wuGHYKTVQ7Rf3E_OrfqZT_XQS1h7NoP_V10Xpg/s320/Surf+wrist.jpg" width="315" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Gnarly tatt dude</td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">A therapist wrote to me this week about a patient of hers
with a wrist injury who wanted to go back to surfing. In short, she didn’t know
whether he could do so safely and without significant risk to his wrist. I
suggested she try and replicate what he needed to do in the water in the
clinic. “But I don’t surf” said she. “That’s ok”, said I, “...he should know,
and if he doesn’t, he doesn’t really surf!” </span></div>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><o:p></o:p></span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwywKBXl0sxUwvA6u-o3I6d6P0Pb6fI6GW2xSU2WI-fEUg_K9zcaQ6KId5FUdwbHKc5ZbEauojw_TvgmEHaqEADHykLliXge8e5SqxIizUeiGccFFd60hdVDc0hYlghl4EXKfcgUnFOFY/s1600/Surf+wrist1.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwywKBXl0sxUwvA6u-o3I6d6P0Pb6fI6GW2xSU2WI-fEUg_K9zcaQ6KId5FUdwbHKc5ZbEauojw_TvgmEHaqEADHykLliXge8e5SqxIizUeiGccFFd60hdVDc0hYlghl4EXKfcgUnFOFY/s320/Surf+wrist1.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">If he can do it...</td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">My comment wasn’t supposed to be as flippant as it sounded.
Instead what I meant was that if you have a patient who needs to do something
with their hand that you are unfamiliar with, be that work or sport, ask them
to show you. Put them in the splint or the tape that you think is best suited
to protect the injury. Then have them teach you how to hold a golf club, or
show you what the western grip of a tennis racquet looks like, or have them demonstrate
popping up from a surfboard by lying down on the floor in your clinic with
their hand gripping the sides of a 5cm thick text book. It won’t be the same as
going out for a paddle with them, but it will be as close as you can get.<o:p></o:p></span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgWiMERjeFJkO3f0ZH7iv7H6b15I-pmRZV1-MrbL5VzYcy6P4AMcOhJiJxhY-bGmiVcIDkKUeQWf8t1QahI3wepX2ScdY42puse-Mta_8lIR-KxkY3W8PJTwQ9bZg-dzIF46U_af2ByNFQ/s1600/Surf+wrist3.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="248" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgWiMERjeFJkO3f0ZH7iv7H6b15I-pmRZV1-MrbL5VzYcy6P4AMcOhJiJxhY-bGmiVcIDkKUeQWf8t1QahI3wepX2ScdY42puse-Mta_8lIR-KxkY3W8PJTwQ9bZg-dzIF46U_af2ByNFQ/s400/Surf+wrist3.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Santa drops in</td></tr>
</tbody></table>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">If the patient is educated in the precautions of their
injury, and can gain an expectation of what they might feel during a particular
activity, then they will truly be in a position to control their condition
without you sitting on their shoulder. <o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">All the best for 2017 everyone. My New Years resolution is
to get amongst it (and to surf at least once a week!) <o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Look after those fingers,<o:p></o:p></span></div>
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<span style="line-height: 115%;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Hamish</span></span>Hamishhttp://www.blogger.com/profile/13296725506088769035noreply@blogger.com0tag:blogger.com,1999:blog-2194063106053473026.post-74237370556689554562016-07-13T19:43:00.000-07:002016-07-13T19:43:18.449-07:00Travis is a Cheater!<div class="MsoNormal">
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhuXY4H36-hzB4MfNZyVLWKZLJRwOuUOWlHG_86L1W23_axMidmxdRtGaK4fEfdn035A64BQKkwUYELRwAqEDcFWKEM3ePQczr3XkYw0pg_tckNBkuhUX8yVMmWAbHAYrroErTblFH2s1Y/s1600/Glove+campbell.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="270" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhuXY4H36-hzB4MfNZyVLWKZLJRwOuUOWlHG_86L1W23_axMidmxdRtGaK4fEfdn035A64BQKkwUYELRwAqEDcFWKEM3ePQczr3XkYw0pg_tckNBkuhUX8yVMmWAbHAYrroErTblFH2s1Y/s400/Glove+campbell.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Couldn't find a photo in school uniform. Think his gloves were sold at Target!</td></tr>
</tbody></table>
<span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;">Travis Cloke, a key forward at the Collingwood Football Club
was fined yesterday for wearing a glove on his left hand. The wearing of a
glove is not a new thing; not for Travis, not for patients of mine, not even
for a fat bloke I went to school with called Tony Campbell (he played for Melbourne and Footscray back in
the day and would have no idea who I am!). The problem with Travis is that he
wore a glove that is prohibited for use in AFL football. The bigger issue I
think is that there is no way that Travis or the staff at Collingwood could not
have known that that glove was on the unapproved list. <o:p></o:p></span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFiTEFXBfM7kQo8oLn7iwQ3fEZk5hgYIWq-TiTv51KYZy34J_Z_MPx1pIzFHknyMbNPcYputgCZhDNJVynWIop-kmg9mT_TxEURT8uW9I8HWJnVSQC7a3AgvzwGpgkhecaukaO4eFYpBw/s1600/Glove+Cloke.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="313" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFiTEFXBfM7kQo8oLn7iwQ3fEZk5hgYIWq-TiTv51KYZy34J_Z_MPx1pIzFHknyMbNPcYputgCZhDNJVynWIop-kmg9mT_TxEURT8uW9I8HWJnVSQC7a3AgvzwGpgkhecaukaO4eFYpBw/s400/Glove+Cloke.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Palm completely covered by silicone coating</td></tr>
</tbody></table>
<span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;">Travis’ glove is made by Nike, and has a full silicone
covered palm. It is incredibly sticky, and there is no doubt in my mind that it
would have given him an advantage in the game last weekend. The reason this
glove was not used more often by others, apart from the fact that it was banned
two years ago is that the stickiness hampers ball drop, i.e. release of the
ball when kicking. This is why gloves are usually removed when players kick for
goal. <o:p></o:p></span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj0pEROomsxicM1hFs157U1d-qCnsb8uJRz_bETArdZ6RdTXuvJ0Pxw2LE0mVyY8GYLMsvs9H5Uxd2nTn9m5IJguG1KScLo1WpzNhf8fP0k3vw_YKaFjD_3JwT3HL-2WUW3xgaIxyEo4Oc/s1600/Glove+NFL+2.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="250" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj0pEROomsxicM1hFs157U1d-qCnsb8uJRz_bETArdZ6RdTXuvJ0Pxw2LE0mVyY8GYLMsvs9H5Uxd2nTn9m5IJguG1KScLo1WpzNhf8fP0k3vw_YKaFjD_3JwT3HL-2WUW3xgaIxyEo4Oc/s400/Glove+NFL+2.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Suction caps for hands</td></tr>
</tbody></table>
<span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;">There is a readily available list of the approved gloves put
out by the AFL to all clubs. I’m happy to forward this list on to Collingwood
and I’ve already shown it to players from the Eastern Football League. The
problem with the list is that the best glove, the Franklin with its’ pseudo
suede palm, is no longer easily found. Gloves are not commonly used in
Australian sport, although they are in America where there does not appear to
be such a hang up about equipment designed to give players an advantage, or
even a modicum of protection. That being said, the NFL is investigating whether the tackiness of a glove needs to be regulated. <o:p></o:p></span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigbBnHohZ_Cp34_FwIuMyPO7oCzhyphenhyphen4UbK4cAApfua8JRoYVycR03_UbAQ-zx4ZcvANCjxi8SnjGAl87GjcUFqqLh0tNtLqkQSlG-oq_iuqdADENWWKI_EhS3wA4_OW54hzonCGqE83X4Y/s1600/Sharks.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigbBnHohZ_Cp34_FwIuMyPO7oCzhyphenhyphen4UbK4cAApfua8JRoYVycR03_UbAQ-zx4ZcvANCjxi8SnjGAl87GjcUFqqLh0tNtLqkQSlG-oq_iuqdADENWWKI_EhS3wA4_OW54hzonCGqE83X4Y/s1600/Sharks.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Go Sharks!</td></tr>
</tbody></table>
<span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;">The rules governing what can be worn at
a professional level and what can be worn at an amateur level are often very
different and variable. There is no way that my son could have taken the field
for the Camberwell Sharks under 13’s with Travis’ glove. I tell all my patients
to make sure that any protective splint or guard I supply is compliant with the
rules of their sports’ governing body or risk being told they can’t play. <o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;">Gloves are usually worn for protection of a finger or hand
injury, to more easily permit adherence of a thermoplastic guard, or to
compensate for a loss of strength due to pain. On this last point, it is
unlikely they help, with grip and pinch strength shown to significantly
deteriorate once gloves are donned (Rock, 2001). </span><br />
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHSj9fdChv4Va5e7Jfl3Sao-2-5Xa13_3RK_KAActTuVSytnhdWjpUTbJdsKEZx0Vdg2p0SM6NYs5rhhxQh_gT9HIRk885apeliPBS2ND19-PWEbiEWxu8zEO2wbW__L-bu82UaxA5rAY/s1600/Glove+gilbert.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHSj9fdChv4Va5e7Jfl3Sao-2-5Xa13_3RK_KAActTuVSytnhdWjpUTbJdsKEZx0Vdg2p0SM6NYs5rhhxQh_gT9HIRk885apeliPBS2ND19-PWEbiEWxu8zEO2wbW__L-bu82UaxA5rAY/s320/Glove+gilbert.jpg" width="231" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Gilbert make a range of gloves for rugby, <br />some are AFL approved.</td></tr>
</tbody></table>
<span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;">Another researcher with too
much time, Dr Lewis at the University of Sheffield, has determined that
different glove surfaces are appropriate for different weathers, with the
spacing of “pimples” on the palm of the glove dramatically altering ball
handling errors in Rugby 7’s players by enhancing the friction between palm and
ball essential for grip. He predicts a time when gloves and balls will be designed
in such a way that they can “interlock”! Say it isn’t so. <o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;">And that is the point isn’t it? Friction. Travis didn’t need
to enhance his grip strength. He may have a chronically sore finger, but that
could have easily been protected by a legal glove. Instead, Travis Cloke and
the Collingwood Football Club knowingly chose to use a glove that was banned in
2013 not for marketing issues as club president Eddie McGuire claimed, but banned
because its’ full silicone palm was too sticky and provided too much of an
advantage. </span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtd2NQ0-AqEZZ_VyZSFY7XTc2T0eyLJJnOPzM2Vye08MJQ4fY0mYG1m-0QS7fiwRSOQsfYbaY3flfwvH5VyJoxTfxIoFMxXYTMMTTMfN6G0xqbfrsXl96i3VUfJM8GcNBtFkA8GDr3BeY/s1600/Glove+Riewoldt.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtd2NQ0-AqEZZ_VyZSFY7XTc2T0eyLJJnOPzM2Vye08MJQ4fY0mYG1m-0QS7fiwRSOQsfYbaY3flfwvH5VyJoxTfxIoFMxXYTMMTTMfN6G0xqbfrsXl96i3VUfJM8GcNBtFkA8GDr3BeY/s320/Glove+Riewoldt.jpg" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><div class="MsoNormal" style="background: #F5F8FA; line-height: 13.5pt; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="color: #292f33; font-family: "Arial","sans-serif"; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;"><a href="https://twitter.com/JackRiewoldt08"><b><span style="color: #292f33; text-decoration: none; text-underline: none;">JR8</span></b><span style="color: #8899a6; text-decoration: none; text-underline: none;"> </span><span style="color: #b1bbc3; font-size: 10.0pt; text-decoration: none; text-underline: none;">@</span><span style="color: #8899a6; font-size: 10.0pt; text-decoration: none; text-underline: none;">JackRiewoldt08</span><span style="color: #8899a6; text-decoration: none; text-underline: none;"> </span></a></span><span style="color: #8899a6; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;"> <a href="https://twitter.com/JackRiewoldt08/status/294017638701600770" title="1:44 AM - 23 Jan 2013"><span style="color: #8899a6; text-decoration: none; text-underline: none;">23 Jan 2013</span></a></span><span style="color: #292f33; font-family: "Arial","sans-serif"; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;"><o:p></o:p></span></div>
<div class="MsoNormal" style="background: #F5F8FA; line-height: 13.5pt; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span lang="EN" style="color: #292f33; font-family: "Arial","sans-serif"; font-size: 10.5pt; mso-ansi-language: EN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;">Hey <a href="https://twitter.com/AFL"><span style="color: #0084b4; text-decoration: none; text-underline: none;">@AFL</span></a> I know you guys banned some gloves today,
I was just checking that mine was still ok? Cheers Jack<o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;">That advantage allowed him to kick four goals in a game his team was
expected to lose. That advantage allowed him to have his best game for the year
in a season where he hasn’t been able to get a kick in the magoos. That
advantage was illegal, he knew that, and that’s why Travis Cloke and the
Collingwood Football Club are cheats. </span><o:p></o:p><br />
<span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;">Look after those fingers,</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;">Hamish</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif; font-size: xx-small;">Refs:</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif; font-size: xx-small;">The effects of gloves on grip strength and three-point pinch Rock, Kim M;Mikat, Richard P;Foster, Carl Journal of Hand Therapy; Oct-Dec 2001; 14, 4; Health & Medical Collection pg. 286</span></div>
Hamishhttp://www.blogger.com/profile/13296725506088769035noreply@blogger.com2tag:blogger.com,1999:blog-2194063106053473026.post-61766755614371364502016-02-19T20:42:00.001-08:002016-02-19T20:42:42.645-08:00Laura and me and a ganglion called Gloria<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrKk7_JfQrfhw2lqOR3rZb9j4YgBEj5matPvKlXm7fqe0-wWB3y8LUKSOCYsEA-yc3Zn2haSFzefKLg6FGGbKVQEgQlHbGt2JgQhfuMdvjXrlYRAWa6JeJVZ4WA9KVTZZRrIeAXDPTVec/s1600/Laura_Branigan_-_Gloria.png" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrKk7_JfQrfhw2lqOR3rZb9j4YgBEj5matPvKlXm7fqe0-wWB3y8LUKSOCYsEA-yc3Zn2haSFzefKLg6FGGbKVQEgQlHbGt2JgQhfuMdvjXrlYRAWa6JeJVZ4WA9KVTZZRrIeAXDPTVec/s400/Laura_Branigan_-_Gloria.png" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">No wonder Ed Holdaway still loves her.</td></tr>
</tbody></table>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">As Laura Branigan and I glided into the MRI chamber, her
almost tuneful “Gloria” screeching through my headphones, I’d have to say I
felt abnormally calm. Two days earlier, after pushing a trailer up a grassed
hill, my right little finger had gone completely numb. Distal branch of the ulnar
nerve I thought. No muscle weakness, motor branch ok, definitely a transient
compression. Five hours later, once beer, pizza and the cold waters off the
Portsea pier hadn’t worked any magic I was aware that I was going to need help. <o:p></o:p></span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjMLVbTy9s12RAeU44I5GUkfU11DJ6aJ44l_wSwWx6bvedfqfBED0K4LTYm94FOmzQrAijFwtUwaI0KkSEdeU1GyDtDwV2LuVJ3XIQsR_UB8UkCwfhC3nro0ifozZTgbJ35Hro9XXxo9ZU/s1600/IMG_4470.JPG" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjMLVbTy9s12RAeU44I5GUkfU11DJ6aJ44l_wSwWx6bvedfqfBED0K4LTYm94FOmzQrAijFwtUwaI0KkSEdeU1GyDtDwV2LuVJ3XIQsR_UB8UkCwfhC3nro0ifozZTgbJ35Hro9XXxo9ZU/s400/IMG_4470.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Artery and nerve, motor branch at bottom of "V"</td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Greg Hoy organised an ultrasound and a cortisone injection.
The radiologist took a look at the screen, then said he wouldn’t inject. That
evening, contrary to doctors’ orders, I played footy and kicked two goals. The
next morning, considering my fate with Laura’s unavoidable counsel running
through me, I resigned myself to the knife. It was certainly a case of both
what and who you know, and I was booked for surgery the next morning. <o:p></o:p></span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiQLWLtNHf1vlCH_m3WxwSpOOWnRzFu2KVrqFx0949Y0I9c8kYGU-e7P9v-cU1q3k8YlNP3B1MMpaqj4R-TQBNUXxBB8E-fDQWj3GXYQzyDskS54TLrvTOukxzJG15rrCaS5rOUA0jH9S4/s1600/IMG_4471.JPG" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiQLWLtNHf1vlCH_m3WxwSpOOWnRzFu2KVrqFx0949Y0I9c8kYGU-e7P9v-cU1q3k8YlNP3B1MMpaqj4R-TQBNUXxBB8E-fDQWj3GXYQzyDskS54TLrvTOukxzJG15rrCaS5rOUA0jH9S4/s400/IMG_4471.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fragments</td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Greg greeted me into the operating theatre with his iPhone
and a request to “Smile”. I think I called him a bastard in response, which is
probably not the best decision I’ve ever made! I woke about two hours later,
hand numb, but fingers all moving. Greg had removed a sizeable ganglion that
had swum distally from my piso-triquetral joint and pronounced all was well. Mary,
the best receptionist a physio practice could ever ask for, came across the
road to collect me a little earlier than Elizabeth my nurse would have liked.
Mary had coffee and a lamington with her, Elizabeths’ argument didn’t stand a
chance. <o:p></o:p></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrIFy6je5WXetI56l-00VGZXj7HwKtp2AjP7bdbBIxxQKUySyA3n1kNA6mpM6NSht5Fs9UJurtsTqPElD2KcFJ5Kwl7G7U2xOOoNQwZVXb4UNS7IQt5krDrb5czz-8Nq4rVLjqvhQgGJs/s1600/Concrte+chocolate.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrIFy6je5WXetI56l-00VGZXj7HwKtp2AjP7bdbBIxxQKUySyA3n1kNA6mpM6NSht5Fs9UJurtsTqPElD2KcFJ5Kwl7G7U2xOOoNQwZVXb4UNS7IQt5krDrb5czz-8Nq4rVLjqvhQgGJs/s400/Concrte+chocolate.jpg" width="400" /></a><span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">One patient to see, I drove home afterwards. Don’t remember much
of that. I was worried, because I was talking at an upper limb sports symposium
that had been organised by Ben Cunningham. My preparation had been affected
significantly by the preceding events, and my concerns were met by Ben with the
ever helpful, yet predictable, “Harden up Hamma”! <o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">I think the talks went well. Again, I really don’t know.
Codeine has a fabulous way of making the world seem so much better than it actually
is. I do know I had a great steak and a couple of beers with Vanessa from
Sydney, Damien from Brisbane, and Stewart from Perth at the days’ end.<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">It’s Saturday now, and to be truthful, I finally feel like
crap. The scar is minimal, the sensation slowly returning, but there’s a
nagging ache, and pain if I lift or stretch too far. I know that this will
pass, and that I shouldn’t play footy this week. I do wish it hadn’t been
necessary because now I’m asking myself questions.<o:p></o:p></span></div>
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<div class="separator" style="clear: both; text-align: center;">
</div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiHHxX-KF5_A6RpOBPybjH2ISL25RGoC0pAX50U3T7hxpa5WpkJBAWdr4-8hvAPDcJaIE20uJuLJnegSwBaImyugBm15ME_cqNAsdT6QhlpINxMWbPgB484xyqPjmwsZOmrEyKWhlGCGpM/s1600/david_hasselhoff_laura_branigan-i_believe_s.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="337" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiHHxX-KF5_A6RpOBPybjH2ISL25RGoC0pAX50U3T7hxpa5WpkJBAWdr4-8hvAPDcJaIE20uJuLJnegSwBaImyugBm15ME_cqNAsdT6QhlpINxMWbPgB484xyqPjmwsZOmrEyKWhlGCGpM/s400/david_hasselhoff_laura_branigan-i_believe_s.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Something else to smile about</td></tr>
</tbody></table>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Is this what is referred to as empathy? Do I need to be more empathetic? Is it someones’ way of ensuring that I truly understand and can sympathise with my patients? Did I need to go through this relatively smooth process in order to comprehend what they feel? I think the short answer is no. The slightly longer answer is of course not you self-indulgent wind bag. Suck it up, harden up, and call “Gloriaaaaaaaaaaaaaaa”. That always makes you smile. </span><br />
<span style="line-height: 115%;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span></span>
<span style="line-height: 115%;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Look after those fingers,</span></span><br />
<span style="line-height: 115%;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span></span>
<span style="line-height: 115%;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Hamish</span></span>Hamishhttp://www.blogger.com/profile/13296725506088769035noreply@blogger.com0tag:blogger.com,1999:blog-2194063106053473026.post-67733748885630271102016-01-29T18:17:00.000-08:002016-01-29T18:17:32.282-08:00It was supposed to be a month off...<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwUsRfdUkpMGLykWCA-aXXW5u5Ez9cmPPT1qCLc8Pj99nGIkjrTX7r_uEB0Nt3RIMSoVvhhAJv_w2EJBDBshqF_-2aY2929emYv5Pj86jtyZfKnoQNax6pbNt7kmB_jnyr_OSNcjXFydw/s1600/Beaches-Surf-South-Sri-Lanka-SK-Town-300x300.gif" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwUsRfdUkpMGLykWCA-aXXW5u5Ez9cmPPT1qCLc8Pj99nGIkjrTX7r_uEB0Nt3RIMSoVvhhAJv_w2EJBDBshqF_-2aY2929emYv5Pj86jtyZfKnoQNax6pbNt7kmB_jnyr_OSNcjXFydw/s400/Beaches-Surf-South-Sri-Lanka-SK-Town-300x300.gif" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Now that's a holiday</td></tr>
</tbody></table>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Three weeks of travelling through Sri Lanka’s highlands and
jungles, before a week of surfing. Ten days before I left, my conscience got
the better of me. Kathy Minchin had done a lot of volunteer work in Sri Lanka
with Interplast, and was good enough to give me a contact. I emailed </span><span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"> </span><span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Asha, the senior OT at the National Hospital
in Colombo, and she asked if I wouldn’t mind doing a couple of hours work on
splinting with some students. Perfect I thought, two hours and I’ve done my bit
for the world. Asha however, had different plans. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj1Hc9dFMXL-opa1hz3LsEfVEyiCHh20XfAzXMdZNrkcQprfBT3FUQxepsuW7gMHslX0i9XfoDnOkDGl8XD-9tOV7KFWq5YmSGkemSAjPLmDWgZIsnE1_2tuZV4BRm0HU1QxZ07Mogzdfs/s1600/750px-Brachial_plexus_2.svg.png" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj1Hc9dFMXL-opa1hz3LsEfVEyiCHh20XfAzXMdZNrkcQprfBT3FUQxepsuW7gMHslX0i9XfoDnOkDGl8XD-9tOV7KFWq5YmSGkemSAjPLmDWgZIsnE1_2tuZV4BRm0HU1QxZ07Mogzdfs/s400/750px-Brachial_plexus_2.svg.png" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">In case you need a recap</td></tr>
</tbody></table>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">I prepared a basic talk about playing with plastic before I
left, and loaded a couple of other things onto a USB stick. On arrival in Sri
Lanka I received an email from Asha detailing the two days I would be spending
at the hospital talking to surgeons, treating patients, lecturing to the Sri
Lankan OT association, as well as those poor students. I would be talking
extensively on shoulders, brachial plexus injuries and tendon transfers. Now, I
can crap on with the best of them at any time about any number of issues
related to the upper extremity, but brachial plexus injury? I was up the
proverbial creek without the paddle in the barbed wire canoe. <o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">After a bit of negotiation, I was back on more comfortable
ground. Sports and fractures, wrists and PIP joints. We scheduled it in for the
last week of my trip, and I bundled my family onto a third class train carriage
heading north and away from the city. I couldn’t escape Asha’s enthusiastic
tentacles however. Within a week another day of talking had been added on, this
time with the physios for the Sri Lankan cricket team. Some preparation needed
to be done.<o:p></o:p></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEifxxUc0cr0IJH4iKMxTZIRGGRzrs0yX4reVMmG88snecWVVaYPNMOffYtH8Gw_Zo6AEwUhWXiSX75oYnooe_OBteci6Nv2P4-IAdHwF5nEbzoQ_w9X3RAQwOD4IH3TR9RYIJrILOIkKs0/s1600/barbed-wire-canoe.gif" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="242" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEifxxUc0cr0IJH4iKMxTZIRGGRzrs0yX4reVMmG88snecWVVaYPNMOffYtH8Gw_Zo6AEwUhWXiSX75oYnooe_OBteci6Nv2P4-IAdHwF5nEbzoQ_w9X3RAQwOD4IH3TR9RYIJrILOIkKs0/s400/barbed-wire-canoe.gif" width="400" /></a><span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Borrowing a laptop from the 16 year old son of a woman we
were staying with, I beefed up my talks and created a plan. Unfortunately, that
laptop was infected with a virus, and the presentations couldn’t be opened. Ben
Cunningham, Greg Hoy, and Sarah from the AHTA came to my rescue, uploading a
variety of stuff onto Dropbox. My family left me for the rainforest, I put on
my cleanest, most un-crinkled shirt, and headed off to work. <o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Anyone I’ve ever talked to or heard talk about volunteering
always emphasise how intense it is. I was assaulted (in a great way) from every
angle by therapists who were desperate to learn more, patients desperate to get
better, and doctors desperate to have their therapists help them achieve the
results they expected. The hand therapy room in Colombo was crowded, with
patients and families lined along the corridor outside waiting hours for their
turn. I talked and talked and talked. I’m certain the students understood
nothing in spite of their protestations, however the questions I received from
the OT’s were insightful and challenging.<o:p></o:p></span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj93ncfdmeGtZKCbdfIGu94SwnbRq-H-gtSuVGovGmqBSKf6U9nmtnpJS0cXmBlmqrkknf9phPNcJWLB_j7vWNVwwg3fgIr9xrSJCsXtj7L66pVE81H6gm3XyRCEQ5-KNeCzFky1cc7jUo/s1600/Sl+Cricket+physios.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj93ncfdmeGtZKCbdfIGu94SwnbRq-H-gtSuVGovGmqBSKf6U9nmtnpJS0cXmBlmqrkknf9phPNcJWLB_j7vWNVwwg3fgIr9xrSJCsXtj7L66pVE81H6gm3XyRCEQ5-KNeCzFky1cc7jUo/s400/Sl+Cricket+physios.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Hamish Highpants and the Sri Lankan cricket team physios</td></tr>
</tbody></table>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">The cricket physios were also demanding. We discussed the
usual suspects, then spent a lot of time problem solving how best to deal with
metacarpal head bruising and finger web splits. I didn’t have a definitive
answer, but as they say in the classics, before you find a solution you must
understand what the problem actually is. I talked a lot about the role of the
intrinsic muscles in the hand, as well as encouraging proprioceptive training. <o:p></o:p></span></div>
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<br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">The impression I ultimately left Sri Lanka with was guilt.
There was so much more I could have done if I’d been better prepared, if I’d
had the inclination to offer help earlier than I did. I don’t believe I wasted
anyone’s time, and I know I was able to pass on some of my knowledge, but I
also know I could have done it more effectively. Volunteering in countries with
developing hand therapists should not be done lightly or in the manner I
initially approached it, because to do that creates a real risk of devaluing
the intensity of the teaching that is required. Having said that, if you are an
expert in some area, your time would be welcomed. All you need is the
understanding that two hours will become more, which in turn, will make it
worth so much more to you, and those you are helping. </span><o:p></o:p></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Look after those fingers,</span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Hamish</span></div>
Hamishhttp://www.blogger.com/profile/13296725506088769035noreply@blogger.com1tag:blogger.com,1999:blog-2194063106053473026.post-55283130572037654302015-12-21T22:29:00.001-08:002015-12-21T22:29:50.493-08:00Oh really?<span style="font-family: Arial, Helvetica, sans-serif;">I know it's close to Christmas, it's the silly season, but this brilliant observation has capped off a year for me during which I have dealt with more "if he can run he can play" idiocy than I've ever seen before. </span><span style="font-family: Arial, Helvetica, sans-serif;">J.J Watt broke his thumb, but resumed playing NFL for the Texans within a week.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">The news feed I saw after the game against the Patriots quoted a Patriots staffer below.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<br />
<div style="background-color: white; color: #111111; line-height: 22.4px; margin-bottom: 13px;">
<span style="font-family: Arial, Helvetica, sans-serif;">"He really only had one hand," as one Pats staffer put it. "He couldn't really pull or tug and that's where he gains his advantage. He couldn't really get his arm over for that move. He was very limited. No doubt about it. He couldn't really use that hand."</span></div>
<div style="background-color: white; color: #111111; line-height: 22.4px; margin-bottom: 13px;">
<span style="font-family: Arial, Helvetica, sans-serif;">You think? Have a look at the photo! Seriously fellas, there must have been someone else on that roster who could have done a better job. Oh, and if the Patriots need a new staffer to hand out observations of gold, then I'm pretty sure Mr Magoo hasn't had a gig in a while.</span></div>
<div style="background-color: white; color: #111111; line-height: 22.4px; margin-bottom: 13px;">
<img alt="J.J. Watt's injury has severely limited his game-changing ability. (USATSI)" src="http://sports.cbsimg.net/images/visual/whatshot/640Watt121915.jpg" /></div>
<div style="background-color: white; color: #111111; line-height: 22.4px; margin-bottom: 13px;">
<span style="font-family: Arial, Helvetica, sans-serif;">Look after those fingers,</span></div>
<div style="background-color: white; color: #111111; line-height: 22.4px; margin-bottom: 13px;">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div style="background-color: white; color: #111111; line-height: 22.4px; margin-bottom: 13px;">
<span style="font-family: Arial, Helvetica, sans-serif;">Hamish</span></div>
Hamishhttp://www.blogger.com/profile/13296725506088769035noreply@blogger.com1tag:blogger.com,1999:blog-2194063106053473026.post-63568165927880564602015-10-18T19:11:00.001-07:002015-10-18T19:21:49.088-07:00If you can run, you can play.<div style="margin-bottom: .0001pt; margin: 0cm;">
<span style="font-family: Arial, Helvetica, sans-serif;">Below is an edited and adapted extract of the talk I gave this weekend on sporting injuries to the wrist and hand as an invited speaker at the Australian Hand Therapy Associations national conference in Perth.</span></div>
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRi2KHLfiomm9xKsbECaXIbgvJUPQvjg6SnxXJBlIgZIaoDI1eYF5K_ToNZu9W0ocuY5QgLHKHjH8uvO0T9LhQtfYdkA85hDekCTfiIntYRWvd_35a2BYRC1mKY5ICHGrfaihPwNGd2eY/s1600/Hawks+2015.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="288" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRi2KHLfiomm9xKsbECaXIbgvJUPQvjg6SnxXJBlIgZIaoDI1eYF5K_ToNZu9W0ocuY5QgLHKHjH8uvO0T9LhQtfYdkA85hDekCTfiIntYRWvd_35a2BYRC1mKY5ICHGrfaihPwNGd2eY/s400/Hawks+2015.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">If you can't be a champion, find a way to hang out with a champion team!</td></tr>
</tbody></table>
<span style="font-family: Arial, Helvetica, sans-serif;">...Today I’ll be discussing hand &
wrist injury in sports. However, I’m not going to talk about specific sports
and specific injuries or statistically which sport is the worst for hand
injury, because I don’t believe that is important or different enough to be
practice changing. I will however, talk about how these injuries are reported,
and what I believe needs to change with regard to that. My principle theme, one
which I will be referring back to incessantly over the next half an hour, is
that currently, our role as hand therapists and hand injury experts with
regards to the sporting population is undervalued because the injuries
themselves are undervalued.</span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
</div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<span style="font-family: Arial, Helvetica, sans-serif;">Whilst there is certainly potential
for increased hand therapy intervention in sports, what is more likely to
happen in the short term, is that there will be a better approach to hand
injury from the generalist sports physios. The problem with this is that any
monkey, even Ferno, can make a thumb guard, but not everyone can rehabilitate a
chronic UCL injury as well as you in this room can (well, the full members that
is). If we are to have more of a role in sports injury management we need to be
better able to define and demonstrate our expertise. <o:p></o:p></span></div>
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<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<span style="font-family: Arial, Helvetica, sans-serif;">I doubt anyone in this room would
dispute the impact sports participation has on their work.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">3 – 15% emergency presentations for upper extremity
injuries are sports related. 25% of sports injuries are to hand
/ wrist. These statistics vary according to sport and population, with combat,
motor and contact sports being the usual suspects, but the public perception of
the severity and potential impact of sporting injuries to the hand is limited.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmbvSGGx0Nm9VgIN15HBhxKvtNGGVxclb_u9SxRv04Pkg-zURo5ZdxsxdPLnyC9NCcmVbbKnmjh7GDXkRAcBntCsWFuDqtScKLHsLUqt6YP9s8SNNbJ3rBZeVekyT1e7C-Mq3TWEnNlsQ/s1600/Pearson+holding+wrist.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="245" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmbvSGGx0Nm9VgIN15HBhxKvtNGGVxclb_u9SxRv04Pkg-zURo5ZdxsxdPLnyC9NCcmVbbKnmjh7GDXkRAcBntCsWFuDqtScKLHsLUqt6YP9s8SNNbJ3rBZeVekyT1e7C-Mq3TWEnNlsQ/s400/Pearson+holding+wrist.jpg" width="400" /></a><span style="font-family: Arial, Helvetica, sans-serif;">For if 25% is an accurate
figure, then why don’t we see more? What the sport is or how the injury
happened, is not the issue. The issue is in how these injuries are perceived. There's been nothing in the press or online that I could find re Sally Pearson’s horrific wrist injury since July, until
two days ago when I read an article that said she was having difficulty moving
her wrist, and that her thumb had only just regained some strength. </span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<span style="font-family: Arial, Helvetica, sans-serif;">Although
she historically is known for keeping a tight rein on her image, the lack of
information about such a severe injury is deafening and I think a lot of that
comes from the belief that it is not an injury that will affect her because
she’s a runner. But her sprint starts are from a crouched all fours position,
and she gets drive over the hurdles with her arms. Her wrist injury will affect
how she trains and prepares both on the track and in the gym. The impact of her
injury on her preparation for the Olympics in Rio next year will only become
known if she fails to medal. My hope, is that when she does medal, that she
publicly acknowledges the work her hand therapist, not her physio, has had to
do to get her back. <o:p></o:p></span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwjyYF_BL79w0TFSty3fyAmnQdfp2YFj7YZCS66nFHSU4YofCJZvZkUqOsYJtYWETs28W47i8iypCu7Sbv_glDhK0oaUi8cmi43ogMwZdcPmPz8YcvyQNuTovE9yAR3JDuIocKnAJn09c/s1600/Three+fingered+AFL.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwjyYF_BL79w0TFSty3fyAmnQdfp2YFj7YZCS66nFHSU4YofCJZvZkUqOsYJtYWETs28W47i8iypCu7Sbv_glDhK0oaUi8cmi43ogMwZdcPmPz8YcvyQNuTovE9yAR3JDuIocKnAJn09c/s400/Three+fingered+AFL.jpg" width="260" /></a><span style="font-family: Arial, Helvetica, sans-serif;">And this is not new
situation. If you can run, you can play. This image is of a Melbourne player in
the 50’s who had only 3 fingers on his right hand. The type of injury that
occurs is not the issue because I have never seen a sports related injury I haven’t
seen in the clinic. What is different is the circumstances in which the injury
happens, and the environment the athlete works in outside of the field of play.
How many times have you seen chronic PIP joint degeneration referred to by your pt as an old football injury. Two days
ago I saw an AFL player whose mallet finger had not been addressed
appropriately, and was now presenting to me for the first time with a painful, snapping swan
neck deformity. As hand therapists, we have a responsibility to attack the premise that
these injuries are not significant, in a way that benefits both the athlete and
ourselves.<o:p></o:p></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<br />
<div style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 0cm; margin-right: 0cm; margin-top: 7.7pt;">
</div>
<br />
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdfKCGEyjcsNXpd-fOAG0LmZJGOOBpf-dkNqXxgzfQqjGqy5Ukv4Bf3Tm-lHGo0ilqoW1KOGsowlgJ1kX9igustIZpjm00ZHyEZuupg9NOD_hC_FueqX0z51zhuu8oxcihqiv93CffqLw/s1600/lee-keegan-dislocates-his-index-finger-292012e-390x285.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="291" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdfKCGEyjcsNXpd-fOAG0LmZJGOOBpf-dkNqXxgzfQqjGqy5Ukv4Bf3Tm-lHGo0ilqoW1KOGsowlgJ1kX9igustIZpjm00ZHyEZuupg9NOD_hC_FueqX0z51zhuu8oxcihqiv93CffqLw/s400/lee-keegan-dislocates-his-index-finger-292012e-390x285.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">As per the AFL, this is NOT an injury. (I do realise that this athlete plays soccer)</td></tr>
</tbody></table>
<div style="margin: 0px;">
<span style="font-family: Arial, Helvetica, sans-serif;">The AFL define an injury as an … “injury or medical condition which causes a player to miss a match”. So who is going to bother having hand therapy for a compound dislocation, much less a collateral ligament strain? If junior players don’t see professionals missing games after dislocating a finger, then why should they even consider it? Why should they even seek help from experts? It also means that many injuries are under-reported if at all. AFL is essentially a running game. I know of several players who have completed games with a fractured metacarpal. If they can run, they can play. However, I have treated 70% of the players on Hawthorns list at least twice this season so it’s not as if injuries don’t happen.</span></div>
</div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 0cm; margin-right: 0cm; margin-top: 7.7pt;">
<table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="background: #00B0F0; border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 1184;">
<tbody>
<tr>
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 168.45pt;" valign="top" width="225"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<b><span style="font-size: 14.0pt;">AFL
2014. Injury Report<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
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</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 105.15pt;" valign="top" width="140"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<b><span style="font-size: 14.0pt;">Incidence:<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<b><span style="font-size: 14.0pt;">New
injuries per club, per season<o:p></o:p></span></b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 107.45pt;" valign="top" width="143"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<b><span style="font-size: 14.0pt;">Prevalence:
Missed games per club, per season<o:p></o:p></span></b></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 168.45pt;" valign="top" width="225"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Head / Neck<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 105.15pt;" valign="top" width="140"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">1.8<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 107.45pt;" valign="top" width="143"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">2.7<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 168.45pt;" valign="top" width="225"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Shoulder /
Arm / Elbow<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 105.15pt;" valign="top" width="140"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">2.7<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 107.45pt;" valign="top" width="143"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">17.7<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="background: yellow; border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 168.45pt;" valign="top" width="225"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-size: 12pt;">Forearm / Wrist / Hand<o:p></o:p></span></div>
</td>
<td style="background: yellow; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 105.15pt;" valign="top" width="140"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-size: 12pt;">1.6<o:p></o:p></span></div>
</td>
<td style="background: yellow; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 107.45pt;" valign="top" width="143"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-size: 12pt;">5<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 168.45pt;" valign="top" width="225"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Trunk / Back<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 105.15pt;" valign="top" width="140"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">2.7<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 107.45pt;" valign="top" width="143"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">8.3<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 168.45pt;" valign="top" width="225"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Hip / Groin
/ Thigh<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 105.15pt;" valign="top" width="140"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">10.0<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 107.45pt;" valign="top" width="143"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">32.8<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 168.45pt;" valign="top" width="225"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Knee<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 105.15pt;" valign="top" width="140"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">4.3<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 107.45pt;" valign="top" width="143"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">27.6<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 168.45pt;" valign="top" width="225"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Shin / Ankle
/ Foot<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 105.15pt;" valign="top" width="140"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">10.3<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 107.45pt;" valign="top" width="143"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">48.3<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 168.45pt;" valign="top" width="225"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Medical<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 105.15pt;" valign="top" width="140"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">2.4<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 107.45pt;" valign="top" width="143"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">3.7<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 168.45pt;" valign="top" width="225"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Non-football
related<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 105.15pt;" valign="top" width="140"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">0.3<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 107.45pt;" valign="top" width="143"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">0.5<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 168.45pt;" valign="top" width="225"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<b><span style="font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Total<o:p></o:p></span></b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 105.15pt;" valign="top" width="140"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<b><span style="font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">36.1<o:p></o:p></span></b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 107.45pt;" valign="top" width="143"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<b><span style="font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">146<o:p></o:p></span></b></div>
</td>
</tr>
</tbody></table>
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Calibri; font-size: 12pt;">Orchard, J. (2014) </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">The current focus of
discussion in aggressive sports like AFL, rugby and American football is all
about concussion. I’m not saying that that is not worthy, and certainly, the
potential for severe dysfunction is more likely following repeated head injury,
whilst the ability to play is severely hampered by an ACL tear in the knee. What gets lost amongst this, is that injuries to the upper extremity
are actually more common than head injury and ACL injury. I showed you that in
the AFL slide a few back, but an NFL (American football) study of
musculoskeletal disorders also demonstrated this.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9e8BshFAspOEfyQ7KndlpfvWHzgynUkCLHq_iRrHIk-nPZ8Q277MS-2T9Gi6NNQKICv427fp7pX9kB1pGh2fKK0i-Z1nzVkxiOJolWpshbv_YTNQYU_EX2G12Be-Ftk1qkppyOnxkuIQ/s1600/NFL+hand+measure.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="260" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9e8BshFAspOEfyQ7KndlpfvWHzgynUkCLHq_iRrHIk-nPZ8Q277MS-2T9Gi6NNQKICv427fp7pX9kB1pGh2fKK0i-Z1nzVkxiOJolWpshbv_YTNQYU_EX2G12Be-Ftk1qkppyOnxkuIQ/s400/NFL+hand+measure.jpg" width="400" /></a><span style="font-family: Arial, Helvetica, sans-serif;">There is a paucity of
information on the real impact of hand injury in all sports in spite of the
established importance of the hand to the athlete. The photo is of how they
measure hand span in NFL. It is measured because they have established a
correlation in their game between hand span and success, specifically as a
quarterback (ball thrower) but to a lesser degree in other positions. Shouldn’t
it follow then, that if you regard hand span as important enough that it
determines to an extent, the make-up of your team, then maintenance of hand
span be also considered important? <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Arial, Helvetica, sans-serif;">This NFL study is
significant in the time period it considers, and the specificity of the
injuries it considers. I’m involved in a similar audit of hand and wrist
injuries in the AFL for 2015, however we are including any player who chooses
to report a problem, which is in line with Gaston’s suggestion for how best to
define sporting injuries to the hand. </span><span style="font-family: Arial, Helvetica, sans-serif;">“</span><span style="font-family: Arial, Helvetica, sans-serif;">Classification (of hand injury) is best done not in terms of what or how but in preferring to classify and treat
these injuries in the context of injury pattern, sport, position, level of
competition, ability for protected play, and time frame for return to sport.”
(Gaston, 2015). </span><span style="font-family: Arial, Helvetica, sans-serif;">In order to define a role
for HT in this population, how we gauge an injury needs to be addressed better
and promoted more aggressively.</span></div>
<div style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 0cm; margin-right: 0cm; margin-top: 2.9pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Arial, Helvetica, sans-serif;">So what then, do I see as
the role of the hand therapist with a sporting population? Well, there are
several areas. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
</div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhKuZA2k56n9QegOnceqKOrXWkG-2lgUBZCgN6oGIwF0-4lXMDLqL_WzewAg36B83bmRmYLbqDnls9ve9iJYBn8KUshfHk_qhgJha2vzKF98YliGl9tO-tfhbKmsYU0SvsbSNmJoNnK5vw/s1600/Enduro+cross.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhKuZA2k56n9QegOnceqKOrXWkG-2lgUBZCgN6oGIwF0-4lXMDLqL_WzewAg36B83bmRmYLbqDnls9ve9iJYBn8KUshfHk_qhgJha2vzKF98YliGl9tO-tfhbKmsYU0SvsbSNmJoNnK5vw/s400/Enduro+cross.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Enduro cross, not easy with a fractured scaphoid!</td></tr>
</tbody></table>
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Education: What are the
implications of not treating now? If the athlete understands why we are taking
a finger injury seriously for the first time in his career, we have a better
chance of fixing the problem</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Expertise. Splinting easy, but
it’s not what do we do better than anyone else. I don’t necessarily make a
better thumb splint than any of the sports physios I work with (well actually
that’s not entirely true), but I do understand how to rehab a hand and a wrist
better than anyone else in the physio room at Hawthorn & that’s why I’m
there.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Pre-hab. Help the athlete
to create habits especially those with chronic complaints, or those coming back
from serious injury eg a scaphoid fracture in an enduro-cross motor bike rider. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Consider the potential or
current injury. What is worst thing that could happen to prolong or worsen the
injury? That will happen in the sport. How do we stop that?</span></li>
</ul>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Arial, Helvetica, sans-serif;">The implications are that
as hand therapists we need to consider what is best management and to
acknowledge that there is a flow on from professional down. At the
very least we need to know how we best protect the injured hand in play,
because we know they will be returning to the field. Protection can be plastic,
neoprene, tape depending on what is legal for your sport and I’ll talk more
about that later but you do need to be aware that what is legal at a
professional, elite level, is not always permitted at an amateur level. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtfjjximeEQc1mSaUVMGBQof-m2QS7oFxSJxesm6Da060_j0A2j1m9qmTgW1Tgd3iJwqhqB7ElaZPcsh-SWXScHPZAfxB13Fa-gn9Q3Es202Yuhz6MluweupYc0XcW-NMVT90kJSwWQII/s1600/Chick+3.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="247" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtfjjximeEQc1mSaUVMGBQof-m2QS7oFxSJxesm6Da060_j0A2j1m9qmTgW1Tgd3iJwqhqB7ElaZPcsh-SWXScHPZAfxB13Fa-gn9Q3Es202Yuhz6MluweupYc0XcW-NMVT90kJSwWQII/s320/Chick+3.jpg" width="320" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;">I will talk a little about
what I do at Hawthorn because it is such a unique environment, and so different
to what most of you experience. Since 2013, I have been a contracted, in-house
hand therapist with the Hawthorn Football Club. Daniel Chick was at Hawthorn
well before me. My main job as I see it, is to ensure that no Hawthorn player,
and by extension, no patient that sees me ever has to have a finger amputated
because of a chronic PIP joint injury. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Arial, Helvetica, sans-serif;">There are 45 players on the
list, this year I have seen 33 of them at least twice this year.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Arial, Helvetica, sans-serif;">My role is as it is in my
own clinic. I management and assess the hand and wrist injuries. I splint &
I treat. I have no game day role. I am at the club for two + hours a week, and
there is an understanding that any player who needs more than that will be seen
in my clinic. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Arial, Helvetica, sans-serif;">I am part of a team with
three physios, 2 full time. Two sports doctors (part time = full time). There
are four fitness coaches, they are full time exercise physiologists. Two part
time dieticians, one part time kinesiologist, one part time osteopath, one part
time podiatrist, and 8 part to full time masseurs. All are intense, focussed
and highly intelligent. The biggest difficulty I have had is not that I’m not
intense, focussed or highly intelligent although some might argue that point,
but I do work at the bottom of the hierachy of the club as a part-timer in a new
role dealing directly with injuries that have rarely been considered prior to
me being there. And I'm comfortable with that because I understand that the benefit of my presence does mean that the physios can focus
on the injuries that will stop the athletes from getting out onto the park. It
also tells the players, that their injuries, regardless of how small will be
taken seriously. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6b1f6BoMHtxx0VFPSUz5e2_-mpuMe9rUqvdFA-dgdgaL0lkqvDNmU1fATHGr7FOvjMyISsTSWN9XdClniU1cr5YUJC-JfhB2GMNnMTI85UJBwmSmZawvTBlFpOdTMjUK0PKRAHzvqWRs/s1600/LukeHodge+edit.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6b1f6BoMHtxx0VFPSUz5e2_-mpuMe9rUqvdFA-dgdgaL0lkqvDNmU1fATHGr7FOvjMyISsTSWN9XdClniU1cr5YUJC-JfhB2GMNnMTI85UJBwmSmZawvTBlFpOdTMjUK0PKRAHzvqWRs/s400/LukeHodge+edit.jpg" width="343" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Hodgey and his premiership winning "Finger Dinger"</td></tr>
</tbody></table>
<span style="font-family: Arial, Helvetica, sans-serif;">Communication is paramount
especially with relation to what my recommendations are, an I’ve had to learn when
ignore a niggle and to pull my head in, and what niggles to make a big deal of
and discuss with the training staff. As the players come through on a Monday morning,
I follow up on any twinges reported post game, and those previously treated. Pleasingly,
players are self-reporting more and more.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Arial, Helvetica, sans-serif;">The injuries I treat are
usually pretty mundane, with my greatest contribution to the team being the
development of the “finger dinger”, a neoprene tube that provides compression,
warmth and protection. I’m also gradually getting the boys to be better at
icing and compressing there sore hands after a game. It’s amazing how many will
look after a swollen ankle appropriately, but look at me in amazement when I
suggest they apply a cold pack to an oedematous finger. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Arial, Helvetica, sans-serif;">I’m also responsible for
player <span lang="EN-US">rehab
post wrist and hand surgery. I set up protocols for when I’m not there, discuss
with fitness staff how best to adjust a recovering player into pre-season
training, and create strengthening and stabilization programs for those players
with chronic problems that affect their thumb or hand strength.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span lang="EN-US"><span style="font-family: Arial, Helvetica, sans-serif;">(I’ve cut
out the sections on orthoses, and comparisons between management of amateur and
professional athletes. Will likely include that as a “part 2” at some stage) <table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3qonpGwzMuk2R5EwuJ3z1tcsEwlYqLIwOEx7r-9WdulzJT5Il6b0zCFQdjDQWIzW8l3-ZS_dyJPTx53yMVmkMIPWV368QpXx3Cd7SE7diJ82MW1TWPOnurewZfMr2cCEQRmykkI8HBkY/s1600/DSC_0140+%25282%2529.JPG" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3qonpGwzMuk2R5EwuJ3z1tcsEwlYqLIwOEx7r-9WdulzJT5Il6b0zCFQdjDQWIzW8l3-ZS_dyJPTx53yMVmkMIPWV368QpXx3Cd7SE7diJ82MW1TWPOnurewZfMr2cCEQRmykkI8HBkY/s400/DSC_0140+%25282%2529.JPG" width="266" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">It's not all about the Hawks! My eldest son is an Eagles fan!</td></tr>
</tbody></table>
<o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Arial, Helvetica, sans-serif;">In summary then, </span></div>
<div class="MsoNormal">
</div>
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">the injuries professional athletes have to their hands aren’t different, but the way
they sustained them may be and the environment into which the athlete will be
returning is. We need to consider how we classify these injuries and if we can
do that, I anticipate our management of these injuries will also change for the
better.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">If you are treating an athlete and don’t understand his or
her sport, ask them. You have the anatomical understanding and pathology
knowledge to be able to apply to both diagnosis and management of the injury
within the context of their sport.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Your job as an HT in sport, is to educate, guide, and
protect as best you can given an environment that is inherently unpredictable.
We are experts which is why we are being asked to treat. Elite athletes are
experts at what they do also, when they understand what you need them to do and
why, they will usually follow through.</span></li>
</ul>
<br />
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Yeah you can run, yeah you can play, but if you let me fix
that finger, you will play even better! Thank you.<o:p></o:p></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">Look after those fingers,</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">Hamish</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">Refs:</span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">Gaston, R.G., Sports Specific Injuries of the Hand and Wrist. Clin Sports Med 34 (2015) 1–10</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">Orchard, J. http://www.afl.com.au/staticfile/AFL%20Tenant/AFL/Files/2014-AFL-Injury-Report.pdf</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;"><br /></span>
<br />
<div>
<span style="font-family: Calibri; font-size: 12pt;"><br /></span></div>
</div>
<br />
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
Hamishhttp://www.blogger.com/profile/13296725506088769035noreply@blogger.com6tag:blogger.com,1999:blog-2194063106053473026.post-64000981898936987052015-09-22T16:42:00.002-07:002015-09-22T16:42:57.547-07:00Procrastination<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh08FcPGS3mndzrx1OmUGC-nNB5FcPxkMoxhb05GOHL00IJb_ivPAdqZQuzP2MVK0y-nPhZbwjx-5jSm-fg38-_XdW3_uNtE4XuCMJ0ve6hy8PCyR9biSvy-tUTpVfiyHjaOLr7l9e9B9o/s1600/1660144.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="103" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh08FcPGS3mndzrx1OmUGC-nNB5FcPxkMoxhb05GOHL00IJb_ivPAdqZQuzP2MVK0y-nPhZbwjx-5jSm-fg38-_XdW3_uNtE4XuCMJ0ve6hy8PCyR9biSvy-tUTpVfiyHjaOLr7l9e9B9o/s400/1660144.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Looking forward to it, and to it being over!</td></tr>
</tbody></table>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">It's 9:00 am on a day when I don't see patients. I day I have identified as being suitable to devote wholly to getting my presentation on the management of hand injury in sports for the Australian Hand Therapy Conference next month sorted. </span><br />
<br />
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEin5VA1yx6nt3a5KRYJfyDrQwoDVa0fZUKs0KOhCI3f668OhxdctLcTX9FpsTrKG1JeDfjvcFPnwyyfNhEdsiIItrKIQoQGOIE7CaDKm_rIbdM3uVxKce7jr6yatzxvh1WxNRf3DIIh_Uc/s1600/logo-issporth.gif" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="244" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEin5VA1yx6nt3a5KRYJfyDrQwoDVa0fZUKs0KOhCI3f668OhxdctLcTX9FpsTrKG1JeDfjvcFPnwyyfNhEdsiIItrKIQoQGOIE7CaDKm_rIbdM3uVxKce7jr6yatzxvh1WxNRf3DIIh_Uc/s320/logo-issporth.gif" width="320" /></a><span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">I have been in front of the lap top for an hour now. Twitter is updated (nice banter with @mike_hayton), Linked In is updated for both ISSPORTH and Sporting Hands, the roof racks have been cleaned (don't mention the Discovery), I've had a cup of tea, breakfast and two glasses of water. Haven't opened the presentation yet. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGZ-ReH2F9rEPcVq0IFZDFH6TXttRgJB7aBoGUeDF5CD013DerGsXVNmEvD4r5XTdtPNIrC9Du2run2sasgb7Cw3ymy0Om1X4Szle2gLZVJfCcd9UQwPB-NeGJUB9t_CFBWPafij2JjGA/s1600/Josh.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGZ-ReH2F9rEPcVq0IFZDFH6TXttRgJB7aBoGUeDF5CD013DerGsXVNmEvD4r5XTdtPNIrC9Du2run2sasgb7Cw3ymy0Om1X4Szle2gLZVJfCcd9UQwPB-NeGJUB9t_CFBWPafij2JjGA/s400/Josh.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Great work Josh, Go Dees!</td></tr>
</tbody></table>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">I'm procrastinating for no good reason other than I can't focus. My football team play a preliminary final in three days, win that (as they should) and they are through to the Grand Final for the fourth year in a row. Is there something else I could have done for the player with the acute boutonniere? He's playing of course, but what else could I offer? Or what about the rookie player for another team who got dropped after four years without a senior game. Could I have helped him more after his FDP tendon avulsion, to get him back sooner and help him make his mark? The mate of mines' kid, who has a double dislocation of his thumb in outback Australia playing football. I told them to ice it, and protect it, and to keep him away from sport for a time, which was more than they got from the hospital... could I have done more? </span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh12DzAcgNW-LvkfAxbcmRdcvI1pB_fLB9HayN8Zu-fZ8ZXxIJSsr1rSS8dIjLO9pMXgGkQClK4P_9p7bGY-d5D7Pu_wgr7I2d051na6IcvRgGLmbwK_kUUCuynqRAYiBm5irUkcbiiMEE/s1600/Hawks+2014.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh12DzAcgNW-LvkfAxbcmRdcvI1pB_fLB9HayN8Zu-fZ8ZXxIJSsr1rSS8dIjLO9pMXgGkQClK4P_9p7bGY-d5D7Pu_wgr7I2d051na6IcvRgGLmbwK_kUUCuynqRAYiBm5irUkcbiiMEE/s400/Hawks+2014.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">B2B2B?</td></tr>
</tbody></table>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">The short answer is yes, but probably no. They all got the best I had to offer then, and it's unlikely I'd change anything even with hindsight because they all got back to the game. My minds clear now, thanks for letting me purge, I'll get back to my game. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">GO HAWKS, look after those fingers!</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Hamish</span>Hamishhttp://www.blogger.com/profile/13296725506088769035noreply@blogger.com1tag:blogger.com,1999:blog-2194063106053473026.post-70182680525540441422015-08-06T03:34:00.002-07:002015-08-06T03:46:35.646-07:00Athletes Are Real People Too!<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhcR_99wQJFGYrSxRUqw8a4gqvYQDm9QXZRRAWiis1UksiRG4tpeok9AUgZAlV91ox3Jryvop8bnXqvL2avF0WS0mZXEB-EEi6Dk_PEAw_cauCAA8ciiTad6seszWMvJ-cFdAsJIb6i4dM/s1600/jppreaxweb1s-1-web.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhcR_99wQJFGYrSxRUqw8a4gqvYQDm9QXZRRAWiis1UksiRG4tpeok9AUgZAlV91ox3Jryvop8bnXqvL2avF0WS0mZXEB-EEi6Dk_PEAw_cauCAA8ciiTad6seszWMvJ-cFdAsJIb6i4dM/s400/jppreaxweb1s-1-web.jpg" width="307" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Look Ma, no hand!! Position of wrist looks dreadful btw.</td></tr>
</tbody></table>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">On the Fourth of July this year, not one, but two highly paid NFL footballers blew at least one finger off one of their hands by doing stupid things with fireworks. I've seen what blasts can do to hands and it's not pretty. The loss of a finger is bad enough, but sustaining severe burns to the palm of the hand can be especially debilitating. My understanding of the game is limited (GO JETS), however I know enough to realise that for one of them, as long as they can get his wounds under control, and avoid joint contracture, he should be able to get back on the park to tackle, push and hit. The other was a cornerback and he sometimes has to be able to intercept and catch the ball. He lost two fingers and I wasn't surprised to hear he has decided to "step away from the game" while he recovers. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLOnMwtlo0D45gE_VrpUC5357mQEkaAdFr5FfJwYt4fmyJCSVFBQTwd8xSimjlLMpa97B596ANwQQ_C3unT9U6Eeb7sIUbttskvUiqt8nk3WR5ZvTcOgoCMkmV9_xSAe3jXgnh5Vj-C8o/s1600/DW2D+Games.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLOnMwtlo0D45gE_VrpUC5357mQEkaAdFr5FfJwYt4fmyJCSVFBQTwd8xSimjlLMpa97B596ANwQQ_C3unT9U6Eeb7sIUbttskvUiqt8nk3WR5ZvTcOgoCMkmV9_xSAe3jXgnh5Vj-C8o/s400/DW2D+Games.jpg" width="400" /></a><span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">One Google hit led to another, and I started to read about other foolish sports injuries to hands that didn't happen during the sport itself. There's a lot out there, but I'll tell you about some of the best I found. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgTWxK9k4LbGNo8kQFKOmlNGDuQON3lNxACOZyLG4-tm-N3TcliV_b4ABVVvdFzeZkaQ5DlAYPCwgx8QVGlKxZTgnsf9Fv4AcUKMkBE6I7zRDU9gKOGw4Rg_qAchFaQCTCRUjZoSZ6DMwg/s1600/lindsey-vonn_whklj40l5p6v18jhdnq0a1tnd.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="262" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgTWxK9k4LbGNo8kQFKOmlNGDuQON3lNxACOZyLG4-tm-N3TcliV_b4ABVVvdFzeZkaQ5DlAYPCwgx8QVGlKxZTgnsf9Fv4AcUKMkBE6I7zRDU9gKOGw4Rg_qAchFaQCTCRUjZoSZ6DMwg/s400/lindsey-vonn_whklj40l5p6v18jhdnq0a1tnd.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Kudos to the hand therapist. Nice splint, although not sure re direction of pull.</td></tr>
</tbody></table>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Lindsey Vonn is a champion skier. She sliced what appears to have been a flexor tendon in her thumb on a champagne bottle after winning a race in the 2009 World Championships. After surgery, she skied the rest of the season. She did break a finger once too, but bizarrely did that skiing. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvV2ISU3updLqydfHUdhBziNqn8_VOResHf3JatKp_1Hwhr6bP2kn7sSEgYajw51t4kXY9w269qXzUZOzN1rMb69KgEg9QzUma3Yx-bgeO9aMek7S-lkdXltSN2tOzj-nw4zu1SFXpLcE/s1600/zumaya_guitar.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvV2ISU3updLqydfHUdhBziNqn8_VOResHf3JatKp_1Hwhr6bP2kn7sSEgYajw51t4kXY9w269qXzUZOzN1rMb69KgEg9QzUma3Yx-bgeO9aMek7S-lkdXltSN2tOzj-nw4zu1SFXpLcE/s400/zumaya_guitar.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Digitally altered image. </td></tr>
</tbody></table>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Joel Zumaya was a baseball pitcher who missed several games of baseball because he was so addicted to Guitar Hero that he sustained an acute forearm tenosynovitis that was so bad he couldn't throw. Standard treatment for tenosynovitis is to stop doing the activity that caused the problem. He worked that out, and managed to return to his sport. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiY8cnOjdaSQzCiElSVccLmmC2RHwemMHf7iLx44ZID1vOw_A0aYFKNtiUwx-Juj5IC-bD9ZKPGuCJPZw8wZjV2GQdIebvCa6pB5e72zXF6F0TcxyD0y2rne_CKKYV8l6S17YMWnXuOdZs/s1600/brandon-marshall.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="282" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiY8cnOjdaSQzCiElSVccLmmC2RHwemMHf7iLx44ZID1vOw_A0aYFKNtiUwx-Juj5IC-bD9ZKPGuCJPZw8wZjV2GQdIebvCa6pB5e72zXF6F0TcxyD0y2rne_CKKYV8l6S17YMWnXuOdZs/s400/brandon-marshall.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Seems to be able to catch alright</td></tr>
</tbody></table>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">In 2008, another NFL footballer called Brandon Marshall slipped on a discarded McDonalds bag whilst wrestling with a family member. His right arm went through a television screen and he "sustained right forearm lacerations to one artery, one vein, one nerve, two tendons, and three muscles". That's almost a spaghetti wrist. He's done well since, is till playing (GO JETS), but did say that his right hand was numb for the whole of the 2008 season! I'm betting ulnar nerve, but he did well if he avoided damaging the motor branch. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgL5tyzX4ZofIFDBcEEMQRokjYUqAV_wMe4xA21tVK4h3wr3p8slctjaInEcnXVSbxwJTixzhb0hhYsJmsIB9XGb64AKWbUW7OmhEbjn2QVpA-9ITKdZFRvxKRxfM8x0VaHvO_7QiQaVF4/s1600/Diogo+finger.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgL5tyzX4ZofIFDBcEEMQRokjYUqAV_wMe4xA21tVK4h3wr3p8slctjaInEcnXVSbxwJTixzhb0hhYsJmsIB9XGb64AKWbUW7OmhEbjn2QVpA-9ITKdZFRvxKRxfM8x0VaHvO_7QiQaVF4/s320/Diogo+finger.jpg" width="305" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">But the best, and most gruesome injury belongs to an athlete who could play his game even if he had both hands amputated. He actually almost tested that theory out. Diogo jumped up a fence celebrating a goal. Unfortunately, on the way back down, his wedding ring got caught on the fence resulting in a ring avulsion injury. That is, the finger was effectively skinned or as it is also termed, degloved. Photos clearly show exposed bone and tendon. The YouTube clip is worth a look if you like that sort of thing. </span><span style="background-color: white; color: #006621; font-family: arial, sans-serif; font-size: 14px; line-height: 16px; white-space: nowrap;"> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"> https://www.youtube.com/watchv=qRzHu4heNiU </span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">That will do. Acknowledgements go to the athletes that have just proved to us all that they are human, Wikipedia, and various webpages that are entitled "50 Dumbest Sports Injuries of all Time" etc. I'll get back to the boring, real life stuff next time!</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Look after those fingers,</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Hamish</span>Hamishhttp://www.blogger.com/profile/13296725506088769035noreply@blogger.com0tag:blogger.com,1999:blog-2194063106053473026.post-88890788513189834002015-07-21T23:11:00.001-07:002015-07-21T23:11:43.272-07:00A Quick Bite<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCBBZoCPuxR1gB21m1BN-PoyRiZiVvfVJuxMVnhB_T0ajZJnc0erUPUu7IGW30lYMSI0qikg2yZsVq0lUQeVVhwfbKH4AoyrT0_2kjejid3Zg7P0JYhcZ54eKB-nF0z1rpSISaBOcqQIQ/s1600/Mick+Fanning.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="223" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCBBZoCPuxR1gB21m1BN-PoyRiZiVvfVJuxMVnhB_T0ajZJnc0erUPUu7IGW30lYMSI0qikg2yZsVq0lUQeVVhwfbKH4AoyrT0_2kjejid3Zg7P0JYhcZ54eKB-nF0z1rpSISaBOcqQIQ/s400/Mick+Fanning.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Lives to surf another day</td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Watching Mick Fanning disappear behind a couple of waves
just after the world had seen him turn to face a shark in the final of a surfing
contest in south Africa, my first thoughts were of Bethany Hamilton. For those
of you that don’t know, Bethany lost an arm to a shark whilst surfing in
Hawaii. She recovered well enough to compete and win several professional
surfing titles. Mick’s encounter was the premium topic of conversation with all
of my patients that day, but Bethany’s story was the one I discussed with one
particular patient. <o:p></o:p></span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJLp2tiqOD_IrU2FQYkvUoOBS-UF8wucbXie2lZLSGTXwSjnNYDmGv0rJ1aF3ILWJmyEu-gqoQ2y8qR4wl7h86hlw1Jl82pv-kruebXLLxVBsI0B0B5PWaicPfh_s9Hq8cxxeSB1zETYY/s1600/Daniel+Chick1.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="273" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJLp2tiqOD_IrU2FQYkvUoOBS-UF8wucbXie2lZLSGTXwSjnNYDmGv0rJ1aF3ILWJmyEu-gqoQ2y8qR4wl7h86hlw1Jl82pv-kruebXLLxVBsI0B0B5PWaicPfh_s9Hq8cxxeSB1zETYY/s400/Daniel+Chick1.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Chicky</td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Ned (not his real name) wasn’t an elite sportsperson. He had
rolled a car almost 20 years previously resulting in a terrible crush injury to
his right arm, and the eventual amputation of his index finger at the
metacarpal (knuckle) joint. His right hand had adapted really well to this,
with his thumb bypassing the now gone finger, and working with his middle
fingertip in order to pinch and grip strongly. Unfortunately, Ned had never
attempted to increase his left hand use to compensate for his injuries. His right
hand now demonstrated advanced degeneration, and he had significant pain
related to muscle overuse and strain. Treatment involved supportive splinting,
exercises to divert stress to under utilised muscles and away from the
overworked ones, and loads of education on how to adjust activity including
dirt bike riding.<o:p></o:p></span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEii1OvfL22orM0fS85xnL0cGw_mOXPxl6uzPd-xYZzxm-EyKvxx-qi904NxGrXg5WtnmqD7vOwHSEvrx3liE0nUSNsJeeO8ZywG1ZIbuWgcNLtqs2r1UZ8DUtImZxSvuKAphLvt6GzXPdU/s1600/Jack+Newton+before.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEii1OvfL22orM0fS85xnL0cGw_mOXPxl6uzPd-xYZzxm-EyKvxx-qi904NxGrXg5WtnmqD7vOwHSEvrx3liE0nUSNsJeeO8ZywG1ZIbuWgcNLtqs2r1UZ8DUtImZxSvuKAphLvt6GzXPdU/s320/Jack+Newton+before.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Jack before...</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg7hPH9WWezrL-sEeP7xa-U0qIQRRAEg5-UzJ3a3YFX5Ainktq-7NGWZu5Sg82cztQ2exQVCdxLbqWCz3cQRoUCgLRDBl18t9NEh7iEKfvDGlut3FZFh0i2R1BAXi-_5VMbPDFHXLiKLbI/s1600/Jack+Newton.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg7hPH9WWezrL-sEeP7xa-U0qIQRRAEg5-UzJ3a3YFX5Ainktq-7NGWZu5Sg82cztQ2exQVCdxLbqWCz3cQRoUCgLRDBl18t9NEh7iEKfvDGlut3FZFh0i2R1BAXi-_5VMbPDFHXLiKLbI/s1600/Jack+Newton.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Jack after.</td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Ned also wanted to know how I felt he would go if he had another
amputation and I told him I believed he would adjust well albeit with a caveat.
Several Australian Rules footballers have had a finger amputated and have been
able to play at the top level, Daniel Chick being the first to spring to mind. My
first patient ever in my career was a former champion amateur golfer with only
one arm who claimed to have taught Jack Newton how to play golf again after he
had walked into a propeller. The key is something called neural plasticity
combined with something they all had in common called perseverance. Ned hadn’t
been too keen on the latter, and was now suffering the consequences. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"></span></div>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><o:p></o:p></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhfnHp7ce3z6_TsClM2_nJLxiKUPWBtSDqhSAvnj36oCBZawoOOmOEX5EeFyX4ZsrIdwqr7hC4Nffj2s10N1-mYATBJc5WBi6fd1wPrNB_p_TAgt4Nxk_Or8C1Jh-4X04zOC66-KmtYuu8/s1600/Brain+weights.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhfnHp7ce3z6_TsClM2_nJLxiKUPWBtSDqhSAvnj36oCBZawoOOmOEX5EeFyX4ZsrIdwqr7hC4Nffj2s10N1-mYATBJc5WBi6fd1wPrNB_p_TAgt4Nxk_Or8C1Jh-4X04zOC66-KmtYuu8/s400/Brain+weights.jpg" width="400" /></a><span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">My point is, that it is all very well to understand that the
brain will automatically start to redirect its’ energies towards existing
fingers or limbs once it recognises that it has lost fingers and / or limbs.
There has been plenty of research to explain this with a good article at <a href="http://www.thenakedscientists.com/HTML/interviews/interview/1000517/">http://www.thenakedscientists.com/HTML/interviews/interview/1000517/</a>
and the NOI group website <a href="http://www.noigroup.com/en/Home">http://www.noigroup.com/en/Home</a>
a good place to start learning. However, there is a disturbing tendency in my
profession to put patients in front of a mirror box for half an hour and expect
them to come out of the session with no pain and full movement. It doesn’t
happen because even though neural or cortical plasticity is automatic, cortical
retraining is not. It takes work. If patients like Ned are not prepared to put
the work in, then non-dominant hands will remain non-dominant, and allowing a
thumb to bypass an amputation will not be enough. <o:p></o:p></span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhe1omVGvA49Ffs3bkVsS7_OCIz88ylqReJHAtL9lgp-PjgTrAWRnkqEqxGU0Gxgo7_ZXO7ZnKOQYioJoaR4iuBXXSpLHhrk3IB2ZBfm6HXOkDf5TsoR4aWeW7dCbQ1LFreDne1XxZTrXc/s1600/Bethany+Hamilton.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhe1omVGvA49Ffs3bkVsS7_OCIz88ylqReJHAtL9lgp-PjgTrAWRnkqEqxGU0Gxgo7_ZXO7ZnKOQYioJoaR4iuBXXSpLHhrk3IB2ZBfm6HXOkDf5TsoR4aWeW7dCbQ1LFreDne1XxZTrXc/s320/Bethany+Hamilton.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Preachy? You bet!</td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">I know I have simplified things almost too much. Certainly I
am guilty of being too preachy. But then, that is part of my role. Using
Bethany, Jack and Daniel as examples helped me explain to Ned what he needed to
do. Will he do it? I have no idea. I’d back Mick Fanning in though had that
shark been hungry. <o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Look after those fingers,<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Hamish</span><o:p></o:p></div>
Hamishhttp://www.blogger.com/profile/13296725506088769035noreply@blogger.com0tag:blogger.com,1999:blog-2194063106053473026.post-4796667029283426502015-06-15T01:20:00.000-07:002015-06-15T01:20:31.990-07:00Don't Lay Down Sally!<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitI99PVYidXuOtOrcHCs8tt1Hyvmsar5HG3yc39jyNFVl1t1biadl58yf6L8D097B5JE6Z1nTU51INQ8dG7XXvur26lyy7sHN2YHaUZltMHosjsBZYyZNZut0N28gvk9UArqhskqzYs4w/s1600/Pearson+holding+wrist.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="245" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitI99PVYidXuOtOrcHCs8tt1Hyvmsar5HG3yc39jyNFVl1t1biadl58yf6L8D097B5JE6Z1nTU51INQ8dG7XXvur26lyy7sHN2YHaUZltMHosjsBZYyZNZut0N28gvk9UArqhskqzYs4w/s400/Pearson+holding+wrist.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Ouch</td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Running. It’s not just about your legs. Sure, strong
hamstrings, powerful glutes, and quads can hurl you down a track, but they’re
not the be all and end all of speed. In order to harness that energy, you must
have control, and control is far more difficult to achieve if it’s not innate. <o:p></o:p></span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiupp1PPxX3pLeYvwNl1dML7fDoy23OrqYDlefg6VFRW9SO3qoOVVTn7_MJHxo1UPxQUn4o9TLaJJZtg7I8KtptbcoTVPgEeTYFCbdO5SboUkWWBWzkCevHJhYLH5eK0wQSIgxl6EvWIYw/s1600/Bob+moore+running.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiupp1PPxX3pLeYvwNl1dML7fDoy23OrqYDlefg6VFRW9SO3qoOVVTn7_MJHxo1UPxQUn4o9TLaJJZtg7I8KtptbcoTVPgEeTYFCbdO5SboUkWWBWzkCevHJhYLH5eK0wQSIgxl6EvWIYw/s400/Bob+moore+running.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Bob running at school (digitally altered image that's nothing like Bob)</td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">When I watch runners, I watch their hands. When I run, I’m
conscious of my hands especially when I’m tired. There was a good runner at my
high school. Bob Moore was his name. He ran with a loping, stretched out and
lazy gait that mimicked the sort of student he was. Kind of like the Dalai Lama in sneakers. I might have been smarter
than Bob, but I was never going to be as fast as him. Once I’d accepted that, I
decided to at least try and run like him. I worked out quickly that the easiest
way to start was with my hands. <o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Bob ran with his thumb lightly touching his index and middle
fingers. There was no tension, just the slimmest of contacts. Somehow, this
connection worked to release any tightness in his arms and shoulders, directing
all energies to where they were required. I saw Bob recently at a school reunion and we
talked briefly about that. He laughed as I explained my theory, and said he
just ran without wasting time about thinking how his hands were held. <o:p></o:p></span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7Jepel8F6Brcc9gAsZqoSCo2EeCOeqkMP3Y9V1l8XEYSPXdex8kIKvRdsYbvVkqcZreYLyymhYAiuWY5gaUQgjUy11lFsx0w-2H43rQgfmyR-PP5231KVYi0Fi1YAi7ZCGqJU2f0HKis/s1600/Pearson+wrist+xr.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7Jepel8F6Brcc9gAsZqoSCo2EeCOeqkMP3Y9V1l8XEYSPXdex8kIKvRdsYbvVkqcZreYLyymhYAiuWY5gaUQgjUy11lFsx0w-2H43rQgfmyR-PP5231KVYi0Fi1YAi7ZCGqJU2f0HKis/s400/Pearson+wrist+xr.jpg" width="300" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">I'm sure that scaphoid's gone too...</td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">I’m sure Sally Pearson has always been a Bob Moore sort of a
runner as opposed to a Hamish Anderson type. At least, I’m sure she was until
she got good, really good. Because at her level, everyone is powerful, and
everyone is quick. Differences are minute, and control is crucial. With her fracture
of her ulnar, her radius, quite possibly the scaphoid, and the dislocation, the
potential for a loss in motion is significant. </span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhAK4wCoXSuWpTOiPd3EvOXMDEfJNbo9TWW-1guiN8THHdRb-yiO1CNOfcDr1M4ql_uBYRdb_J_QxRvE17TQH7sWg7yfprkuoakVwwj5dXDH1wVlMl_ttSTNQga9V0JcKowvdqvZgLybC0/s1600/Pearson+start.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="224" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhAK4wCoXSuWpTOiPd3EvOXMDEfJNbo9TWW-1guiN8THHdRb-yiO1CNOfcDr1M4ql_uBYRdb_J_QxRvE17TQH7sWg7yfprkuoakVwwj5dXDH1wVlMl_ttSTNQga9V0JcKowvdqvZgLybC0/s400/Pearson+start.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Wrist extension, finger extension and significant loading to push off</td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">A loss in motion means that as
she runs, there is a reduction in the co-ordination of her wrist movement which
in turn affects her balance as she hurdles. There is also the certainty that
her starts would be affected because of an inability to weight bear through the
affected hand. But would that be enough of a reason for Sally to pull out of
World Championships that are 10 weeks away? <o:p></o:p></span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiH-tt45aHa0rnPmBFmhHvZ-8mht11QminrC47d1mrl1aIT-Feh6joicvyQ0-VnPY3nluF3982qCWGm8ypV_6DU4SHTu0m_R4tdQ1UQj4p1YGdxgmBHaswueYtYmYQcp5dqLVJqskpoZro/s1600/Pearson+hurdle.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="224" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiH-tt45aHa0rnPmBFmhHvZ-8mht11QminrC47d1mrl1aIT-Feh6joicvyQ0-VnPY3nluF3982qCWGm8ypV_6DU4SHTu0m_R4tdQ1UQj4p1YGdxgmBHaswueYtYmYQcp5dqLVJqskpoZro/s400/Pearson+hurdle.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Left wrist extended and fully pronated. Could be tricky now.</td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">At two weeks post fracture, Sally would not yet have any
idea of what her wrist would be feeling like in another two weeks, let alone
ten. Her fracture on x-ray, whilst significant, isn’t going to keep her from
running, but it will stop her from running well at least in the short term. It
will rob her of that sense of fluidity she has always had, and the control she
has developed. That affects her training, and that affects her ability to
compete at an elite level. I think Sally is aware of this and I think that is
why she has pulled the pin early. <o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">I can only hope that the surgeon who operated has been able
to do so in such a way that Sally is already moving her wrist. I can only hope
that the rehab staff she has have the good sense to ask for help before it is
obvious that things aren’t progressing because whilst I’m sure they’re world
class with hamstrings, I bet they don’t see “exploded” wrists every day like I
do. Will she be able to run like Bob Moore again? Time will tell. I just hope
she never runs like Hamish Anderson!<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Look after those fingers,<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Hamish</span><o:p></o:p></div>
Hamishhttp://www.blogger.com/profile/13296725506088769035noreply@blogger.com0tag:blogger.com,1999:blog-2194063106053473026.post-14134186644079620182015-06-03T03:04:00.000-07:002015-06-03T03:05:13.822-07:00Playing with Plastic.<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnDdv7TpbN1ZwVqYvTU4Z1bD3OLooqmeNnBLLdEzsIcOq-b_0eJkUkvPR8Kb8airzfHv_CWrCkvWIO33HAymzR17Wl01mK6ObuK248rOMZDLfPKXdhVdmJsNJG8es_uBH3PuqBnP4bd2Y/s1600/Hand-GamekeeperBunny.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="211" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnDdv7TpbN1ZwVqYvTU4Z1bD3OLooqmeNnBLLdEzsIcOq-b_0eJkUkvPR8Kb8airzfHv_CWrCkvWIO33HAymzR17Wl01mK6ObuK248rOMZDLfPKXdhVdmJsNJG8es_uBH3PuqBnP4bd2Y/s320/Hand-GamekeeperBunny.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif;">No bunny hurt in the taking of this photo</span></td></tr>
</tbody></table>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">At the risk of doing myself out of a job, and incurring the wrath of hand therapists everywhere, I want to share front-line management of thumb MP joint injuries. Greg Hoy, the hand surgeon I work with, refers to tears of the radial collateral joint of the thumb as "AFL (Australian Rules Football) thumb". Tears to the ulnar collateral ligament are more commonly recognised as "skiers or gamekeepers thumb. </span><br />
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjN5HpJCLhlLmLTT87-Dj494LQ-6w84P3l_Rl0TJ8UBAyBW8pjAI4bFPbYVUHvZY3TvB4NO2MY3zOXdoM7Msj_5Orlgs1cnfvGt1BaKL0FQs_BhrJzGAROjLqzifnb1Lczvs6yyiccSJLM/s1600/unstable+skiers+thumb.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjN5HpJCLhlLmLTT87-Dj494LQ-6w84P3l_Rl0TJ8UBAyBW8pjAI4bFPbYVUHvZY3TvB4NO2MY3zOXdoM7Msj_5Orlgs1cnfvGt1BaKL0FQs_BhrJzGAROjLqzifnb1Lczvs6yyiccSJLM/s1600/unstable+skiers+thumb.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif;">GAWN</span></td></tr>
</tbody></table>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">No matter what the moniker nor whether the ulnar collateral, radial collateral, volar plate, or a combination of all three ligamentous structures of the thumb MP joint are injured, taping is usually not sufficient to allow the player back to sport safely. Splinting is required. </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">I find smug, self serving amusement in the fact that so many skilled therapists and doctors shrivel at the thought of using thermoplastic to support a joint. Whilst their trepidation works to my advantage, ultimately it helps no one. So here is a basic recipe.</span><br />
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgUUs_HjYgD_YgYQDKX_Ld7DcrZInyznxuXkOly9ihhZUlubX_yCGnMaFiyFIUiBQsQc2sOTh5NHcaXDREaY66BE6Hka0P3AVz63YgTPdIL4_WKiiKJLFrl2BZoAjZLLKdbegG8NujhcKs/s1600/thumz-up-skier-s-thumb-splint-beige-strap-left-large-model-551785.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgUUs_HjYgD_YgYQDKX_Ld7DcrZInyznxuXkOly9ihhZUlubX_yCGnMaFiyFIUiBQsQc2sOTh5NHcaXDREaY66BE6Hka0P3AVz63YgTPdIL4_WKiiKJLFrl2BZoAjZLLKdbegG8NujhcKs/s320/thumz-up-skier-s-thumb-splint-beige-strap-left-large-model-551785.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif;">It should look similar to this too thick, poorly fitted pre-fab thing </span></td></tr>
</tbody></table>
<ol>
<li><span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Get a piece of thermoplastic, 1.6mm thick.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Cut out a pear shaped piece, long enough to extend from just proximal to the IP joint of the thumb, to just distal to the CMC joint. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Put the plastic in hot water just as if you were softening a mouth guard.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">When it has softened enough, place it over the dorsum of the thumb, working it into shape so that it contours well</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Trim to fit, making sure it doesn't impinge over the CMC with wrist extension and radial deviation.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Tape on</span>. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Refer to a hand therapist for treatment (happy with that BC?)</span></li>
</ol>
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<div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj0F6RPmtEY8bDQyK5xB6-ZdV1DJt7I9OLbXU3kP-5B3PzPtRiN1Ih_P6joKIo2KLd_ZfWmFcam_OPvEiNCkXhMLOtmSq5PeaCFprC-vQuYT-8jamUmxh8Lhz2VTFqYqta3ZQ857uUsl4g/s1600/Buddy+splints.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj0F6RPmtEY8bDQyK5xB6-ZdV1DJt7I9OLbXU3kP-5B3PzPtRiN1Ih_P6joKIo2KLd_ZfWmFcam_OPvEiNCkXhMLOtmSq5PeaCFprC-vQuYT-8jamUmxh8Lhz2VTFqYqta3ZQ857uUsl4g/s320/Buddy+splints.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif;">Before something</span></td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Different players in different positions like different things about these splints. Some can't have any coverage over the thenar eminence. Some like it to wrap around the proximal phalanx. As long as it protects the MP joint, and restricts movement but permits play, it's good.</span> <table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3euLbpm9v2jVg9GeclDaHylROcgv5U9M4wNghoajyVNj6WuK0HO8_v8mX89bIOinXzsZtXLsAjd1lzD45n4xWq70etult836rE4pTfWG0h9xw-prBlZEKRIotzfAE1JmhyphenhyphenQ_2WLBY33E/s1600/Buddy+no+splints.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3euLbpm9v2jVg9GeclDaHylROcgv5U9M4wNghoajyVNj6WuK0HO8_v8mX89bIOinXzsZtXLsAjd1lzD45n4xWq70etult836rE4pTfWG0h9xw-prBlZEKRIotzfAE1JmhyphenhyphenQ_2WLBY33E/s320/Buddy+no+splints.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">After something</td></tr>
</tbody></table>
</span><br />
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<div>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Rehabilitation after that is more involved, and here's where you need to refer to an experienced hand therapist because the splint cannot be expected to do anything more than limit more damage. If you can get that at least half right, it's a start. I can always fix up your smashed up, finger dinted thermoplastic disasters afterwards and no one needs to know but us!</span></div>
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<div>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Look after those fingers,</span></div>
<div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Hamish</span></div>
Hamishhttp://www.blogger.com/profile/13296725506088769035noreply@blogger.com0tag:blogger.com,1999:blog-2194063106053473026.post-38267661826626291382015-05-05T18:30:00.002-07:002015-05-05T18:30:57.886-07:00Surely it's not that tricky?<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhnYAnEUg9-z2T1jSQ_JcEjrcrBxEtq-kGiXTZlg-Il_bljsFtg_Z16HWbEvObuw7RH1wyRcjnn_SwQEv5kYDcvDgO4jS5wQRg8pvBsBEmndTrXVq_kEHXpYe9XyVOAjGAhq2aKLQJFP4/s1600/Hand+foot+meme.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhnYAnEUg9-z2T1jSQ_JcEjrcrBxEtq-kGiXTZlg-Il_bljsFtg_Z16HWbEvObuw7RH1wyRcjnn_SwQEv5kYDcvDgO4jS5wQRg8pvBsBEmndTrXVq_kEHXpYe9XyVOAjGAhq2aKLQJFP4/s1600/Hand+foot+meme.jpg" height="251" width="320" /></a><span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Come on Doc. You've had at least 6 years of study to get to where you are. The nature of the two letters that come before your name engender an immediate level of respect that no other working stiff can generate. So why is it so bloody hard for you to treat a finger volar plate injury? I just explained this injury to an eight year old, and she got it. Surely it's not that tricky a concept? </span><br />
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJ1cZzU0ryxp2zmZzTjkHPkF_mI3DX0aReeA-gzpLD76YAGeCsZqC8CGipwuO_GGk_uHuIozfVzkGqZUOshQjsJ5FE-Tkjr0BBihUDkDf5qkBzkXceWQl2IPUY2rFXaX0gFBxGrvNVju4/s1600/VP+XR.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJ1cZzU0ryxp2zmZzTjkHPkF_mI3DX0aReeA-gzpLD76YAGeCsZqC8CGipwuO_GGk_uHuIozfVzkGqZUOshQjsJ5FE-Tkjr0BBihUDkDf5qkBzkXceWQl2IPUY2rFXaX0gFBxGrvNVju4/s1600/VP+XR.jpg" height="320" width="283" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Spot the tiny bit of bone. </td></tr>
</tbody></table>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"></span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">For the purposes of keeping things simple for the late referrers out there and truth be told, you're not all doctors, I'll just talk about the middle joint of the finger today, the PIP. Think of the </span>volar plate as a bridge across the palmar aspect of the PIP joint. If this bridge is hyperextended too far, either the bridge will snap, and / or a piece of bone connected to the bridge will be pulled off. If that piece of bone is less than 50% of the articular surface, not significantly displaced or overtly unstable, the finger can heal without surgery. </span><br />
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi8B8CmHUTaCxv1BsPJK7BjG-VzsknNIwYw9tBpTECCoVSkoHO2fuqdFBaDHDCTIq0foNiwkJloIzsYTKQWxLyeSg27nRSW0ieEOpwM-htCnTocRoSzVgKqn5Rso8WtG5qtWjoMejh4d70/s1600/VP+bridge.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi8B8CmHUTaCxv1BsPJK7BjG-VzsknNIwYw9tBpTECCoVSkoHO2fuqdFBaDHDCTIq0foNiwkJloIzsYTKQWxLyeSg27nRSW0ieEOpwM-htCnTocRoSzVgKqn5Rso8WtG5qtWjoMejh4d70/s1600/VP+bridge.jpg" height="240" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Broken bridge means bits are missing...</td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">From here, there are only two things you need to know, so stick with me. When you splint the patient's finger in extension, the ends of the broken bridge are too far apart to join up. Do I need to say that again? I will. When you splint the patient's finger in extension, the ends of the broken bridge are too far apart to join up. </span><br />
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEix1QdbrT3s-YA85wtUCp1TrFVJluhEiyQ94_mgG-ZaAwSzpdDU8u7q71AsNtfT75uiy6k67DRs6c6efYaMoEJZ4PulRQx36ZEwJsgny0fgVICaPmKi136D7TK_z0iPCnJENB-aaGCoQ2o/s1600/VP+Hamish+001.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEix1QdbrT3s-YA85wtUCp1TrFVJluhEiyQ94_mgG-ZaAwSzpdDU8u7q71AsNtfT75uiy6k67DRs6c6efYaMoEJZ4PulRQx36ZEwJsgny0fgVICaPmKi136D7TK_z0iPCnJENB-aaGCoQ2o/s1600/VP+Hamish+001.jpg" height="232" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">I drew this. Brilliant right?</td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"></span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Point number two. If you tell the patient not to bend the finger, the finger will get stiff very quickly making my job even more difficult when you eventually decide to refer him or her on after 7 weeks of ineffectual management. Bending the finger will not stress the repairing ligament. Straightening it too far will. </span><br />
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh9fEh-2fBekd27iHn8eciARCZGCtbYZ-ecdQq1hjjTCzfMgkuHtXHfCYR5iLJnPuA6UyDbAPYvUk_6XIM9omEAIj2yKS5x5sUcCdGV2Vac7bUYEhyxvUnyyg3T4oLYgS8_YXIVR8c8eHY/s1600/VP+splint+prog.png" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh9fEh-2fBekd27iHn8eciARCZGCtbYZ-ecdQq1hjjTCzfMgkuHtXHfCYR5iLJnPuA6UyDbAPYvUk_6XIM9omEAIj2yKS5x5sUcCdGV2Vac7bUYEhyxvUnyyg3T4oLYgS8_YXIVR8c8eHY/s1600/VP+splint+prog.png" height="217" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">One option. But understanding the concept is everything.</td></tr>
</tbody></table>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">If you are still with me, you should be able to understand what to do next. Right. Splint the finger in a bent position. This will approximate the ends of the bridge, allowing the natural healing process to join them up. Encourage the patient to bend the finger as tolerated as long as there is no instability. Again depending on the patient and the circumstances, next week, straighten the splint a little. </span><br />
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<div style="text-align: right;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFo6PEvPRwBBMT05_byhVXQhhFbdWVN0917gWdTqmCi2yZl8BYNT8RGDv0v4jvoILVwIfHvtZmgFMIs9VmDCDCiCflcTuve2npeI375rFtqquup8Uy9M9yLGl2EtqejXMCAXXQ8qrLx8o/s1600/Pear+shaped.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFo6PEvPRwBBMT05_byhVXQhhFbdWVN0917gWdTqmCi2yZl8BYNT8RGDv0v4jvoILVwIfHvtZmgFMIs9VmDCDCiCflcTuve2npeI375rFtqquup8Uy9M9yLGl2EtqejXMCAXXQ8qrLx8o/s1600/Pear+shaped.jpg" height="192" width="400" /></a><span style="font-family: Arial, Helvetica, sans-serif;"></span></div>
<div style="text-align: left;">
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">My treatment protocol varies significantly according to the patient. Some are in a splint for 4 weeks, some more, some just 2 and then buddy taped. Some never get splinted at all. They're an easy injury to treat properly, but can quickly go pear-shaped if basic principles are ignored. What you, dear late referrer need to comprehend, is that none of my patients are ever splinted straight because although my wife tells me I need the money, fixing your mistakes is not work I enjoy. </span></div>
<br />
<span style="font-size: large;"><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">Look after those fingers,</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">Hamish</span></span>Hamishhttp://www.blogger.com/profile/13296725506088769035noreply@blogger.com0