The initial symptoms may be innocuous and fleeting; an ache in the wrist which may then extend into the forearm or into the hand. Later, as the condition develops, you may notice numbness or tingling in the hands or fingers, or pain that begins radiating through the entire arm. Sometimes weakness is present in the arms or the hand, and grasping objects can be difficult. Oftentimes the symptoms will be most severe upon waking up in the morning, or when using your hands.
Here are some ways to minimize the stress on your hands:
When doing tasks, reduce your force and relax your grip. Try putting foam padding around gardening or other tools to cushion your grip. Most people use more force than is required when gripping an object.
Watch how you hold your wrists. Repetitive motions performed by cashiers, hairdressers, sewers and workers using a keyboard can contribute to Carpal Tunnel syndrome. Ideally, you should keep your wrists straight or very slightly bent.
Take frequent breaks; set a timer for every hour or two to remind you to take a break. Stretch, bend and massage your wrists and hands to promote circulation and blood flow
Be sure your form is correct when performing repetitive tasks on the computer, with tools, or in sports. Be sure your equipment fits you properly and consult a coach to make sure your posture and form are correct. When working on a keyboard, make sure your posture is correct. Incorrect posture can cause your shoulders to roll forward, and shorten the muscles in the neck and shoulders, causing the nerves in your neck to be compressed. This in turn can affect your wrist, fingers and hands.
Ice can be helpful to reduce pain and inflammation, and non-steroidal anti-inflammatory drugs can often help.
Wearing a wrist splint may also help, especially to keep the wrist straight at night, when many people have a tendency to curl the wrists. Bracing the wrist at night will help you keep it straight, reducing the discomfort of carpal tunnel syndrome in the morning.
If you or someone you know is experiencing pain, tingling, numbness or pain in the wrist and hand, contact Dr. Rehman’s office today. She will do a complete evaluation, and her experienced team of hand therapists will use a variety of modalities to help you get relief and to return the wrist and hand to full functioning. And, if surgery should be required, Dr. Rehman is a hand specialist, and has performed many successful Carpal Tunnel release procedures. Contact Dr. Rehman today to get relief from the pain and back on the road to full strength and mobility.
Corticosteroid injections, sometimes called Cortisone, are often employed to reduce inflammation and pain following an injury, or in the degenerative conditions of arthritis or carpal tunnel syndrome. It is best to consult with a doctor who specializes in the area needing treatment. In the case of the hands and arms, a hand specialist should perform the injection. For the foot, ankle and lower extremities, a podiatrist should be consulted.
In the case of injury or degeneration in the hands or wrists, corticosteroid injections are just one part of an overall plan to return the patient to full health and mobility. Hand exercises, hot and cold modalities and massage therapy may also be employed by the team of hand therapists at Midwest Hand Therapy.
Here is a step by step description of what you can expect from a corticosteroid injection procedure:
The patient will be placed in a comfortable position, so that the area requiring the injection is readily accessible to the doctor.
The injection site will be disinfected with alcohol or iodine.
The patient will be encouraged to relax. If the muscles around the joint are relaxed, the injection will glide more smoothly and with less resistance and discomfort.
If ultrasound is being used, a gel will be applied near the injection site, and a technician will gently press an ultrasound transducer against the skin to show an image of the joint space.
If the affected joint or bursa contains excess fluid, the doctor may gently draw off the fluid with a needle and syringe. This is known as joint aspiration or arthrocentisis.
The doctor will then inject a small amount of cortisone into the joint; the cortisone may be mixed with an anesthetic such as lidocaine or bupivacaine. The patient may notice a pinching or a burning sensation.
The injection area will then be cleaned and bandaged, and the patient may be asked to flex the joint several times to help distribute the medication.
Usually patients wait about 30 minutes in the doctor’s waiting room, following this procedure, just to insure they have no unusually severe pain or an allergic reaction to the medication.
These injections can be helpful in reducing inflammation and its associated pain over varying periods, depending on the individual. Frequently the pain is reduced for several weeks or even months, allowing the patient to participate in therapy to strengthen and elongate the muscles and tendons around the joint, to help resolve the issue.
If someone you know is struggling with pain, swelling, tenderness or tingling in the fingers, hands, wrists or elbows, contact Dr. Rehman today. She specializes in injuries and conditions of the upper extremities, and will perform an in-depth analysis of the cause of the condition. Utilizing state-of-the-art technology, she will design a comprehensive program of therapy to return the affected area to full strength and mobility.
Neuropathy is any disease condition of the nervous system. The ulnar nerve is the longest unprotected nerve in the human body; it is not shielded by bones or muscles as most other nerves are. This nerve runs from the neck, all the way down the arm, and is responsible for sensation in the fourth and fifth fingers of the hand, the palm of the hand and the underside of the forearm.
This sensitive nerve can become damaged from repetitive jarring motions. Individuals who work with jackhammers or other hydraulic equipment, and even long-distance cyclists and baseball pitchers can be at risk for developing this condition. When the ulnar nerve becomes compressed or “pinched” near the elbow, it is said to be “entrapped.”
Patients with this condition report symptoms of weakness or tenderness in the hand, tingling in the palm and fourth and fifth fingers, sensitivity to cold and tenderness in the elbow joint. Sometimes these symptoms will resolve on their own, but often, if the damage is more severe or the activities causing it are ongoing, medical intervention may be required.
A thorough examination by a specialist trained to heal the hands, arms and upper extremities of the body is the best person to diagnose this condition. The orthopedic doctor will examine the arm and hand, possibly tapping lightly on the ulnar nerve to determine sensitivity. She will take a detailed account of when the condition began and how it has progressed. Other tests may be ordered such as X-Rays, MRI or Nerve Conduction Velocity tests.
Often, Ulnar Neuropathy or Ulnar Nerve Entrapment can be treated through minimally-invasive methods. Non-steroidal anti-inflammatory drugs may be prescribed, and corticosteroid injections may be considered. Bracing or splinting, especially at night, may be undertaken. Occupational therapy exercises, when done faithfully, will help to rebuild flexibility and strength.
Occasionally, the condition is more serious and Cubital Tunnel surgery is required. Surgery is typically done on an out-patient basis, and the patient can go home that same day. In this situation, the cubital tunnel is cut to allow more space for the ulnar nerve. Splinting of the arm will be required for several weeks, and occupational therapy with home follow-up exercises will be utilized.
If ulnar neuropathy goes untreated, complications can result:
Partial or complete loss of feeling in the hands or fingers
Partial or complete loss of hand or wrist movement
Chronic pain
Emotional depression stemming from the pain or lack of ability to engage in sports or other life activities
If you or someone you know is experiencing tingling, numbness or pain in the hand, arm, wrists or shoulder, contact Dr. Rehman . She is a specialist in treating disorders, conditions and injuries related to the upper extremities, and will conduct a thorough evaluation and design a comprehensive plan to return you to full functionality. Her team of experienced hand therapists will follow up with exercises and other treatment modalities for a return to full strength and range of motion. Don’t endure pain for even one more day – contact Dr. Rehman today! 586-532-0803
The ice and cold weather of the winter are behind us. It’s that time of the year when thoughts turn to spring cleaning, fresh air and outdoor activities. Our vigilance for accidental trips and falls may be lowered, since sidewalks and parking lots aren’t icy or slick. But it’s just that element of surprise that can cause an accidental slip or fall, even in warm weather. Younger people are at risk for falls, too.
Outdoor hazards include:
Potholes in parking lots: The harsh Michigan winter takes a toll on parking lots, and not every business owner has the money or resources to fix problematic holes or cracks. Be vigilant and look ahead as you cross these areas, especially if you are pushing a shopping cart, which could camouflage holes.
Uneven sidewalks: Even a difference of a mere inch is enough to trip up a walker or runner out on a sunny afternoon. If you’re not nimble enough to get your feet back under you in time, you could wind up with a serious injury to a wrist or hand. Joggers are even more at risk; due to their forward momentum, they have less time to recover their balance.
Boating, skiing or tubing accidents: Weird things can happen with ropes and boats and water. Injuries to fingers can occur, and passengers getting into or out of boats should be especially careful of slippery conditions.
Indoor hazards include:
Carpeting or rugs: All of the edges of carpeting and rugs should be tacked down.
Lighting should be adjusted: Dim lighting can be a culprit, but so can lights that are too bright.
Secure the bathroom: Be sure non-slip bath mats are in place, and grab bars and even shower chairs are on hand for older family members or those with mobility limitations.
Safe Stairways: All stairways must have sturdy handrails. And be sure to use them each and every time you go up and down the stairs.
User-friendly kitchens: Keep frequently-used items at waist height, so reaching, bending and stooping are not repeatedly required. People are more likely to lose their balance if they are not standing upright, evenly balanced on both feet.
Even with diligence, accidents can’t always be prevented. Dr. Rehman and her team of experts are here to assist in the repair and recovery from injuries to the hands, wrist or upper extremities. From the initial evaluation, to the proper diagnosis and design of a comprehensive program utilizing the latest modalities and techniques, Dr. Rehman and her team of hand therapists will guide your recovery. Reach out to Dr. Rehman’s office today to learn more or to schedule an appointment.
Contracture: A shortening or distortion of muscular tissue.
When it occurs in the hand, it is called Dupuytren’s Disease or Dupuytren’s Contracture.
What it is:
For some reason, still unknown to doctors, collagen builds up in the palm of the hand, forming a thickening of the skin near the palm. Over a period of time, the collagen can build underneath the skin into long rope-like formations, that then pull on one or more of the fingers of the hand. Usually only one hand is affected, and the condition does not seem to be related to particular occupations, sports or other repetitive activities. Often the ring finger and the pinky finger are affected, but sometimes the middle finger can be involved. Usually the condition does not cause a great deal of pain, but in the later stages, if the formations pull on the finger and cause it to bend, this can be problematic.
How it is diagnosed:
An orthopedic hand specialist is the best person to consult for this condition. She will examine your hands, and compare one to the other. She will also feel your hands to see if toughened knots or bands of tissue are present. A simple exercise may be performed; she may ask you to place the affected hand flat on a table or countertop. If you are unable to flatten your fingers, Dupuytren’s Contracture is indicated.
How it is treated:
If the condition is mild, or in the early stages, regular monitoring and check-ups may be all you need to do. If it has progressed so that knots or bands are present under the skin and one or more fingers are bent, the doctor may implement a series of usually three injections of an enzyme that breaks up the bands of tissue. This enzyme is a collagenase; the brand name is Xiaflex. As the injections work to break up the tissue, the doctor will manipulate the hand to further break up the cords that are causing your fingers to bend. The advantages to this procedure are that there is no incision, and usually very little physical therapy is needed afterward.
In severe cases, surgery may be required. In this case the hand surgeon will make one or more incisions, usually in the creases of the hand, and will remove the fibrous bands of tissue. This procedure typically results in a long-term resolution of the condition, but the surgery is more invasive than injections, recovery will take longer, and physical therapy will be required.
Who to consult:
The hands are complex and delicate appendages, and a specialist trained in hand problems and their resolution is the best person to consult for such conditions. Be sure to engage a Board Certified Osteopathic Doctor, such as Dr. Rehman, for a thorough evaluation and comprehensive treatment program. She has a team of specially-trained hand therapists who will insure that your recovery is complete, with no pain and full range of motion and strength as the final outcome. To learn more, contact Dr. Rehman today or call 586-532-0803.
After one of the hottest summers on record, the cooler weather of fall is a welcome relief. Breezes blow, days are sunny, and homeowners’ thoughts turn to getting their castle ready for the blasts of winter. Gardens need to be put to bed, siding needs cleaning, windows need caulking and the leaves and abundant acorn crop need raking.
But injuries caused by strains or too many repetitive tasks in a short time span can occur.
The first step is to pace yourself. You can’t get it all done in one day, or even one week. Work for two or three hours, and then rest until the next day. Pay attention; if your hands or wrists start to feel numb or are tingling, you should stop the activity and come back to it later or the next day. Try to get leaf rakes that are the proper size for you, and that have ergonomically designed handles.
Do some warm-up stretches before you start, especially if you are not an active person. Lifting the arms overhead, bending side to side, toe touches or forward bends can help loosen up arms, back and legs for the demands of fall clean-up. A five to ten minute warm-up period will help to generate heat in your body. This in turn helps to make the tendons, ligaments and other connective tissue more pliable and less prone to injury.
Even when walking about your neighborhood, beware of fallen leaves. They can disguise holes or uneven pavement, and they are very slippery when wet. In the earlier hours of the day, patchy frost may form in shaded areas, making dangerous slippery spots. Falls onto an outstretched hand can damage the bones, ligaments and tendons in the hand and the wrist. The hand is comprised of 27 bones, and even a slight injury to one of these can be painful and require proper medical attention.
If you or your family are dealing with pain, stiffness, lack of mobility or numbness /tingling in the hands, wrist, arm or shoulder, reach out to Dr. Rehman today. Upper body injuries that are incorrectly diagnosed or left untreated can cause permanent damage. Seek a thorough examination and comprehensive treatment program by a Board Certified Osteopathic doctor with a team of rehabilitation experts. Call Dr. Rehman’s office today at 586-532-0803 to learn how she and her team can help.
The triangular fibrocartilage complex (TFCC) is a small piece of tissue composed of cartilage and ligaments on the little finger side of the wrist, situated just past the end of the forearm bone called the ulna. Cartilage is a tough, rubbery tissue that acts as a cushion for joints. Ligaments are connective tissue that attach the cartilage to the bones , in this case in the wrist.
Usually an injury of some sort causes this condition; either an accident or a sports-related injury. A fall onto an outstretched hand or a direct blow to the little finger side of the wrist can generate the problem. Sometimes swinging a bat or racquet can cause it, or a violent twist to the wrist at work or in a sport can also result in damage to the TFCC.
Pain on the little finger side of the wrist is indicative of the condition, often accompanied by clicking or catching when moving the wrist. A doctor who specializes in the hands, wrists and shoulders is the best person to diagnose this condition. A physical exam will be conducted, and your doctor may order an X-Ray, an MRI or an arthrogram—an X-ray that is taken after a special contrast dye is injected into the wrist, to better show the area of injury. Arthroscopy may be necessary to diagnose the tear.
The early treatment of TFCC injuries includes:
Wearing a protective support, such as a splint or a cast
The application of ice for 20 to 30 minutes 3 to 4 times each day
Oral anti-inflammatory medications, such as ibuprofen or other s
Rehabilitation exercises designed specifically for the wrist
An injection of a cortisone-like medication
A complete tear in this area may require surgery. However, many tears do become painless with rest and time, even if they don’t actually heal.
Patience with wearing the splint or cast, and dedication to performing the prescribed exercises to regain full range of motion and strength once the TFCC is healed will result in the best outcome. The goal is to have your injured wrist be as strong as the uninjured one, with no pain present when performing your activity such as golf, gymnastics or work. Returning to your activity too soon could cause permanent damage to the area.
Prevention is always a good idea, but typically these injuries are a result of an accidental mishap. Using proper equipment that fits you correctly, stretching before working out, and taking frequent breaks can help prevent over-use or injuries cause by fatigue.
If you or someone you love is experiencing pain, stiffness, tenderness or numbness in the fingers, hand, wrist, arm or shoulder, contact Dr. Rehman for a thorough evaluation and comprehensive treatment plan. Her team of specially-trained therapists will help you recover more quickly and with confidence, with the best chance of regaining full use of your affected limb. Call her office today at 586-532-0803.
With the changes in schedule summer brings, sometimes it’s difficult to keep up the exercise routines we’ve committed to. With a little bit of creativity, you can stay in shape and entertain your kids at the same time. A bonus: the more flexible and strong each family member is, the less likely they are to be injured in a sporting event.
Morning Family Stretch
Set aside five to ten minutes each morning for the whole family to do some stretching exercises. Stretching helps to get the blood flowing and warms up the muscles for the activities of the day. Make this a daily routine for your family; it is healthful and a quiet bonding experience to help balance the hectic life most kids have.
Kids Make Great Dumbells (and their giggling will keep you going)
Try this Russian Twist: While seated on the floor with your knees bent, hold your child in front of you, engage your core and twist from side to side. Repeat 10 to 20 times. This is a great one for arms and abs.
Squat Press: Stand while holding your child in front of you with your feet hip distance apart, arms extended, but elbows not locked. Slowly lower into a squat like you are sitting in a chair and then slowly stand back up straight. Be sure to keep your knees in line with your ankles. Repeat this 10 to 15 times. Great for the arms and lower body.
Throw a Dance Party
Push the furniture out of the way, round up your family’s favorite tunes, and crank up the speakers for a blast of exercise that will get everyone involved. Dancing is super fun and a great cardio workout. Make one afternoon or evening a week your “Dance Party Night” from now till the kids go back to school.
Family Competition
We’re all about competition in our culture, and most kids are involved in at least one organized sport by the time they are a few years old. Motivate your family by setting weekly goals, and create a chart and point system that helps your family track their activity or eating habits throughout the day. See who can be the healthiest!
All these suggestions should help, but if you or your child are injured in one of your organized sports—or at the company baseball game—be sure to reach out to Dr. Rehman and her team of rehabilitation professionals. Specialists in hand, arm and shoulder rehabilitation, they can help resolve tendonitis, golfer’s or tennis elbow, hand and wrist pain, and many other conditions. To learn more, contact Dr. Rehman’s office at 586-532-0803 today!
Swelling of the hand and arm, also sometimes known as “Puffy Hand Syndrome”, or lymphedema, is a condition where excess bodily fluid, usually lymph fluid, builds up in the hand and sometimes in the arm. The condition, if left untreated, can become quite uncomfortable, as the skin is stretched tight over the fluid-filled area. Additionally, a reduction in movement or range of motion may occur, due to the limb being engorged.
The lymphatic system is a delicate system comprised of lymph nodes and channels through which lymph fluid flows. It is the job of the lymphatic system to carry waste, dead cells, bacteria and viruses to the various organs for disposal: the kidneys, the digestive tract and the liver. As such, the lymphatic system is an important part of the immune system. Unlike the circulatory system, which is powered by a pump (the heart), the lymphatic system relies on gravity and the motion of the body to move the lymphatic fluid through the channels to remove waste from the body.
A build-up of lymphatic fluid in the hand and/or the arm can be the result of a variety of underlying conditions.Salt retention and pregnancy can generate this condition, as can heart and liver problems. Cellulitis may occur with edema in the hand and arm, particularly if the person has had radiation or breast surgery with lymph node removal. Cellulitis is a bacterial infection in the limb which affects the skin and the fat below the skin. The infection is compounded by the damaged drainage channels where lymph nodes have been removed. Cellulitis and lymphedema can occur weeks, months, or even many years after the surgery or radiation.
Treatment for this condition requires specialists trained in the rehabilitation of the arm and the hand. A variety of modalities may be used to alleviate the pain and swelling, such as hot or cold packs, as well as electrical stimulation. Soft tissue massage may be performed, to help move the lymphatic fluid to reduce swelling and pain and to return to full mobility. Specific exercises may be prescribed to rehabilitate the hand and the arm, and to help prevent the build-up of fluid in the future.
If you have noticed swelling in your hand or arm, reach out to Dr. Rehman and her team of certified hand therapists today. A thorough evaluation to determine the underlying cause will be conducted, and medication or other treatments will be included in a personalized, multi-faceted treatment plan to reduce the swelling and the discomfort, and to return your limb to full mobility. Call today for more information! 586-532-0803
The quintessential game of summer in America is baseball, and we all have our favorite Tiger. Kids and adults alike love to engage in the sport, and baseball teams and games abound – from organized Little League events to the match-up between competing departments at the company picnic. It’s all fun and games, but accidental injuries can happen, and then what?
A forceful blow to the tip of a finger – as can occur when catching a flying baseball—can create an injury called Mallet Finger (also sometimes known as Baseball Finger). When this injury occurs, the tendon attached to the end of the fingertip is damaged by the blunt force trauma of the flying baseball. Often, the finger cannot be extended fully, and pain, redness, tenderness and swelling are also present.
The hands and wrists are comprised of delicate bones, ligaments, tendons and muscles, all working together to allow the hands to perform the finest of movements. If an injury like this occurs, choose a specially-trained hand doctor, an orthopedic surgeon, to evaluate your condition and prescribe the right treatment. Reach out for treatment soon after the injury occurs, to make sure you can attain a full recovery and the injury does not become permanent.
A physical exam will be conducted, and sometimes an X-Ray may be needed to insure the bones in the finger are not fractured. Treatment typically involves straightening the finger and placing it into a split to keep it stabilized. This splint may need to be worn up to 6 weeks. This will allow the tendon to reattach to the finger or, if a piece of bone has been pulled off, to allow the bone to heal. The finger will most likely be swollen, so apply ice packs 20 to 30 minutes 3 to 4 times per day, or until the pain is gone. To reduce pain and swelling, elevate your hand on a pillow when you are lying down, or place it on the back of the chair or couch if you are sitting. Physical therapy exercises may be prescribed, and the more faithful you are in performing these, the sooner you can expect to heal.
You should expect to wear the splint for at least 6 weeks after the injury. If you wear the splint as the doctor has recommended, you may be able to return to your activities sooner. Not wearing the splint could lead to permanent damage and deformity to the finger.
Contact Dr. Rehman and her team of specialists today if you are experiencing pain or tenderness in your hands, wrists, arm or elbow. She is an orthopedic doctor who specializes in treating these areas of the body, and is a Board Certified and experienced hand surgeon, in the event that surgery is required. Call her office today at 586-532-0803 for more information.
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