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.
Summer is the perfect time to instill in your children the love and the fun of outdoor activities. There’s no doubt about it; kids are much more sedentary these days, and childhood obesity is a chronic problem.
Kids play outdoors much less now than decades ago, and many factors go into the equation. Parents often have concerns about kids playing outdoors without supervision, and with the hectic lifestyle of most two-worker families, parents don’t have the time. Poor coordination skills and cuts to school recess and sports programs may have an effect. Children are often encouraged to play safely indoors, without the worry of outdoor activities. They have a lot of entertainment available to them now on their screens, which unfortunately promotes sitting and inactivity.
But grab the waning days of summer and reverse this trend! A simple walk to the park after dinner as part of the family routine can build bonds, happiness and physical health. Outdoor hopscotch on the driveway, trips to the local nature center or the zoo, skateboarding parks and events and even bike riding can help kids breathe in fresh air and work their muscles, helping them sleep better at night too.
As parents, the more active you are, the better example you set for your children, and the more likely they are to embrace physical activities. Experts have found that if children just moved around for an hour each day, the obesity rate would fall. Beginning at a young age, involve your kids in age-appropriate physical activities. Let them choose what they would like to try, and if one activity doesn’t fit, move on.
Activity promotes wellness and wellness yields health and happiness. If you or someone you know is missing out due to pain, stiffness, numbness or tingling in the hands, arms, wrist or elbow, reach out to Dr. Rehman today. She will conduct a thorough evaluation to determine the cause of the problem, and will design a comprehensive program to regain strength, mobility and range of motion. So you can get back out there and have outdoor fun with your family in the glorious remaining days of summer!
For more information, call the office today: 586-532-0803
Arthritis is inflammation in the joints. Most joints in the body have the potential to develop arthritis, which causes swelling, stiffness, pain, a reduction in mobility of the joint, and sometimes deformity.
There are generally two types of arthritis: osteoarthritis and rheumatoid arthritis. Osteoarthritis is the more common, and tends to worsen over time. It can be the result of a traumatic injury or a defect in the cartilage; the smooth white tissue that cushions bones in the joint where they come together. Osteoarthritis affects the large weight-bearing joints in the body, such as the knees, hips, shoulder and spine, but it can also affect the small joints of the hand, most commonly the thumb. Gripping, grasping or pinching objects may become painful with this condition.
Rheumatoid arthritis is a chronic disorder that can affect any part of the body, including large or small joints, the heart, circulatory system, the lungs, the muscles used for breathing and even the digestive system.
Oftentimes joint replacement surgery is recommended if the condition becomes too painful, and interferes with the activities of daily living or the patient’s occupation. But prior to that, there are steps you can take to make your daily life more comfortable if you have arthritis.
To reduce pressure in your hands when holding or gripping objects:
Wrap foam, cloth or tape around the handles of everyday objects like knives, pots and pans, to cushion the grip. Look for household or gardening tools with larger, ergonomically-designed handles. These are available in many retail stores. Keep a pair of gardening gloves with rubberized palms in the kitchen, to help grip and hold, and use common tools like jar openers to help with household tasks.
To reduce pain or pressure before or after activities, and while sleeping:
Apply either heat or cold to the affected joints before and after activities, and before bed. Elevate and support your arms and legs on pillows when sleeping.
Reduce pain and stress on your joints:
Use carts or carriers with wheels to move heavy items like garbage bags, laundry, or grocery bags, so you don’t need to lift them. Replace round doorknobs with lever-style handles.
An entire profession, known as Occupational Therapy, is devoted to helping people with disability issues perform their jobs and household tasks more easily. They can recommend personalized adaptive equipment that will put less weight on the joints. They can also instruct patients on how to use compression garments and thermal agents (heat and cold), and can make custom splints to support or properly position your joints during activities or while sleeping. These professionals can evaluate your home environment and suggest changes or modifications that will make it easier for you to perform your activities. They can also address both the physical and emotional effects of arthritis. They can recommend therapeutic exercises and activities designed to decrease stiffness and improve endurance and strength. And they can address the emotional stress that results from lack of sleep or being in constant chronic pain.
If someone you know is struggling with arthritis, or numbness, tingling or pain in the hands, wrists, elbows or shoulders, contact Dr. Rehman and her team of Occupational Therapists today for help! Dr. Rehman is a specially-trained orthopedic doctor who specializes in conditions and injuries affecting the upper body. She will conduct a thorough evaluation and design a comprehensive, individualized treatment program to correct the problem and return the affected area to health, strength and full range of mobility.
Call Dr. Rehman and her team today for more information: 586-532-0803
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
What is it?
As this injury can often occur when catching a baseball, it is sometimes called baseball finger or mallet finger. It is an injury that occurs to the fingertip that is caused by a sharp blow, or a jamming injury, to the fingertip. In this condition, the tendon that is responsible for straightening the tip of the finger is damaged, and you may not be able to straighten your finger.
What are the symptoms?
Pain and swelling at the end of the finger are the most common symptoms, coupled with an inability to straighten the finger completely. This could become a permanent condition if treatment is not sought early enough.
How is it diagnosed?
A doctor who specializes in the hands, wrists and shoulders is the best person to diagnose this condition. The doctor will examine your finger and review your symptoms. An X-ray may be taken to rule out the presence of a fracture. Frequently, the tendon will pull off a piece of the bone to which it is attached at the end of your finger. Most injuries of this nature can be healed through rehabilitation. But if a large fracture of the bone has occurred, or the joint is misaligned, surgical repair may be required.
How is it treated?
Assuming there is no fracture, the finger will need to be straightened and placed 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 ice packs should be applied for 20 to 30 minutes 3 to 4 times per day, or until the pain is gone. Your hand should be elevated on a pillow when you are lying down, or placed on the back of a chair or couch if you are sitting. Most injuries of this nature can be healed through rehabilitation.
When can I return to my sport or activity?
In general, the longer you have symptoms before you begin rehabilitation, the longer the time period of recovery. Returning to your sport or activity will be determined by your rate of healing, rather than a set number of days or weeks. If you return too soon you may worsen the injury, which could lead to permanent damage. Each person recovers at a different rate. The goal of rehabilitation is to get you back to full function as soon as it is safe for you to do so.
It is important for you to wear the splint for your mallet finger 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.
How can I prevent this injury?
Usually the direct blow that causes mallet finger is accidental, so often these types of injuries are not preventable.
If you or someone you know is experiencing pain, stiffness, numbness or tingling in the hands, wrist, arm or shoulder, seek a consultation from Dr. Rehman. She will provide a full evaluation and workup to determine the exact cause of the problem, and her team of hand therapists will implement a comprehensive program to help you attain full recovery, range of motion and strength in the affected area. Contact Dr. Rehman today for more information. 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.
Every day another glorious gardening catalog arrives, sparking dreams of the gorgeous gardens we will have in the spring and summer. The planning is great fun, but don’t let hand pain stop you from getting your gardens in shape for a knockout blooming season. A bit of preventive planning and you’ll be gardening to your heart’s content.
Avoid Overdoing It. Too much of one repetitive motion can cause a flare up in hand pain, and it will typically happen after about 45 minutes of continuous activity. Break gardening tasks (weeding, digging, transplanting) into smaller blocks of time and take frequent rests to keep flare-ups to a minimum.
Update Your Tools. Look for gardening tools with bigger handles that are easier to grip. Or, wrap the handles with pipe insulation or foam to make them easier to grip. Electric tools can also ease hand, wrist and arm strain, although the vibration from prolonged use can irritate arthritis, so make sure to take frequent breaks. Use gloves with heavy padding for heavy grasping tasks.
Drink Water. Stay well hydrated to minimize stress not only on your fingers and wrists, but on all of the joints in your body.
Avoid Too Much Stooping and Reaching. Whenever possible work at waist height and avoid excessive overhead work. Use a planting table and a garden bench in place of squatting or stooping. Get good long-handled pruning shears or trimmers to keep large bushes looking nice.
Repetitive Motion Disorders
Many people experience hand, wrist or finger pain during the course of their lifetime. If this is not obviously a result of traumatic injury, like a jammed finger or wrist sprain, it may be a repetitive motion disorder, or RMD. There are a range of RMDs and the discomfort associated with them can range from a mere annoyance to debilitating pain.
Carpal tunnel syndrome is not always treated with surgery. In fact, there are many workplace and lifestyle changes that can be made to help cope with the condition, which can range from annoying to painful. But, you don’t have to put up with carpal tunnel syndrome; you have options.
The big holiday is just around the corner, and you’ll love watching their faces light up when they unwrap the new skates, skis or snowboard on their wish list. But beginning athletes in these sports are more likely than experienced ones to receive an injury. So along with that great equipment, be sure to book some lessons from a professional trainer, to make sure the equipment fits them properly and they learn some basics of how to fall correctly.
In the U.S., snowboarding accidents are on the rise, and most of these injuries involve the wrist or the hand. Since a snowboarder’s feet are locked into place, they are not as likely to twist when falling. Usually the hand and wrist take the brunt of the fall. It’s estimated that about 25% of snowboarding injuries are to the wrist. Most are fractures of the forearm bone, just above the wrist joint; another susceptible area is a small wrist bone called the scaphoid. The best defense is to wear wrist guards and to be taught how to fall correctly before even hitting the slopes. Wrist guard technology has advanced dramatically in recent years, and gloves are even available with built-in wrist guards. If your child or teen is experiencing pain after a snowboard fall, get it checked out by a specialized hand surgeon.
The most common upper body injury in downhill skiing is an injury to the thumb. This condition, often called “skier’s thumb” occurs when the skier falls and fails to release his or her poles. The pole acts as a lever upon impact with the ground, and bends the center of the thumb, tearing the ulnar collateral ligament (UCL). Accounting for 8 to 10% of skiing injuries, this type of injury may need splinting or even surgery, depending on the severity of the tear.
Young Olympian hopefuls may be inspired by the complex ice skating routines they see on TV. But as usual, it’s harder than it looks. Most upper body injuries in this sport involve a fracture of the wrist, and if your child is experiencing pain here, it is best to get it checked out by an orthopedic hand surgeon. Training from a professional on how to fall can minimize the chance of this type of injury, and be sure to warm up for 5 to 10 minutes before hitting the ice.
The hand and wrists are delicate and contain an abundance of bones, ligaments and tendons. They can be easily damaged in a sporting accident, and if not treated properly and early, can become lifelong problems. If your young athlete sustains an upper body injury this winter, seek a full and complete evaluation by a specialized hand surgeon such as Dr. Rehman. She and her team of hand therapists will use the least-invasive treatment that will return full range of motion and strength to the injured area.
A few more tips for those Olympian hopefuls in your family:
Be sure they’ve got the right gear and that it fits them properly; helmets and wrist guards for snowboarders and poles without platforms or saber handles for skiers
Teach them to inspect their gear or skates each time before they go
Keep blades on skates sharpened; watch for chips or gouges in the ice
Warm up for 5 to 10 minutes before hitting the slopes or the ice rink
Know how to fall: Snowboarders should practice falling onto the forearms, as this will protect the hands and wrists and disperse the energy of the impact. Snowboarders should also try to land bottom first when falling backward, as this protects the head and tailbone. Skiers should practice releasing their poles when they fall.
Skaters should limit the number of repetitions of jumps per session, and practice new jumps off the ice first, using a harness
And never allow your youngster to skate or ski if it is painful
Winter time sports can be a fun, lifelong pursuit. Start them off on the right foot with the proper gear and training this winter, and then enjoy!
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.
Sports injuries and on-the-job injuries are unpredictable and sometimes unavoidable. Volleyball, football, baseball, basketball, gymnastics; most sports involve some degree of risk. A sharp blow to the finger, whether from a pop fly, a hurtling volleyball, a hammer, or landing on the hand incorrectly can cause a fracture.
The hand is comprised of many bones, and each finger in the hand is made up of three small bones called phalanges. Damage can occur to any one of these bones. Typical symptoms of a broken finger are immediate pain with swelling and bruising. It will be difficult to move the finger, and the finger may appear deformed if the joint is dislocated or the bone is displaced. Numbness and tingling may be present if nerve damage has occurred. Needless to say, if the injury is severe and the bone is visible through the skin, a trip to the Emergency Room is required immediately. Serious problems with infections or bones that heal out of alignment can occur with any finger break.
Especially in children, these types of injuries can be difficult for the lay person to differentiate from a serious sprain or strain. An X-Ray is the definitive diagnostic tool to determine whether a break has occurred, and your doctor or a special hand surgeon will perform this procedure. Once diagnosed, treatment usually consists of realigning the bones and splinting or casting to immobilize the area for several weeks for the bones to knit back together. Initially the doctor may also recommend keeping the hand elevated above the heart to reduce swelling and pooling of blood, and to ice the affected area for 20 minutes 3 to 4 times a day until the pain is gone. Depending on the age of the individual, over the counter or prescription anti-inflammatory medications may also be prescribed to reduce swelling and pain.
Once the cast or splint is removed and the phalange has healed, stiffness and immobility may be present. Specially-trained Occupational Therapists, known as Hand Therapists, will create a treatment program including exercises, stretching and other modalities to assist in regaining full range of motion and strength in the hand. Faithful performance of the exercises, using the proper alignment, will result in the most favorable outcome.
We rely on our hands for everything we do! Injuries to the hand that aren’t treated properly can have long-term effects, including disfigurement and immobility. Most broken fingers heal well with the above-described measures, but if the break is in multiple locations, or very severe, surgery may be required. In this case you especially need a hand specialist, who understands the complexities involved in repairing damage to the hand. Reach out to Dr. Rehman and her team of professionals today if you are experiencing hand, arm, wrist or shoulder pain. Click here to contact her office, or call 586-532-0803 for more information.
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