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Fractures of the hand, wrist, and arm


Fractures (broken bones) are commonly seen and treated in our clinic. We are able to provide conservative fracture management through immobilisation in splints or casts to allow the fracture to heal. For fractures that require surgical intervention we liaise closely with our plastic and orthopaedic hand surgery colleagues to provide splinting and therapy following surgery. Surgery for fracture fixation can involve wires, plates and screws to secure the bone while it heals. Following any type of fracture it is important to get to therapy early so ensure your fracture is supported in the correct position for healing, and to prevent other joints and fingers from getting stiff unnecessarily. Your therapist will also be able to provide you with information on appropriate exercises and advice on safe return to work and sport.

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Dislocations commonly occur in sport injuries, and are often a result of impact to the end of the fingers by balls, sports equipment or the ground. The most common joint to dislocate in the fingers is the PIP joint (proximal interphalangeal joint), which is the second joint down from the tip of the finger. Joints are supported by ligaments and tendons, and during dislocation these structures are damaged. Treatment can be different depending on which soft tissues are injured. Custom made splinting using either thermoplastic or lycra compression is applied at our clinic to protect the joint whilst the surrounding structures are healing. Treatment also involves safe early mobilisation exercises to prevent stiffness from occurring. Many amateur and elite sportsmen, especially those involved in high contact sports such as football experience recurrent dislocations which require specialised protective splinting for safe return to sport.

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Sports Injuries

Hand, wrist and elbow injuries are common in sport of all levels. We treat all ages and levels of ability from school students and amateurs through to professional sports people. We pride ourselves on being able to manage all of our patients according to their specific sporting requirements to bring them back to their previous level of competition as soon as possible. Our therapy team are service providers for many local and state sporting teams and enjoy the unique challenges of facilitating early yet safe return to sport.

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Paediatric Fractures

Our therapists regularly work with children and their families to treat  upper limb injuries such as a broken arms or dislocation. Given that children are still developing and growing, bone fractures of the upper limb need to be assessed and treated in a timely manner to ensure that future growth is not affected. Several of our therapists have worked at PMH and we have close affiliations with several of Perth’s leading paediatric hand surgeons

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Elective Hand Surgery

We work closely with Plastic and Orthopaedic surgeons who specialise in Hand Surgery. Common elective surgeries treated include surgery for Dupuytren’s Disease, Carpal Tunnel Release, De Quervain’s Tenosynovitis and Trigger Finger release.  We help to manage individuals who require these surgeries to ensure the gains obtained by surgery are maximised and maintained.

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Trauma Surgery

Unfortunately we see many large injuries to hands and arms, often the result of industrial equipment accident or crush injury. Traumatic injuries result in large amounts of trauma to the soft tissues in our arms and hands, and produce large amounts of swelling. In turn, this causes scarring of our tissues to one another, which as a huge impact on movement. Hand therapy helps to guide the balance between resting the injured part to allow tissues to heal, and commencing appropriate exercises to movement in the injured limb prevent long term stiffness

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Trigger Finger

Trigger finger is a mechanical problem that occurs when the tendons that flex your fingers to make a fist enlarge and have difficulty moving through a pulley. This creates friction, inflammation and thickening of the tendon and pulley.  Over time, a nodule can develop and the finger can get stuck when the nodule clicks through the pulley, but then has difficulty returning through the pulley as the finger extends. The condition can be painful. Splinting can help to relieve the symptoms and our hand therapist can give provide education on surgical intervention if conservative management is unsuccessful in achieving complete symptom resolution.

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Carpal Tunnel Syndrome

Compression of nerves in the upper limb is common and can cause numbness, tingling, pain and clumsiness. In the wrist we have a tunnel in which the tendons operating our fingers run. The median nerve runs through the same tunnel, and not being as robust as the tendons, it can become squashed if there are changes to the shape of the tunnel, or increases in inflammation. In carpal tunnel syndrome sensory changes occur in the thumb, index and middle finger. Symptoms are often exacerbated at night with patients complaining of waking with numbness and needing to “shake out their hands” for the feeling to return.

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De Quervain’s tenosynovitis

When you have DeQuervain’s, you commonly have pain and swelling on the thumb side of the wrist. Pain is increased with gripping and pinching and is a common cause of pain in new mothers. The cause of the condition is friction occurring due to two tendons in the thumb that rub together or are compressed in a tunnel at the level of the wrist. Education on activities and postures to avoid, in combination with splinting for rest and reduction of inflammation, work well to settle the condition.

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Epicondylitis (Tennis & Golfer’s Elbow)

The bony lumps on either side of your elbow joint are your epicondyles. The muscles that operate the wrist and the fingers attach onto these bony points via the muscle tendon. Inflammation and injury to these tendon attachments can result in Lateral (Tennis) and Medial (Golfer’s) Epicondylitis. People with epicondylitis can get sharp pain at these attachment points, often during gripping activities. Weakness often accompanies this pain. Despite the generic names for these conditions most people do not get these conditions specifically through sport although they can be activity and work related. These conditions are best treated early with rest before a specific exercise and strengthening program so early contact with a hand therapist is recommended.

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Osteoarthritis is a wear and tear condition that often affects us as we reach middle to late age. A common spot for arthritis to occur is at the base of our thumbs. Over time, pain can develop from damage to the joint itself, from weakness that occurs, or an imbalance of muscles that are working to try and support the joint. We can educate you on the cause of your pain, teach you how to protect the joint for long term use, and help provide symptom relief from pain with custom and pre-fabricated splints and braces and specific exercise programs designed to strengthen and re-balance muscle power in the thumb.

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Post traumatic stiffness

The joints of the hand are prone to getting stiff very quickly. After any injury or condition, stiffness can occur and strength lost due to disuse of the muscles, prolonged periods of being held still in a cast, or persistent swelling that hinders movement. Our therapists use a variety of therapy techniques to ensure we get your hand and wrist moving first and then we work on regaining your strength.

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Wrist Pain

Both acute and chronic wrist pain that has not been formally diagnosed is a common occurrence,. The wrist is a complicated joint involving not only the two forearm bones but also the eight small carpal bones and there many inter connections. Wrist pain can be caused by many factors, such as tendon inflammation, instability or laxity of ligaments that support the joints, fractures, or injured ligaments that then don’t hold the bones in the correct places. Our therapists have lots of experience in assessing wrists to form and diagnosis and provide best treatment. We will liaise with your GP and any specialists as required to ensure an optimal recovery.

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Neurological Conditions

The upper limb can be greatly affected by neurological injuries, such as spinal cord injury, stroke or brain injury. It is not uncommon to develop tight muscles resulting in wrist and finger contractures, tremors, weakness, and some muscles that just don’t work anymore. Splinting to prevent contractures is often a mainstay of treatment and we are able to work with your rehabilitation team to fabricate required splints.

As neurological rehabilitation is complex (particularly in the presence of spasticity) we recommend seeing therapists who specialize in neurological conditions but we may able to assist with assessment, goal planning and therapy program development in conjunction with your neurological rehabilitation team.

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Peripheral Nerve Injuries

Nerves in the arm are susceptible to compression at a number of different sites (including the carpal tunnel). A nerve compression can start gradually, when under repetitive stress or from direct injury. When a nerve is compressed there are patterns of symptoms that may include pain, changes to touch or sensation and/or muscle weakness. We can help with a clinical assessment to work out the likely site and severity of the compression, provide a splint and/or exercises to help the nerve recover and in some cases liaise with your doctor regarding imaging and/or further tests.