Healthy Hands - Aug 14 ACH Health Lecture Focuses on Upper Extremity Injuries
By Shannon Harsh, The Review, Published August 26, 2015
Kristy Willison, occupational therapist and certified hand therapist with ACH Outpatient Therapy Services, was on hand to educate community members about three common upper extremity injuries during the monthly health lecture held Aug. 14 at Alliance Community Hospital (ACH).
Willison, who works on issues “from the elbow to the fingertip,” focused on three injuries she sees quite often at the clinic — carpal tunnel syndrome, thumb arthritis and tennis elbow.
“Sometimes I see these three things a little too late, meaning if I would have gotten patients aware to come to see the doctor a little bit earlier, they wouldn’t have to go through the pain that they’ve gone through,” she said. “I wanted to kind of bring awareness to this so maybe if you’re starting to have some symptoms of these three things, you could go get it checked out a little sooner.”
Willison explained the anatomy, symptoms, risk factors, diagnosis and treatments for each injury.
In describing carpal tunnel syndrome, she explained that repetitive motions, such as sewing, golfing or accomplishing workrelated tasks can cause the tendons that run through the tunnel in the wrist to swell, pinching the median nerve — which provides sensation to the thumb, index finger, middle finger and half of the ring finger. “When these things start to swell, the nerve has nowhere to go because it’s trapped by the ligament on top and the bones at the bottom,” she said.
She said symptoms, such as pain, burning, tingling and numbness in the fingers affected by that nerve, usually start gradually and at night, but they eventually continue to be a problem during the day.
“What you will notice as this continues to progress is you will lose grip strength; you’re just dropping things; you can’t hold onto stuff; you’re not able to pick up small objects,” she described.
Willison said people often decide to try to live with the symptoms, but as the syndrome progresses, muscle at the base of the thumb starts to deteriorate.
“That nerve provides sensation, but it also provides what’s necessary to contract these muscles,” she said. “Once you start to lose the muscles of the thumb, there’s no guarantee even with surgery that you’re going to get that motion back. The damage might be too far.”
Willison stressed the importance of early diagnosis and treatment to prevent permanent damage to the thumb and hand. She said those with mild symptoms can be treated with rest, a splint, modalities such as ultrasound, and tendon gliding exercises to try to clear the space and pressure from the hand.
Thumb arthritis — also called carpometacarpal or basal joint arthritis — occurs when cartilage wears away between the bones in the thumb joint, causing a sharp, stabbing pain. Willison said it is a “wear and tear thing” that can develop over time.
“That joint does a lot of motion. It’s really a fantastic joint, but there’s a lot of wear and tear with it,” she said. “We do have strong ligaments and muscles that provide stability to the bones, but once that is gone, it doesn’t matter. The muscles and ligaments are stretched; the muscles are weak; it becomes a problem.”
The condition may start as a dull ache and develop into sharp pain, and pain may radiate into the wrist, hand and forearm. There can also be cramping, stiffness and swelling, which can affect motion. Motions like pinching, gripping, using the doorknob, buttoning buttons, tying shoes and cutting with a knife can bring out symptoms.
She added that she expects to see a lot of future thumb arthritis patients due to the popularity of texting.
Willison said mild to moderate arthritis can be treated with a splint, rest, change in behavior, ergonomic hand tools and modalities, such as ultrasound and paraffin.
“My job here is to educate you so hopefully we cannot have that arthritis progress to something that does need surgery,” she expressed.
Willison said tennis elbow, or lateral epicondylitis, is not necessarily caused by tennis and doesn’t really have to do with elbow motion. She explained it is caused when the extensor tendon rubs on the bone due to repeated motions, causing inflammation and pain.
“Rest assured, it has nothing to do with how we’re moving the elbow. It has everything to do with how we’re moving our wrist,” she said.
She said it can be caused by an abrupt or subtle injury to the tendon or repetitive activities, such as carpentry, swimming, yard work, throwing a ball or assembly line work.
In addition to pain on the outside of the elbow, symptoms can include nighttime aching and morning stiffness, decreased grip strength with the elbow straight, pain with wrist extension and feeling of tight muscles.
She said non-surgical treatments can include wrist splint, specific exercises, activity modification and modalities, such as heat, ice and pulsed current.
Willison said patients often take a wait-and-see approach when it comes to these issues, hoping the problem will go away, but it hurts them in the long run, and she stressed the importance of seeking treatment. “These three things generally do not go away; they need some sort of intervention,” she said.
Kristy Willison, occupational therapist and certified hand therapist with Alliance Community Hospital Outpatient Therapy Services, talks about carpal tunnel syndrome during the monthly community health lecture held Aug. 14 at the hospital. (Courtesy of The Alliance Review, Aug. 26, 2015)