Caring for hands,
empowering lives

The carpal tunnel is an area on the palm side of our wrist, formed by our small wrist bones and a roof of connective tissue. This tunnel houses nine tendons and a nerve, making it a very busy and compact part of our anatomy. If you bend your wrist forwards, or clench a fist, this can squash the nerve. With repetition, these movements can eventually compress or irritate the nerve, leading to numbness, pain, and weakness in the thumb, index and middle fingers.

This condition can be diagnosed by your doctor based on ultrasound imaging, otherwise Nerve Conduction Studies can be arranged as an alternative measure. That said, our hand therapists are able to assess the wrist prior to imaging and commence treatment straight away if warranted. When managed early, carpal tunnel syndrome can typically respond very well with non-operative treatment.

De Quervain’s Tenosynovitis occurs from repetitive movement of the thumb and wrist joints, e.g. repetitive lifting or gripping, high volumes of computer-based work or picking up/holding of a baby. Symptoms typically include inflammation of the two tendons that move the thumb upwards and outwards, causing radiating pain up the thumb side of the forearm and wrist. This pain tends to occur with tasks that involve downward or side-to-side twisting of the wrist.

Conservative treatment for De Quervain’s includes splinting, activity modification, tendon gliding exercises, taping and, once pain has settled, a gradual strengthening program to prevent re-aggravation of the tendons. If pain is still persistent after a period of conservative management, a corticosteroid injection or surgery may be recommended. Our hand therapists are able to assist with recommendations to a hand surgeon if this is required.

Most commonly affecting the ring and little finger, Dupuytren’s is a disease whereby the connective tissue in the palm of the hand gradually contracts and develops thickened cords/nodules that pull the fingers in towards the palm. Little is known about the cause and progression of the disease, however it is suggested that those of Celtic or European Ancestry are at increased risk of developing this condition.

Generally, treatment is not required until you are unable to place your hand flat on the table or it limits your day to day function. Treatment options are limited to surgical interventions, in which your surgeon will discuss suitable options to improve your symptoms.

Post operatively, you will likely be required to see a hand therapist to assist with managing wound care, swelling, pain and finger stiffness. After the wound has healed and sutures removed (if required), your hand therapist will fabricate a thermoplastic orthosis to prevent your scar from tightening and further pulling your finger(s) down into the palm. Your therapist will also guide you through an individualised home exercise program to assist with scar management, finger movement and strength to optimise your return to meaningful activities.

Elbow fractures or dislocations usually occur following falls, high impact blows or sporting injuries, tending to be very painful and functionally limiting. Following such injuries, your doctor will most likely refer you for an X-ray and further treatment. At Hand Works, our therapists will be able to provide you with a custom-made waterproof thermoplastic splint/orthosis in order to immobilise and protect the elbow joint throughout your recovery.

In the event of no fracture being detected, the ligaments and surrounding soft tissue in the elbow may still be injured in the form of a dislocation. In our rooms, our therapists are able to perform a number of tests to assess the stability and strength of your elbow and, if suitable, will manage your injury conservatively with a period of splinting, strengthening and proprioception exercises. If a high-grade injury is suspected, you may be referred on for further imaging and advice. If there is a significant fracture to the elbow, this will be treated surgically, followed by an extensive hand therapy rehabilitation program to regain your movement, strength and hand function.

Finger dislocations occur due to a sudden force being applied to the finger, most commonly seen in sporting injuries, forceful twisting injuries and falls. The goal of therapy in this case is to increase the stability of the affected joint whilst maintaining movement and function of the finger. Once a thorough examination has been completed, an appropriate splint may be fabricated to help support the finger while the injured structures heal. This splint/orthosis protects the joint from re-injury throughout your recovery, whilst also assisting to reduce swelling and pain. Your therapist may also provide you with specific finger exercises in order to reduce finger stiffness and ultimately improve your hand function and strength.

The term “fracture” or “break” are interchangeable when referring to bone injuries. These injuries often occur from falls, high impact blows, sporting injuries, crush injuries, or twisting forces. Common associated symptoms include pain, redness, swelling, stiffness and difficulty moving impacted joints.

To assess for a broken bone, you will be required to have an X-ray or a CT scan of the injured site. Depending on the severity of the fracture, your doctor may recommend immobilisation in an orthosis/splint or a surgical opinion.
Simple fractures that are minimally displaced can often be managed in a thermoplastic orthosis/splint. Our hand therapists are well-trained in the creation of waterproof, custom-made thermoplastic splints for a wide variety of upper limb fractures, which can be remoulded throughout the recovery process as your swelling improves.

For fractures requiring surgery, a thermoplastic splint may also be made pre- or post-operatively to immobilise and protect affected joints. Throughout your treatment, our hand therapists will continue to liaise with your treating doctor/surgeon to ensure you receive the best possible functional outcomes from your splinting and rehabilitation.