DEALING WITH HAND PROBLEMS 
Very often patients present with pain in the hand(s). Symptoms may include numbness, tingling, and sharp pain. Swelling may also be a problem. Pain may extend up to the elbow, shoulder or neck. We may find the cause of the problem is in the neck, yet the patient does not complain of pain in the neck. Instead it is in the patient’s hands. They complain of pain /numbness. Why is this? First of all, a much greater percentage of the brain is devoted to provide sensation to the hands than any other part of the body except the lips. The hands are highly innervated and extremely sensitive. We can use this sensitivity to our advantage. Our painless nerve testing (PSSD) can show if the compression on the nerve is coming from the hand, wrist, elbow, shoulder or neck. Because it is so sensitive we can detect nerve damage early enough in many cases. We can then better predict the outcome of therapy. Best of all it is painless. One of the biggest problems we face with these problems is tissue hypoxia and nerve swelling The nerve itself has no lymph drainage system, so chronic nerve pain leads to fibrosis of the nerve within the connective sheath. Anti-inflammatories help address this issue and can help make therapy more tolerable. However, we have found no substitute for a Medrol Dos Pac, all else equal. We can do nerve gliding or stretching of the affected areas without fear of inflaming tissue further. In fact, we have found that edema and pain control go hand in hand with a good nerve injury or tendinitis program. Medical conditions which can be a contributing factor to compressive neuropathes include: diabetes mellitus, hypothyroidism, amyloidosis, hematologic disease, renal disease, rheumatoid arthritis, lupus, acromegaly and alcoholism. Obesity and hormonal imbalances can also be contributing factors (pregnancy and menopause). Anatomic structures, lesions and congenital anomalies may also be factors. Anatomic structures such as fibrous bands, over developed muscles and vascular lesions may directly compress nerves. Chronic nerve compression may be caused by pressure on a hard object or vibrating hand tools. Highly repetitive and forceful motion of the upper extremities and abnormal joint position may also be contributing factors. (See illustration with Compression Neuropathy in the Work place, page 2.) Compression Neuropathies may result from abusive athletic activities and musician’s repetitive activities. (See illustration with Compression in Athletes and Musicians, page 3) TIPS TO AVOID COMPRESSION NEUROPATHIES Stretch regularly, especially the forearm flexors. Put hand flat on wall slowly slide down until you feel a pull, hold 15 seconds repeat 5 times. Exercise regularly to loosen over used muscles. We prefer low impact stuff such as: bicycle, stepper, walking briskly. Try yoga. The benefits are just beginning to come in, but early results are promising. The Harmonious Connection at Rocky Gap has an excellent program. Before or after work stretch out on the floor. Get instructions from a yoga instructor or come see us. The PSSD Nerve Test can be done to detect problems and is inexpensive and painless. It can ‘map’ sensory nerve loss. Try to design your work space to minimize reaching and awkward movements of the arms, wrist, elbows, shoulders and neck. We can help you with these problems. If you can take care of your body now you can avoid surgery later. Give us a call today. You don’t have to suffer, we can help. Read below what Carla Lease has to say about her positive experience. “SUCCESS STORY” My story began about 8 months ago when I started having numbness, tingling and cramping in my right hand and arm. I was concerned that my symptoms were a forewarning of carpal tunnel syndrome. I heard a radio interview one day discussing nerve compromise that described the symptoms I had been experiencing. I immediately contacted Tri State Hand & Occupational Therapy for a free consultation. That consultation and an exam by my family doctor indicated a probable pinched nerve somewhere between my wrist and neck. The occupational therapist, Brian, conducted a painless, non-invasive nerve test of both hands and thoroughly explained to me the anatomy of the arm and neck; this was helpful to me as I started my therapy because I was better able to monitor the mechanics of my body as I performed my daily tasks. Within a week of therapy, my hand was no longer tingling. By the second week, the burning tightness in my shoulders was dissipating. The therapists taught me stretches and exercises that I could do at home; I couldn’t believe how quickly I was noticing positive results from the therapy. Not only did the therapists help me to achieve a “quick fix”, they also have shown me how posture and body positioning can help me to prevent future stress to my neck. I will recommend Tri Sate Hand and Occupational Therapy to anyone who expresses similar symptoms. Carla Lease |
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