ARTICLES | Grand Central Physical Therapy and Hand Therapy

Dupuytren’s Disease

By Marianne Pilgrim, OTR/L, CHT

Dupuytren’s disease is a disorder of the connective tissue in the palm of the hand. The disease usually starts with nodules that progress to tendon-like bands. These eventually pull the fingers, particularly the ring and small fingers, into a bent position toward the palm. It becomes difficult to straighten or spread the fingers, limiting activities such as shaking hands, putting hands into pockets or gloves, and holding large objects.

The exact cause of Dupuytren’s disease remains unknown. There is a strong genetic basis, with a family history in 25% of cases. The disease is most common among Caucasian males of Northern European descent, and is less prevalent among people with Asian or African ancestry. There is also a higher incidence among smokers, alcoholics, diabetics and epileptics. The average age of onset is 45 years for males and 60 years for females. Dupuytren’s disease typically takes 10 years to develop from onset to the stage where correction is needed.

Mallet Finger

By David Ricci, OTR/L, CHT

Mallet finger is caused by damage to the extensor tendon, the thin tendon that allows you to straighten your finger. When an object such as a basketball hits the tip of the finger, the extensor tendon can be overstretched, or it can avulse from the bone and pull away a piece of bone. The finger swells, cannot be straightened, and droops at the tip. This causes the mallet-shaped appearance.

Diagnosis is usually confirmed through X-ray. A splint that extends to the tip of the finger is usually worn for eight weeks, followed by therapy to regain motion. Many mallet finger injuries do not require surgery, but those with large fracture fragments or misalignment of the joint may require surgical intervention. Surgery usually involves pins, wires or small screws to realign the joint and repair the fracture. An untreated mallet finger could lead to arthritis or to a permanent deformity of the involved finger. Make a wise choice and seek early medical advice for the treatment of a mallet finger.

Stress Fractures

By Nancy Simpkins

$stress fracture$ A stress fracture is a small crack in a bone, occurring most often in the lower leg or foot. These fractures are usually caused by overuse, particularly among participants in sports such as tennis, running, gymnastics and basketball.

Bones break down and repair themselves in response to stress, and the muscles also act as shock absorbers to protect the bones. When the muscles become fatigued, extra force may be transmitted to the bones. If an athlete increases the amount or intensity of activity more quickly than the bones can rebuild themselves, a stress fracture will develop.

Poor nutrition that diminishes bone health can increase the risk of stress fractures, and having leg-length discrepancies, flat feet or high arches increases the risk as well. People with osteoporosis can experience stress fractures from activities of daily living.

The symptoms of a stress fracture are pain and swelling that increases with activity. Treatment includes rest, ice and pain relievers. Some experts recommend acetaminophen because non-steroidal anti-inflammatory medicines may interfere with bone healing. For severe stress fractures in the foot, a splint, cast, walking boot or crutches may be necessary, or a surgeon may need to insert a pin to hold the bone together. Patients recovering from stress fractures can benefit from physical therapy to learn exercises that improve strength and stability.

Align Your Spine

By Nancy Simpkins

What single thing can improve your appearance, reduce your risk of suffering chronic back pain and headaches, improve your circulation and digestion, and reduce your stress levels? No, it’s not a miracle drug. It’s good posture.

hip exercise Good posture keeps your bones properly aligned, reducing the strain on your muscles and joints. When your posture is correct, your spine will curve slightly forward at the neck, slightly backward in the upper back, and slightly forward in the lower back. These are the cervical, thoracic and lumbar curves. Strong and flexible muscles in the abdomen, hips and legs make it easier to maintain good posture.

Poor posture can increase the risk of arthritis, back pain, headaches and GERD

Poor posture can cause misalignment of the joints, resulting in excessive wear and tear that leads to arthritis. Muscles become imbalanced, with some growing stronger and tighter, while others grow weaker and overstretched. Imbalances can put pressure on nerves, causing pain. For example, studies have shown that the shoulder position of a person who slumps while sitting may cause damage to the median nerve, which runs from the shoulder to the hand. Excessive pressure on the sciatic nerve causes pain in the back and legs, and misalignment of the cervical spine can lead to headaches.

When a slumped sitting posture compresses the abdomen, stomach contents may back up into the esophagus and cause gastroesophageal reflux (GERD). Poor posture can also compress blood vessels, interfering with normal circulation.

Causes of bad posture include weak muscles, poor flexibility, improper sitting and standing habits, obesity, pregnancy, and wearing high-heeled shoes. Physical therapists can evaluate and treat problems with posture. Treatment will usually include exercises to strengthen weak muscles and stretch tight ones, so that the body can achieve proper alignment.

Trigger Finger

By Marianne Pilgrim, OTR/L, CHT

Have you experienced a locking or catching sensation while trying to bend or straighten one of your fingers or thumbs? You may have developed trigger finger, also known as stenosing tenosynovitis.

The tendon that moves each finger is surrounded by a sheath (tenosynovium) that keeps the tendon lubricated. Both the tendon and sheath pass under ligaments that form a tunnel known as the A1 pulley. Trigger finger occurs when inflammation or a nodule prevents the tendon from moving smoothly through the tunnel. The tendon can get stuck, and when it is finally released, the finger snaps like a trigger. This release is usually quite painful.

Symptoms of trigger finger may include the following: swelling on the palm side of the involved finger; a painful nodule on the palm; pain with movement or heavy gripping; joint stiffness; painful popping and clicking while bending and straightening the finger; and if left untreated, the inability to fully straighten the finger due to locking.

Trigger finger generally affects people between 40 and 60 years of age, and women more often than men. The condition may result when repetitive or sustained gripping with fingers or pinching with the thumb causes inflammation of a tendon and its sheath. A history of the following diseases may be associated with an increased risk of trigger finger: diabetes, rheumatoid arthritis, carpal tunnel syndrome, De Quervain’s tenosynovitis, hypothyroidism, and Dupuytren’s disease.

Is Pilates Safe to Do After a Back Injury?

Pilates is a physical fitness system developed in the early 20th century by Joseph Pilates, a man who was inspired by his poor health as a child to study anatomy, yoga, Zen and the exercises of the Greeks and Romans. By the time he was 14, Pilates had developed such an impressive body that he modeled for anatomy charts. His later jobs included boxer, circus performer and fitness trainer.

pilates Based on his studies and his personal experience, Pilates developed a system of exercises that he called Controlology, which is now called Pilates. The principles of Pilates are mind over matter, breathing, centering, concentration, control and precision. The exercises, which can be performed on a mat or machines, aim to teach correct postural alignment of the spine and strengthen the deep torso muscles (core muscles).

Physical therapy and Pilates share many concepts, and many physical therapists are integrating Pilates into their rehabilitation programs. Physical therapy is the science of preventing, diagnosing and treating movement dysfunctions. Physical therapy exercises focus mainly on muscle balance, postural alignment and, most importantly, function.

The Pilates machines are great for many patients because the system of ropes, pulleys, and springs can resist or assist movement in positions that decrease loads on the spine. This is safer and less painful than some other forms of exercise.

Pilates movement patterns can adapt to a variety of diagnoses, but they aren’t recommended for everyone. Pregnant women should only do Pilates under the supervision of an instructor with training in using Pilates during pregnancy. Some women experience separation of the abdominal muscles (diastesis) during pregnancy, and should avoid Pilates. Patients with an acute disc injury of the spine should complete core stabilization exercises first and then transition to Pilates exercises. While Pilates can help strengthen the back, if you’re being treated for a back injury, it’s best to consult with your doctor and physical therapist before starting a Pilates program.

Viscosupplements for Osteoarthritis

By Hector Mayo, PT

Osteoarthritis is a condition in which the cartilage in a joint breaks down. Consequently the bones may rub together, which leads to pain and stiffness. There is also a thinning of the synovial fluid, the slippery substance that cushions and lubricates the joint. As a result, the fluid doesn’t lubricate as effectively.

Treatment for osteoarthritis generally includes physical therapy and medicine that reduces pain and inflammation. A physical therapist can teach you exercises to reduce pain and improve strength, endurance, and range of motion. Advanced cases of osteoarthritis are sometimes treated with corticosteroids, and in severe cases, a surgeon may replace the damaged joint.

For patients with osteoarthritis of the knee that doesn’t respond to conservative treatment, doctors may inject artificial synovial fluid, which is also referred to as a viscosupplement. This fluid is available under various brand names, including Synvisc, Hyalgan, Supartz, Euflexxa and Orthovisc. These products are based on hyaluronic acid, which is one of the lubricating substances found in natural synovial fluid.

Treatment with viscosupplements requires a weekly injection,* from three to five times, depending on the brand’s formulation. Some patients feel relief from pain right away, but most report the greatest pain relief 8 to 12 weeks following the start of treatment. It is generally recommended that patients avoid putting a lot of weight on the legs for about 48 hours following an injection. This means temporarily refraining from activities such as jogging, tennis or heavy lifting.

While the Food and Drug Administration has approved viscosupplements for osteoarthritis of the knee only, they are being studied for effectiveness in treating arthritis in the shoulder, hip, ankle and the joint at the base of the thumb. Regulators in Europe have approved Synvisc for use in the knee, shoulder, hip and ankle. In December, 2007, a single-injection formulation, Synvisc-One, was approved in Europe to treat osteoarthritis of the knee, and the FDA is currently reviewing an application for approval of this treatment in the United States.*

(*update: The FDA approved Synvisc One in 2009.)

Shoulder Injuries and Tennis

The tennis serve and stroke are complex movement patterns demanding rhythmic coordination and timing of specific upper extremity muscles. When a tennis player has poor flexibility, muscle imbalances or poor technique, faulty movement patterns can lead to shoulder injury.

The most common injury in tennis is impingement syndrome. This is a narrowing of the space occupied by the rotator cuff tendons, under the acromion. The tendons are impinged, causing inflammation and pain.

An excellent way to prevent injury is to do exercises that stretch the muscles and capsule in the back of the shoulder. One way to do this is by grasping the elbow and pulling the arm across the body without shrugging the shoulder. Another way is to hold the racket behind your back and move it up and down.

A physical therapist can evaluate whether muscle imbalances or poor mechanics have led to impingement syndrome. The therapist will then develop an appropriate treatment program.