Frozen hand due to injury

[Willow Born 2.2.10<3 (:]

A client had an injury due to an accident about 4 weeks ago. Her hand was damaged from grabbing the steering wheel. Now she cannot close her hand. It has been diagnosed as carpal-tunnel, but that seems to be label for anything and everything now.

I told her to try to squeeze a tennis ball as a PNF treatment in addition to the weekly massage treatment. But I wondered if this is something I should even try to resolve as a massage therapist. Should I refer her to an occupational therapist instead?

 

[Finnegan]

Frozen hand due to injury

In our area, there are a couple of MTs who specialize in hands. Doctors refer to them for injuries. I'd send someone with an injury like that to either of them in a heartbeat. Maybe check around to see if there is someone available? Also, I'd have the client ask the doctor specifically (though not all doctors know about the specialty, much less who to refer), and to ask about a prescription for PT. I have had many clients go to PT either while receiving massage or instead of massage, returning to me after they had used all the PT sessions. Without having that specialty yourself, helping her to find a specialist would be best for her. If that is not available or she isn't interested, then I'd proceed with massage, working gently but very, very specifically.

 

[jlde2001]

Frozen hand due to injury

With any carpal tunnel diagnosis, you don't want to start a client on gripping exercises until the source of the problem has been identified and addressed. Otherwise the exercises could simply aggravate the condition.

Even if you don't believe that this client has carpal tunnel, before you tell her to start gripping exercises, she should be properly evaluated by a PT or OT. There could be neurological damage/dysfunction that needs to be addressed before normal function can return.

With a client like this, I'd prefer a proper PT/OT assessment, and would primarily use "indirect" methods like fascial work, positional release, and active isolated stretching. It may well be necessary to assess and work with her hips and shoulders before you attempt to address the hand.

 

[Magz]

Frozen hand due to injury

I second Jason's thoughts. The indirect fascial work may be all the person needs.

 

[angel G]

Frozen hand due to injury

I'm with Walt & Jason on this one. And since you're in Florida, you could send them to Aaron Mattes's sports & rehab center, or to an AIS practitioner who trained with him.

 

[Karlie]

Frozen hand due to injury

It will sound completely nuts, but, if you can somewhat imitate the manner in which the client injured her hand in the first place, you might be able to "unlock" her frozen hand [ortho-bionomy]

Eg - if I grabbed at something, missed, then damaged my hand and my hand was left only partially-closed/partially opened, I would have one of my pals - or my hubby if he weren't so squeamish - GENTLY place my hand in the position it was in during the injury and just GENTLY hold it still till the circling, wobbling, or whatever unwinding motions they might feel in the musculature of my hand. 9 out of 10 times, that type of treatment will go a very long way to undoing what was done during the actual damaging of the limb, etc.

One of our local orthopedic surgeons refers a lot of folks to me with "damage" that has been repaired physically and then needs the musculature "unlocked" and put back to work, so to speak, so that the rehabbing will go more easily for the patient. I use a blend of ortho-bionomy, myofascial release, and very gentle massage to do most of my "unlocking" for his patients and have had a great deal of success.

Pay attention to your instincts regarding treatment as well. Sometimes, it will give you a better answer than all of us put together.

 

[Fireflies]

Frozen hand due to injury

One interesting therapeutic method available to physical therapists is mirror box therapy. It takes a solid understanding of neuroscience, but the results can be dramatic. Definitely outside our scope of practice, but here's a vid clip explaining the basics of mirror box therapy: http://www.youtube.com/watch?v=hMBA15Hu35M

If you can find a PT that uses mirror box therapy, they might be a good person for clients that have phantom limb pain, motor control problems, complex chronic pain patterns, and other stubborn issues.