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Ron French, OT, CHT

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Shoulder & Hand Therapy Blog

 An ongoing series of informational entries on shoulder, elbow, wrist, and hand conditions and injuries.

As well as health, nutrition, and wellness advice to help you get fit and stay fit.

Carpal tunnel surgery is performed after therapy and splinting have stopped providing relief and pain and numbness are constant.  The transverse carpal ligament is released to relieve pressure on the median nerve.

What is carpal tunnel syndrome?

June 7, 2017

Your carpal tunnel is located on the palm side of your wrist and is covered by the transverse carpal ligament and several tendons and the median nerve.  When inflammation occurs, pressure is placed on the median nerve and causes pain, numbness, and weakness.  There are many reasons people get carpal tunnel, repetitive activities, diabetes, autoimmune or thyroid conditions, and pregnancy.  A doctor may recommend carpal tunnel release or decompression surgery when conservative treatments (injections, splinting, rest, etc.) no longer provide relief from the pain, numbness, and weakness associated with carpal tunnel syndrome.   During this procedure, the doctor divides the transverse carpal ligament, freeing or "releasing" the median nerve.  Now that the nerve is no longer "compressed," nerve pain and numbness should subside.  However, pain, stiffness, muscle tightness, weakness, or atrophy may remain after surgery and  the patient may require therapy to regain full function.  See my You-Tube video for more.



Once your doctor has removed your bandages you will notice stitches are intact.  Keep the stitches/wound clean and follow your doctors orders for care, notifying them of any signs of infection (redness, warmth, pus).   There are three exercises you can begin now to keep the tendons that run through the carpal tunnel gliding freely so they don't get caught up in scar tissue, just remember to be gentle and stay pain free.    Your hand should move freely on it's own, do not pull or add force. 

The First Ten days after carpal tunnel surgery

June 8, 2017

Once your doctor has removed your bandages you will notice stitches are intact.  Keep the stitches/wound clean and follow your doctors orders for care, notifying them of any signs of infection (redness, warmth, pus).   There are three exercises you can begin now to keep the tendons that run through the carpal tunnel gliding freely so they don't get caught up in scar tissue, just remember to be gentle and stay pain free.    Your hand should move freely on it's own, do not pull or add force.  Click here to watch video.

  1. Straight Fist: Start with hand open, bend at large knuckles, then middle knuckles , keeping small knuckles straight, let fingers touch palm, this is your straight fist starting position. Begin exercise by curling small knuckles into a regular fist, pause, then straighten your large knuckles (keeping other bent), this is your claw fist, then open hand and gently bend hand backwards.  Repeat 3-5 times, and perform 2-3 times a day. 
  2. Thumb Opposition: Touch tip of thumb to tip of each finger beginning with index finger.  You may not be able to reach the tip of each finger at first, but keep trying you will get there.  Repeat 3-5 times, perform 2-3 times per day. 
  3. Roof Top:  With elbow on table and hand open, bend gently at the knuckles keeping the fingers straight, this is your "roof top."  Open and extend the fingers and gently bend hand backwards.  Repeat 3-5 times, perform 2-3 times per day.   
Now that your stitches have been removed and strips are in place over the wound it is time to increase your exercises as you may display stiffness, weakness, and pain.  Once the strips have fallen off and your wound is fully closed it is time to address scar tissue.  Scar tissue does not stretch and can attach to nearby tendons so it is important to address this as soon as the wound is fully closed  with a dry deep massage followed by an application of Vitamin E oil.   Your exercises are going to change too, but you will have to watch my video for them, I just can't explain them here. 

Carpal Tunnel Surgery - Full Exercise Program After Stitch Removal

June 9, 2017

Now that your stitches have been removed and strips are in place over the wound it is time to increase your exercises as you may display stiffness, weakness, and pain.  Once the strips have fallen off and your wound is fully closed it is time to address scar tissue.  Scar tissue does not stretch and can attach to nearby tendons so it is important to address this as soon as the wound is fully closed  with a dry deep massage followed by an application of Vitamin E oil.   Your exercises are going to change too, but you will have to watch my video for them, I just can't explain them here.  Click here to watch.

Now that your stitches have been removed and strips are in place over the wound it is time to increase your exercises as you may display stiffness, weakness, and pain.  Once the strips have fallen off and your wound is fully closed it is time to address scar tissue.  Scar tissue does not stretch and can attach to nearby tendons so it is important to address this as soon as the wound is fully closed  with a dry deep massage followed by an application of Vitamin E oil.   Your exercises are going to change too, but you will have to watch my video for them, I just can't explain them here. 

Joint Pain: What is joint pain? Why do I have it? How do I treat it?

July 18, 2017

Injury is an obvious cause of joint pain, and most people can recall the moment they injured themselves. Others say the just reached, twisted, or picked-up their grandchild like they do every day and had increased pain. A recent injury may bruise, swell and be painful to touch or move, It may be hard to tell initially if it is a muscle, tendon, or joint problem. If you do not show improvement after a couple days you should see your doctor to determine the scope of injury.


Osteoarthritis is the cause of joint pain for many over the age 40. It usually affects one or more joints with the knees, shoulders, and hands most often affected, and most who suffer from OA say there symptoms worsens . Unfortunately it worsens with time, but there are things you can do to slow the progression and manage the pain. There are many medications your doctor can prescribe to reduce pain and inflammation and a therapist can help reduce pain and stiffness and teach you how to protect your joints. An occupational therapist can show you adaptive items that can help make some task easier for you at home.


Gout is another common cause of joint pain especially found in the big toe. Usually the affected joint will be swollen, red and will be warm and painful to the touch. Your doctor can help you manage this condition with medication and diet.

Other rarer forms of joint pain such as rheumatoid or psoriatic arthritis, lupus, scleroderma, and from infections can take time to diagnose and will require medical management which may include therapy.

Heat Warm heat is used to relieve minor stiffness or tension.  Moist heat is best as it penetrates deeper into the tissue layers which improves blood supply and nutrients to the injured or sore area to facilitate healing.  Apply heat for 15-20 minutes at a time, several times a day.  More moderate pain may benefit from longer sessions, up to an hour, no more.   **Precautions: Heat should not be used if the area is bruised, swollen, or there is an open wound.  People with diabetes, vascular disease, dermatitis etc., should not use heat treatments as they may be at higher risk for burns.  Those with heart disease, hypertension, or other disease should ask their doctor before using heat therapy.  Do not fall asleep or lay on a heating pad as this may cause burns.  Cold Cold therapy is used to reduce swelling and pain and is generally applied shortly after an injury.  Soft ice gel packs are the best way to apply cold therapy as they are pliable and mold to your body.  If you don't have one, a package of frozen peas or corn works well.  Always wrap a towel around the ice pack to protect your skin.  Never apply an ice/gel pack directly to the skin as it can damage the tissues.  Apply ice to the injured area for 10-15 minutes, three to five times a day.  Never apply ice for more that 20-minutes as this can cause damage to nerves and skin tissue.  Elevating the limb, above the heart, can aid in reducing swelling.   Cool gel topical analgesics can also work to relieve muscle and joint pain as it penetrates deep to soothe muscles and nerves.  I use Biofreeze in my clinic, you can request a sample from me.   **Precautions: Do not use cold therapy on people with sensory disorders as they may not be able to feel the pain that can result from over icing.  Do not use cold therapy on those that have poor circulation.  Cold therapy should not be used to ease stiff muscles or joints.

Heat Vs. Cold: When and How to Apply  

July 19, 2017

Heat

Warm heat is used to relieve minor stiffness or tension.  Moist heat is best as it penetrates deeper into the tissue layers which improves blood supply and nutrients to the injured or sore area to facilitate healing.  Apply heat for 15-20 minutes at a time, several times a day.  More moderate pain may benefit from longer sessions, up to an hour, no more. 

**Precautions: Heat should not be used if the area is bruised, swollen, or there is an open wound.  People with diabetes, vascular disease, dermatitis etc., should not use heat treatments as they may be at higher risk for burns.  Those with heart disease, hypertension, or other disease should ask their doctor before using heat therapy.  Do not fall asleep or lay on a heating pad as this may cause burns.


Cold

Cold therapy is used to reduce swelling and pain and is generally applied shortly after an injury.  Soft ice gel packs are the best way to apply cold therapy as they are pliable and mold to your body.  If you don't have one, a package of frozen peas or corn works well.  Always wrap a towel around the ice pack to protect your skin.  Never apply an ice/gel pack directly to the skin as it can damage the tissues.  Apply ice to the injured area for 10-15 minutes, three to five times a day.  Never apply ice for more that 20-minutes as this can cause damage to nerves and skin tissue.  Elevating the limb, above the heart, can aid in reducing swelling. 

Cool gel topical analgesics can also work to relieve muscle and joint pain as it penetrates deep to soothe muscles and nerves.  I use Biofreeze in my clinic, you can request a sample from me. 

**Precautions: Do not use cold therapy on people with sensory disorders as they may not be able to feel the pain that can result from over icing.  Do not use cold therapy on those that have poor circulation.  Cold therapy should not be used to ease stiff muscles or joints. ​​