On Tuesday evening, April 16, Congregation Etz Chaim hosted a virtual lecture on repetitive stress injuries of the hand. Dr. Mel Breite, Founder and Director of the Navigating the Medical System Lecture Series greeted everyone. Next, Jee Yoan Chong, MS, OTR/L, CHT/CLT, shared a comprehensive overview of different types of stress injuries to the hand. The lecture, as always, contained informative and practical information. These lectures truly educate our community.
She began with an illustration of the anatomy of the hand, which has 14 bones in the fingers of each hand. Each finger has three phalanges. These are the distal, middle, and proximal. The thumb has two phalanges. The middle part of the hand is the metacarpal. There are five bones of the hand. There are eight carpal bones, which include the wrist, which has two rows of carpal bones and it is connected to two rows of the forearm, the ulna, and the radius bone. There are numerous muscles, ligaments, tendons, and tendon sheaths. Ligaments are fibrous tissues that bind together joints in the hand. Tendons connect muscles in the arm or hand to the bone, to allow movement, and they pass through sheaths.
Arteries, veins, and nerves in the hand provide blood flow and sensation to the hand and fingers. There are 34 muscles in each hand.
She shared the definition of repetitive strain injury (RSI). It is cumulative trauma disorder or overuse syndrome caused by damage to muscles, tendons, or nerves, resulting from repetitive motions or constant use. It often occurs in people with jobs that require repetitive use of the same body parts or fine-motor movements like typing, playing a musical instrument, and writing. There are also intrinsic factors that can cause it, such as genetic and anatomic structures. A small body frame with strenuous use of a body part over and over can cause it. Also, environmental factors or situations like job demand or daily activities can trigger the problem.
RSI can occur in any body part. Fingers, thumb, wrists, elbows, arms, shoulders, and knees are common sites for it.
Symptoms include pain, swelling, tingling or numbness, and stiffness or weakness.
She then detailed common types of repetitive stress injuries for the arm: carpal tunnel syndrome, de Quervain’s disease, trigger finger, and tennis elbow.
Following this, Janet Kim, Occupational Therapist at NewYork-Presbyterian Hospital Queens, shared specific information about the above problems. She said that carpal tunnel is mostly from repetitive movement. Some conditions that can predispose someone to RSI include diabetes, obesity, arthritis, pregnancy, acute trauma, renal failure, and thyroid problems.
She listed conservative treatments for carpal tunnel syndrome, which include: nonsteroidal anti-inflammatory drugs, corticosteroid injections, splinting, rehabilitative therapy, ergonomic education, yoga, and surgical release of the carpal tunnel.
Treatments can also include Kinesio taping, ADL retraining, as well as joint protection techniques and activity modification.
She then spoke about de Quervain’s disease, which is caused by cumulative overuse resulting in the tendon sheath thickening and degenerating. It involves the thumb abductor and extensor tendons at the side of the wrist. It’s considered a work-related upper limb disorder.
Symptoms include thumb-sided wrist pain and tenderness. There is a special test for this called the Finkelstein test. It is a very common disorder, and it is more prevalent in women. The treatment is nonsteroidal anti-inflammatory drugs, corticosteroid injections, and splinting, which inhibits wrist movement. There is also rehabilitative therapy and surgical release.
Ice cubes or thermal therapy, and ultrasound, helps to guide tendons through the tendon sheath area. Massage and gliding and stretching Kinesio tape and ergonomic education all help. She demonstrated some thumb and wrist movements that stretch the wrist and strengthen the thumb.
She then listed some strategies to reduce forceful grip and pinch. Use friction material on hand tools and utensils. Maximize surface contact with the hand. Wear handle straps to relax grip intermittently. Use electric power tools to replace manual tools. Spread the force over four rather than one finger on trigger-activated tools. Try to use all the fingers.
Next, she spoke about tennis elbow tendinosis of wrist extensor tendons at lateral elbow. Symptoms are persistent lateral elbow and forearm pain during activities. Pain is worse with resisted wrist extension or with wrist, finger, or forearm movements. There is a special test called the Cozen Test that is performed by a doctor or therapist. Tennis elbow usually occurs in nonathletes. It is not an inflammatory condition. It is due to degenerative changes when the tendon fails to heal properly after injury or repetitive trauma. Risk factors include age 30-50, manual labor, smoking, other issues like carpal tunnel syndrome or de Quervain’s, repetitive activities, poor social support, or poor tennis mechanics. Treatment includes corticosteroid therapy, corticosteroid injection, splinting, rehabilitative therapy, ergonomic education, sports rehab, surgery. Therapy includes rest, limit of painful activities, use of heat, ultrasound, ice, massage, stretching or flexibility exercises, and gradual strengthening exercises.
She suggested using two hands as much as possible. “Be sure your wrist is held straight.” Don’t use your wrist to stir. Use your shoulder and make sure not to strain the wrist.
After this, Jee Yoan Chong spoke about trigger finger. This is an inflammation of the tendon or tendon sheath. There is no clear cause. Repeated gripping can increase the risk. It is more common in people with diabetes, arthritis, or trauma to the hand. There is a pain, a nodule, or bump in the palm, and catching or locking of a finger when bending it. There are different stages of symptoms. Treatment includes surgical release, nonsteroidal anti-inflammatory medicines, corticosteroid injection, hand therapy, splinting for 6-10 weeks, heat, hot pack paraffin, ultrasound cold packs, tendon gliding, and stretching.
She emphasized that education is the key to treatment. They tailor therapy programs to the patient’s symptoms. Patients need to see a doctor to be properly diagnosed.
She shared that thumb osteoarthritis is the most common type of arthritis. It is caused by wear and tear of joints, and muscle weakness. Hand osteoarthritis peaks at ages 55-64. There were 57% clinical findings of it in ages 61-70. Thumb CMC (carpometacarpal) is the most common type of arthritis.
Treatment includes splinting, stretching, strengthening exercises, adaptive equipment, joint protection, energy conservation, and learning ways to put less strain on the hand.
She demonstrated some exercises to strengthen the muscles surrounding the joint, which form joint protection. These must be performed properly, she cautioned.
She said it is important to respect pain, and balance rest and activity. Exercise in a pain-free range. Utilize adaptive equipment to reduce stress on affected joints. She shared some examples like a book holder, an electric jar opener, or rubber jar gripper.
She then shared some general joint protection tips: Avoid bending elbows, knees, hips, and back while sleeping. Practice good posture during the day. Use proper ergonomics when working at a desk or performing household chores. Avoid improper workstation setup. If you have to do repeating tasks or movements, change positions and take breaks, and stretch to relax muscles. Use larger and stronger joints. Slide heavy objects instead of lifting or carrying them. Use palms instead of fingers to lift or push. Carry a backpack or shoulder bag instead of a hand-held bag. Use two hands to carry and push a door open with the side of the body instead of hands.
She taught that for arthritic management, it is important to be active. She suggested yoga, meditation, and tai chi. Manage your weight and diet. Consult with your primary care provider, rheumatologist, or orthopedist.
She then shared a contact number and listed the various therapies available at NewYork-Presbyterian Hospital Queens: 1-855-37R-EHAB (1-855-377-3422).
By Susie Garber
