Volume 5, Issue 1 www.exploringhandtherapy.com APRIL 2005

In This IssueFeatured Article...............1In The Spotlight ..............3Splinting Tips & Tricks... 8Ergo Tips and Tricks......11In The Web ...................14POP Quiz.......................14

Hand Exam Tips ...........15Quiz Answers............... 16Pssst Did You Know......16Ask The Experts...........19Hand Club......................11EHT’s Modality Course..20

From the Editors’ Desk:

Susan Weiss Nancy Falkenstein

Exploring Hand Therapy, Inc (EHT)continues to provide you withexcellence in education at afford-able prices. We have great cours-es you can watch with kids on lap,coffee in hand - in your PJ’s... any-time day or night.

EHT recently added a few newvideo courses. Don’t delay go towww.treatment2go.com andorder: *Cervical Exam: ThePhysicians Perspective toDifferential Diagnosis *OfficeErgonomics: Take Control andMODALITIES:a Four or Five partPAM’s course earning you 34contact hours or 3.4 AOTACEUs. EHT’s Physical AgentModalities course meets moststate requirements.

YOU ASKED FOR IT EHTRESPONDED. We launched theEHT HAND CLUB. Excellent fornetworking and more. Join Today.

EHT’s magazine is for information-al purposes only and is not intend-ed to be a substitute for profes-sional medical advice, diagnosis ortreatment. Always consult yoursupervisor before implementingideas.

Order our courses at:www.exploringhandtherapy.comor www.treatment2go.com

Thank you to our sponsorsfor making this magazine possible.Please click their ad (if viewing on-line) or visit their website.

FASTER, BETTER, EASIERSOFT-TISSUE MOBILIZATION

In a world of no limits, the ideal soft-tissue mobilization technique wouldbe one that lets you readily and reli-ably detect and release scar tissueand fascial restriction of the digits,wrist, forearm, elbow, upper arm andeven the shoulder. And at the sametime, it would reduce or eliminatethe wear-and-tear on your own setof hands.

Hand therapist Lori Hiatt, OTR, CHT,who works at OrthoCarolina inHuntersville, N.C., is more specificin her description of the ultimatesoft-tissue mobilization process: itwould prevent adhesion in post-operative patients by ensuring thetendons glide beneath new scar tis-sue.

"The problem of adhesion is espe-cially pernicious in those partswhere muscle tissue is in short sup-ply, such as on the back of thehand," she says. "There, post-opera-tive scar tissue tends to adhere rightdown to the bone, thereby prevent-ing the gliding of tendons."

STAINLESS-STEELINSTRUMENTS

Heretofore, Hiatt, like the majority ofhand therapists, has effectivelytreated upper extremity dysfunctionswith the tried and true-myofascialrelease, cross-friction, scar massageand other methods-despite thephysical demands on their ownextremities. Now, it seems Hiatt anda growing number of therapistsacross the country are discovering

an approach known as instrument-assisted soft-tissue mobilization(ISTM) that comes about as close toideal as any technique thus far.

ISTM, developed in 1991, entailsuse of specially designed stainless-steel instruments - in conjunctionwith a variety of motions and pres-sures and a carefully laid-out treat-ment protocol. It permits soft-tissuemobilization'sobjectives to beachieved more effi-ciently and withless physical exer-tion, according toadvocates.

"Instrument-assist-ed soft tissue mobilization has beenvery beneficial in my practice," saysGretchen L. continue page 3

1

2

Maurer, OTR/L, CHT, owner of HandRehabilitation of Hampton Roads,Inc., a four-office enterprise based inNorfolk, Va. "I often use ISTM inplace of the manual soft-tissuemobilization techniques I had beenrelying on previously.

"By working with the instruments, Ican accomplish more in less timeduring each visit”.

"Also, the instruments are very easyon my hands and I don't fatigue orexperience thumb-joint pain admin-istering therapy as I did in the dayswhen I had only my hands to use."

Further, Maurer can see morepatients during the course of a daybecause of the time-efficienciesgained from use of the instruments.

Hiatt echoes Maurer's sentiments:"It's amazing how easy ISTM makes

identification of restrictions that can-not be detected with your unaidedhands," she says. "Then, whenyou're performing the actual therapywith the instruments, they let youwork down deeper than you canwith hands alone.

"I'm amazed too at how people getbetter quicker when ISTM is used."

SUITED TO MANYINDICATIONS

Therapists find that integrating ISTMwith one's regular retinue of manualsoft-tissue mobilization techniquesproves a simple matter. "I'm usingISTM on virtually every type of caseI see - post-operative tendonrepairs, hand fractures, wrist frac-tures, you name it," says Hiatt. "Theexception is the patient who is veryearly post-op and his or her skin hasyet to regain sufficient integrity to be

worked on."

Hiatt reports excellent results usingthe ISTM with high risk patients, pre-venting complications from adhe-sions. "No matter what you do, scaris still going to form," she says."However, I can count on ISTM tokeep things moving along a lot bet-ter."

Mary Sue Tank, OTR, CHT, stafftherapist at St. Vincent Physical-Occupational Therapy Center inCarmel, Ind., has been an ISTM fansince 2000. She reports that thetechnique is useful for amelioratinglateral and medial epicondylitis, lum-brical strain and thumb adductorstrain.

Therapists who've adopted ISTMtypically don't hesitate to incorporatethe tools in as many patient treat-

Continued page 4

Q: What school did you attend? A: I received my undergraduatedegree in psychology from theUniversity of Florida and my mas-ters degree in OccupationalTherapy from the University of St.Augustine for Health Sciences.

Q: Why does hand and upper

extremity rehabilitation interestyou?A: Hands are one of our most use-ful tools for everyday living. Theyhelp us care for ourselves and forothers, they help us communicateas well as create. To help peoplereturn to these activities independ-ently is very rewarding.

Q: What state do you practicehand rehabilitation in?A: Florida....... AventuraOrthopedic Care Center

Q: Q: What part of your job doyou find most challenging?A :I work in a fast pacedOrthopedic Center along side ahand surgeon who sends us manychallenging cases with variouscomplex injuries. Managing this

volume ofpatients can bechallenging at times.

Q: What part of your job do youfind most rewarding?A: Paraffin Unit- $59.99

Theraputty- $5.95Seeing the look on a patients

face when they re-learn how tohold a coffee mug, sign theirname, or turn a key.........PRICELESS

Q: What area of your expertisedo you want to perfect?A: Modalities- Even though I had ashort weekend course in schooland listened to a few conferencelectures, I feel there is so muchmore to learn. I am a big believerin the

In The Spotlight ....Dana Eber OTR/L, CHT

3

continued on page 6

Dana Eber OTR/L, CHT

4

ment plans as possible - or to begintheir usage at the earliest practicaljuncture.

"I like to start in with ISTM as soonas possible, preferably on thepatient's first visit and continuingwith each visit afterward," says Hiatt."I generally stop toward the final fewvisits in order to focus on posturaland ergonomic exercises and func-tion instruction."

DIAGNOSTIC TOOL, TOO

ISTM can be administered in a vari-ety of ways, which is importantbecause not every patient respondsto the same maneuvers.

"Part of the magic of the tools," saysHiatt, "is that you have so manyoptions for ways to use them. So, ifone technique doesn't seem to behaving the effect you're looking for,

you can try another. And if thatdoesn't work, you can try anotherand another and another. Eventually,in all probability, one of them willprovide the result you want."

Upon discovering the one approachthat works best for the patient inquestion, Hiatt notes it in her chartand then uses that particular methodevery visit thereafter.

Intriguingly, ISTM plays a dual role,in that it is as much a diagnostic aidas a therapy tool.

"We know the general location ofthe problem, and ISTM allows thetherapist to identify specific restric-tions that may not be felt by theunaided hand," says Maurer.

To illustrate, Maurer describes thesteps she takes in preparing to workon a lateral epicondylitis patient.

"Prior to initiating the instrument-assisted technique, moist heat isapplied to soften the tissue," shesays. "A cream is then applied toallow the ISTM tool to glide moreeasily over the skin. Then, an ISTMtool known as the half-moon is usedto scan below the surface of the skinto assess the presence and extentof fibrosis.

"I sweep the scan tool both proxi-mally and distally to identify adhe-sions and fibrosis that may be felt inonly one direction."

As she scans, Maurer asks thepatient questions to elicit feedbackthat will be helpful in the detectionprocess.

"I ask if pain is felt when I work in aspecific area or what it feels like tothem - for example: gristly, bumpy,rope-like," she says. continued on page 9

5

6

benefit of modalities and hope tobroaden my knowledge base.

Q: What suggestions do youhave for therapist preparing totake the hand therapy exam?A: BUY THE PURPLE BOOK!!!And buy Exploring Hand Therapy's(EHT) comprehensive study guide!But just as important, try to find astudy group. You can always learnfrom other people or at least rein-force what you may already know.

Q: Do you have a tip, trick orjust some words of wisdom youcan share with us?A: (A tip for your patients): "Youcan catch more bees with honeythan vinegar" Just use a little psy-chology to turn those problempatients into perfect patients.

( A trick for splinting): Just drizzlea few drops of Goo Gone on yourscissors before cutting anythingsticky, ie velcro or padding. Yourscissors will come out adhesivefree.

Q: What is your favorite diagno-sis to treat?A: Any diagnosis where I can uti-lize my artistic tendencies to fabri-cate funky splints.

Q: What do you do when youare not consumed with handtherapy?A: I sit on the Fine Arts Board ofMiami Beach where I produce the'Miami Beach Festival of the Arts".I am the Local Artist CommitteeChair assisting emerging artists inthe community. I also co-chair and

founded "Create For A Cure", andart auction benefiting the AmericanCancer Society.

Q: How did you find EHT? Whatdo you like about EHT?A: Through networking at meet-ings. EHT is a one stop shop forcontinuing education, study materi-als, networking, and sharingknowledge, tips and tricks.

Thank you Dana!!

In the Spotlight (continued)

7Prices vary depending on Media (CD, DVD, Internet) -- above list is not complete-- only a sample of our course variety

Exploring Hand Therapy (EHT) Provides Excellence in Education!Exploring Hand Therapy (EHT) Provides Excellence in Education!Want to Learn Hand Therapy?

Want to Earn CEU’s ?Need HTCC Recertification Hours?

EHT has over 30 AOTA CEU Courses to Meet YOUR Needs!Internet Streaming, CD-ROM, DVD and VHS

www.exploringhandtherapy.com

Course Title

Static Progressive Splinting:Up Close and Personal

Treatment 2 Go: What Nobody TellsYou

CTD: Aching Arms No More

Study Exams (two exams)

I Too Can Mobilize Edema

Understanding The MysteriousIntrinsics

Clinical Activities Made Simple

CEUs/Contact Hours

3.2/32

.25/2.5

.225/2.25

.45/4.5

.275/2.75

.275/2.75

.75/7.5

CEUs/ContactHours

.6/6

1.0/10

.675/6.75

.125/1.25

.175/1.75

.175/1.75

Course Title

Basics & Beyond: AComprehensive Study of theHand and UE Rehabilitation

Finger Fractures: A Detailed Look

Cervical: The Physicians Approach

Wound Healing and Beyond

A ROYAL Pain in the.... THUMB

Lateral Epicondylits: The TherapistsApproach to Conquering Pain

RSD/CRPS

Price

$158

$244

$208

$199

$48

$57

$58

Price

$499

$108

$99

$124

$99

$99

$185

8

**Need to serial cast a patient? Wehave a great tip we just learned fromPaul Bonzani OTR/L CHT in EHT’smodalities course. Before you applythe plaster of paris, dip the patientsfinger in paraffin and let it cool. Thenapply the cast to the PIPJ. The paraf-fin creates a “sleeve” for the splintturning it into a removable fingercast/splint.

**Treating CRPS/RSD with splints. Animportant tip is to know up front whatyour splint goals are to prevent thesplint from becoming a crutch. If thepatient is using the splint 24/7 he/shemay end up stiffer decreasing func-tional outcomes. Make sure thepatient understands your splintingregime and why you are splinting.Remember, educate, educate, edu-cate with CRPS patients.

**Next splint tip is to always heat

velcro hook before you stick it to the splint - that way it will be less likely topull away from the splinting material.If it still wants to pull away you canuse a solvent and this will bond iteven more. Materials that have acoating will have more problems withthe velcro sticking to the plastic.

**When assessing the length of yourstraps, make sure your straps arelong enough to cover all the stickyback velcro. This makes for a moreprofessional looking splint and youcan avoid the frustration your patientswill experience when they fray theirclothing and furniture with exposedvelcro. If you make the straps tooshort the hook will catch on everythingand will also get dirty very quickly. Ifthey are too long they roll andbecome an eye sore. So take thetime to put on the perfect strap length.

**Want to avoid the nasty splint smelland limit bacteria growth? Well, didyou know Sammons Preston has thesolution with their antimicrobialsplinting material. I just used it on apatient with an extensor tendon repairand after 6 weeks the splint still didnot have that "Wow - I need a bath"smell. This new anti-microbial pro-tection will not wash or peel off andcomes on a variety of commonly usedmaterials. Call them for a free sam-ple NOW: Phone: 1-800-323-5547

If you have a splinting tip or trick youwant to share let us know.www.exploringhandtherapy.com

Splinting Tips and Tricks

9

"Often times I will scan the non-involved skin to let them feel the dif-ference."

GETTING DOWN TO BUSINESSMaurer indicates that several instru-ments might be used in treating aspecific area. "I stroke with fairlylight pressure at first, then increaseit as I work deeper," she says.

Applying the right amount of pres-sure, when using the tools, is cru-cial. Tank relies on feel and patientfeedback to gauge whether she'soverdoing it, not bearing down hardenough, or right on the money. Sheinstructs the patient to tell her if thepressure causes too much pain. If itdoes, she immediately backs off.

Pain is most reliably triggered andstrongly felt when treating scar tis-sue, experts assert."Given that scar is painful tissue, I

may work the area for only a minuteor so," says Hiatt, who shares that avery effective method of using ISTMon scar tissue calls for light, shortstrokes down each side of therestrictive area, then inward with alifting or scooping motion."

Tank, meanwhile, likes to switchbetween sweeping and strummingmotions for treating lateral epi-condylitis. She describes the sweep-ing motionas onethat's usedlongitudinal-ly on amuscle, whereas strumming is deepand perpendicular - similar to cross-friction massage technique.

The length of each stroke, if varied,causes a considerable difference ineffect. Long strokes, according toHiatt, are used to acquaint the

affected area with treatment at thestart of intervention, or to soothe itat the conclusion. Short strokes, onthe other hand, concentrate thepower of the instruments on thearea of restriction.

"No matter what type of motion youuse, a goal is to first clear away thesuperficial dysfunction," Hiatt says."Only then will the deeper dysfunc-tion become apparent."

SEEING RESULTSAn ISTM session at Maurer's officeslasts eight to ten minutes; however,it may take several visits beforegood results emerge. An importantelement of the treatment protocol,according to Maurer, is to followeach session with a few minutes ofstretching exercises.

CONTINUED ON PAGE 13

10

11

Problem: Aching neck and uppershoulders while working on thecomputer.Solution: 20/20/20 rule: Every 20seconds; look 20 feet away; for 20seconds. Also, have a spray bottleof BioFreeze on hand.

Problem: An employee has beenat the same job for 10 years andrecently c/o tight muscles, strain-ing, & tingling. FYI: Overall, thisemployee is deconditioned.Solution: Be aware that non-workfactors increase CTD risk: poorphysical condition, smoking, poornutrition, personal stresses, previ-ous injuries, aging, and certaindiseases can reduce the body'stolerance to stress. Learn how tominimize your risk for injury whileyou are living the rest of your life,

outside of work. Learn moreabout the identification, preven-tion, and treatment of CTD’s. Themore you know, the better you willbe able to treat yourself. All goodsolutions start with knowledge.Self-care is critical when you areinvolved in everyday activities thatcan influence CTDs, such as: TVand computer games, home com-puter work , painting, home con-struction projects, sewing, artsand crafts, applying makeup, set-ting hair, playing musical instru-ments, racquet sports, golf, motor-cycle and bike riding, cooking,housework, and gardening. Some suggestions to helpdecrease symptoms:*Ice massage*BioFreeze spray or roll on*Massage*Stretches

*Vitamins*Re-position frequently*Get up and walk for 10 seconds(if you sit for extended periods)

Problem: Poor workstation designrequiring extended reach.Solution:Keep most-used materi-al close to the body; within armsreach. Stand to reach anythingabove your shoulders. Keep yourelbows directly under your shoul-ders.

Ergo Tips and Tricks

modified from: working well ergonomics

Everyday

Occasional

Non-working Area

The FIRST and ONLY CLUB dedicated to the Hand Therapy Community

YOUR EXCLUSIVE MEMBERSHIP IS JAM PACKED WITH BENEFITS!

JOIN TODAYwww.exploringhandtherapy.com

MEMBERSHIP INCLUDES all this and MORE...

* Free DVD or CD-ROM course with Annual Membership * Club member discounts* Interactive Discussion Board * Case studies presented for open discussion * Q and A on the discussion boards * Live Chat* 20 page magazine mailed to your home quarterly* Network with other therapists * Prepare for the hand exam by networking and MORE.

12

13

"Usually, improvement is seen thevery first time the tools are used,"she says. "I can often count on see-ing improved range of motion on theorder of 15% to 20% at the end ofthat initial usage. Pain also will beappreciably reduced."

Maurer says she continues ISTMuntil either the patient achieves whatshe deems sufficient flexibility andmovement, or is indicating a sub-stantial decrease in pain.

Only in the rarest of circumstancesdo the instruments yield little or noimprovements in patient conditionover time. Even so, Tank contendsISTM ranks among the finest inno-vations she's seen during her nearly35 years in practice.

"ISTM is a very valuable addition tothe toolkit I have at my disposal inworking with patients," she says.

"And I'm not the only one in thiscenter who thinks that. These toolsnever sit idle during the daybecause they're constantly in use -from the moment we open up in themorning until the time we close upfor the evening. When somethingworks, you stick with it. This works."

For more informationabout instrument-assisted soft-tissuemobilization and training coursesoffered in your area, visit www.gras-tontechnique.com, or call888.926.2727. If you prefer, write to3833 N. Meridian St, Suite 307,Indianapolis, IN, 46208-4040.)

Mary Sue Tank’s StoryISTM puts therapists on a new track.Many hand therapists who useinstrument-assisted soft-tissue mobi-lization (ISTM) first learn about itfrom colleagues. Such was the casefor Mary Sue Tank, OTR, CHT, staff

therapist at St. Vincent Physical-Occupational Therapy Center inCarmel, Ind.

Actually, the colleague who broughtISTM to Tank's attention also hap-pened to be her physical-therapisthusband. Back in the mid-1990s, hehad become a proponent of theinstrument-assisted technique. Athome, around the family dinnertable, he would discuss with Tankthe patients he'd seen earlier in theday and talk about the good resultshe was obtaining with ISTM.

Tank, eventually became intriguedenough by the concept of ISTM thatshe asked her employer at the timeto consider acquiring a set of toolslike those her husband was usingwhere he worked.

Unfortunately, her request wascontinue page 18

14

1. A 12 year old girlhas bilateral sym-metric radial andpalmer curving ofthe tips of her littlefingers. Whatmight the diagnosisbe?

2. What positionshould you splint apatient after a boxer's fracture of the5th metacarpal neck?

3. After a styloidectomy of theradius what ligament is disrupted?

4. What tissue is responsible forDupuytrens contracture involving theMP joint?

5. What nerve passes through thequadrandgular space?

6. What are blood carrying struc-

tures thatsupply eachof the flexortendons in the digits called?

7. What is the bump on the distalradius termed. Hint: It is used ananatomical landmark.

8. What is the most effective way todiagnosis RSD/CRPS?

9. Distal radioulnar joint disruptionin association with a displaced radialhead fracture and proximal migrationof the radius describes what injury?

10. List some provocative tests forTOS.

IN THE WEB

Test Your Knowledge... POP Quiz!

Answers on page 16

EHT has gathered some infor-mation from the “Net” abouttrigger point and myofascialtheory and therapy. Enjoy!

**Some good info on triggerpoints and a workbook that isavailable (EHT has no clue aboutthe workbooks content - let usknow if you like it:

**This was a nice article onTrigger Point Diagnosis and Management written by 2 D.O.'s

**FUN STUFF for the reader.This site has some trigger point

charts, hand charts, models andfun things like a glow in the darkfinger bone pen - check it out.

**This site is the internationalmyo- pain society.

**Nancy likes this book on triggerpoints. Good photos and instruc-tions. The Manual of Trigger Pointand Myofascial Therapy by:Dimitrios KostopoulosKonstantine Rizopoulos

et the Newly Revised "PURPLE BOOK!" Signed by the Authors!

Hand Rehabilitation a QuickReference Guide and Review,

2nd Edition by Weiss & Falkenstein

Order Now atwww.treatment2go.com

http://www.triggerpointbook.com/triggerp.htm

http://www.aafp.org/afp/20020215/653.html

http://anatomical.com/catego-ry.asp?c=14&ci=1

http://www.myopain.org/

http://www.slackbooks.com/view.asp?SlackCode=45422&CatID=1

15

HOW DID YOU THEY DO IT!!Exploring Hand Therapy (EHT) is bringingyou a great section devoted to talkingwith recently Certified Hand Therapistsand how they DID IT!! EHT will includecoments from recently certified handtherapists as they share their advice.EHT has included some questions wesent to the recently certified hand thera-pists asking how they did it. Lets seewhat they have to say.....

THANK YOU! THANK YOU! THANK YOU!After my THIRD try I was finally able to passthis *&^%$##@@ exam. I first took it thesecond year it was offered, the "year of con-troversy." The second time I took it was in1998, and finally this year ("Third time is acharm" was my mantra) The first two timesthere were NO study materials such as yourpractice exams and the RSD course. I wasactually planning on writing to you, as yourstudy materials were THE BEST of every-thing there was to study. The format, thereferences, the explanations, and the clinicalgems (LOVED the clinical gems) all madethis exam much more do-able. Am I better atherapist for it? You betcha! AND I passedTHE exam!

THANK YOU! THANK YOU! THANK YOU!Not only for the conception of practiceexams, but also for all the wonderful workwith your on-line courses and that terrificnewsletter. I hope you have many, manyprofitable, fun-filled years to come!Christie Sternbach-Feist, MA, OTR, CHT

Q: When did you begin preparations forthe exam? MayQ: How many hours did you put intostudying for the exam? We had 2 hourweekly study groups, as well as independentstudy on the weekends. Around September,we started looking over material 1-2 hours inthe evening as well as on the weekends.Q: Did you participate in a study group?If yes - was this helpful. VERY MUCH. Afew times there was a question on the testand I remember one of my study buddiestalking about that very subject. It also helpedme cover more topics and beef up on myweak areas.Q: What study resources did you use? Ofcourse the purple book, the study test ques-tions, the yellow books, Hand Secrets.Q: What resources were most helpful?The purple book and the study test ques-tions.Q: Did you feel prepared for the exam?Yes, I still had a few areas of weakness (e-

stim and tendon transfers)Q: What else would have been helpful forpreparation of the exam? More studyquestions and info on specific parametersfor the different e-stim units, especiallyTENS.Q: What other suggestions do you havefor future students preparing for the handexamination? When you are studying, andthink something isn't that important and wantto breeze over it...Don't! It will probably beon the test.Christina DeRoia, OTR/L, CHTMayo Clinic - Jacksonville

Thank you very much.I purchased both practice exams and foundthem to be helpful in determining my weakareas. Also, the Purple Book 2nd editionwas a great study tool the last few weeksbefore the test.Thank you both for helping me pass the testand for your dedication to our profession.

Sincerely,John E. Duffy, OTR/L, CHT!!!

Q:When did you begin preparations forthe exam?Formalized studying 6 months before theexam. However, I have been preparing for acareer in hands and the CHT even back tomy MPT coursework in graduate school, 5+years ago. I took an elective course in handand upper extremity the last semester of myprogram. I also completed a clinical affilia-tion at the Curtis Hand Center in Baltimore.I had the privilege of working at a very busyhand center with a strong resident/fellowprogram. We were able to attend weeklylectures/case presentations offered bythe chief of the hand/upper extremity divi-sion. Q: How many hours did you put intostudying for the exam?Approximately 5 hours per week until Sept.and then it was 10-12 hours per week fromSept. up until the exam.Q: Did you participate in a study group?If yes - was this helpful?No, I did not participate in a study group.Q: What study resources did you use?-Rehabilitation of the Hand; Hunter, MD, Etc.-Hand Secrets; Jebson, MD, Kasdan, MD-Hand Rehabilitation A Quick ReferenceGuide and Review; Falkenstein and Weiss-Practice Exams offered by Exploring HandTherapy (EHT)-Self Assessment exams offered by ASSH-In-services given by my CHT colleagues

-CD offered by ASHT-Attending the PhialdelphiaMeeting in March-Clinical Affiliation at The Curtis Hand CenterinBaltimore-EXPERIENCE in the clinic

Q: What resources were most helpful?***EXPERIENCE!*****Rehab of the Hand for knowledge on exten-sor/flexor tendons.*Hand Rehab reference guide (Purple Book)and review and theExploring Hand Therapypractice exams for all other material.Q:Did you feel prepared for the exam?Actually, yes. That is until I completed theexam.Q: What else would have been helpful forpreparation of the exam?For this particular exam, a bit more studyingabout modalities.Q: What other suggestions do you havefor future students preparing for the handexamination?Research, explore, and gain acccess toevery resource possible. This is especiallytrue for those clinicians who are not treatinghands for the majority of their case load.

Jennifer Thompson MPT, CHTPRO Physical Therapy - Hand and UpperExtremity Center, Delaware.

Q: What study resources did you use?THE PURPLE BOOK. THE PURPLEBOOK, and oh did I mention THE PURPLEBOOK! I also bought the Comprehensive ReviewCD ROM by Nancy and Susan,Rehab of the Hand, Fundamentals of HandTherapy, and The Interactive Hand. I basi-cally sacrificed buying new clothes for theyear to have the best materials out there.Q: What other suggestions do you havefor future students preparing for the handexamination? THE PURPLE BOOK, THE PURPLE BOOKand I forgot one...... THE PURPLEBOOK! Q: Did you feel prepared for the exam?YES! Between THE PURPLE BOOK! andthe Comprehensive Review CD ROM, I feltlike I had it all! (I sound like WhitneyHouston) Dana Eber, OTR/L, CHTOrthopedic Care Center- Aventura, FL

Tell Me Some Secrets..... PLEASE!

16

1. Kirner's deformity

2. MP flexion and PIP extension

3. Radial collateral ligament

4. Pretendinous bands

5. Axillary

6. Vincula

7.Lister's tubercle

8. Clinical exam

9. Essex-Lopresti lesion

10. Adson's test, costoclavicular maneu-ver, Wright's hyperabduction maneuver

Answers to Test Your Knowledge

****IMAK has some great prod-ucts for computer use and CTD’s.The Smart Glove is nice becauseit can be used with either hand.Plus, it provides light support butdoes not interfere with use of thehand. It is great for conservative-ly treating carpal tunnel syndromeas the splint cushions and pro-tects the volar wrist. Also, youknow how the ulnar wrist can beproblematic; well the smart gloveprotects the pisiform bone pre-venting and relieving FCU ten-donitis. You have got to try thisglove. (see ad on page 4)

Also another product I have hadgreat success with is the IMAKPil-O-Splint. I have used theelbow Pil-O-Splint often for cubitaltunnel and lateral epicondylitis.

Try it, patients’ love it!

****Exploring Hand Therapy canmeet all your hand therapy needs.We offer an interactive hand clubforum, the Journal of HandTherapy, Networking, Study aids,and quality education to earn yourCEU’s. Visit us online at: www.exploringhandtherapy.com

****BTE has acquired a newname... BTE Technologies.Nancy has the BTE Primus andshe loves it. She often feels it islike having an assistant with her.Currently, BTE has a trade-in pro-gram. You can upgrade and getmoney for your older equipmentuntil June 30. Call and ask themabout their trade in program orvisit: www.btetech.com

Pssst! Did you Know.........

17

18

refused on the grounds that it wouldcost too much from the particularsource to which Tank had pointedher bosses.

Several years later, when Tank washired by St. Vincent, she made asimilar request. This time, though, itturned out that her new employerwas already considering acquiringISTM tools, only from a differentsource, the Graston Technique®,whose offerings were significantlyless expensive but equally if notmore effective than those Tank hadpreviously sought.

Evidently, Tank's was not a lonevoice - St. Vincent administratorshad been fielding from otheremployees unprompted requests forISTM tools, and that's what got theball rolling on their decision to atleast explore the possibility of buy-ing.

Following an evaluation of theGraston Technique products,administrators became convincedthe instruments would make a goodinvestment, so they ordered severalsets and also arranged for staff tobe properly trained, a requirementby the company, prior to purchasingthe instruments. Tank was amongthe first to step forward when thecall for training-course volunteerswas issued.

That was in 2000. Since then, she -and her colleagues - have beenusing the instruments on a dailybasis. Numerous out-patient facili-ties in the Indianapolis-area utilizeGT, including PhysiotherapyAssociates and CommunityHospital, which has more than 65GT-trained clinicians at its five sites.

Lori Hiatt, OTR, CHT, withOrthoCarolina in Huntersville, N.C.,discovered Graston Techniqueinstruments for ISTM in October,2004, while attending an AmericanSociety of Hand Therapy confer-ence in Charlotte, N.C.

Impressed by the ISTM demonstra-tion conducted by GT representa-tives, she volunteered for a demon-stration at the convention - andcame away a believer. A monthlater, she attended a formal 12-hourtraining course. ISTM now is a pri-mary intervention in her day-to-daypractice.

Byline for the Graston Technique article:ByScott Smith, freelance writer from the LosAngeles area who specializes in the health-care field.

Q: What is a trigger point?

A: Janet Travell and DavidSimons, "Myofascial Pain andDysfunction, The Trigger PointManual, vol 1," define a triggerpoint as "a focus of hyperirritabili-ty in a tissue that, when com-pressed is locally tender and, ifsufficiently hypersensitive, givesrise to referred pain and tender-ness."

Q: What are some commontrigger points in the upperextremity?

A: There are multiple upperextremity myofascial triggerpoints which contribute to severalpain patterns and syndromes.For example, trigger points in thescalenes, subscapularis and pec-toral muscles refer pain distallyinto the arm.

Q: Please discuss referredpain and some examples in theupper extremity.

A: Referred pain is pain felt atsite distant from its source.Upper extremity myofascial trig-ger points refer pain in specificpatterns. For instance, referredpain from a trigger point in thepectoralis minor muscle is locat-ed over the front of the chest andanterior shoulder on the sameside and may extend down themedial arm, ulnar border of theforearm and fingers.

Q: What are the various treat-ment techniques that can beused to treat trigger points?

A: A variety of methods are usedto treat trigger points, includingischemic compression, heat,quick icing followed by a stretchof the involved muscle, and localinjections.

Q: Please review the differencebetween inactive, latent andactive trigger points.

A: An inactive trigger point is nottender on palpation and does notrefer pain. A latent myofascialtrigger point is not painful unlessprovoked through palpation butmay have associated stiffness.An active trigger point is con-stantly painful and may refer painat rest as well as with motion.

Q: What is fashia?

A: Fascia is a type of connectivetissue. It is pervasive networkthroughout the body. Fascia sur-rounds and invests the organs,vessels and neuromusculoskele-tal system.

Q: How is it different frommuscle?

A: Muscle is a contractile tissue.Fascia is extensible upon stretchand has varying degrees of elas-tic qualities, however, it cannotactively contract.

Q: Is massage the same thingas myofascial release?A: Although some may use theterms massage and myofascialrelease interchangeably, they arenot the same technique.

Q: What exactly is myofasialrelease?

A: Myofascial release (MFR) is aform of manual therapy used totreat soft tissue dysfunction.There are different MFRapproaches. According toManheim and Lovett in the text,"The Myofascial ReleaseManual", the myofascia is firstpalpated to determine the area ofrestriction or tightness. A sus-tained, light stretch is applied tothe tight area in the direction ofthe restriction. Some approach-es refer to the restriction as a"barrier". The therapist waits forthe tissue to relax and thenincreases the stretch. Theprocess is repeated until the areais fully relaxed. Then, the nextarea is stretched. The lengthand direction of the stretch iscontinually guided by propriocep-tive feedback the therapistreceives from the patient's bodyresponse.

Thank you Lori and GrastonTechniques.

From the Experts!This month’s featured expert...Terri Loghmani

19

8318 40th Place NorthSt. Petersburg, FL 33709

www.exploringhandtherapy.com727.341.1674

PRSRT STDU.S. POSTAGE PAID

ST. PETERSBURG, FLPERMIT NO. 2219

Do you want to learn updated modality intervention techniques, includingcold laser therapy?

Do you want to learn from the leading educator in the modalities industry, Paul Bonzani OTR/L CHT?

Do you want to learn right from home, just by watching a DVD or CD-ROM?

If you answered yes to any of these, then EHT has the course package for you!

Order Now at www.treatment2go.com Or call 727-341-1674

Exploring Hand Therapy (EHT) offers a five part modality course 34 contact hours or 3.4 AOTA approved CEUs.

You will view Paul Bonzani OTR/L, CHT as he takes you from theory, research to clinical application in parts 1-4 for 18 CEUs ... only $399.00 Need more hours for your state requirements? No problem!

EHT offers Part 5 (E-Book) to get 16 additional contact hours for only $99.00

This is the way to learn!

Have you completed your state requirements for modalities certification?

Keep Scrolling to learn about our greatmodalities course!!

ATTENTION CALIFORNIATHERAPISTS: EHT’s

Modality courseis APPROVED!