Physio Charlie

Upper limb disorders Occupational aspects of management

This is a very up to date look at the evidence for the management of ULD's in the workplace.  As with a lot of research, the only good evidence they have found is that multidisiplinary treatment with a biopsychosocial approach for non specific arm pain and changing a keyboard for carpal tunnel are better than usual care.

I have a new website!!

http://physiocharlie.vpweb.co.uk

My friend recently severed two of the extensor tendons of her right hand about 3 months ago.  She had surgery to repair the tendons and she has been having physio weekly since then.  She has been wearing a splint daily and now has been told to only use it when going out in case she bangs her hand.

She has recently c/o increased hair growth and sweating on her affected hand and a sharp shooting pain in her palm that travels proximally to her elbow.  The site of the injury was on the dorsum of her hand so this was a bit strange.  She says she has difficulty moving her wrist and fingers now as they "do not know how to move".  She has slight purply discolouration of her skin on the affected arm and her skin is very sensitive, so much so that she feels "sick" when it is touched.

This all rang alarm bells with me.  I had had a patient a few year ago with similar symptoms and she had RSD or Complex regional pain syndrome as it is sometimes called.  I told my friend that it was related to increased sympathetic nervous system activity and said TENs/contrast baths and normal movement would help it.  I am not treating her as she is having physio elsewhere but I decided to research RSD in a little more detail. 

What is RSD?  See this leaflet for an in-depth explanation:  rsdukleaflet.pdf, RSDguidelines.pdf

The RSD UK website is very good for information and support for patients:  http://www.rsd-crps.co.uk/