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Hand Overuse Injury? Occupational Therapy May Come to the Rescue

From manufacturing to computer jobs to the demands of being a professional chef, the hazards of hand overuse injuries are real. In the U.S., there are over 213,835 assembly line workers who do repetitive motions like gripping and lifting. Then there are the 147,434 U.S. chefs who prepare dishes — performing the same motions daily. Beyond that, millions of Americans engage in data entry or use a computer daily.
If an employee is diagnosed with a hand, wrist, or elbow problem—and surgery is premature or not indicated—physicians will often refer patients to occupational therapy, a proven and cost-effective way of getting people back to work promptly. Upstream Rehabilitation, the nation’s largest dedicated outpatient physical and occupational therapy provider, performs enhanced rehabilitation at many of its locations throughout the U.S.
Whether employees are contending with carpal or cubital tunnel syndromes or other hand conditions, such as arthritis at the base of the thumb, working with an occupational therapist—either as a standalone treatment or postoperatively—is a time- and expense-saving way of getting employees back to work quickly.

Common hand conditions include:

Carpal Tunnel Syndrome

The carpal tunnel is a narrow passageway of ligament and bones in the wrist and base of the hand. Carpal tunnel syndrome occurs when the median nerve is compressed by inflamed ligaments and tendons.
Carpal tunnel syndrome is the most frequently diagnosed upper extremity musculoskeletal condition and often involves pain or numbness in the hands. The fingers may feel swollen, and a burning or tingling sensation can occur; pain may worsen at night. Failure to treat carpal tunnel syndrome may lead to long-term nerve damage, which could result in permanent weakness, numbness, and tingling.
But rushing to the OR isn’t necessarily the answer. There is evidence that an occupational therapist-led pathway reduced conversion to carpal tunnel surgery and increased perceived improvement and satisfaction in people who were on a waitlist for a surgical consultation.
Globally, occupational therapy has been demonstrated to result in dramatic cost savings by improving function, increasing return-to-work rates, reducing disability claims, and decreasing dependence on prescription medications.

Management of Carpal Tunnel Syndrome

Managing carpal tunnel syndrome isn’t necessarily complicated. For those who type a lot, one easy measure is to use light strokes instead of pounding on the keyboard. Other tips include keeping one’s wrists in a neutral position — as opposed to bending — maintaining good posture and adjusting desks or chairs. It is also helpful to take frequent breaks from work and mix up tasks to give overworked muscles some relief. Lastly, wearing a splint at night or during activities helps keep the wrist straight.

Occupational therapists can help by working with employees on exercises such as

• Wrist Extension
Hold one arm straight out in front of the body at shoulder height. Try not to lock the elbow when stretching the arm out. Bend the wrist back as if making a “stop” sign. Use the opposite hand to gently pull the palm back toward the body to feel a stretch in the inner forearm.
• Wrist Flexion
Extend one arm in front of the body at shoulder height. Try not to lock the elbow when stretching the arm out. With the palm facing down, bend the wrist, so the fingers point toward the floor. Using the other hand, gently pull the bent hand toward the body to feel a stretch in the outer forearm.

Cubital Tunnel Syndrome

After carpal tunnel syndrome, cubital tunnel syndrome is the 2nd most frequent compression neuropathy of the upper limbs. Repetitive elbow bending—as with reaching, or lifting—can result in cubital tunnel syndrome, i.e., compression of the ulnar nerve. The ulnar nerve travels through the cubital tunnel — comprised of muscle, ligament, and bone — and runs from the neck into the hand. If this nerve is compressed behind the inside part of the elbow, inflammation and irritation may occur.
Patients with cubital tunnel syndrome often present with “pins and needles” sensations in the forearm and hand. Numbness and pain along the inside of the forearm, as well as part of the fourth and fifth fingers, may also occur. In addition, patients may experience hand weakness and frequent dropping of objects. Expedient treatment is recommended as left untreated, cubital tunnel syndrome can lead to irreversible nerve damage, resulting in a loss of function of the forearm and hand.
The appropriate level of treatment is vital, however, as one study found a growing number of discontent individuals receiving possibly unnecessary surgery, which has resulted in the number of surgeons considering conservative therapy for cubital tunnel syndrome.
Regarding cost, it is estimated that the direct charges of surgical intervention for cubital tunnel syndrome (from the index surgery to 90 days post-op) are a mean total of $9,297.13.

Management of Cubital Tunnel Syndrome

To manage cubital tunnel syndrome, employees should keep arms flexible and strong—and warm up before repetitive movements. Avoid resting on the elbows (especially on hard surfaces) and consider cutting back on activities that may exacerbate symptoms, such as tennis or golf. Also, keeping the arm straight while at rest and wearing a splint during sleep (to prevent the elbow from bending) and while playing sports can help.

If the employee’s physician suggests rehabilitation, then the occupational therapist may work with the employee on exercises such as

• Elbow Flexion and Wrist Extension
Sit tall and extend the affected arm out to the side, level with your shoulder, with the hand facing the floor. Extend your wrist and pull your fingers up toward ceiling. Bend your arm and bring your hand toward your shoulders.
• Head Tilt
Sit tall and extend the affected arm out to the side with elbow straight and arm level with your shoulder. Turn your hand up toward ceiling. Tilt your head away from your hand until you feel a stretch. To increase the stretch, extend your fingers toward the floor.
Arthritis at the Base of Thumb
Thumb arthritis, often a type of osteoarthritis, involves the wearing away of cartilage at the base of the thumb. It is estimated that up to 15% of the population over 30 suffers from symptomatic thumb basal joint osteoarthritis.
Mechanics, sewing specialists, or chefs, who tend to hold their thumb in the pincer grasp, are frequently affected. Repetitive movements or previous trauma or injury to the thumb joint also can cause thumb arthritis. Patients with thumb arthritis may experience swelling, aching, discomfort, or tenderness at the base of the thumb. Range of motion typically becomes limited, with the base of the thumb appearing enlarged or bony, and a loss of thumb joint strength may occur.

Management of Arthritis at the Base of Thumb

Because symptoms of thumb arthritis can be aggravated by forceful or repetitive pinching, grasping, and twisting, experts recommend devices such as electric can openers to protect the thumb joints. Patients with thumb arthritis are cautioned against exercises such as squeezing a ball because gripping and pinching tend to aggravate the condition. What may be helpful is using a splint to support your joint, and limiting movement of the thumb and wrist.

An occupational therapist may work with employees on exercises such as

• Thumb Metacarpophalangeal Flexion
Place forearm and hand on a table (affected thumb points up). With other hand, hold base of thumb and palm steady. Bend thumb downward where it meets palm, then straighten it.
• Thumb Interphalangeal Flexion
Place forearm and hand on a table (affected thumb points up). With other hand, hold thumb steady just below the joint nearest thumbnail. Bend tip of thumb downward, then straighten it.
When management strategies fail
In the event that surgery is recommended for any of the above conditions, postoperative rehabilitation can mitigate some post-surgery costs and help get patients back to work in a timely manner.
When a physician has referred an employee to occupational therapy, connect with Upstream Rehabilitation, whose nationwide family of brands offer robust physical therapy and occupational therapy programs to get patients back to work as soon as safely possible.
Find a convenient Upstream Rehabilitation location near you. Learn more about how Upstream Rehabilitation can help you or your employees get back to work.


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