SHAUN STANLEY/Durango Herald
When patients come out of surgery they’re only part way to full recovery. Still to come is therapy to regain their pre-operative physical condition.
It’s certainly true of hand therapy, said Mary Oswald, owner of San Juan Hand Therapy.
“People come to us scared, afraid they won’t be able to work or return to normal activities,” Oswald said. “We like to see them through to the end, so they’re able to do what they love to do.”
The hand/wrist is a delicate area, Oswald said. The 27 bones in the hand, eight bones in the wrist and eight tendons in the thumb are needed for even small activities.
“Even a small problem can affect the whole balance of the hand and the ability to take care of oneself,” Oswald said.
Dr. Gareth Hammond, an orthopedic surgeon in Durango, said therapy is critical to recovery.
“In general, I can’t think of a hand, wrist or elbow surgery that doesn’t require therapy to regain movement,” Hammond said Thursday.
Hammond said that elbows and shoulders, in the same category as fingers, hands and wrists, are notorious for being very stiff after surgery.
Therapists are valuable for educating patients about how to end up with a fully restored appendage, Hammond said.
Trudy Callison, four weeks into therapy with Oswald, can testify to that.
Just normal use of her hands for 67 years wore out the cartilage in the joint at the base of her right thumb, Callison said during a session last week. She compensated by becoming a southpaw when answering the phone or manipulating a computer mouse.
She put up with bone on bone for a year until one day she dropped a bottle while pouring wine.
“That was the end of the line,” Callison said. “I booked surgery.”
Surgery in late March removed bone and a bone spur and replaced it with tendon from her own arm. Therapy, focused now on regaining motion, soon will concentrate on regaining normal strength, still six to eight months out.
“But I’m weaning myself off my arm brace,” Callison said.
Rachel Warren, 35, a fourth-grade teacher in Aztec, was at a station next to Callison with therapist Kate Smail.
In early March, she broke the first bone in the middle, ring and little finger on her right hand when she stepped wrong out of her back door and fell to a concrete pad.
The surgeon inserted nine metal pins to stabilize the bones and capped the ends with tiny metal balls to keep the pins from shifting.
“It’s the most pins I’ve seen in one hand,” Smail said.
In the classroom, Warren used her left hand to write.
“I did that for a month until I switched back,” Warren said. “I still write a little sloppy, but it’s getting better.”
Warren’s hand is again flexible enough to grip the handle bars on her bicycle and shake hands.Oswald, who’s been in business for 17 years, employs two certified hand therapists – Lani Beattie and Kate Smail. Beattie also is certified to treat lymphedema, tissue swelling caused by a compromised lymph system, a condition often occurring in women after a mastectomy.“Our first goal is to decrease swelling and pain and increase the range of motion,” Oswald said. “Further down the road we work on bringing strength back to normal.”Therapy for a tendon requires a balance between protecting it but using enough manipulation to prevent the formation of scar tissue, Oswald said. The use of a cast would allow the tendon to heal, but it would be completely stiff.Splints range from one that immobilizes to protect an appendage to a functional splint that offers support but allows patients to work or garden or ski.
Dr. Kane Anderson, a Durango orthopedic surgeon, considers therapists as part of a team.
In complicated cases, Anderson said, he may have one of Oswald’s therapists watch the surgery in order to better gauge what post-operative treatment will be needed.
“We work collaboratively,” Anderson said. “They have different training and so can teach me things.”
Physical therapists treat most joint injuries, but hand injuries require specialized training, Oswald said.
A certified hand therapist needs a doctoral (not medical) degree in physical therapy or a master’s degree in occupational therapy; five years of experience in either field; and 4,200 hours of upper extremity work (which can fall within the five years) to qualify for a national certification test.
Hand therapists see patients with carpal tunnel syndrome, arthritis, fractures, burns, tendonitis and tennis elbow. They get walk-ins as well as referrals from workers compensation doctors, orthopedic and plastic surgeons and family practitioners.
Therapy is relevant to all ages, Oswald said. She’s had patients from a 2-month old boy to a 98-year-old man.
Courtesy of Rachel Warren