Hand Therapy recommnedations (fracture, x-rays, pain, cold)
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Hello,
I fractured one of my pinkies a few months ago but since the pain went away mostly and I was able to bend the finger I didn't seek help for a couple of months until I realized that I could not completely straighten my finger and sought care.
So now cut to about 5 weeks ago I go to a highly recommended hand therapist after my doctor x-rayed and determined that I had a "mildly displaced fracture."
I have basically been getting my finger casted weekly and having some physical therapy at each session too straighten it out. That seems to be successful as I have gotten to about 95% straight.
The issue is this second phase. After being assured that the hard part was over - the straightening - the bending will come with time. Tehy were saying 3 or so weeks.
I was given a separate finger splint with a couple of straps and told to do bending exercises throughout the day.
Well I have been trying the exercises for the last 5 days and it has not been going well. The pain I am having feels worse than the initial break. My finger swells after doing just a few and I am losing the straightness that I gained over the last 5 weeks (and about $600 in already)
I have put in a call to my therapist as this is the exact opposite of what they led me to believe.
So question.
I know that everyone is different but has anyone out there had this experience where they were trying to fix a small finger fracture - not surgically - and had gotten to the bending phase and had great pain trying to get the movement back to their digit?
They did a follow up x-ray to make sure everything looked OK before they started me bending the finger so I am assuming that there were no issues there.
There are 3 joints in the pinky. If you look at the palm side of your hand you will see the 3 lines indicating each joint. To get the finger to bend better you need to address each joint individually. Start with the joint at the top of the finger.
Place your opposite hand thumb just below the line in the finger and then try to bend it. Repeat a few times at each joint.
Another thing you can try is fill up your sink with cold water and try gently squeezing a big car washing sponge. The cold water will help reduce the swelling.
A little bit of swelling in the joints and tendons will really prevent motion. Ice and massage help reduce the swelling.
NSHL10 ,
Thank you for the reply. The exercise you describe is the exact one they recommended to start out with.
That way I have limited movement but not much pain. The issue is what happened after I started that.
It was when I combined it with the exercise that is supposed to get me my ability to bend my finger again that the issues started.
Despite using the splint, I keep having my finger swell after the lighter exercise and I have lost about 15 degrees of extension in about 5 days.
I just came back from my latest pt visit and asked a bunch of questions.
Their answers were along the lines of "everyone is different " and" we have to wait and see"
I am averaging about $90 per visit until I hit my threshold and this is starting to get expensive. ( close to $700) for this last one.
They have added a laser to reduce the swelling but at this point I am slightly worse off than I was before I started 6 weeks ago.
I know it is my fault that I didn't go to the doctor right when the accident happened but I am worried that I missed my window for healing and I'm not sure how much having a finger I can extend approximately 8 degrees more than what I could at the start is worth to me.
How much hands on stuff are they doing? Ask if they are cleared to do joint mobilization yet. That is what will get the joints moving, but you need to be sure the fracture is healed enough to do it.
Swelling control is really important. Somethings I have tried with patients in the
past are wearing an isotoner glove to keep compression on the finger or wrapping it with half inch wide Coban wrap which you can get in a drug store.
Another activity to help gain motion is put a thin kitchen towel on your wood table. Put your palm in the middle of it. Scrunch the towel together to strengthen finger flexors, then spread it out to strengthen the extensors.
Everyone thanks for your help on this. I have not had a chance to answer yet because I have been slammed at work.
NSHL10 regarding hands on stuff there has not been a lot to be honest. They are rubbing my finger a little with some cream and doing a "laser treatment" which looks like a low grade ultra sound. It feels a little like needles.
The only thing they have done over the past weeks is when they would take off my cast was to put it on a board to stretch it out for about 5 minutes. then I would be let go.
now since I have told them that I look to be getting worse - went from 6% extension down to 16% they are trying to come up with ways to help.
It really seems like they expected me to proceed right away.
I am doing the coband with the splint and that keeps the swelling down. The pain is still there however. I will try the kitchen towel exercise.
novadogs - I have looked them up in your listing and while my therapist is not on the list one of the women in the office - who has been advising her - is. For whatever that is worth.
What I still don't understand is this.
If i fractured my finger and for whatever reason it "healed" in the wrong position why was I able to recover use after the initial injury without this type of pain? If i move my finger too much it hurts worse than the initial break.
If I don't move it at all it doesn't hurt.
I will ask about joint mobilization. I thought that is what they were trying to have me do with moving all of my fingers - including the hurt one- at the same time. That still hurts.
They took their own x-rays after my initial splinting so when I asked about it they said that it only shows bone. If it doesn't show the tendons then why keep taking xrays?
I am starting to really worry. It may be that I have to start this all over again and i had a planned vacation at the beginning of October but if I have to keep spending $100s of dollars to begin this journey all over again then that may not happen.
Honestly, they haven't been doing too much. There is a lot more that can be done: dynamic splinting to help increase the motion, soft tissue work to the tendons to make sure they are flexible, progressive strengthening exercises for the finger tendons etc.
The laser is great, but is not a substitute for hands on therapy.
Are these people in your insurance network? I would tell the office manager I am.unhappy with the results so far and due to the specificity of the injury, I would like to be seen by the certified hand therapist.
What has the doctor said about this during follow up visits?
Well my next appointment is tomorrow Thursday 5/27. I will have to have a come to Jesus moment with them.
Again thank you for the advice.
I really do agree that they have not done much. I am reading everyone's advice here and realized that over the last 10 years I have been to physical therapy at about 4-5 different places for different injuries. (sesamoiditis - foot, jumpers knee and back issues)
The small amount of actual hands on with this place is about what the other places - even the sub par places - would have done as part of the warm up to loosen the joints in order to get down to work.
My appointments have not exceeded 20 minutes so far which is also not the norm for physical therapy.
I will ask about soft tissue work and additional splinting.
When you say doctor what do you mean my primary care physician or the physician's assistant that I have seen at this office?
He has interacted with my a few times but mainly for checking to see where I was in the initial meeting and after 5 weeks of casting.
Well my next appointment is tomorrow Thursday 5/27. I will have to have a come to Jesus moment with them.
Again thank you for the advice.
I really do agree that they have not done much. I am reading everyone's advice here and realized that over the last 10 years I have been to physical therapy at about 4-5 different places for different injuries. (sesamoiditis - foot, jumpers knee and back issues)
The small amount of actual hands on with this place is about what the other places - even the sub par places - would have done as part of the warm up to loosen the joints in order to get down to work.
My appointments have not exceeded 20 minutes so far which is also not the norm for physical therapy.
I will ask about soft tissue work and additional splinting.
When you say doctor what do you mean my primary care physician or the physician's assistant that I have seen at this office?
He has interacted with my a few times but mainly for checking to see where I was in the initial meeting and after 5 weeks of casting.
The doctor who gave the prescription for PT.
It sounds like this is a doctor or corporate owned PT office. You don't always get the best therapists working at these offices. Really good therapists tend to want to open their own offices.
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