Need a hand with hand? Call hotline

LeAndra Brush calls 2007 the "Year of the Saw Injury."

That's been a common trauma treated by hand specialists recently at The Orthopedic Specialty Hospital. And when it happens, patients have to deal with nerve, bone, circulatory and tendon injuries in one small package.

It's among the most complicated of hand traumas from which to recover, says Brush, a certified hand physical therapist.

They also have seen a number of basic fractures, many of them caused by falls.

Hands (and wrists and elbows) that hurt — whether from injury, arthritis or overuse — are the topic of today's Deseret Morning News/Intermountain Healthcare Hotline. From 10 a.m. to noon, Brush and certified hand occupational therapist Scott Nobis will take phoned-in questions.

Many traumas require surgery, and scarring is always an issue with hands, she said. While a hand that has been fractured and perhaps even has a plate and screws as part of the repair needs protection, it doesn't need as much as a tendon that has been sewn back together. In that case, rupture is a real possibility.

Tendons, though delicate, do heal if handled properly. Then it's a matter of regaining motion and strength.

Promoting healing means protective splint and lots of precautions, along with specific exercises when the time comes. Because "scars are huge in the hand," some patients need a second procedure to free up the scarring, Brush said.

"There's a lot of tissue in a really small area," she said, "and not much adipose tissue to protect it. You end up with scarring being a huge problem with every patient that walks in the door." Even inflammation from arthritis can cause scarring.

They also see a fair amount of distal bicep repairs, where the bicep crosses the elbow. A decade ago, they'd see two in a year, but the number has risen to 30 or 40 annually. They see truckers injured strapping down loads, bull riders who fell off, even the guy who was lifting too much in his garage. It literally tears off.

There are a lot of tools available for hand therapy, regardless of whether the problem began with trauma, arthritis or overuse, including ultrasound, custom and off-the-shelf splints, electrical stimulation, contrast baths, medications to control pain and inflammation and adaptive devices and techniques, Nobis said.

In early stages of arthritis, custom splinting may be used to stabilize the irritated joint. As with an overuse injury, care comes with "a lot of instruction on how to avoid continuing to irritate it." Simple things, like using a bigger pen when writing or voice-activated typing, can help.