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A-1141 Athletic hand injuries
Mike Hayton, Wrightington, UK
Thursday, June 14, 2018 · 11:43 a.m. · 13m 59s
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so you will talk about twelve minutes to talk about this hand injuries
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in a school also i was gonna concentrate on two topics
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that you may or may not be firmly with rather than just trying to cover up so yeah everything
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and in particular in your head on speaking today about why the weight locus easier notes only case so
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easy to types of surgery now that i do routinely with the patient awake with all those huge benefit
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that we know what type surgery offices once flexibly reconstruction climbers
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and the second is easy use stabilisation often in golfers
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so probably injuries you're an advanced audience you don't need reminding of this is a highly complex structure a huge
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forces go through the pulley system incline is indeed some
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climates can even do it one finger hole
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this is a few she was not one of my patients so you just imagine the false
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going through that probably system so anything that we do to try and recreate that
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to make that as strong as that is always gonna file so you say to a patient right at the beginning an athlete
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i cannot make you stronger than you were before and that's
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a great bailout free things go badly wrong down why
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or whatever you deal with athletes is always worth knowing a bit about what they do and so with the
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various climbers you wanna be firmly with its at various types of groups that they do put grip
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slow grip and the terrible terrible crime grip and the current grip is
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the one take home grip that you need to ask them
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would you doing a cream great it means that they will know that you dealt with all those
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of climbers and they'll feel really short and you'll feel really short so this is a
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terrible grip people's enormous forces on the flexibly system
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the history is they're climbing usually do the cream grip they feel is paul either one part
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or series of pops as they go down that probably system a row during this
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uh the clinical examination there's often bruising in the middle actual aspects of the digits
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bow string and they lack flexion so that only able to make a fully uh um a
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tight grip because they're read by mechanical advantage that that probably system office has been destroyed
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investigations we can do all just um that's what i tend to do ask looking for a lift off
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of the tendons away from the bone and you comparing that with the all that only injured side
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m. or i will c. t. scans or also available if you don't have dynamic ultrasound
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so generally speaking if there is both stringing you looking at surgery
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it is no bow stringing you looking at some rigid types but some protection
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these the types let's that we use than not allowed to climb in these these uh
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for them to rest a two splints and then a to a full splints
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so what we need to do first of all is trying get the swelling down swelling is the enemy of the
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finger so we need to get a demon that as quickly as we can with some cool band taping
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some rest the icy compression in trying keep that thing yeah elevated
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absolute wrestle talent to go away on holiday for at least a
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forty five days in an external rigid split that you saw
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that some no climbing a in a partial to have the first
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forty five days a two probably eight today for probably
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these planes do not allow them to go back to climbing okay so that's a really important uh take a message
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and of course all climates generally speaking put a bit of tape around i think is
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is that i'm the only take it just helps that it will probably office them no increase simple whatsoever
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and as we all um post operative look of these
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patients the splints become increasingly important for the rehab
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so i think one of the important things uh that you need to take home when you deal
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with climb is essential that you climate hydrate some cells that's pretty good anecdotal evidence that
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injuries do occur in ah please have a look at themselves i'd rated uh for the day or the day or two
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before their injuries and that's worth a um a further exploration
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and that again avoid backroom grip at all costs
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so surgery and this was uh i write the bouquets to talk about next year on sports injuries no hand
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and uh uh mcgovern transform we checked uh a show me this
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technique which uh i i've now taken i use it routinely
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and i now do this wide awake on the local it's easier on the back of
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the race i take a strip of accents or rats inoculate which is a pulley
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i then transfer that's the fronts of the hound ice each right into the leaflets that always intact
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but don't use f. b. s. lips this is a direct out summit repair this isn't really climber
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she presented me with a a swelling she fell on her three or doubles not
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all just sounds come showed that she taken all of flexible is out
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so on the wide awake local it's easier to forgive me if don't show some of this this
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morning and you can see what's real on the finger up she bow strings on table
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we don't simply the bride uh the remaining yeah i'm a central portion of the uh uh
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am a flexibly system but retaining these lateral wings
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less fixed down the bone extremely securely
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we can then use those as the as the bad for extensive that's enough to them that we can switch back of that's all
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so but every prime and
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sort of move this along a bit just for the uh so that we go to the back of
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the rest take a bit of accents rectum articulate let's take judicially three slip so maybe four slips
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and then i can see have secured wanting to place
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and then i just sit sure a series of those where i think maybe do it in the i think be free
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i'm on table immediately she's got full flexion was before she couldn't get full flexion
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so she understands know immediately that had by mechanical advantage that the flex offered a of now they re still
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check unstable that there's no post ringing and you wanna check that you've not
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always into tight and this is one of the advantages white awaken
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surgery is i can put a little tiny mcdonald uh retract underneath that
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just to make sure it's tight enough but not too tight
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if you just lately just wouldn't know whether we were title formal so this is one other advantage that's a a
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simple case in her hey she is it three and a half weeks we do a lot of ultrasound scan
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she's got no bow string at three and a half weeks and uh both you can see that the knots
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the not rule intact marshall what i'd do if you'd remote to trade off
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week so it's a bit worrying when you do these really scans
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so three laugh we she's not boast ringing issues at seven weeks
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would you feel pretty well
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you start to get a movement back
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little flexion contractor the p. i. p. job which is improve with time
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or just sounds kind of three months again you can see the not so well that that's all
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he's not both really a new movie ultrasound up and down the finger and hey
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she is she's just later this morning the senate issues now six months out
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it's not perfect
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just lost a little bit of a movement is pretty good and this is uh yesterday
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terrifying uh_huh she's pretty good cheese in the top ten well
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a bit better the mayhem pretty go yeah
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okay and then this is the first time yesterday that she did six months is
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ah oh she's taking the ways at the first sign so so that
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i you don't um as i say i'm really great from each half a rash show me those that
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and optimise actually those fantastic technique which i've taken some attractive so
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so easy you instability for the last six minutes and we all know that
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e. c. u. and can become unstable and the fact is that
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come first ability all the teams of the group so look on your axial m. or i scanned to see how the the groove is
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you gotta stop sheath and then you got the overlying retina calypso those combined together come first ability
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and and this is um can what we're dealing with the uh um
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it saddens of looks in a in a bowl on the direction and it's a
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injury to this area so you'll see me talking in a minute about
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i'm pretty i'm 'cause in here to stop it from sub look see and this
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is tom grains technique which uh i know used widely isn't about america
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so i don't believe in this i don't think i am beer any different to tall
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apartment just moved so that is a traumatic terribly uh easy use of she
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and this is a it's a it's a new way shouldn't be easy
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use of she i think these two classification ones sarasota she
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and the second is where it becomes attenuated and so block says
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so um let's just look first of all of this uh the traumatic less of she's is tall
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the sub she then seems to slip underneath the ten then and he'll down into the groove and
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it fills the group so the tendon call sits in the groove right now becomes grossly unstable
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so they can see it sounded is now sitting on top of the sub she's all the nice
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and it is healed and it said and it's filling that groove and the apple sauce to slip
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the second technique is where you put attenuated and moving so his they uh an illegal for is a
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very quick videos on table wide awake flicking his own able to play at all because of this
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here is a wake
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ask him to move
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you can see in flicking
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so hey this is a a and and the the the second
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variation this is the one where it's uh it's slipping
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so i've now in size will make sense to rattle like eleven and there's some sheaf intact
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accents retroactive them extends right circular a soap she hey intact but attenuated to
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just play the video show you uh i'm i'm really signal out
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that's the extent to return back eleven that's some chic intact
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which we now in size
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just in size along that's easy use of the shop shave and then do a sign it
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back to me having done that you know come on out of all the all the
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broader input free i'm case into the bow to
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stop the tandem from sub look simple words
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you repair the easy use of sheath oriented and back down and speech right over the
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top so the show this is very quick video store is a very quick video
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just three row three anchors and this is that got no uh
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this is the by met one millimetre juggernaut soft bank uh
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is the one i yeah i like his s. three anchors
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so tending can now not go down to the space
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we simply repaired that over the top
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and then re paddy accents wrecked once every pad you then repaired accents retina climb over top of it here it is
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and i sense right and often but over the top so it's a direct comments on it
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rip and i'm very grateful for the autograph or rather share not technique with this
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the second time in the last couple of slides is where a is different
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so this is way e. c. u. s. so she thinks tall
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and is now he'll down into the groove and therefore easy you've
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now uh it's not it's groovy it's just slipping around
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so this was a few years ago and i haven't truly appreciated what was going on
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i've now read head it so this was sitting on the knee easy use all
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i didn't i elevated accents right and actually i'm i could just see ten
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so i'm left handed out the way and the whole group was full
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of this uh thicken fibrous tissue which i in size long actually
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and you can see there's the two flights of it that i've not read pad over the top ten that immediately come fearing stability
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and that's probably all i need to do because we've got video v. show it was stable want to don't ah
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but i then still put a row lanka's here here here it's
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it should base down just to again close that bed space
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and you can see my role rank is just hit close it that space and then extends a retina limp back over that's all
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there's the full video uh of it which i think is on few maybe and on the on you too
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so basically summary there's two uh am uh topics hope
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it gets a time just to show use aren't
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in it to the way it using one side surgery which gives this great biofeedback for more patients
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my hand therapist is usually in fayette set discussing the rehabilitation with the patient when there is
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when they're away when the search is going on we show them the repair we
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show them how to look at some of the repair as off so it does allow
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June 14, 2018 · 11:43 a.m.
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