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Mallet finger is a common tendon injury that occurs in everyday life, so termed due to the classic presentation of a finger deformity that resembles a “hammer” or ”mallet”.

 

You are playing a friendly game of basketball with your friends on the weekend and you reach overhead to catch a ball thrown to you. However, instead of getting a firm grip on the ball, it hits you on the finger and bounces off. You feel a “pop” in your finger as this happens and when you look at the finger, something does not look right. The last joint of the finger seems to be jammed in a bent position and try as you might, you are not able to straighten it on your own. There is also some pain and swelling over the last joint of your finger, but not too much to cause immediate concern. “Maybe it’s just a mild sprain and it’ll get better on its own in a few days”, you think. After a few days, the pain and swelling seems better, but you are still unable to straighten the last joint of your finger. What is happening here? Will you be able to straighten your finger ever again? If this sounds like a familiar scenario, it is likely that you have sustained a mallet finger injury.

What is a mallet finger?

Mallet finger is a common tendon injury that occurs in everyday life, so termed due to the classic presentation of a finger deformity that resembles a “hammer” or ” mallet”. Also known as a “baseball finger”, this finger deformity results from the disruption of a muscle tendon, called the extensor tendon, which helps to straighten the last joint of your finger or thumb. The extensor tendon travels along the back of the finger or thumb and attaches to the last bone of the digit. Its main function is to assist in the straightening of the thumb or finger.

During injury, this tendon is torn from its attachment site on the bone (called a tendinous mallet finger). But, there are also cases whereby the force of impact causes a small fracture at the base of bone where the tendon is attached to (called a bony mallet finger). In both cases, the tendon is no longer attached to the last bone of the digit and is thus unable to pull the end joint into a straightened position, resulting in a fingertip that droops.

How common is a mallet finger injury?

The prevalence of mallet finger is relatively high, accounting for 9.3% of all tendon and ligament lesions in the body. Injury trends indicate that it is more common among young to middle-aged men and occasionally in older women. 74% of mallet injuries occur in the dominant hand, and >90% of the injuries involve the middle, ring and/or little fingers.

How does a mallet finger occur?

Common injury mechanisms include (clockwise from right to left): (a) stubbing the finger against a hard surface while cleaning, (b) injuring the finger while removing a sock forcefully, (c) injuring the finger while tucking in bedsheets, and (d) the hand/finger is hit by a ball during sports activities.

A tendinous mallet injury (only the tendon is ruptured) usually occurs from a traumatic blow, which results in the sudden forceful bending of the end joint of the finger (e.g. the hand is hit by a ball during sports activities, the finger is injured after a fall, stubbing of the finger against a hard surface while cleaning furniture). This force tears the tendon at the back of the finger from its attachment site on the bone. Occasionally, the force of the impact may be strong enough to break off a piece of bone (fracture) together with the tendon, resulting in the aforementioned bony mallet finger. Finally, a crush injury over the fingertips (e.g. having a finger caught in a door) or a deep cut over the back of the fingertip can also result in detachment of the tendon.

What are the signs and symptoms of mallet finger?

In the initial stages following the injury, you may experience pain, swelling and bruising over the end joint of your finger or thumb. The end joint of your finger stays in a bent position and there is an inability to straighten the joint on your own, unless helped by your other hand.

How can mallet finger be treated?

It is important to seek early treatment for mallet finger as treatment success rates tend to decrease as more time passes by before the start of treatment.

Non-surgical Treatment Options

Most mallet finger cases can be treated successfully without surgery. Generally, the doctor will refer you to an occupational therapist, who will fabricate a customised splint for your finger. This splint will help to support your fingertip in a straight position so that the ends of the ruptured tendon are positioned close to each other, allowing for healing to take place. It is therefore of utmost importance that this splint is worn at all times for a period of at least 6 to 8 weeks. There should be no movement of the end joint of the finger during this period as bending of the joint during can lead to a re-rupture of the tendon.

After this period of immobilisation, if your finger has regained the ability to straighten on its own, your therapist will advise you on gentle exercises that will help you gradually regain the movement and strength of the finger. The amount of time required for splint wear will also be gradually reduced according to your progress. It usually takes around 4 to 6 weeks of therapy after immobilisation to regain maximal movement and strength of the injured finger.

Surgical Treatment Options

Surgery may be needed for mallet injuries under the following circumstances:
– Bony mallet injuries where the bone fragment that broke off is of a larger size
– The presence of joint misalignment
– The tendon has been injured via a cut by a sharp object
– Previous non-surgical management by splinting has been unsuccessful

Surgical procedures may include the use of wires or small screws/metal plates to help realign the joint or re-attach the fracture fragment onto the original bone, as well as the repair or reconstruction of the cut tendon. Regular therapy sessions are usually required after surgery to help in regaining movement and strength of the injured finger/thumb.

Why is it important seek early treatment for mallet finger?

Without early treatment of a mallet finger, the extensor tendon will not be able to re-attach itself onto the bone and heal, leading to a permanent deformity of the finger. Over time, this may continue to worsen due to the imbalance in muscle tendon forces, resulting in a swan-neck deformity of the finger, where the middle joint becomes hyperextended in addition to the end joint being in a permanently bent position. Swan-neck deformities can cause difficulties in finger bending, as well as a snapping sensation during finger movements.

OT Joanna Lim is a senior hands specialist in the Lifeweavers team. She is passionate about ergonomics and rehabilitation of hand and fingers injuries, often writing specialised articles like this on her blog and contributes to the Lifeweavers Magazine.

Sources:
American Society for Surgery of the Hand. (2020). Mallet finger: Symptoms & Treatment: The hand society. Retrieved April 13, 2021, from https://www.assh.org/handcare/condition/mallet-finger

Physiopedia. (2021). Mallet finger. Retrieved April 13, 2021, from https://www.physio-pedia.com/Mallet_Finger

Salazar Botero, S., Hidalgo Diaz, J., Benaïda, A., Collon, S., Facca, S., & Liverneaux, P. (2016, March 18). Review of acute traumatic closed mallet finger injuries in adults. Retrieved April 13, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4807168/

Sheth, U. (2019). Mallet finger. Retrieved April 13, 2021, from https://www.orthobullets.com/hand/6014/mallet-finger

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Stroke Recovery's Golden Window of Opportunity is As Early As Possible.

Like any medical condition, a stroke can vary for each patient, presenting a diverse set of symptoms. This will in turn affect the subsequent recovery greatly. Recovery may be different for different individuals, which will have a lot to do with the type of physical therapy that will be provided. The Lifeweavers team is set out to support the person with stroke in every step they take towards recovery.

First things first, recovery following the development of a stroke should be implemented immediately – when the patient is in first stage of the condition. Before explaining what happens in this stage, we should talk a little about how this stroke is generated in order to understand more about it.

Physiology of a Stroke: Stage 1.

A stroke occurs when the blood supply (oxygen, nutrients, etc.) stops flowing to a part of the brain. This can happen due to a blockage of the blood vessel (thrombus) or a rupture of one of these vessels (aneurysm), that is, ischemic and hemorrhagic stroke, respectively.

Due to the arrangement of the existing nerve fibers and that usually this failure of blood supply is in a specific area of the brain, certain functions of the body contralateral to the injury (relating to or denoting the side of the body opposite to that on which the condition occurs) may be affected in one way or another. One of the most frequent symptoms is contralateral paralysis, that means, if the right side of the brain is affected, the paralysis will affect the left side of the body and vice versa.

Another thing to know is that, during this first stage, the affected part of the lesion is not completely dead, but a large part of it is responding to the damage by inflammatory processes that will gradually disappear. This gives way to stage 1 symptoms, which include:

Flaccid paralysis, or complete lack of voluntary movement, usually occurs in stage 1. Because the brain is affected, signals to the muscle are not sent correctly, which affects its motility. Over time, if the case is not professionally attended to, the muscles will lose strength and volume, making the patient weaker, at least on the affected side.

Hypotonia, or low muscle tone, is capable of causing weakness and numbness of the affected limb. Unlike the previous symptom, where the patient cannot move the muscle, in this case, he/she can move it but very weakly, which seriously affects the performance of daily life activities, such as walking, holding something in the hand, dressing, etc.

Treatment methods for stage 1 stroke symptoms.

Although a stroke can represent a quite severe compromise to a person’s motor and mental functions, nowadays, fortunately, there are known therapeutic methods capable of improving this condition, not only by enhancing the affected functions, but also by taking advantage of the unaffected ones, mainly belonging to the contralateral side of the body and to healthy neuronal parts.

With luck and hard work, the patient will be able to move on to other stages of recovery with a better prognosis in which the Lifeweavers team to enhance the support for.

Some of these methods include:

Use of unaffected limbs. A good way to help the affected body part not to lose muscle volume and develop joint stiffness is to use the unaffected limbs to carry the work. This will allow you to passively exercise the affected limbs, as the voluntary function is not available. While this can be done perfectly well by the patient him/herself, many of the methods applied by the health professional will be based on this, promoting movement in the least painful way possible and increasing, little by little, the patient’s range of motion.

Active movement. For patients who have maintained a certain degree of muscle strength, simple movements are recommended, which, over time, can favor the maintenance of muscle tone and recover the functionality of the limb. With this method, repetition is essential for recovery. Lifting a cane or small weight, rolling a medicine ball with the legs, or straightening the arms and legs are all examples of this.

Mirror therapy. The brain is able to create new neural pathways to perform actions in which pathways have been damaged. This is the case of using a mirror box in stage 1 strokes. By placing the affected limb inside the box, the patient will proceed to move the healthy limb in front of the mirror. This will observe the whole process, which may promote neuroplastic changes in the brain that can make the affected limb move in the future.

Visualize the movements with the mind. Similar to the previous method, mental visualization can also promote neuroplasticity. Because the brain does not differentiate between real and imagined images, thinking about moving the affected limb can produce the same effects of creating new neural pathways.

Golden window of opportunity. Both the person and their family are probably dealing with the shock from the stroke happening but it is very important to understand the need to find calm to quickly decide on rehabilitative therapy as soon as possible before the brain and body let the effects of the stroke set in.  

Our therapy team specializes in working with people in this window to intensify the goals towards recovery with a multi-disciplinary approach from occupational therapists, physiotherapists, psychotherapists, hands, speech and throat therapists to massage technicians all working hand-in-hand with the person’s caregivers and family to form a strong support to accelerate healing.

quality of life is happiness

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Answer: Professional Therapy is not a Luxury but a Life Necessity.

Everybody should live a healthy and stress-free life. Many do not really want to think about anything stressful such as the possibility of falling sick, but it does take discipline and being correctly informed about one’s health and the potential pitfalls to keep this serenity.  

There are many reasons to consider the need for therapy. We really hope you do not need to but as a medical company in the community, we saw the necessity to promote sustainability in one’s health as a wider strategy to uplift the population, starting with the right mindsets.

Rising Medical Costs

Let’s be honest, healthcare costs have been rising exponentially over the past decade to the point that some people perceive therapy as a luxury and ignore it till it’s too late – when their health desperately deteriorates. Having to potentially deplete one’s savings is one thing, but to put health at risk would be even more painful, literally.

It takes a lot of resources to keep the high standards of healthcare, which usually corresponds with the rising cost of living. Even with state subsidies, the cost of deploying all the resources is undeniable when everything and everyone working on a case is to be accounted for.

Moreover, our quality of life is priceless. People should be able to prevent diseases and live healthy, fulfilling lives. Not only can one save on medical bills, but it is even more important to design a life that is full, meaningful and sustainable.

asian active ageing

Prevention and Wellness

Therapy designed by Allied Health Professionals (AHPs) is aimed at promoting wellness to everyone. To think about prevention of decline when one’s healthy is the best insurance one can buy.

The prevention of disease and achieving good health brings confidence for us to plan our lives ahead and have the ability to take on challenges without doubting one’s future. It is our responsibility to work on this now so to avoid complications later – you are futureproofing yourself and those who may end up being responsible for you.

Our clinicians systematically assess the individual in the most holistic perspective of medicine – the biopsychosocial model of healthcare – which will take into consideration of the person, their past and current medical and mental condition, their routine, habits and interests, their social network and what they want to achieve before an intervention is recommended and a therapy plan executed.

After the industrial revolutions, many people let work take over their lives. At some point, there is even a culture that somewhat glorifies working. While it is an admirable trait to be hardworking, it should not overcome one’s health and overwhelms life. AHPs look deeply at these issues. They work with companies to actively solve health related issues, working with corporate management by pinpointing ergonomics problems and mental health which may hinder their staff from their full potential and having a work-life balance. This in fact, will even yield higher productivity and turning the workplace into a highly positive environment to spend a large part of their waking hours at.

AHPs also work with mothers in the pre, during and post natal stages to ensure their own health are not neglected during the childbearing months and look into ergonomics, mental health and general wellness after childbirth.

With our older population, the AHPs see that the seniors flourish, living meaningful lives with dignity, self-efficacy and the opportunity to enjoy themselves with their loved ones and family. They’ll help them find new meaning in life after retirement and help keep them active and sociable to promote high quality well-being.

They will even look into the skills and condition of caregivers, such as our domestic helpers, to ensure they have ample and the right skills to avoid injury to the ones they care for, and themselves. Having a caregiver who is burnt out is one of the most common pitfalls in our society. You won’t have a strong care support structure if one of the pillars are weaken and all will fall apart.

AHPs promote simple and highly creative interventions that are usually in the simplest of forms, to yield maximum therapeutic benefits. A walk might seem to be just commuting for some but time spent in a park or out in nature will lower the levels of cortisol at the same time raising the levels of serotonin without having to take a single pill! They are specialists in incorporating social activities like these and beyond with the right clinical reason to enable a more holistic therapy plan than just medical interventions.

Treatment

Allied Health Professionals are crucial in the rehabilitation of both short and long term health complications back to normalcy. They work with people with physically disability as young as from birth and through continuous therapy, they can attend school, undertake normal activities and learn life skills to “hack” their impairment. In hospitals, AHPs are highly vital alongside doctors in the acute setting to enable people to be outpatient safely and find strategies to sustain themselves at home.

Outside of the acute setting, they have the advantage of working on deeper goals. They’re not limited by the constraints of the hospital and the world is their oyster, quite literally. One will find a very different approach to therapy in the community setting, when the AHPs are free to include any available resources they can find to help achieve the goals one can dream of. They will make use of any environment, tools and collaborators that are appropriate and align to the therapy plan and standards they’ve designed.

At Lifeweavers, this is our specialty: delivering accelerated or continuous therapy in the community, to rehabilitate people in their own homes. The home is one of the most natural and effective tools for rehabilitation. Lifeweavers have a multidisciplinary AHPs team consisting occupational therapists, physiotherapists, psychotherapists, hand therapists, speech and language therapists, dieticians, and each clinician also have condition-specific specialisations such as dementia, stroke or amputations. The team works hand in hand as a concerted effort for each client, sharing medical knowledge and expertise, to achieve higher quality outcomes.

They educate and impart knowledge, skills and strategies to both clients and their families with decades of evidence-based experience to ensure that one takes their health in their own hands. No one can help you better than yourself – that’s the first switch in mindset one needs to take in – or even miracles won’t necessarily work the wonders in one’s life.

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5 Simple Tips To Reduce Everyday Caregiving Mistakes

When we do Caregivers Training (CGT) and see a caregiver pull on a person’s arm to help them get up, our first question is simply “Do you have shoulder pain?”. Nine times out of ten, the answer is Yes. Often, the patient doesn’t report the pain to their carers, so the problem remains or gets worse. Shoulder pain can limit activities such as dressing, feeding, toileting, brushing teeth and reaching for items.

Rehabilitation of shoulder injuries can be a challenging and slow process, which is why we place emphasis on prevention through good manual handling practice. Using best practice techniques will ensure the safety of both the person and carer, and minimise the problem occurring in the first place. 

The Agency for Integrated Care (AIC) guidelines for manual handling condemn any lifting or pulling on the arms during caring activities. Additionally unilateral pulling on an arm (pulling on one side) is generally an inefficient way to help a person balance, if support is needed it’s best to support both sides or in the middle.

Five Things To Watch & Do

1 / Know where you should and shouldn’t place your hands when moving a person: position your hands over larger joints such as the hips and shoulder blades.

2 / Give yourself time to practise a new (recommended) technique. Practise on someone who doesn’t need help first so you can get familiar with how you are going to position your body.  

3/ Let the person know when you’re going to help them up, counting in “1, 2, 3, up!” helps prepare the person for the change in position.

4 / Position your body close to the person’s body.

5 / Hug method – if the person starts to lose their balance, you can try hugging them close to you, using your center of gravity re-balance them. If they are falling don’t try and hold them up, position yourself so they can fall down your body and lower them to the floor ensuring the person’s head doesn’t knock onto anything.

If you want more hints and tips on manual handling you can refer to this helpful guide created by AIC for the Silver pages, just click on the link.

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Social Prescription explained.

The Snap-Shot Answers 

What is it?
Improve or maintain health through non-healthcare, local and usually pretty fun activities!
Who is it for? 
People who want to know what local community activities are suitable for them to engage in to optimise their health and well being
People who may need short-term additional support to make the first steps to make changes in their activities and social engagement. 
What is the aim? 
Optimising health, combating loneliness and anxiety, reducing dependency on GP and health services for positive health outcomes, overall reduction in health care bills. 
Who prescribes? 
Your local Social Prescribers can be medical professionals including doctors, social workers, occupational therapists or trained therapy technicians. 
Where can I find a prescriber? 
Ask your local care professional or simply ask us at askforot@lifeweavers.org.

The Detailed Explanation

What is Social Prescription?

When medical personnel refer a client for non medical services in their local community to promote and maintain their health and wellbeing. The activity or social engagement selected may be chosen to target something in particular, for example, chronic condition management, improving social skills or just to stay young.

Where Did The Idea Originate?

Recognising that people’s health is determined primarily by a range of social, economic and environmental factors, social prescribing seeks to address people’s needs in a holistic way. It also aims to support individuals to take greater control of their own health.

If we attend to our health needs through our normal routines ( physical, mental and social needs) we are less likely to need support from the health sector. It is not always easy to identify where we have imbalance and how to promote that balance, so social prescribing helps support the client in this. 

How Is It Cost Effective?

Evidence is currently in its infancy but it has been shown to reduce health care visits and associated costs. The benefits which are difficult to quantify financially are related to preventative health care by improving quality of life, emotional wellbeing and opportunities to learn and volunteer. 

How Does It Work?

First, the client is assessed and supported to develop a simple well being plan, they are given advice on what activities would be appropriate for them to regularly engage in to optimise health through physical and / or social engagement. Potential activities will be explored with the client based on their motivations and interests. Depending on the clients abilities, support will be given to get them to the point that they can attend the chosen activity independently or with minimised support. The aim is for them to be able to increase confidence and independence to engage long term or until there’s a change in function.  

How is it relevant to Singapore?

It’s not uncommon to hear that people don’t have time to do anything other than work and attend family duties or for seniors to say they do nothing because there’s nothing to do. Lack of engagement in activities that promote balanced health, be it physical, mental or social can lead to health issues as a result of imbalance. This can contribute to problems with posture, frailty and stress management to name a few.

Looking at what activities can help plug your health gaps is the key to prevention without the creation of dependency on the healthcare system.

 

Who Is It For?

Persons…

– with one or more long-term conditions

– who need support with their mental health in the community

– who are lonely or isolated

– who have complex social needs which affect their wellbeing

– who are interested in active aging

 

Where Can We Get More Information On Social Prescribing in Singapore?

There’s currently limited information on social prescribing in Singapore, we at Lifeweavers are working to change that. Occupational therapy is uniquely positioned as the only profession with specialized understanding of the impact of participation and engagement in activities on health and well-being, so asking an occupational therapist is the ideal place to start. 

Social Prescription and Occupational Therapy

With a holistic assessment, an occupational therapist or therapy technician will be able to guide you in understanding which community activities will enhance your health and wellbeing. If needed the OT/technician can also support you in tackling any barriers which may be blocking your engagement to your chosen activity.

Social prescribing services could be the step you need to make lasting change to your health and wellbeing, so do not hesitate to get in touch.

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