Mole Snake Bite

A 55 year old man was bitten by a Mole Snake in Zambia on his thumb. These are the things that were done right by the family and medical team after the bite: 1. The snake was kept for identification purposes so that the correct treatment was possible. If the snake cannot be captured a picture of the snake can be taken. 2. The patient was not given anti-venom. The reason being is because Mole snakes are not toxic snakes that require antivenom. There are only a few highly venomous and toxic snakes are on the list of species that require antivenom. 3. The thumb was kept clean. 4. The surgeon elected not to surgically debride the thumb on presentation as the wound was clean. The reason b

Necrotic Wound & Fractured Finger - Progress Images

The Casting Motion to Mobilise Stiffness Technique (CMMS) was used to treat this lady's stiff and oedematous hand. Initially, an intrinsic minus cast was applied to the hand. This cast design supported the wrist in neutral and immobilized the MCP joints. Motion was directed to the PIP and DIP joints into a hook fist position. After 3 weeks the cast design was changed to an intrinsic plus cast in order to regain flexion of the MCP joints, whilst maintaining the gains made in PIP and DIPJ flexion. The oedema improved significantly and produced a scar that is soft, mobile and tolerant to frictional forces. In addition to the CMMS technique, the patient has been provided with Forever Freedom Gel

Necrotic Wound & Fractured Finger in an Elderly Lady

This elderly lady fell on the 17-08-18 and fractured her left little finger as well as lost skin over the dorsum of her wrist and hand, which became necrotic. On the 11-09-18 she had a wound debridement and a split skin graft. Image I shows her initial presentation. The oedema was accumulating distal to the skin graft and was becoming brawny. There was very poor active range of motion. The CMMS technique was applied. The circumferential cast provides the right amount of pressure to stimulate the superficial lymphatics. Coban was applied to the fingers to reduce the oedema. The patient was taught how to perform a hook fist within the intrinsic minus cast. The movement pattern was more effecti

Causes of Forearm and Wrist Injuries in Rowers

Forearm and wrist injuries can usually be traced back to poor technique or fatigue, through excessive wrist motion during the action of feathering the oar (turning the oar so that it moves parallel to the water on the recovery), or a tight grip. Injuries include: * Exertional compartment syndrome (ECS) * Lateral epicondylitis * De Quervain's tenosynovitis * Intersection syndrome Wrongly sized handle grips, poor rigging, and wet or cold conditions can all exacerbate the problem #HandConsultSA #RowingInjuries

Therapeutic Management of a 14 year old Rower

Cubital and Carpal Tunnel Syndrome in a 14 year old rower: While treatment to relieve the symptoms, including ice and analgesia, may prove adequate acute pain relief, long-term management involves correcting muscle imbalances including strengthening scapulothoracic stabilizers, stretching the neck muscles, postural realignment, and technique modification. In the case of the 14-year-old girl who is attending hand therapy, treatment is including: * Neck exercises * Nerve glide exercises * Massage of the ulnar nerve to improve circulation * Provision of night time * Provision of CMC I OA splints to support the CMC joints * Shoulder mobilization and strengthening * Hand strengthening * Core stre

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