Case Discussion - Not Getting Results with a Hand Numbness Case
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[00:00:00] You're working with some hand cases where you're just not really sure what to do. Well, stay tuned. We're going to discuss a case today. My name is Wong. I'm an occupational therapist and certified hand therapist, and inside the mentorship program is an opportunity for my students to send me questions about their cases.
And so we're going to discuss a case. That has to do with someone who got injured and they have thumb and hand pain. So let me share with you the question so you can see it for yourself and then we're going to discuss it. So is this really a hand case? is what I want to encourage you to think about, right?
So my student goes, I wanted to ask a question about my patient. She's 44 years old, preschool teacher. And, um, she's having like hand thumb pain and numbness because a student, um, that she was holding onto just fell all of a sudden to the floor. And ever since then she started having numbness and tingling in her hand and arm [00:01:00] area.
So everything looks good in terms of range of motion. She has a lot of mobility, but she continues to have thinner muscle and nerve types of pain. So They did ultrasound, but then afterwards the hand was cold to the touch and you can see the veins and stuff like that. So let's discuss what that is really about.
If you have someone who has numbness and you go and you do ultrasound and all of a sudden their color changes, I would encourage you to think about the position that you had them in when you were doing ultrasound, right? So. Let's say we're at a table and you have me outstretched like this and like this so that you can ultrasound my hand.
Look at the position at the shoulder and of the arm and that might be What is causing some of that temperature change or what feels like symptoms are worse. So first and foremost, what are the easiest things you can do is just change [00:02:00] position. Be really mindful of the position that you're putting your patients in.
It's something that I see all the time. We have this idea that hand therapists, like we work, you know, at a table and, you know, I'm here. You're here. And then the patient is like this in front of you. So think about how they're positioned and how it might not be the best position. Um, especially if you're doing ultrasound or especially if you're doing certain tests, like you'll see a lot of people though, if they roll their elbow in, it's because they don't have really great positioning of their shoulders.
So that's number one. Number two, anytime you have numbness. So I always like to visualize what that looks like. So if you're holding onto a kid and all of a sudden they drop to the ground and they pull on you, what's happening? There's a lot of distraction, like a pulling sensation, and you're not just pulling at the hand, though you might, though they might hurt at the hand.
The traction is at the hand, at the [00:03:00] elbow, and also at the shoulder. So when you're working with these types of patients, don't just think, is it a hand? Is it a shoulder? Or is it the whole thing? It might be the whole thing. So nerves, anytime you hear about nerves, anytime you hear about numbness, right?
Anytime you hear about numbness, it's either a nerve, right? It's always a nerve. But from the nerve, you have to think, well, where is it? Is it at the shoulder, at the elbow, or at the hand, right? My other thing I would encourage you to think about is it coming from the neck, right? It's a little bit more advanced, but you want to kind of keep that in mind because all the nerves come out of the neck.
So, So, um, I want you to consider that even if it's not an area that you currently treat right now. Right? Even if it's not an area that you currently treat right now, [00:04:00] you can still, you can still think about it, right? Because if you can't do it, one, you can learn or two, you can refer out. It's, it's all simple.
But if you have hand problems, right? If you have hand problems, then I want to encourage you to think about, you know, where is the root cause of that problem. This is especially true if you're working with someone and they have great range of motion, but you cannot get rid of their symptoms. The thing is, if someone came into you and they didn't have any range of motion, you could fall into the, very easily get the range of motion.
But when your patients are coming into you and they have really good range of motion, then what are you left with? You know, you're left with, is it a ligament issue? Is it a muscle tendon issue? Is it a nerve issue? And if there's any kind of numbness or tingling or anything like that, I would encourage you to think it's a nerve issue.
It's not to say that muscles and tendons and all that good stuff are not involved. Of course they are, [00:05:00] but nerve issues are the main thing that you want to think about, right? So then it becomes, well, how do I treat that nerve, right? How do I treat that nerve? So if you had a pulling. accident where it was being pulled out of, you know, the whole arm away from your body.
One thing that you can do instead of stretching it more because they already have good motion is actually think about how can you compress them a little bit more. How can you Um, so as to kind of like let that nerve relax a little bit instead of constantly just moving it. I'm not talking about immobilization.
I'm just talking about what are some movements that you can do that that could like put those joints together. back into their socket, essentially, and then slowly but surely strengthen so that they can so that the muscles and the nerves can move in the way it's supposed to be moving. Right. [00:06:00] This is the way I like to do it.
Um, there's a lot of great ways to do it, but I would definitely encourage you. So this is what I do with my student. So I encourage her to look at the shoulder, right? I encourage you to look at the shoulder and look at what motions are happening at the shoulder. And, um, it's not just the range of motion.
But I would look at nerve glides. I would look at how that's moving, right? And then I would also, I encourage her to look at the elbow, right? Because the elbow, the shoulder plays a role in the elbow. So when it comes to the elbow, shoulder and elbow. I always look at the biceps, right? Biceps is a huge muscle that plays a role in the shoulder and the elbow and in the hand.
Think about this. The biceps originates in the labrum. So it starts in the shoulder, crosses the shoulder, Crosses elbow and inserts into the radius, right? [00:07:00] The proximal radius. So a lot of times these people if they if you're holding onto something your biceps and then when they go and they pull and they jerk.
What do you think the biceps is doing? It's going to jerk and pull up. So believe it or not.
Check the biceps. A lot of times the bicep really hurts and contributes to pain down to the thumb, right? Because where the biceps is, is underneath there, like the median nerve is really deep, but the median nerve passes in the middle of here, comes all the way down, crosses the wrist, goes to the thenar muscles, and then these, uh, these three muscles for the most part.
And the biceps has a really huge role to play. So in an injury like that, imagine if they're holding on, their biceps is working, right? Their biceps is working. I don't really have big biceps, but they're holding on. And then child [00:08:00] drops to the floor, something that's pulling and then in order for the arm to protect itself and also for the person to not fall back, they are going to pull back using what?
Their biceps. Check the biceps. So, um, instead of focusing only on hand injuries, right? Instead of only focusing on the hand where the symptoms lie. Nerves. nerve issues. You feel it distal, but the problem is always proximal. That's just how nerves are. That is the nature of nerves. Nerves, the injury is proximal and the symptomology is distal.
I didn't make that shit up. This is how your body was created. So just keep this in mind. If you're working on the hand because someone told you to work on the hand, but you're not getting any results, it could be because you're missing out. and not thinking [00:09:00] outside the box, not considering, and sometimes it's like you don't know what you don't know, right?
Which is the whole point of being inside something like the mentorship program so that you can get a little bit more insight and more knowledge, um, that can help you just grow your skills and help your patients faster without having to like, Do everything yourself, right? So, I'm encouraging you to think, Is the hand really the hand?
I see this so much in my clinic. This is where I feel like a lot of times people who have work injuries, they are failed by this system that we work in because if they, if their hands hurt, then somehow us therapists are just told to work at the hand and wrist level, right? But when in actuality, their problem stems above that.
And I just want to encourage you not to be so fearful of working above the [00:10:00] problem, especially if you identify that this is a nerve related issue. Is there a lot more to do? There's a ton more to do. I teach various forms of exercises and movement patterns and corrective movements inside the mentorship, but I wanted to just showcase how you can think about it and have it help you.
have some direction in terms of what to do and think about when you're working with your patients, you get cases, I get cases, we all get cases that sometimes they look the same, but they all present just slightly different. Um, people's activities, people's age, like they all present like so differently sometimes, but their root cause is.
Or how we could go about thinking about how to help them can be very similar. There's a pattern that we, um, um, that they go through and there's a framework that I teach to help you figure it out like a hundred percent of the time so you can get to the results that you're looking [00:11:00] for. So, um, I hope this video helped to give you or shed some insight into how to really think through your cases, um, and not be scared, you know, not be scared to.
Go to where you need to go to in order to get the results that you're hoping to get for your patients If you want to find out how to work with me inside the mentorship program The links are all below if you have comments leave them below for me. Thanks
