Foosh Explained

Transcript

What Happens In A Fall On The Hand

Radius, Ulna, And Scaphoid Basics

Surgery vs Casting: Therapist’s Take

First Week Post-Op: Wound And Swelling Care

Custom Orthosis And Safe Motion

Active Range Guidelines And Lymphatic Benefits

Week-One Exercises And Elbow-Assisted Forearm Rotation

Pain-Free Range Progression And Why Early Movement Wins

Recap, Resources, And Subscribe

SPEAKER_00 0:01

Welcome back to the Hand to Shoulder Solution where pain meets its match. I'm your host, Carl Petito. I'm an occupational therapist and a board certified hand therapist specializing in the rehabilitation of orthopedic conditions affecting the fingertips through the shoulder. Today I want to talk about foosh injury. Foosh stands for fall and an outstretched hand. Very common. And that's a natural reflex. So the body can perfect the face and the head. So we fall on an outstretched hand. When that happens, we end up striking the distal radius. So the radius R-A-D-I-U-S strikes first and the end of the radius bone, which I'll show you in a little more detail in a moment, moves toward the back of the wrist. So oftentimes people will notice that after the fall, they're not able to bend their wrist very well. And in fact, there's a big hump this way. So if the fracture or the break is displaced, then oftentimes they have to have surgery, which includes plates and screws. I do have a past episode that shows the plates and screws, and look for future episodes where I'll actually be interviewing a hand surgeon and we're talking about all of the different nuances of the different hardware that is placed and what that entails. I really like the surgery. If I were ever to need something and I had a choice between having it heal with routine healing with just a cast without surgery, or having the surgery, I would elect to have the surgery because the surgeon can get his or her hands on it and align it perfectly. And then the hardware works as an internal brace to hold it together perfectly so it can heal optimally. So now let's look at the forearm. So the forearm is a joint, and when you turn this palm up, this is the right hand palm up. The radius on the thumb side is parallel with the ulna. When you turn a palm down, the radius flips over the top of the ulna. And now the radius is still longer than the ulna. And when you land and hit right there, the radius hits first, also the scaphoid, a little one of the small carpal bones, and that could be a big problem too. But today let's just talk about the radius. And that's why this is not treatment or treatment advice. There's a lot of details and nuances you have to be seen by healthcare professional, especially ideally a hand surgeon who is a uh fellowship trained uh beyond a general orthopedic surgeon who specializes in these conditions. So after surgery, it's very important that me as a hand therapist, I see my patients post-operatively after one week. So they'll come into the office and they've had the plate and screws put in, their fracture, the brake is realigned perfectly, it started some healing, and they're in the post-operative dressing. It's typically a post-operative half-cast where there's some casting material is sort of acting like a split, and then it's wrapped with ace wrap. I remove all of that, throw it in the garbage, and talk to patients about washing with soap and water, antibiotic whitem. If there's you know, there's there's you know some details that are very important to go over regarding the wound care, swelling, continuous elevation. The elevation is easy. It's just when you're up when walking, bend the elbow or lay the hand on the chest. The if the hand is down by the side and swinging, and that centripetal force will just throw a lot of swelling in there and cause movement to be very, very difficult and actually increase pain. So when when up and active, keeping the elbow bent or just laying it on the chest will keep it above the heart. When seated, watching TV or just relaxing, stack up some bed pillows on the armrest and have the hand above your heart. I usually tell my patients at night is where that custom orthosis that I fabricated for you. Your whole body is horizontal, so it's not terribly important to have it elevated at night when you're sleeping. I start some light range of motion with people. No, this is not meant for you to do this. If you just had surgery, don't blindly follow what I'm showing. I want to explain to you what I show my patients about a week out after surgery. So I remove the postoperative dressings, I fabricate a nice custom orthosis that will stabilize the fracture site so it can be put on with velcro straps, and then all the surrounding muscular musculature can just let go and relax. It still allows the inflammation to reduce. The fingers are free, the forearm can still move a little bit inside of the splint, and it optimally stabilizes that fracture site and keeps it safe while it's healing. I can heal in minimal time and heal perfectly. I'll have patients remove that custom morphosis three or four times a day and perform what we call active range of motion. So active range of motion is when a person is moving actively under their own muscle power. Any stretching, the outside force, that's a that's called passive range of motion. For self, if the person is doing it themselves, that's the self-range of motion where they're pushing. But you're not ready. The patient at this point is not ready for that yet. So I explained to my people that at that point the goal is clinically to start to reintroduce motion to the body, to the joints, and movement actually increases blood flow because it helps squish blood through the vessels. And also we have another vascular system, the lymphatic system. So the lymphatic fluid is moving and circulating and carrying away bacteria, bringing it through the lymph nodes. It's a nice filter uh system for the body, and it helps also uh to stabilize a fracture site with internal swelling, and we want to get the excessive swelling to start to decrease. And it's not a big emergency to hurry up and get that swelling out of there because the inflammatory phase of wound healing, which sends more blood and sends more swelling, the swelling is carrying away bacteria, the blood is bringing nutrients and oxygen to all the tissues to really get um to get healing started that lasts for seven to 14 days, so a week or two. Now let's get back to the movement that I have people start after one week of healing after their first week postoperatively. The first one is I have people bring their hand right over their head and look right up at their fingers and solely close, not clenched fist, but close and open a dozen times. And then it's important that we start rotating that forearm, palm down and palm up, and getting those bones to move around each other. Yes, the one that's fractured, we we get that moving a week after surgery. So, in order to have those movements to be as stress-free as possible, it's important that the forearm is moving in conjunct in conjunction with the elbow. So, one motion is turning a palm up while you bend the elbow and then palm underneath the elbow. And this is a good resource for my current patients who I showed this. They can watch this and uh and have a good reminder. Hold the elbow so it's not going to kick out. The patient to turn their palm down while they're straightening their elbow. And then a good way to remember is when you wash your face, you turn your hand palm up and bend your elbow. And when you reach out for something, you turn it palm down and straighten your elbow. So that's moving in a functional normal pattern of movement. When you can turn your hand palm down with your shoulder, that's the reason for the opposite hand. We hold that here so the shoulder's not moving, that isolates the forearm. Now, very important. I have patients move in their pain-free range. And I tell people, if you if you go this far and it hurts, next repetition, don't go that far. So we work work in your pain-free range, and then over the days, that pain-free range of motion starts to increase. So perhaps maybe they start and here they're there it hurts and then they stop, there it hurts and they stop, or perhaps they can't turn it and palm up as far, but then after maybe a few hours or after a day or two, they can start getting that full range of motion. Years ago, we used to wait for six weeks or so until healing was done, and then it was very difficult stretching and you know, forcing some of these joints to move, but getting it to move sooner rather than later is always better anytime it's possible because it actually leads to better wound healing, better fracture site healing because of the increased uh blood flow, bringing more oxygen and nutrients to that healing location. And it's better even for the skin, the scar on the skin, and we and we don't want things to get stuck, we want things to start moving. So that's what we do starting one week after surgery, and we teach the elevation, fabricate the custom orthosis, and start light range of motion. Thank you for watching. Thank you for liking and subscribing. And I appreciate it very much if you share this information with other people who might be dealing with such a situation. Remember to check out our website, carlpatito.com, and thank you for subscribing to the hand to shoulder solution, where we are the solution to your pain. Thank you.