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Part I of II

Farmers and gardeners in NEPA always say that Memorial Day, the “kick off” day for planting without the fear of frost, however, this year we have had an unusually cold and wet spring… but it is not too late to start…not only for the beds but your body! While gardeners are anxious to work in their gardens and enjoy the fruits of their labor, a relaxing and enjoyable activity can turn dangerous quickly. Precautions are necessary as repetitive stress injuries such as shoulder and elbow tendonitis and carpal tunnel syndrome can stem from raking, weeding, digging and pruning. Additionally, simple scrapes, blisters, and bites can turn into serious problems if not treated appropriately.  Since prevention is the best approach, the American Society of Hand Therapists (ASHT) promotes warm-up exercises and injury prevention tips to help all levels of gardeners avoid serious and long-term injuries while enjoying this popular outdoor activity.

ASHT recommends following these upper extremity warm-up exercises prior to gardening:

Note:  These exercises should never be painful when completing them.  You should only feel a gentle stretch. Hold 10 seconds and repeat 5 times. Should you experience pain, please consult a physician or hand therapist.

  1. Forward Arm Stretch: Fold your hands together and turn your palms away from your body as you extend your arms forward.  You should feel a stretch all the way from your shoulders to your fingers.
  2. Overhead Arm Stretch: Fold your hands together and turn your palms away from your body, but this time extend your arms overhead.  You should feel the stretch in your upper torso and shoulders to hand. 
  3. Crossover Arm Stretch: Place your hand just above the back of the elbow and gently push your elbow across your chest toward the opposite shoulder.  This stretch for the upper back and shoulder and should be performed on both sides.

ASHT recommends the following guidelines to prevent injury and foster healthy gardening practices:

Professional Contributor: Nancy Naughton, OTD, CHT, is an occupational therapist and certified hand therapist practicing in NEPA.

Next Week: “Prevention of Gardening Injuries” Part II of II.  

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog

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This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

What medical problem does a carpenter, typist, truck driver, jackhammer operator, violinist, pianist and court stenographer have in common? Carpal tunnel syndrome! Over the past 10-15 years, carpal tunnel syndrome has moved to the forefront in medicine and has become water cooler conversation. So what is carpal tunnel syndrome and how is it treated?

Carpal tunnel syndrome (CTS) is a nerve disorder caused by compression of the median nerve at the wrist. The median nerve is one of three main nerves that provide sensation to the hand. This nerve specifically supplies sensation to the thumb, index, middle, and half of the ring finger. In CTS, compression on the median nerve occurs as it travels through a narrow passage in the wrist called the carpal tunnel. The carpal tunnel is formed by eight bones in the wrist (the floor of the tunnel) and the transverse carpal ligament, a strong ligament traveling across the roof of the tunnel. Within the tunnel there are nine tendons, which are a bit smaller than a pencil. These tendons share this space with the median nerve. In the case where there is swelling on the structures in the carpal tunnel, a person can experience pins and needles, numbness, and aching in the hand.

Common causes of CTS include:

Risk factors for CTS include:

Some common symptoms include:

Diagnosis

To be properly diagnosed, a physician will discuss your symptoms and medical history, and examine strength and sensation. A nerve conduction study, electromyography (EMG), and x-ray may be ordered to provide information regarding sensation in the median nerve distribution and confirm compression at the carpal tunnel.

Treatment

Treatment focuses on the causes. Therefore treatment suggestions may include activity modification and postural changes during activities. Other suggestions may include frequent rest periods, elevation, and exercises or stretching. Wrist splints are effective in relieving compression at the carpal tunnel and are typically recommended for night wear. Appropriate fit of the splint is vital. Occupational and physical therapists or certified hand therapists can check the fit of pre-fabricated splints or can fabricate a custom splint. The above mentioned treatments all focus on decreasing inflammation and compression on the median nerve.

Medication

Your physician may order pain relievers or anti-inflammatory medication. A cortisone injection into the carpal tunnel may also be recommended to assist with decreasing inflammation near the carpal tunnel.

Occupational or Physical Therapy

A referral to an occupational or physical therapist or certified hand therapist may be made. A therapist can provide information regarding the diagnosis, appropriate treatment, and symptom reduction. They can make recommendations to introduce into daily activities to allow appropriate positioning of the upper extremities. A therapist will also instruct individuals on helpful stretching exercises or fabricate a wrist splint. Other treatments include ultrasound, iontophoresis, and massage. The focus of therapy is to introduce changes and interventions that reduce inflammation at the carpal tunnel to assist with symptom relief.

Surgery

Surgery, referred to as a carpal tunnel release, may be indicated if symptoms are significant and impair functional activity performance.

Prevention

To reduce your chances of getting CTS:

Guest Contributor: Nancy Naughton, OTD, CHT, is a doctor of occupational therapy and certified hand therapist, specializing in the rehabilitation of the hand and upper extremity at Hand Surgery Associates, Olyphant, PA.

NEXT WEEK! Read Dr. Mackarey’s "Health & Exercise Forum" – every Monday

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor  in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM. For of Dr. Paul's article, check out our exercise forum!