cause of pain in a finger...??

[nari]

Hi all
here is a thought or two about what would seem to be a musculoskeletal injury.

While clambering down a series of tree roots on my latest trek, my left foot dropped about half a metre from one root down to the next (a perpendicular drop) into very wet mud. My right hand came against a tree trunk for balance, but my foot slid in the mud and I hyperextended my middle finger (MF) under load, and heard a snapping sound. Ouch. It complained. swelled and I nursed it until we reached the hut about three hours later. Next day, it was colourful - blue, black and pink, and fat. ROM was limited by swelling and pain. Another hike, and I kept it elevated by sticking my thumb in behind the front backpack strap, occasionally putting it down for a change of position.

The point I am making is this: I do not know what had happened to it, but without any doubt the pain disappeared when I walked along the track, doing ULNT1 movements. (The others probably thought I was nutty)
The pain remained unaltered if I did not tension and mobilise the median nerve.
I assume from that, the digital nerves had been twanged, but that would not solelycause the discolouration and all of the swelling.

So - what of the pain resulting from countless other m-s injuries people have? Are orthopaedic injuries being compromised because we attend only the muscles, ligaments and joints?


Nari

[emad]

Hi Nari :

What i have understood from yopur post v;

Addressing only joint,muscles ,ligaments , and neglecting nerves usually make the issue /the psocess not progressed good ,
yes , you are right dealing with nerves in case of immo0bilisation is extremely important as i belive nerves also goes under some thimg like tightness , which make the issue more complex .
am i on the track?

cheers
emad :lol:

[nari]

Hi Bernard and emad

The point I wanted to raise in my post was that the pain in the finger post-injury seemed to be neural in origin.
I can't explain any other reason why the pain would disappear under neural mobilisation, and not under any other condition. It was purely of academic interest...

I agree, Bernard, that injury needs attention and time to rest for a day or so, but I was not in any position to attend to it - other than immobilise which I did not want to do.

I cannot assume that all injury has a neural component - the swelling and bruising indicates ligament damage. Damaged nerves can cause considerable swelling - but not in technicolour. (Axoplasmic bleeds are colourless)

What I am thinking, in my devious way, is this:

Take a patient with, say, a total knee replacement. Swollen, sore, limited ROM; what if we did nerve glides/tensioning as well as the other stuff? would this be effective as pain relief and thus enhance rehab???

Just a thought.


Nari :roll:

[Diane]

Hi Nari,
".. the swelling and bruising indicates ligament damage."

Maybe.. maybe not...What if the swelling and bruising indicated damage to capillaries and lymph channels WITHIN the ligament? The finger might have had a tiny plexus or two injured and not the ligament. (It wasn't unstable was it?) If we assume that hypothesis for a moment, moving it the way you did would have helped pump it and certainly keep the nerve mobile and the capillaries, in that in a finger they are many (lots of collaterals) and would heal quite rapidly. Motion was lotion for your finger tissues, all of them, even the most microscopic ones.

Swelling is a funny thing. I treated my 76 year old uncle a few weeks ago at a family gathering. He arrived to my mother's home with the back of his left hand enormously swollen, shiny, painful and red, his fingers puffy and getting worse over the last day. (Everyone was suitably impressed!) He'd been to the doctor and had been given antibiotics, told he had arthritis... He had been driving a tractor with a stiff steering wheel a few days before, with his left hand, for several hours, while he worked a scoop shovel with the right, moving snow from his farm yard. He had been wearing a wrist watch on that wrist, which he never removes, which was pressing a watch-shaped depression into his arm. He recalled no injury at the time, but the next day the hand had started to hurt, swell and turn red, and was continuing to worsen.

He let me work with his arm, propped on a pillow, sitting beside him on the couch. I got the watch off, did really light palpation, found where there was tenderness on the dorsum of the hand, right where the extensor tendons dive under the retinaculum of the wrist. I did this and that, some light stim to the skin over the lymph channels in the arm all the way to the shoulder, some positional release, some finger traction, some skin stretch, some prolonged hands-on to the retinaculum... He liked it , said it felt good, didn't hurt.. I had him learn fist squeezing and finger splaying.. told him about heat and cold. The swelling started to go down during the treatment, and continued on its own. By the next day it was all the way down, and he had full painfree range of all his fingers and wrist. The redness was still there some but was improving. I think he had developed tendonitis, made worse by the aggravation of the wristwatch sitting right on the extensor retinaculum.

The point of this whole story is, that no matter what "tissue" is injured, or how, it's always the nerves that are the first tissue injured or aggravated, in his case, the nerves that were buried within and sensing his tendon sheaths.. And maybe in your case Nari, the nerves that supplied the capillaries, drainage, and sensation in the "ligament" tissue, without necessarily hurting the ligament itself. Just a thought, what do you think?

As for a swollen knee, I would probably do exactly the same thing, take care of helping the inflow and the outflow reestablish itself first through skin stimulation, deal with movement second, (a close second, with hands-on,), and third, independent nerve glides etc.
Cheers,
Diane

[nari]

Hi Diane

Being a neurally-obsessive person, I totally like your idea that what I did was overstretch various structures and tissue including capillaries. I had forgotten about the vulnerability of capillaries and other tissue in the digits.
Sometimes I think that there may have been a partial ligament tear, and other times it seems perfectly stable.

I also keep thinking of the many tales I have heard from vets, trainers and also from studies demonstrating that the best remedy for damaged ligament/s is to support, and expose to loaded WB as soon as possible.
For racehorses, they train hard on asphalt as soon as possible after a day's rest or so. The results are faster healing and stronger matrix.
Now the latest study shows that for fractures of the scaphoid, it is better NOT to plaster, but simply bandage, and use as able, so to promote circulation instead of inhibiting it! Incidence of AN is HIGHER if plastered?

Life gets confusing, doesn't it!!


Nari :roll:

[bernard]

Nari,

I can't compare a horse and a human being about behaviors!

[Diane]

Nari, what is "AN"? (You wrote "Incidence of AN is HIGHER if plastered?")
Diane

[nari]

Bernard

I think we may be closer to the animal kingdom in terms of biology than we think!! Except we make animals do what we want, not viceversa!

Diane

AN= avascular necrosis. I will try and find the study where they quoted figures of plaster vs bandaging - cannot remember where I found it.

[bernard]

Nari,

Wild horses have certainly injuries and I suppose that normal repairing occurs. Perhaps the normal recovery take a bit more time?

We share a fantastic library with animals but not our marvelous brain that makes the difference and often our despair?