Halloween season can be fun and ghostly, but nothing is scarier than a hand injury, says Donna Hart Goodson, OTR/L, CHT.  “Every year, I expect to see at least one hand injury that could have been prevented if extra safety measures had been taken when carving a pumpkin,” says Donna.  Most injuries I’ve seen are from a child or adult holding a wet knife while trying to cut through tough pumpkin skin.  The hand slips and a finger gets cut on the knife blade, cutting through vital tendons in the fingers.  Unfortunately, therapy for these injuries is generally needed long after Halloween has passed and sometimes results in loss of hand function.  

In 2019, it was estimated that 40% of Halloween injuries were related to pumpkin carving.  These injuries include minor cuts or lacerations, stab and puncture wounds, and/or severed tendons, nerves, and or ligaments, all of which can lead to long-term loss of motion, sensation, and strength in the hand.  “I’ve seen injuries in the dominant and non-dominant hand that occur when carving pumpkins.” Says Donna.  “Both hands are susceptible to injuries when it comes to using a knife!” 

To avoid finding yourself in the emergency room this Halloween season, follow these basic steps provided by the American Society of Hand Therapists.

1. Choose the best location: Well-lit areas help you to see the task at hand clearly.  Also, having dry hands, a dry pumpkin, and dry surrounds will help to make your work area safer.
2. Adults should do the actual carving:  Kids can help pick out the pumpkin, pick out the design, and clean out the pumpkins.  NEVER allow children to use a knife.  The tough skin and the soft middle of the pumpkin makes using a knife with precision difficult.
   *** NOTE: Consider carving the pumpkin before cleaning out the inside, as this eliminates the ability to place a hand inside while carving the pumpkin.
3. Buy pumpkin carving kits: These tools are specifically made for carving pumpkins and can help decrease the chance of injury.  There are also lots of kits to decorate the pumpkins with paint or stickers that allow the children to decorate the pumpkin.
4. Use safe carving technique: NEVER put your non-dominant hand directly behind the pumpkin where the knife could slip and cut.  Also, make sure your tools are dry to avoid slipping while gripping the knife.  

Following these safety tips can help you and your family have a ghostly fun time!

For more information on safety tips, check out these links.  

1. https://www.assh.org/handcare/safety/pumpkin-carving
2. https://www.asht.org/sites/default/files/docs/2016/Avoiding%20Pumpkin%20Carving%20Injuries%202016.pdf
3. https://www.cpsc.gov/s3fs-public/HalloweenSafetyIn3Steps.pdf

What is Trigger Finger or Trigger Thumb?

Trigger finger is an inflammatory condition that is most common in the ring finger but can affect any of the fingers. Triggering of a finger occurs because the tendon that helps move the finger up and down becomes inflamed and no longer moves smoothly through the pulley that supports this tendon. Thus, when the muscle pulls the tendon to make a fist, the swollen tendon, which normally glides through the pulley without any problem, is now too large; thus, it “pops” or “triggers” as it tries to go through the narrow pulley. This pulley is found at the base of each of the fingers, in the distal crease in the palm of the hand, and this area can be quite tender when this area is pressed.

Our hands are much stronger when we bend our fingers into a fist than when we straighten our fingers, and thus at times, the finger gets “locked” into a fist with this diagnosis. The lack of strength to pull this swollen tendon back through the pulley to straighten our fingers may require the use of the opposite hand to straighten the finger.

What is Trigger Thumb

Trigger thumb is the same as trigger finger; however it affects the long tendon to the thumb. The pulley involved can be found at the bottom crease of the thumb in the palm of the hand. Like trigger finger, the muscle bending the tip of the thumb is stronger than the muscle straightening it; thus, at times, the tip of the thumb can be seen as “popping” or “triggering” as it is bent. And at times, the opposite hand is required to straighten the tip of the thumb
fully.

Symptoms

• The first symptom of this diagnosis is pain in the palm of the hand over the area of the crease line of the finger or thumb. (It is surprisingly a quite
  painful condition!)
• When this inflammation becomes worse, “triggering” can be noted. In extreme cases, making a fist becomes impossible, which can lead to secondary joint stiffness and limited motion.
• If left untreated, limited motion and joint stiffness become more apparent, making performing daily tasks very difficult.
• A finger becomes stuck in a bent position and cannot be extended due to extreme pain.
• In extreme conditions, it may be impossible to even bend a finger to make a fist.

Causes

• Repetitive gripping as when using a tool such as scissors, a hammer, vice grip, etc. Sustained gripping of an object.
• Rheumatoid arthritis, gout, and diabetes are conditions that can make people more susceptible to Trigger Finger/Thumb.
• Sleeping with the fingers in a fisted position is known to make this condition worse.
• Exercising the fingers (including squeezing a ball) after this condition starts can make this condition worse.
• The condition is more common in women than men.
• Recent studies suggest that trigger finger may be a complication associated with surgery for carpal tunnel syndrome surgery, especially during the first six months after surgery.
• Many times, the causes are unknown. Conservative treatment (this means treating it without surgery):
• Heat: Heat can help increase circulation to the involved structures and help promote healing.
• Ice: Decreasing the inflammation with ice after heat will help to decrease the pain and inflammation.
• Modalities: At Premier Physical Therapy, we use several different types of modalities to help increase circulation to help promote healing. Please call Premier Physical Therapy to see if this would benefit you.
• Orthotic: An orthotic to help protect and rest the structures involved is imperative for treating this condition. Orthotics at Premier Physical Therapy are custom-made and are usually covered by your insurance.
• Education: Patient education is the key to help each person fully understand their condition and how to prevent this condition from returning. At Premier Physical Therapy, we make sure you have the necessary information to fully understanding your condition.
• Massage/Transverse Friction Massage: Transverse Friction massage is found to be helpful in treating this condition. Let us show you the correct
  techniques.

Surgery

Early treatment of Trigger Finger/Thumb can make a huge difference in the outcome of Trigger Finger or Trigger Thumb. Trigger finger can be treated
without surgery in most cases, and surgery is recommended only after conservative treatment has failed.’

For more information: Go to ASHT Patient Education at https://www.asht.org/sites/default/files/docs/2018/Trigger%20Finger%202018.pdf

Call Premier Physical Therapy at 573.335.7868 for more information concerning this diagnosis.

Water Facts:

1. 60 to 70 percent of our total body weight is water weight.
2. A typical person with an average body weight is required to drink 64 ounces of water daily. This is about eight glasses of water per day.
   a) (Of course, if you are in a hot environment or are doing a strenuous task and thus are sweating a lot, additional water intake is needed.)
   b) NOTE: This rule does not apply to anyone with heart failure or kidney disease; thus, this amount may need to be adjusted.
3. When you have an open wound, more water is needed to help keep the wound hydrated on the inside due to the loss of fluids that can occur through wound drainage.
4. To know if you are drinking enough water every day, take a quick check the next time you use the bathroom. Urine should be relatively clear and odorless if you are staying well hydrated.

Not drinking enough water will essentially slow down your body’s ability to heal after an injury. This includes an injury to a bone such as a: fracture, an injury to the tendon such as tendonitis, injury to a ligament such as a strain or sprain, or injury to the skin as in laceration or a cut. If you have an open wound with drainage, staying hydrated is essential to healing.

Water affects your body’s circulation and, thus, your ability to heal. The higher your blood volume, the better you will heal. Water is one of the main components of a cell, and it is important to the health of a cell. When the cell doesn’t have enough water, new cells cannot develop, and tissue growth is affected.

Water is needed in our body to help transfer oxygen throughout our body, especially to healing areas. Hydration is essential to healing any structure (bone, tendon, ligament, or skin) as it delivers the necessary nutrients to the injured area. Water is needed to help carry away waste from the injured structure as well. Water provides that river of flow to and from the trauma area to assist in healing and to fight infections.

Tricks for staying hydrated:

1. Keep your favorite drink on hand. Flavored water can help those who don’t like drinking just plain water.
2. When watching a movie or television, get into the habit of drinking a couple of sips at each commercial break.
3. Mix it up! Enjoy a variety of cold and hot drinks to make liquids more enjoyable to drink.
   a) REMEMBER: Avoid caffeinated and alcoholic beverages, as these will actually cause dehydration which ultimately requires MORE water intake!
4. Eat smoothies, gelatin, fruit ices, and other foods with high-water content, such as watermelon.
   a) NOTE: Watch out for these items that may be high in sugar.
5. Make drinking fun! Straws, containers with handles, or angled mouthpieces may help.
6. Have a reusable container with you all of the time and fill it often.
7. Have a daily goal and consider dividing that into a morning and afternoon goal. Get a water bottle with marked time goals.
8. Ask a family member to remind you.
9. Try fruit- or herb-infused water for some added flavor.
10. Make herbal tea to sip throughout the day.
11. Drink a glass of water when you first wake up.
12. Track your water intake on an app or fit bit and make it a goal to reach your goal daily. Your health depends on it.
13. NOTE: My way is to plug my nose and just drink it! It’s really not that bad, and it does make me feel better!

Hydration: It’s what heals you! DRINK WATER!