Orthopedic and trauma
Orthopedic and Trauma Injuries in Singapore, by What Happened
The bone healing and the joint working are two different jobs. Most people are discharged after the first one.
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Nothing matched that one
This list is not every injury, and the name on your discharge letter may not be the name we have used here. Tell us what happened and where it hurts now, and we will tell you which of these it looks like.
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Grouped by what happened rather than by the name on the report. Nothing on this page is a sports injury. These are the falls, the fractures, the road accidents, the cast that has just come off, the joint that has worn down over twenty years, and the pain that was supposed to settle and did not.
After a Fall
Wrist You Landed OnFall on the Outstretched HandYou put a hand out on the wet toilet tile, and now the wrist is puffy, you cannot push up out of a chair with it, and turning a key hurts more than lifting does. The whole force of the fall went through the wrist in one line, and whether it broke or only sprained, the joint stiffens in the same two directions afterward: turning the palm up, and taking weight through the heel of the hand. Sore Thumb-Side Wrist That Was Written Off as a SprainScaphoid FractureA deep ache in the hollow at the base of the thumb weeks after a fall you assumed was nothing, sore when you grip a jar lid or push a heavy door. The scaphoid has a thin blood supply at one end, so a break there can stay quietly painful and slow to unite, and it is a bone that needs a doctor and imaging rather than watchful waiting. Elbow That Will Not Straighten After a FallPost-Traumatic Elbow ContractureYou landed on the elbow coming down the void deck stairs, the swelling has gone, and it still sits a few degrees short of straight and hurts to turn your palm up. The elbow is the joint most willing to stiffen after trauma, because the capsule is tight to begin with and the position it settles into while it is sore is a slightly bent one. Shoulder You Broke the Fall WithTraumatic Rotator Cuff InjuryThe bruise over the point of the shoulder has faded and you still cannot hang a shirt on a hanger or reach the top shelf without hitching the whole shoulder up toward your ear. A fall onto the shoulder loads the cuff tendons at the moment they are working hardest to hold the ball in the socket, so the loss shows up as a reaching problem long after the pain has settled. Hip and Groin Pain After Going DownPelvic and Hip Injury After a FallYou got up, walked home, and only that night found you could not lift the leg into bed or roll over without holding your breath. Groin pain on weight-bearing after a fall, particularly in an older adult, is the presentation that needs a doctor and an X-ray first, because the pelvis and the hip can be broken and still let you walk a short distance. Landed Straight Onto the KneecapPatellar Contusion and Anterior Knee PainYou went down hard on the knee on a concrete kerb, and now kneeling on the bathroom floor and walking down stairs are both worse than going up. The bruised surface under the kneecap is loaded most when the knee bends under bodyweight, and the thigh muscle switches off protectively, so stairs feel unsafe as well as sore. Ankle Rolled Stepping Off a KerbLateral Ankle Ligament SprainYour foot went over the edge of the kerb, the outside of the ankle swelled by evening, and weeks later it is fine on flat ground but feels untrustworthy on grass and in the dark. Ligament tissue heals, but the position sense in the joint does not come back on its own, and that is the part that has to be trained back deliberately. Finger Jammed in the FallFinger Sprain and Volar Plate InjuryYou caught yourself with a hand, one finger bent backward, and weeks later the middle knuckle is thick and warm and will neither fully straighten nor fully close. The small ligaments at that knuckle swell easily and the joint settles into a slightly bent position, and that position is where the stiffness sets in. Tailbone Pain After Sitting Down HardCoccydynia After a FallYou slipped and landed on your backside, and the sore point is right at the bottom of the spine, worst on a hard chair and standing up out of it, and easier once you are walking. The coccyx takes direct load in sitting, and the pelvic floor and low back muscles around it guard afterward, so sitting tolerance drops further than the bruise alone explains. X-Ray Was Clear and It Still HurtsPost-Traumatic Soft Tissue Injury and Joint StiffnessThe doctor showed you the film, said nothing is broken, and six weeks on you still cannot rotate the joint or take weight on it the way you did before the fall. An X-ray answers a question about bone, and ligament, cartilage and capsule injuries do not appear on one, so a clear film rules out a fracture without explaining what you are still feeling.
Fractures and Broken Bones
Wrist That Will Not Turn After the CastDistal Radius FractureSix weeks in a cast, the bone is sound, and you cannot turn your palm up to take change, cannot push a door with the heel of that hand, and the wrist aches by mid-afternoon. The bone healing and the wrist working are two separate jobs, and rotation and weight through the hand are the two the cast cost you, because nothing in ordinary life loads them until you need them. Stiff Wrist After a Thumb-Side FractureScaphoid Fracture After TreatmentTen or twelve weeks of a cast or a screw for a bone the size of a cashew nut, and now the thumb side of the wrist is tight, grip feels weak and bending the wrist back to push up off a table is not on. The scaphoid sits in the middle of the wrist mechanics, so it is held still for longer than most fractures and the joints around it pay for that in stiffness. Broken Finger or KnucklePhalangeal and Metacarpal FractureThe finger was strapped or pinned, and now it will not make a full fist, the knuckle looks flatter than the ones beside it, and getting the hand into a glove or a trouser pocket takes thought. Tendons glide directly across the back of a healing hand bone and scar down onto it, so the bone can be solid while the finger still cannot travel. Fracture at the Point of the ElbowOlecranon FractureThe wires and the plate have healed over and you can bend the elbow to eat, but you cannot get the arm straight enough to hang a bag off the forearm or carry a pail down a corridor. The olecranon is where the triceps pulls, so straightening is the movement that has to be earned back, and the elbow capsule tightens faster after it has been opened than almost any other joint. Broken Upper Arm With a Dropped WristHumeral Shaft Fracture With Radial Nerve PalsyThe arm bone broke in the fall, and now the wrist hangs down, you cannot lift the back of the hand or open the fingers out, and yet you can still feel everything normally. The radial nerve runs in a groove along the back of that bone and is commonly bruised or stretched at the moment it breaks, which is a conduction problem rather than a torn tendon, so the hand is splinted in a working position and every joint in it kept moving in the meantime. Broken CollarboneClavicle FractureThe lump on the collarbone is the bone healing, and the problem now is that the shoulder blade sits forward, reaching overhead catches, and a laptop bag on that side aches within ten minutes. The clavicle is the only bony strut between the arm and the chest, so while it was protected the shoulder blade stopped gliding properly, and that habit outlasts the fracture. Shoulder Fracture in an Older AdultProximal Humeral FractureYour mother fell at home, the arm went into a sling, and a month later she cannot reach her own hair or fasten a bra and the whole shoulder has gone tight. In an older shoulder the sling that protects the fracture also lets the capsule shorten, so movement within what the doctor allows is started early and the stiffness is worked on alongside the fracture rather than after it. Broken RibsRib Fracture and Chest Wall InjuryThree weeks on, coughing, sneezing and turning over in bed are the worst moments of the day, and you have been breathing shallowly since the accident without noticing you were doing it. Ribs move with every breath so they cannot be rested, and the shallow protective breathing is what leaves the chest wall stiff and the chest slower to clear itself. Plate and Screws in the Leg or AnkleTibial or Ankle Fracture After FixationYou are off the crutches, the surgeon is happy with the films, and the ankle will not bend enough to walk up a slope and the calf on that side has visibly thinned. The bone was held with metal so that it could be loaded, and the calf and the ankle come back only with graded weight through the foot, which is a separate piece of work from the healing. Broken Heel BoneCalcaneal FractureMonths after the fall off the ladder you can walk on the flat, but the heel burns on hard floors, the foot looks wider than the other one, and standing through a whole shift is out of the question. The heel bone is the platform the body lands on and it commonly unites in a slightly changed shape, so the work is loading tolerance, footwear and how the foot and ankle share the load, not stretching. Collapsed Vertebra in the SpineVertebral Compression FractureA sudden band of pain across the mid back from something small, a miss on the last step or lifting a grandchild, worse standing and walking and easier lying flat, and you feel a little shorter than you were. The front of a vertebral body has given way under load, which is a bone-strength question for a doctor first, and then a matter of upright tolerance, breathing and hip and back strength. The Bone Healed and the Joint Did NotPost-Traumatic Joint StiffnessThe last review said the fracture has united and you do not need to come back, and the joint beside it moves through half the range it used to and hurts at the end of what is left. Bone union and joint range are separate outcomes, and a joint held still while a bone healed is stiff from the capsule, the scar and the tendons around it rather than from the fracture.
Dislocations and Joint Instability
Shoulder Out for the First TimeTraumatic Anterior Shoulder DislocationIt was put back in at the emergency department, you wore the sling for three weeks, and the arm feels fine by your side but you will not let anyone take it out to the side and back. The front of the joint was stretched or torn on the way out, so the shoulder is now leaning on muscle control for the stability it used to get from the ligaments and the labrum. Shoulder That Keeps Coming OutRecurrent Shoulder Instability with Bankart LesionIt has been out three times, the last one you put back yourself in the carpark, and each time takes less force than the one before: reaching back for a seatbelt, turning over in bed. Every dislocation leaves the front rim of the socket and its labrum holding the ball less securely, which is why the threshold keeps dropping and why the surgical question gets asked at this point. Shoulder That Slips and Goes Back InShoulder SubluxationThere is a dead-arm moment when you reach overhead or behind you, a sick feeling for a second or two, and then it is back in and you carry on as though nothing happened. The joint is traveling further than the ligaments should allow without leaving the socket completely, and the muscles around it are catching it late rather than stopping it early. Elbow That Was DislocatedSimple Elbow DislocationThe elbow was put back in the same night, the sling came off after a fortnight, and now it will not straighten fully and feels loose and sore at the same time when you push a heavy door. An elbow stiffens quickly after being dislocated, and the ligaments on both sides need graded loading before they tolerate side-to-side force again, so range and stability are trained in the same program. Finger Put Back In at the HospitalPIP Joint Dislocation and Volar Plate InjuryThey pulled it straight, strapped it, told you it was only a dislocation, and six weeks later the middle knuckle is still fat, will not straighten the last fifteen degrees and aches in air conditioning. The volar plate at the front of that joint tore on the way out, and a PIP joint allowed to sit bent loses extension that is hard to regain once the scar there has matured. Unstable Thumb BaseThumb Carpometacarpal InstabilitySince the injury the base of the thumb, down near the wrist, clicks and shifts when you turn a door knob or wring out a cloth, and pinching anything has become something you plan for. That joint is a saddle held centered by its ligaments, and once they have been stretched the thumb column slides under load instead of pivoting, which is felt as a shift rather than as pain at first. Kneecap That Came OutPatellar DislocationThe kneecap went to the outside, someone straightened the leg and it went back in, the knee swelled within the hour, and now stairs, squatting and turning on that leg all carry a feeling that it could happen again. The groove the kneecap runs in is shallow at the top of its travel, and the muscle and the ligament on the inner side that keep it there are stretched after it comes out. Ankle That Was Out of LineAnkle Fracture DislocationThe joint was visibly out of line at the roadside, it was reduced and held with a plate, and now the ankle will not bend enough to get the heel down on a slope and feels unsteady on uneven ground at the same time. A dislocated ankle injures the joint surface and the ligaments as well as the bone, so stiffness and unsteadiness sit together, and both are addressed by loading rather than by protecting. Joint That Feels Like It Will Go AgainPost-Traumatic Apprehension and InstabilityNothing actually hurts, and you still will not sleep with the arm above your head, reverse the car with that arm, or stand on that leg near the edge of a step. Once a joint has been out, the nervous system guards the exact position it went out in, so what you are meeting at the end of range is protection and confidence rather than pain, and it is worked on by meeting that position under control.
Road Traffic and Riding Accidents
Neck Pain After Being Rear-EndedWhiplash Associated DisorderYou felt fine at the scene and gave a statement, and by the next morning you could not check your blind spot, the base of the skull ached, and holding a phone up made it worse. The neck was loaded fast in a direction it never trains for, and the guarding that follows limits turning more than the tissue injury itself does, which is why it is worse on day two than on day one. Shoulder Bruised by the SeatbeltSeatbelt Injury to the Shoulder GirdleThe belt did its job across the chest and collarbone, and a fortnight on the bruise has faded while reaching across your body and lifting anything overhead still catch. The belt loads the collarbone, the small joint at its outer end and the front of the shoulder in one line, so the shoulder blade stops gliding normally and the reach goes before the pain does. Arm Braced Against the Steering WheelAxial Load Injury to the ShoulderYou saw it coming and locked both arms straight against the wheel, and now the deep front of the shoulder catches reaching behind the passenger seat and pushing up out of a low chair is sore. A straight braced arm sends the whole impact up the bone into the socket, which loads the labrum and the biceps attachment at the top of the joint in a single moment rather than gradually. Hand Landed On at SpeedHigh-Energy Wrist and Carpal InjuryYou came off the bike and put a hand down at speed, and the whole back of the wrist is swollen, grip is half what it was, and there is a grinding when you turn the forearm over. Landing a hand at that speed loads the eight small carpal bones and the ligaments between them together, so more than one structure is usually involved and it needs a doctor and imaging before any rehabilitation is planned. Road Rash Over a JointPost-Traumatic Scar Contracture and EdemaThe graze has healed into a tight shiny patch across the back of the elbow or the hand, and it is the skin, not the joint underneath, that stops you at the end of the movement. Scar tissue over a joint matures in whatever position it was held in, so that layer is what has to be lengthened and kept mobile, with the swelling managed alongside it so the tissue is not tight from fluid as well. Hand Hit by the HandlebarHook of Hamate and Ulnar-Sided Hand InjuryThe heel of the hand on the little-finger side took the handlebar, and now gripping a throttle or a bag handle aches deep in the palm, and the ring and little fingers tingle after a few minutes of holding on. The hook of the hamate and the ulnar nerve sit in exactly that spot, so a blow there presents as a deep ache with pins and needles rather than as an obvious break, and it is a bone that is easy to miss on a first X-ray. Knee Into the DashboardPosterior Cruciate Ligament InjuryThe knee hit the dashboard with the joint bent, it was the back of the knee that was sore rather than the front, and now walking down a slope and slowing yourself on stairs feel unreliable while flat ground is fine. The PCL stops the shin sliding backward under the thigh, so it is going down and braking that find it, and quadriceps strength is what the knee borrows to manage without it. Ankle Crushed Under the BikeComplex Ankle Fracture After FixationThe bike came down on the foot and ankle, the joint was plated, and months later the ankle swells by the end of every day, will not bend enough for a normal step, and aches through the joint line rather than along the scar. A crush injures the joint surface and the soft tissue envelope around it at the same time, so swelling control, graded weight through the foot and a walking pattern the ankle tolerates are the work, not stretching. Chest Wall Pain After the CrashRib and Costal Cartilage InjuryWeeks on, the seatbelt line or the side you landed on still catches when you cough, laugh, reach into a high cupboard or turn over in bed, and you have been sleeping propped up on pillows. Ribs and the cartilage joining them to the breastbone are loaded by every breath, and the shallow protective breathing that follows keeps the chest wall stiff and the trunk unwilling to rotate. Waiting on the Claim and Getting StifferDeconditioning and Persistent Pain After a Road AccidentFour months of MC, letters and appointments, the claim is still open, and the shoulder or the knee that was supposed to settle by itself now moves less than it did in month two, and you have stopped using that arm or leg without ever deciding to. Joints and muscles respond to what they are asked to do, so a limb rested through a long claim loses range and strength for reasons that have nothing to do with the original injury.
After a Cast, Splint or Sling Comes Off
Wrist That Will Not Turn Palm-UpPost-Immobilization Forearm Rotation LossThe film says the bone has healed, and you still cannot turn the palm up to take change or carry a bowl of soup flat, so you have quietly started doing everything with the other hand. Rotation is the first movement a cast takes away and the slowest to come back, because the forearm joints and the tissue around them have been held still and nothing in ordinary daily life asks for that range until the moment you need it. Fingers That Will Not Make a FistComposite Flexion Loss After ImmobilizationEach finger bends a little, but the tips will not reach the palm, and you notice it holding a bus handrail, wringing out a cloth or trying to get a full grip on a jar. Held still, the skin and tissue over the back of the hand tighten and the tendons glide less freely inside their sheaths, so what is limiting the fist is usually stiffness and gliding rather than anything torn. One Finger Stuck Half-BentProximal Interphalangeal Joint ContractureOne finger sits half-bent, will not lie flat on the table next to the others, and the middle joint looks thicker than the same joint on the other hand. The capsule and the ligaments at the sides of that joint tighten fast when the finger has been splinted or guarded, and the PIP is the least forgiving joint in the hand about being held still, which is why range work and splinting are done together. Shoulder Stiff After Weeks in a SlingPost-Immobilization Shoulder StiffnessOut of the sling and you cannot reach the seatbelt, the back pocket or the hook behind the toilet door, and putting on a shirt has become a two-stage operation. The capsule tightens while the arm is strapped to the body and the muscles around the shoulder blade stop taking their share of the movement, so the range comes back through graded joint and muscle work rather than through time out of the sling. Elbow That Will Not StraightenPost-Traumatic Elbow Extension LossYou only saw it when you held both arms out and compared them, or when you reached for a high shelf and the arm stopped short, and the elbow now aches by the end of the day. The elbow lays down thick capsular tissue faster than any other joint after a fracture or a spell in a sling, and the last few degrees of straightening are the range that resists longest. Knee After a Long-Leg Cast or BracePost-Immobilization Knee Stiffness and Quadriceps InhibitionThe bone has healed and the knee bends far enough to walk on the flat but not enough to get down the void deck stairs normally or sit in the back seat of a car. Weeks held straight shorten the tissue at the front of the thigh and around the kneecap while the quadriceps switches off, so the bend and the strength to control the bend have to be trained at the same time. Ankle That Will Not Point or Pull UpPost-Immobilization Ankle StiffnessOut of the boot you can stand and walk, but the foot will not pull up enough to clear the floor and will not point enough to push off, so you walk with a flat, careful step and hold the rail on slopes. Ankle range disappears quickly in a cast and the calf shortens with it, which is why this shows up as a limp and a fear of kerbs more than as pain. Leg That Has Gone ThinDisuse Muscle AtrophyStanding in front of the mirror you can see it plainly: the calf on that side is thinner, the thigh has lost its shape, and the leg feels unreliable stepping down off a kerb or onto a wet tile. Muscle bulk and the nerve drive to it fall away within days of unloading, and it comes back through graded, measured loading rather than through walking about more. Swelling That Arrives Every AfternoonPost-Immobilization EdemaThe hand or the foot looks near normal at breakfast, and by four in the afternoon the skin is tight, the ring will not come off and the shoe feels a size too small. Once the cast is off the limb is upright and working again, but the muscle pump and the drainage of fluid out of the tissue have not caught up, so it collects through the day and settles overnight. Skin and Scar That Cannot Be TouchedPost-Immobilization Tactile HypersensitivityThe skin over the wrist or the shin cannot stand a shirt cuff or a bedsheet, a light touch feels like a scratch, and you have started holding the limb away from anyone who might brush against it. Skin that has been covered and unused for weeks loses its normal tolerance to touch, and the nerve endings report ordinary contact as something sharper until they are gradually and deliberately re-exposed to it.
After Orthopedic Surgery
Wrist After Plate and Screw SurgeryOpen Reduction and Internal Fixation of the Distal RadiusThe surgeon is happy with the film, the scar is neat, and the wrist still will not turn palm-up, the grip gives way opening a bottle and the forearm aches by evening. The plate holds the bone while it heals, and what is left afterward sits in the joint capsule, the scar and the forearm rotation, which are worked on directly rather than left to settle on their own. Hand After Tendon RepairFlexor Tendon Repair RehabilitationA deep cut to the palm or the finger has been repaired, you are in a splint, and you are frightened to move the finger at all in case something gives way inside. A repaired tendon has to glide inside its sheath early or it sticks to the tissue around it, and how much movement is allowed at each stage is set by the operating surgeon and carried out with your therapist. Hand After Carpal Tunnel ReleasePost-Surgical Median Nerve DecompressionThe night waking has stopped, which was the point of the operation, and now the base of the palm is tender to press, the scar is thickened and the grip feels weak lifting a wok or pushing up out of a chair. The incision passes through the part of the palm you lean on every time you push, and grip strength comes back with progressive loading of the hand rather than with resting it. Finger After Trigger Finger ReleasePost-Surgical A1 Pulley ReleaseThe catching and the painful click are gone, and the finger is now swollen, stiff, short of straight, and sore where the scar sits at the base of it. By the time the pulley is released the finger has usually been held bent and protected for months, so the joint stiffness and the scar are what remains to be worked on rather than the triggering itself. Hand After Dupuytren SurgeryPost-Fasciectomy RehabilitationThe finger is straighter than it was, the palm is stitched or grafted, and the hand feels tight across the knuckles, numb in patches and too swollen to close. Scar in the palm contracts as it matures and pulls the finger back toward where it started, which is why splinting and daily range work are part of the plan from the first appointment rather than added later. Knee After Knee ReplacementTotal Knee Arthroplasty RehabilitationThe grinding joint pain that sent you for surgery is gone, and the knee is swollen, tight to bend much past a right angle, and you are still taking the stairs one foot at a time with a hand on the rail. Swelling limits how far the knee bends and switches the quadriceps off, so getting the swelling down, the bend worked and the thigh loaded are the same piece of work rather than three separate ones. Hip After Hip ReplacementTotal Hip Arthroplasty RehabilitationThe hip joint itself feels fine, and what actually bothers you is the limp you cannot drop, the stick you still carry outside and a deep ache over the side of the hip by the end of a day out. Years of limping before the operation leave the gluteal muscles weak and the walking pattern learned, and a new joint changes neither of those on its own. Shoulder After Shoulder ReplacementShoulder Arthroplasty RehabilitationOut of the sling, the arm lifts to about shoulder height, which covers eating and driving but not hanging laundry on the pole or reaching the top shelf of the kitchen cabinet. How much range and load the shoulder is allowed depends on which parts were replaced and what was repaired around them, so the surgeon sets the limits and the therapy works on range, control and strength inside them. Shoulder After Rotator Cuff Repair in an Older AdultPost-Surgical Rotator Cuff Repair RehabilitationWeeks on from the repair you can swing the arm up but not lift it slowly, the shoulder aches at night on that side, and you have stopped using it for anything above head height. The repaired tendon is protected early and then loaded in stages, and in an older shoulder the stiffness and the loss of muscle around the shoulder blade usually need more attention than the repair site does. Back After Disc SurgeryLumbar Microdiscectomy RehabilitationThe leg pain that had you unable to sit through a meal went the day after the operation, and what is left is a stiff, weak-feeling back, a numb patch on the calf and real reluctance to bend down for anything. The nerve has been decompressed, and the back has been guarded for months, so trunk endurance, hip movement and confidence with bending and lifting are what the rehabilitation is built around. Ankle After Fracture SurgeryOpen Reduction and Internal Fixation of the AnkleThe boot is off, there are two scars and a plate you can feel through the skin, the ankle swells by evening, and you manage the flat but avoid kerbs, slopes and the wet tile at the market. Weight has been off that leg for weeks, so ankle range, calf strength and single-leg balance all have to be rebuilt before the limp goes, and they are trained in that order. Discharged From Hospital Physiotherapy and Still ShortIncomplete Post-Surgical RehabilitationYou were seen a few times in the ward and at the outpatient clinic, told you were doing well and discharged, and you still cannot kneel to the floor, carry the groceries up to the flat or get through a full day at work without paying for it. Hospital rehabilitation is aimed at getting you safe and independent at home, and the demands of your own job, stairs and household sit beyond that point, so that is where the next stage of work starts.
Crush, Cut and Machinery Injuries
Finger Caught in a Door or GateCrush Injury of the FingerThe finger was slammed in the car door or the gate at home, the nail has gone dark, and a week later it is fat, throbbing and will not bend more than halfway. A crush bruises bone, nail bed and soft tissue all at once, and it is the swelling trapped inside the finger rather than any break on the film that is stopping it bending. Hand Caught in MachineryComplex Hand TraumaThe hand went into a press, a mixer or a moving belt at work, several structures were repaired in one operation, and now each part of the hand behaves differently: one finger stiff, one numb, one still too swollen to bend. Injuries like this involve skin, tendon, nerve, joint and bone together, so the plan is built around which tissue is limiting which movement at that point rather than around one diagnosis. Crushed Hand That Stays Swollen and StiffPost-Traumatic Edema and Joint StiffnessThere was no break to see on the film, and weeks later the hand is still puffy across the back, the knuckles will not bend fully and the skin looks tight and shiny. Fluid left sitting in the tissue matures into thicker scar between the surfaces that are meant to glide over each other, which is why swelling management and movement are done in the same appointment rather than one after the other. Cut Tendon in the Palm or FingerFlexor Tendon LacerationA knife slipped cutting frozen meat, or a glass broke in the sink, the wound looked small and closed cleanly, and the finger will not bend at the tip however hard you try. A flexor tendon that has been fully divided cannot bend the finger at all, and it needs surgical repair followed by staged, protected movement rather than exercise alone. Cut Tendon on the Back of the HandExtensor Tendon LacerationThe cut ran across the back of the hand or the top of the finger, and now that finger droops at one joint and will not lift level with the others, though you can still curl it in. The extensor tendons lie directly under thin skin with nothing over them, so even a shallow cut can divide one, and the repair is then held in a splint while gliding is worked on in stages. Fingertip and Nail Bed InjuryFingertip Crush and Nail Bed RepairThe tip was caught and either stitched or left to heal open, the new nail is coming in ridged and thickened, and the tip cannot stand being knocked, so you hold that finger up out of the way when you use the hand. Fingertips carry a dense supply of nerve endings and heal with a sensitive scar, so desensitization and getting the tip back into ordinary contact with things are what the work is aimed at. Numb Finger After a CutDigital or Peripheral Nerve LacerationThe blade or the broken glass caught the side of the finger or the front of the wrist, and one side of that finger has been numb since, so you burn it on the wok handle and drop small things you cannot feel. A cut nerve is repaired and then regrows down its old path from the level of the injury toward the fingertip, and during that time the hand is protected from burns and pressure and retrained to use what feeling it has. Finger Lost or Partly LostTraumatic Digital AmputationPart of a finger was taken off by the machine or the blade, the stump has healed over, and the trouble now is a pinch that no longer meets, a tip too sore to lean on and a hand you keep out of sight in public. The remaining fingers have to take over the grips the lost one used to do, and that is trained deliberately alongside desensitization of the stump and getting the hand back into open use. Replanted Finger or ThumbDigital Replantation RehabilitationThe finger was reattached and it is alive, and it is also cold, stiff, half-numb and doing almost nothing useful, and you have been told to keep it warm and protected. A replanted digit has bone, tendon, nerve and blood vessel all healing at once, so the surgeon sets what may move and when, and the therapy works within that, keeping the joints and the tissue moving in the range that is allowed.
Nerve Pain, Numbness and Weakness
Hand That Wakes You at NightCarpal Tunnel SyndromeYou wake at two in the morning with the hand numb and buzzing, hang it over the side of the bed and shake it out, and by daylight it is nearly normal apart from fumbling buttons and dropping a cup. The median nerve is compressed where it passes through the wrist and the pressure is highest at night with the wrist curled; where that compression continues long enough the thenar muscle at the base of the thumb wastes and that bulk does not come back, so numbness that has stopped coming and going is a reason to be assessed by a doctor as well as treated by a therapist. Little Finger That Goes Numb on the PhoneCubital Tunnel SyndromeTen minutes holding the phone to your ear, or a night with the elbow folded up, and the little and ring fingers go numb and stay that way, and lately the little finger catches on the edge of your pocket. The ulnar nerve is compressed behind the elbow and stretched further every time the elbow bends; sustained compression there leads to wasting of the small muscles between the fingers and a clawing of the little and ring fingers that does not recover, so visible wasting or weakness needs a doctor's assessment. Pinched Nerve in the NeckCervical RadiculopathyThe pain runs from the neck over the shoulder blade and down the forearm into the thumb, it is worst lying flat at night, and you have caught yourself resting the hand on top of your head because that takes the edge off. A nerve root is irritated where it leaves the neck, which is why the pain is felt down the arm rather than where the trouble actually is, and why neck position and the load carried in that hand both change it. Leg Pain From a DiscLumbar Disc Related SciaticaIt started lifting a tub of water or getting up out of a low sofa, and now the back is the least of it: the pain runs through the buttock, down the back of the thigh into the calf, and sitting through a bus ride is the worst position of the day. A disc bulge is irritating the nerve root that supplies that leg and the pain follows the nerve, which is why sitting, coughing and bending forward all set it off while walking sometimes eases it. Numbness or a Slapping Foot After a CastCompressive Peripheral Neuropathy After CastingThe cast or brace came off and there is a patch of numbness along the outside of the shin and the top of the foot, or the foot slaps down audibly when you walk on the flat. A nerve that runs close against bone can be compressed where a cast or a brace presses on it, which shows up as numbness in that nerve's own patch of skin and weakness in the muscles it supplies, and it is tested, tracked and reported back to the doctor managing the fracture. Dropped Wrist After an Arm FractureRadial Nerve Palsy After Humeral FractureThe upper arm was broken in the fall or the motorcycle accident, and since then the wrist hangs down and the fingers will not lift at the knuckles, although you can still curl them and feel them normally. The radial nerve runs tight against the shaft of the humerus and is stretched or bruised when that bone breaks, so while it recovers the wrist and fingers are splinted in a working position and the joints kept moving so they are ready when the nerve is. Repaired Nerve That Is Now TinglingPeripheral Nerve Repair RecoverySince the repair the numb area has been shrinking and filling in with pins and needles, an electric zing when you knock one particular spot, and a wrong, unfamiliar feeling when someone touches the skin. Nerve fibers regrow from the repair site toward the fingertip and those sensations mark their progress, and sensory re-education teaches the brain to read the new signals, which is a trained skill rather than something to sit and wait for. Burning, Numb SoleTarsal Tunnel SyndromeBurning and numbness spread through the sole and the arch after a shift on your feet or a walk round the market, worst in the evening and easing with the shoe off and the foot up on a stool. The tibial nerve is compressed behind the inner ankle bone, and foot position, standing load and swelling around the ankle all change how much room it has to move in. Burning Pain in a ScarScar-Related Neuropathic PainOne spot on the scar is electric to touch, a waistband or a sock seam sitting over it is unbearable, and the burning spreads out around it for an hour after something has brushed against it. Small nerve endings caught up in the healing scar report ordinary touch as pain, and the work is graded desensitization and scar mobilization rather than protecting the area, which tends to leave it more sensitive than before. Hollow Between the Thumb and Index FingerIntrinsic Hand Muscle WastingYou noticed it in a photograph: the web between thumb and index finger on one hand is hollow where the other side is full, and that hand tires holding a pen or turning a stiff key. Visible thinning of the small hand muscles means the nerve supplying them has been under pressure or injured for some time, so it needs a doctor's assessment and nerve testing alongside hand therapy for the strength and the grip patterns.
Arthritis and Joint Wear
Worn KneeKnee OsteoarthritisGoing down stairs one step at a time and holding the rail, a deep ache after an hour round the mall, and the first few steps out of a chair worse than the hundred after it. The joint surface is less tolerant of load than it was, and the thigh and hip muscles that used to take the edge off it have quietly got weaker, which is the part that is trainable. Worn HipHip OsteoarthritisGroin and front-of-thigh ache putting on socks or getting out of a low taxi, and a stiffness first thing that makes the first ten steps to the kitchen the worst of the day. Range is lost before strength here, usually rotation and extension first, so the hip stops giving you the last part of a stride and the back and knee start covering for it. Thumb Base ArthritisFirst Carpometacarpal Joint OsteoarthritisYou hand the jar to someone else. Turning a key, pinching a clothes peg and opening a bottle cap all bite at the base of the thumb, and the hand feels as though it has no grip left in it. Pinching multiplies force through that small joint many times over, so a light-looking task is a heavy one for it, and a well-fitted splint plus a change in how you grip often changes the day more than exercise alone. Knobbly Finger JointsInterphalangeal Joint OsteoarthritisThe end joints of the fingers have gone bony and a little crooked, rings no longer go on the same finger, and the hand is stiff for the first half hour after waking before it loosens for the day. The bony shape does not go back to what it was, but the stiffness, the swelling around the joint and the grip are three separate things, and the last two move with treatment while the first does not. Wrist Pain Years After a FracturePost-Traumatic Wrist OsteoarthritisYou broke that wrist years ago, it healed, and now it aches pushing up out of a chair, lifting a full pan off the stove or leaning on it to get off the floor. Loading the wrist in extension is what the changed joint surface likes least, so most of the useful work is redistributing that load, building forearm and shoulder strength, and finding the positions the wrist tolerates. Worn ShoulderGlenohumeral OsteoarthritisReaching back for the seat belt and behind you for the wallet are the two movements that catch, there is a grind you can feel more than hear, and the ache wakes you when you roll onto it. The joint surface change comes with a capsule that has tightened around it, and rotation is usually the range that has gone furthest without you noticing, because daily life stops asking for it early. Age-Related Neck ChangeCervical SpondylosisTurning your head to reverse out of the carpark lot is now a shoulder-and-body turn, the neck is stiff and gritty first thing, and there is a familiar ache into the top of the shoulder blade by late afternoon. These changes show up on the scans of plenty of people the same age with no pain at all, so the report is not the problem to be treated; the stiffness, the endurance of the neck muscles and how long you hold one position are. Low Back Pain That Is Worse Leaning BackLumbar Facet Joint PainStanding in a queue and reaching up to a high shelf are worse than sitting, bending forward over the sink gives relief, and the back is stiff for the first twenty minutes of the morning. The small joints at the back of the spine are loaded most in extension and rotation, so this is a pattern that responds to changing what the back is asked to hold, and to building hip and trunk endurance so standing is not all spine. Inflammatory Arthritis in the HandsRheumatoid Arthritis, Hand InvolvementBoth hands, the small joints across the knuckles, puffy and warm rather than just sore, and stiff for well over an hour every morning before they will close around a cup. The diagnosis and the drug treatment sit with your doctor and rheumatologist; the hand therapy side is joint protection, splints made and fitted for the joints that need them, range work that keeps the fingers moving, and grip trained without stirring an inflamed joint up. The Big Toe Joint After a Gout FlarePost-Flare Stiffness and Gait ChangeThe attack itself has settled and the redness has gone, but weeks later the big toe joint still will not bend enough to push off and you are walking on the outside of that foot without meaning to. The flare is managed by your doctor; what is left afterward is a stiff joint and a foot that has been offloaded for long enough that the calf, the arch and the other leg have all changed how they work. Waiting for a Joint ReplacementEnd-Stage Joint Osteoarthritis, Pre-Operative PhaseYou have been told the knee or the hip will need replacing, there is no date yet, and in the meantime you are still doing stairs, still carrying shopping and wondering whether you are supposed to be resting it or using it. Whether and when to operate is your surgeon's call. What can be worked on now is the strength and range you will start the other side of surgery with, and how much of daily life you keep hold of while you wait.
Tendon and Ligament Problems Outside Sport
Achilles Rupture Stepping Off a KerbAcute Achilles Tendon RuptureYou stepped down off the kerb at the void deck, felt what you were certain was someone kicking the back of your ankle, and heard a pop. You could still shuffle along flat, which is exactly why people wait a week before getting it looked at. The tendon was asked to lengthen fast under body weight in a step you have taken ten thousand times, and whether it is managed in a boot or with surgery, the first weeks are set by your surgeon and the loading after that is the long part. Outer Elbow Pain From Household WorkLateral Elbow TendinopathyNo racquet anywhere in this story. It started the weekend you put up shelves with a screwdriver, and now lifting a full kettle, turning a wok one-handed and shaking hands all catch on the outside of the elbow. The tendon on the outer elbow takes load every time you grip, so grip strength drops and the pain follows the hand rather than the elbow, which is why the elbow is rarely what needs treating on its own. Inner Elbow Pain From CarryingMedial Elbow TendinopathyTwo heavy bags up from the carpark in each hand, every day, and now there is a tender point on the inner bump of the elbow that bites when you squeeze a cloth or lift a full pot with the palm up. The tendons of the gripping muscles all anchor to that one bump, so carrying with a hard grip and a straight elbow loads it repeatedly, and how you carry usually has to change before the tendon settles. Shoulder Pain Reaching a High CupboardRotator Cuff TendinopathyGetting the rice tin down from the top cupboard and hanging washing out on the pole are the two movements that hurt, the ache sits in the outer arm rather than on the joint itself, and lying on that side at night is uncomfortable. The cuff tendons are compressed and loaded most in that overhead reach, and a shoulder blade that is not moving well underneath makes that reach a narrower space than it needs to be. Stiff Shoulder That Started With NothingAdhesive CapsulitisNothing happened. No fall, no lift, no bad night, and yet you cannot reach your back pocket or fasten a bra, the arm has stopped going sideways past shoulder height, and the worst of it is at two in the morning. The capsule around the joint is thickening and contracting, which is why it gets tighter even though you have been careful with it, and it moves through stages that need different handling at each one rather than the same stretch throughout. Finger That Clicks and LocksStenosing Flexor TenosynovitisIn the morning the finger is bent and will not come up on its own, so you straighten it with the other hand and it snaps out with a click you can feel in the palm. There is a tender lump at the base of the finger where the palm creases. The flexor tendon has thickened where it passes under a tight band of tissue, so it catches going through rather than gliding, and the click is that catch letting go. Thumb-Side Wrist Pain Lifting a GrandchildDe Quervain's TenosynovitisLifting the grandchild up under the arms is the movement that does it, and now pouring from a full kettle, wringing a cloth and taking your hand out of a tight sleeve all send a sharp line up the thumb side of the wrist. Two thumb tendons share a narrow tunnel there, and lifting with the thumb out and the wrist bent toward the little finger is the position that loads that tunnel hardest, which is why a splint changes a day quickly. Side-of-Hip Pain That Stops You SleepingGluteal TendinopathyA tender point right on the bony knob at the side of the hip. You cannot lie on that side, lying on the other side with that leg dropping across is no better, and crossing your legs or standing on one leg to put trousers on picks it out exactly. The gluteal tendons are pressed against the bone when the hip crosses the midline, so the positions that hurt are compressive ones, and this is a tendon that does better with strength than with stretching. Heel Pain in Someone Who Does Not RunPlantar Heel PainThe first three steps to the toilet in the morning are the worst of it, then again after sitting through a long meeting, and it eases once you have been on your feet a while. You have never run anywhere. Standing hours, the flat shoes you wear indoors and a stiff calf all load the tissue under the heel, and the morning pain is that tissue being asked to stretch out cold after hours of being shortened. Partial Tear Found on a ScanDegenerative Rotator Cuff Tear With Recent Onset PainThe report says partial tear and you have been reading it since. The shoulder was completely fine for years, then started aching the week after you painted the ceiling, and you are now wondering what you have been walking around with. Tendon changes like that are found in plenty of shoulders that have never hurt, so the finding is not new even though the pain is. What changed is the load, and that is the part worth working on and the part your surgeon will weigh if they see you.
Lifting, Carrying and Everyday Strain
Back That Went Lifting a Suitcase Into the BootAcute Mechanical Low Back PainBent over the boot lip with the case out in front of you and a half turn to get it in, something caught low in the back, and by the next morning you could not get a sock on. Reaching over a boot lip puts the load a long way from your body and rotates the spine at the same time, so a bag you could lift easily standing close became several times heavier where you lifted it from. Back and Everything Else After Moving HouseCumulative Lumbar and Thoracic Load IntoleranceNothing went wrong at any single moment. You lifted boxes for eleven hours, slept badly on the floor, and woke on day three with the low back, both shoulders and the mid back all complaining at once. This is a fatigue presentation rather than an injury one: several hundred lifts done with progressively worse technique as the day went on, on a body that does not do that volume in a normal month. One-Sided Back Pain From Carrying a ToddlerSacroiliac and Pelvic Load IntoleranceThe grandchild rides on the left hip, always the left, and now there is a one-sided ache across the top of the buttock that is worse standing to cook and worse again rolling over in bed. Carrying twelve kilograms on one hip means standing with the pelvis tilted and the trunk leaning away for hours a week, so one side of the pelvis takes the load and the muscles on the other side stop doing their share. Leg Pain After Lifting a Mattress AloneLumbar Radicular PainYou lifted the mattress on your own to change the sheets, felt it in the back that evening, and two days later the back had settled while a line of pain ran down the buttock into the calf. Coughing and sneezing find it. The nerve root is irritated where it leaves the spine rather than the muscle being torn, which is why the pain is now further from where the lift was felt and why positions matter more than rest does. Shoulder Pulled Shifting a Gas CylinderRotator Cuff StrainYou swung the cylinder across to the corner of the store room with one arm and felt a sharp pull at the front of the shoulder, and now lifting a wet towel out of the machine with that arm is not on. Swinging a heavy object sideways loads the cuff at the end of its range with no time to brace, and after an acute strain the shoulder blade muscles switch off quickly, which is what makes the arm feel unreliable rather than just sore. Mid-Back Catch Reaching Into the Rear SeatThoracic Joint and Muscle StrainSeatbelt still on, you twisted round between the seats to grab a bag off the back seat, and something caught under the shoulder blade. Now turning the same way, and the seatbelt lying across you, both remind you it is there. A seated twist locks the pelvis and puts all the rotation through the mid back at its end range, and it only takes a small load out at arm's length for a joint and the muscle over it to object. Neck That Seized on WakingAcute Wry NeckYou woke with the head held off to one side, unable to bring it back, and reversing the car is out of the question. The aircon had been blowing on that side of the pillow all night. A joint or the muscle around it has gone into a protective spasm at the end of its range, and although it feels alarming it is a movement and guarding problem rather than something torn, so gentle graded movement is the treatment and not rest in one position. Rib Joint That Catches on a Deep BreathCostovertebral Joint IrritationTwo weeks of a hacking cough, and now there is a sharp point beside the spine that you can put one fingertip on, catching on a yawn, a deep breath or reaching across the body. Each rib meets the spine at a small joint that moves with every breath, and a fortnight of forceful coughing loads those joints hundreds of times a day, which is enough to leave one of them irritated and guarded. Wrist Strain From Wringing a MopUlnar-Sided Wrist Load IntoleranceAfter mopping the whole flat, there is an ache on the little-finger side of the wrist that shows up turning a key, wringing a cloth and pushing up off the arm of a chair. Wringing asks the wrist to rotate hard while gripping hard, which loads the little-finger side of the joint where the two forearm bones meet, and that corner of the wrist is loaded by twisting far more than by lifting. Back That Has Gone Three Times in Two YearsRecurrent Low Back Pain With Movement GuardingYou squat with a flat back to pick a coin off the floor, brace before you sneeze, and get someone else to reach into the bottom of the fridge. Nothing hurts today and you are still moving as though something might. After a few bad episodes the back gets less bending, less loading and less variety than it used to, so what it tolerates drops, and the guarding that felt sensible early on becomes the thing that keeps the margin narrow.
Pain That Has Not Settled
Joint Still Stiff Months After the InjuryPost-Traumatic Joint StiffnessThe ankle was broken in March, the bone healed on schedule and everyone was pleased, and it is now September and you still cannot squat, still cannot get the heel down going down a slope. Bone healing and joint range are two different timelines. The capsule and the soft tissue around a joint shorten while it is held still, and range comes back by being worked at the end of the available movement, not by more time passing. Pain That Has Moved From Where It StartedSecondary Load RedistributionIt began in the left heel. Six months on the heel is a minor part of it, and the calf, the outside of that knee and now the other hip are all in the conversation, which makes you wonder what is really going on. When one part is offloaded for months, everything that takes over gets loaded differently, and tissue that was never the problem becomes sore in its own right. The spread is usually about how you have been moving, not about something spreading. The Scan That Showed NothingPain Without a Structural FindingThe report came back with no significant abnormality, you were relieved for about an hour, and then it started to feel like being told you are imagining it. The pain is real and the report is also accurate. Imaging shows structure, and it cannot show how sensitive a system has become or how much load a limb currently tolerates, which are the two things that usually explain a presentation like this and the two things that can be measured in other ways. Swelling That Comes Back Every EveningPersistent Post-Traumatic EdemaAt eight in the morning it looks like the other side. By nine at night the sock has left a ring and the ring will not come off, and this has been the pattern for months since the injury. Fluid moves out of a limb by muscle pumping and by compression, not by gravity being kind, so a limb that is used less and held down all day fills through the day. Compression, elevation and consistent movement is slow, unglamorous work that does change this. Old Injury That Flares Every Few WeeksRecurrent Load IntoleranceThree good weeks, then five bad days, and you have never been able to pin down which thing set it off because the bad days start a day or two after whatever it was. That pattern usually means tolerance sits just under what a busy week asks of it, so ordinary weeks pass and the heavier ones tip over. Finding where that line actually is, and moving it up in steps that do not provoke a flare, is slower than it sounds and is the whole job. A Limb That Has Become OversensitivePost-Injury SensitizationA shirt sleeve dragging over the back of that hand is genuinely unbearable, aircon makes it throb, and the skin color, the sweating and the hair on it are not the same as the other side. Pain out of proportion to what is left of the injury, with changes in color, temperature and sweating, is a pattern that should be reviewed by your doctor as well as treated here, because how it is handled in the first months matters and the treatment is graded and specific rather than pushed through. The Shoulder That Wakes You Every NightNight-Dominant Shoulder PainThree in the morning, same shoulder, every night, and you have worked out a chair in the living room is better than the bed. During the day it is manageable, which is why it has gone on this long. Night pain means an irritable tendon or capsule with no position that unloads it, and broken sleep then lowers what you can tolerate the next day, so the sleep and the shoulder have to be worked on together rather than in order. Strength That Never Came Back on One SidePersistent Unilateral Strength DeficitThe pain went a year ago. You still push out of a chair through the other leg, still start every flight of stairs with the same foot, still put the bag on the other shoulder without thinking about it. Strength is the last thing to be trained back after an injury and it does not return on its own once pain has gone, because you stopped asking that side for it. A side-to-side measurement usually puts a number on a gap people have stopped noticing. Not Trusting the Limb Enough to Use ItFear-Related Movement AvoidanceThe hand sits tucked against your chest in a crowded lift, you turn your body to protect it before anyone is near it, and you have stopped doing things you could probably manage in case they hurt. That is not imagination and it is not weakness. Protective behaviour outlasts the tissue problem that earned it, and a limb that is guarded gets less movement and less load, so it becomes less capable and confirms the fear. Working back into it in graded steps, with something measurable at each one, is how that gets untangled.
Older Adults, Balance and Bone Health
After Hip Fracture SurgeryPost-Operative Hip Fracture RehabilitationYou are home with a frame, you are not sure how much weight the leg is allowed to take, and the step down at the front door and the lip of the toilet have become the two hardest moments of the day. How much load the hip takes early is set by your surgeon. Everything after that is strength, balance and getting the leg used to being trusted again, and muscle responds to training at eighty in the same way it does at forty, just from a lower starting point. Mid-Back Pain After a Small JoltVertebral Compression FractureA band of pain across the mid back that came on after something minor, a missed step or lifting a pot, worst getting up from lying flat and easier once you are upright and moving. The upper back has rounded and a shirt that used to fit sits differently. Bone density is your doctor's side of this, with their tests and their treatment. The therapy side is loading the spine safely in upright positions, building endurance for standing and walking, and keeping heavy bending out of the day. Wrist Fracture When You Live AloneDistal Radius Fracture, Single-Occupancy HouseholdThe cast is on the dominant wrist, there is nobody in the flat to open a bottle or do up a bra, and showering has become a planning exercise. Both hands are not optional for you. Fingers and the shoulder stiffen fast inside a cast if nothing asks them to move, and swelling settles into a hand that is held still, so the early work is keeping everything that is not fractured moving while the practical business of one-handed living gets sorted out. After One Fall, Not Going Out AlonePost-Fall Loss of Balance ConfidenceOne slip on a wet toilet tile, no fracture, nothing broken, and yet you now run a hand along the wall, avoid the wet market when the floor is washed down, and have stopped going out unless someone comes. Confidence drops much faster than capacity does after a fall, and the walking you have cut out is the walking that was keeping your balance and leg strength up, which is the part that can be measured and trained directly. Pushing Up Out of a Low ChairAge-Related Muscle LossYou take the armrests, rock forward twice to get going, and you have started choosing the dining chair over the sofa because getting out of the sofa is a production. Nothing hurts. Muscle power, the speed part of strength, goes before size does and it is what a chair rise needs most. This is not something to accept as a birthday. Loaded strength work, progressed properly, is the one thing that reliably shifts it. Both Knees Stiff When You Stand UpBilateral Knee Start-Up StiffnessAfter sitting through a service or a long dinner, the first ten steps are careful and slightly bent, then the knees loosen and you are fine again. Neither knee is the bad one. Joints that sit still get stiff and take a few dozen steps to get moving again, and the longer the day is spent seated the more of these start-ups there are, so this responds far more to getting up and moving often than it does to any single exercise. Giving Up the Top ShelfLoss of Overhead Shoulder Range and StrengthThe rice tin has been moved down to the counter, the laundry pole is somebody else's job, and you have quietly rearranged the kitchen so nothing you need is above shoulder height. Overhead is the first range a shoulder loses and the last it gets back, and it goes faster when the mid back has stiffened too, because a shoulder cannot reach high on its own. Every task moved down is a reason the shoulder is asked for less, so the range narrows again. Grip That Has Quietly Got WeakerReduced Grip StrengthThe bottle goes to whoever is nearest, the kitchen tap needs two hands now, and the key in the front door takes a second go. There is no pain at all, which is why nobody has looked at it. Grip is measurable in kilograms on both sides and it responds to being trained, and it is not only a hand matter: the forearm, the shoulder and how you position the wrist all feed into what the hand can hold.
Which stage are you actually in
Every program here runs the four stages of the Phoenix Recovery Protocol: Calm & Protect, Move & Mobilize, Rebuild & Strengthen, Return & Perform. You move up when you meet the criteria for the stage, not when a number of weeks has passed. The first visit is one 45-minute Assessment & Treatment at $230, nett, no GST: a deep assessment to find what is actually limiting the joint, then treatment of it in the same appointment, and a written plan telling you which stage you are in and what the next one asks for.
The descriptions above are common presentations, not a diagnosis. Where your doctor or surgeon has set limits after an operation or a fracture, those limits come first.
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Clinics across Singapore
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WhatsApp 8242 7340The rest of the condition library
Four ways into the same clinic. If what happened to you is not on this page, it is on one of the others: orthopedic and trauma injuries, grouped by what happened rather than by the name on the report; sports and training injuries, grouped by the sport; work and repetitive strain injuries, grouped by the job; and pregnancy, postnatal and women's health. There is also the full A to Z of everything we treat.
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