Milliken Research in Journal of Hand Surgery

Milliken Hand Rehabilitation Center Hand Therapists, Macy Stonner, OTD, OTR/L, CHT & Logan Berlet, OTD, OTR/L were recently published in The Journal of Hand Surgery for their paper, “The Impact of Social Deprivation and Hand Therapy Attendance on Range of Motion After Flexor Tendon Repair.” The purpose of the paper was to examine the influence of social deprivation and hand therapy attendance on active range of motion (AROM) outcomes following flexor tendon repair.

Below is information about the Milliken research that was included in the paper. It discusses how the study was performed and the overall team conclusions.

Method

We performed a retrospective analysis of patients who underwent primary zone I–III flexor tendon repair between November 2016 and November 2020. Area deprivation index (ADI) was used to quantify social deprivation. Medical record review determined each patient’s demographic characteristics, injury details, total hand therapy visits, and final AROM outcome. Active range of motion was converted to Strickland’s percentage for analysis. Spearman correlation and simple and multivariable linear regression models were used to assess relationships between explanatory variables and outcomes.

Results

There were a total of 109 patients, with a mean ADI of 53 and mean therapy attendance of 13 visits. Higher ADI and lower therapy attendance were correlated, and each was associated with significantly decreased Strickland’s percentage. In the multivariable model, therapy attendance, ADI, zone 2 injury, and age maintained significant associations with Strickland’s percentage.

Conclusions

Socially deprived patients attend fewer therapy sessions and obtain poorer AROM after flexor tendon repair. Social deprivation is likely to contribute to poor outcomes both by its association with decreased therapy attendance and by other potential pathways that make it difficult for deprived patients to achieve good surgical outcomes.

Access The Publication and Paper

 

Summer Hand Injuries

We all love summer as it brings warm weather and outdoor fun. Summer hand injuries can put a damper on the good times we look forward to. With proper caution and planning, you can save yourself a trip to the emergency room and a medically created setback!

  • Wrist fractures: Sports-related activities increase fall risk. Biking, rollerblading, skateboarding, and scootering tend often lead to wrist fractures or sprains. Be aware of uneven sidewalks and other pedestrians, and wear wrist guards for protection.
  • Burns: Bonfires, barbeques, and fireworks pose danger around open flames. Keep your distance from the fire, and use long-handled tongs when grilling to protect your hands. Keep your children safe by keeping them aware of the fire.
  • Tendonitis: Golf, tennis, and baseball become more popular in warmer weather, which is often accompanied by elbow tendonitis and pain. Prior to play, consider stretching your wrists to prevent tendon tearing and inflammation. Check your racket/club/bat to ensure proper fit and that it’s not causing unnecessary strain.
  • Lawnmower accidents: 25% of yearly lawnmower summer hand injuries lead to finger or toe amputation. Always use the proper safety guards/precautions when cleaning out lawnmower blades. Keep children away from the lawnmower.
  • ATV accidents. Every year, ATVs cause 135,000 injuries and 700 deaths. 30% of deaths are among children below age 16. If you choose to ride an ATV, please consider the following precautions:
    • Wear a helmet and protective eyewear
    • Limit the number of riders
    • Only ride during daylight hours
    • Never operate an ATV under the influence of alcohol or drugs

Have fun this summer, but keep yourself and others away from summer injuries. If you sustain an upper-extremity injury, don’t hesitate to call the Milliken Hand Rehabilitation Center!

Celebrating Hand Therapy Week 2022

June 6 – 10th, our Milliken Hand Rehabilitation Team participated in activities and challenges celebrating the annual Hand Therapy Week led by the American Society of Hand Therapists. Some of the unique ways that we were able to highlight our talented team was by showcasing “blinged-out” orthotic creations, getting the thoughts of a hand therapist who is pursuing the “CHT” certification, and sharing some throwback photos of the early days at Milliken, just to mention a few.

Here were all of the daily challenges for Hand Therapy Week 2022:

MONDAY (6/6): “Bling It” Orthosis

TUESDAY (6/7): CHT in the Making

WEDNESDAY (6/8): “Nailed It” Challenge — Like Netflix’s “Nailed It!,” we’re looking for “amateur orthosis makers”

THURSDAY (6/9): #ThrowbackThursday

FRIDAY (6/10): Grassroots Effort Day — Share photos, videos, links, etc. to all the ways you’ve spread awareness and advocated for hand and upper extremity therapy

 

Fireworks & Hand Safety

As we approach the 4th of July, it is important to keep in mind that the use of even the smallest fireworks can result in devastating injuries. Sparklers reach temperatures over 1000 degrees and can easily burn skin or ignite clothing. Larger fireworks can fracture fingers or amputate portions of the hand.  While these injuries may seem extreme, they are injuries that the Hand Therapists at the Milliken Hand Rehabilitation Center commonly see in their clinics every July.  According to the U.S. Consumer Product Safety Commission 2020 Fireworks Annual Report, hands and fingers were the most frequently injured body parts, accounting for 30% of the injuries sustained by fireworks.

The safest way to enjoy fireworks is at a public display conducted by professionals. But, if you choose to use fireworks, the Consumer Product Safety Commission has the following tips:

  • Never allow young children to hold or ignite fireworks.
  • Never place any part of your body directly over a firework device. Back up to a safe distance immediately after lighting the fuse, and only light one at a time.
  • Never try to re-light or pick up fireworks that have not ignited fully.
  • Never point or throw fireworks at another person.
  • Keep a bucket of water or a garden hose handy.
  • Never carry fireworks in a pocket or shoot them off in metal or glass containers.
  • After fireworks complete their burning, wait 20 minutes, and then douse them with plenty of water before discarding in a trash can.

Our team at the Milliken Hand Rehabilitation Center wishes everyone a Safe and Happy 4th of July Holiday! If you do experience a hand or upper extremity injury, we are here to help!

Firework & Hand Safety Tip Sheet pdf (Download)

 

 

 

 

 

 

 

 

 

 

OT Month Celebration

Washington University Occupational Therapy works with many healthcare providers, physician groups, living facilities, and community organizations to provide the best care, When & Where our patients need it most. During the month of April, we will be celebrating OT Month and promoting all that our providers and colleagues in the field do for our adult and pediatric patients. To our Community Practice Therapists and Therapists at the Milliken Hand Rehabilitation Center, thank you for all that you do for our patients our clinic wouldn’t exist without you and the expertise that you bring to the field of OT.  Please take a moment and see what the field of OT has been able to contribute to the daily well-being of patients. Learn more about Occupational Therapy from AOTA.

Chronic Condition Spring Safety Tips

Spring is a time of awakening.  As we wake up from our winter slumber, we are eager to be more active.  This could mean getting back to recreational activities such as hiking, biking, or participating in an outdoor sport.  Or it could mean doing housekeeping activities such as spring cleaning or gardening.  Returning at full force may lead to an injury or a flare-up of a chronic condition.  Here are some tips to consider should you reengage a chronic condition: 

  • It is always a good idea to warm up before and cool down after an activity. 
  • Gentle stretching prior to an activity can prevent a muscle strain while gentle stretching after can decrease soreness. 
  • While it may be tough to slow down, breaking down the activities into short intervals can prevent fatigue. 
  • Eating a healthy diet of lean proteins and vegetables can improve your endurance. 
  • Even when the weather is mild, be sure to drink plenty of fluids to prevent dehydration. 
  • To boost your confidence and enjoyment, set realistic goals. 
  • To improve your performance, seek professional tips from a tennis or golf coach.  
  • Maintaining your equipment and tools in proper condition can decrease stress on your joints. 
  • Building up the handles on your tools will lessen hand pain. 
  • Wearing sunscreen will not only protect your skin from harmful UV rays; it will preserve its youthfulness.  

Following these tips will help you to enjoy the cool spring weather but if you do encounter a chronic condition in your hands or upper extremity our team at The Milliken Hand Rehabilitation Center is here to help!

Good Form With Exercise Apps

For many people, the start of the new year symbolizes a time to take on new challenges and adopt new practices to improve physical health and overall well-being and we want to ensure that good form is being practiced. With the rise in popularity of fitness apps and online workout programs since the start of the Covid-19 pandemic, people now more than ever, are deciding to make exercise a part of their daily routine. While fitness apps can be a very powerful tool by providing motivation, accountability, and a fun experience for those new to exercise, a few basic guidelines should be followed to avoid injury and a possible premature end to your new year’s resolution.
  1. Always warm up and stretch prior to starting any workout – When you warm-up and stretch your body temperature rises, blood flow is elevated, and more oxygen is carried to the muscles. Increased blood circulation and higher oxygen levels boost energy, increase muscle stamina, improve range of motion, and decrease the likelihood of strains or sprains by preparing soft tissues for the exertion of exercise.
  2. Practice good form – Proper form is essential to avoiding injury when beginning any new training program. This is especially true if you’re new to working out. Some basic tips for performing the exercise with good form include:

-Perform the exercise slowly through a full range of motion. For example, if performing weighted bicep curls you should start with an appropriate weight that allows you to fully extend and flex your elbow. If weight is appropriate, but you are still unable to move through a  full range of motion, you may need to focus on stretching tight muscles that are preventing full-motion prior to lifting.

-Perform resistance exercises with a neutral spine. To achieve a correct neutral position stand with your chest high, chin gently tucked, feet shoulder-width apart, and abdominals and glutes activated. This position protects your spine and provides a solid platform from which to safely perform resistance training.

-Use a mirror to monitor form throughout the course of your workout. Whether you are lifting weights or doing yoga, you will likely fatigue as your workout progresses and form may suffer as a result. Using a mirror that allows you to periodically check your form will assist with maintaining good posture and symmetry throughout the course of your workout.

  1. Listen to your body – Whether you’re a seasoned fitness veteran or brand new to working out, it is normal to feel some soreness 1-2 days after performing a strenuous workout or trying a new exercise. This sensation is usually spread out over a larger area of the body and can be alleviated through gentle stretching, resting sore areas, and maintaining good hydration.  If pain is sharp, focused in a specific area,  or returns quickly with exercise, the activity that is causing pain should be discontinued or modified. Rest, ice, and elevation may also be helpful. If the pain does not resolve and begins to impact daily function you may need to see a doctor or consider contacting our team at the Milliken Hand Rehabilitation Center.

Safety Tips for Holiday Gathering

The holidays are shaping up to look different again this year from traditional gatherings of the past with recommendations of continued social distancing, masks, and possible outdoor meals. During these times, our annual celebrations with family and friends are so important for our mental health, but it is equally important to stay safe. As indoor dinner parties and social get-togethers are still risky this holiday season due to the COVID-19 pandemic, many people will likely be cooking and gathering outside. It is important to keep safety in mind when using a grill or turkey fryer (especially if it is for the first time) while cooking in the kitchen, and while gathering.  Below are some tips to help you and your family and friends enjoy Thanksgiving safely!

Social Holiday Safety Tips:

  • Cook and eat outdoors. Consider cooking a turkey on the grill or in an outdoor turkey fryer and having dinner outside to avoid being inside with other individuals for long periods of time.
  • Wear a mask. Remember that even outside it is important to maintain physical distance and wear face coverings when gathering.
  • Serve safer. Use single-use cutlery to decrease the transmission across surfaces and choose one person to do the serving to avoid everyone touching the serving utensils.
  • Wash your hands often.

*Refer to the CDC’s guideline to Holiday Celebrations and Small Gatherings for more information.*

Outdoor cooking safety tips:

  • Be prepared. Follow the manufacturer’s instructions and familiarize yourself with the operations, especially if you are a first-time user of a deep-fryer.
  • Use only on a safe surface. Use the deep-fryer on a stable, non-combustible surface outside.
  • Never leave a deep-fryer unattended.
  • Ensure turkey is dry. Dry turkey before placing in a deep fryer to avoid water/oil interaction that could lead to a grease fire.
  • Have a fire extinguisher nearby in case of emergency.

Kitchen Holiday Safety Tips:

  • Wear a mask while preparing food.
  • Minimize distractions. Pay attention while using a knife, removing hot items from the oven, and carrying a heavy object, to prevent injury as these are often prime times to have an accident.
  • Cut away from yourself. Always keep both hands and your body out of the path of your sharp knife to avoid injury.
  • Use a sharp knife when carving. Dull tools require more force to cut through the turkey and you are more likely to cut yourself.
  • Dry workspace. Keep the workspace in the kitchen, tools, cutting boards, and your hands clean and dry to help prevent any injuries that may occur from slipping.
  • DO NOT put water on a grease fire. Instead, smother it by placing a lid on top of the pan.

An additional safety measure has been created by the

From the Milliken team, we hope you have a safe and Happy Thanksgiving! If you do find yourself needing assistance for an injury related to your hands, wrist, or upper extremity, The Milliken Hand Rehabilitation Center is here to help!

Milliken Celebrates 50 years of Helping Hands!

Some years are more special than others in the life of a clinic, this happens to be the case for the Milliken Hand Rehabilitation Center in 2021. This year marks the 50th anniversary of Milliken and its dedication to helping hands and working with physicians to provide outstanding patient care. To honor this milestone a gathering of past and present therapists was held to honor the 5 decades of work that has taken place.

Here are a few photos of the past and present therapists that were at the celebration event.

In addition to having a 50th-anniversary celebration event, Milliken has launched the “Meet Milliken” video series highlighting our outstanding therapists and allowing them to talk about the work that they enjoy doing, and giving our patients a chance to learn more about who they may be working with. View our first two videos here!

 

Hand Safety When Pumpkin Carving

With Halloween being this weekend, we know pumpkins are being carved in preparation for display.  While usually not thought of as a dangerous activity, injuries from knives or other tools used for carving can require surgical repair and sometimes take multiple months to rehabilitate. Here are a few safety tips to help keep you away from our clinic!
  • Be sure that the tools you plan to use, as well as your hands, are dry before you begin carving. This will help prevent any injuries that may occur from slipping.
  • Purchase a pumpkin carving kit that includes a small serrated knife. This is safer than using a large sharp knife.
  • Cut away from yourself and use small, controlled strokes.
  • Be sure that the hand you are using to stabilize the pumpkin is not in a location that the knife could contact if it slips or pierces through both sides of the pumpkin.
  • Find appropriate ways for children to help. They can scoop the seeds and draw the pattern on the pumpkin, but in most cases should not be handling the carving knife.   You can also consider painting or applying stickers to your pumpkins instead of carving them.
  • If you plan to put a lit candle inside your pumpkin, consider cutting a hole in the bottom of the pumpkin. This way you can place your pumpkin on top of the candle, rather than reaching into the pumpkin to light the candle (which may result in a burn).
  • If you cut your hand or finger, apply direct pressure to the wound with a clean cloth. If the bleeding doesn’t stop or slow after 15 minutes of continuous pressure, head to the emergency room.

If you do sustain a hand injury this Halloween season our team at the Milliken Hand Rehabilitation Center is here to help!

New Nerve and Tendon Transfer Chapter

The third edition of ‘Orthotic Intervention for the Hand and Upper Extremity’ was published this year and is recently in print. New to this edition is a chapter devoted to nerve and tendon transfers. The editors reached out to therapists at Milliken Hand Rehabilitation Center at Washington University to write this chapter given the national recognition this center has for treating patients who have had these procedures. In addition, Miliken’s therapists have spoken on the subject both nationally and globally and published peer-reviewed papers about nerve and tendon transfer rehabilitation.

The Surgeons at Washington University are known globally for their work in advancing peripheral nerve care. Patients come from across the country to be treated here and the surgeons rely on the hand therapists at the Milliken Hand Rehabilitation Center to develop post-operative nerve and tendon transfer rehabilitation treatment plans for the patients to take with them to their local therapists.

Lorna Kahn, PT, CHT, Macy Stonner, OTD, CHT and Anna Miller, MScOT, CHT co-authored this work. They collaborated over many months on both the written and visual content that enables any hand therapist to understand and replicate post-operative treatment programs in their own clinic. The text is a comprehensive, valuable resource for both the therapist and surgeon.

Learn more about our services at the Milliken Hand Rehabilitation Center.

Let’s Give Them A Hand

June 7th – 13th we will recognize our Hand Therapists during the American Society of Hand Therapists (ASHT) Hand Therapy Week. This highly specialized group of therapists provide patient care at the Milliken Hand Rehabilitation Center.

The Milliken Hand Rehabilitation Center was one of the first three hand rehabilitation facilities established in the U.S. With over 60 years of experience treating complex and common injuries, Milliken’s occupational, physical and certified hand therapists assist Washington University plastic surgeons, orthopedic surgeons, and community physicians in providing treatment for patients with hand and upper extremity injuries. Some specific conditions that are treated:

  • Arthritis of the hand and wrist
  • Brachial plexus injuries: affecting nerves in the shoulder, elbow, forearm, wrist, and fingers
  • Congenital Hand and Upper Extremity differences
  • Dupuytren’s Contracture
  • Fractures/crush injuries
  • Nerve Compression Syndromes/Peripheral nerve injuries
  • Pre & Post-Operative care for Breast Cancer
    Pre-Operative evaluation and education includes:
     Baseline measurements of upper extremity function, A home program to complete pre-surgery to improve the recovery process post-operatively, Activity of daily living demands and anticipated needs
    Post-Operative care includes: Wound and scar management, Ensure full motion of arms is achieved, Home program personalized to your situation, Activities of daily living deficits, Work demands addressed, Pain management techniques
  • Sports-related injuries of the elbow, hand or wrist
  • Tendon lacerations
  • Tendonitis
  • Work-related injuries and conditions

Pre and Post Operation Services

Milliken therapists are able to work with injuries that both require an operation and provide hand therapy for those that don’t. We provide therapy techniques and services to help optimize your function.

Continue reading about who we are…

Why See A Certified Hand Therapist (CHT)

You may ask yourself why is my physician referring me to see a hand and upper extremity specialist for my arm injury or problem?
To answer that question, a Certified Hand Therapist is a specialist in the field of either Occupational or Physical Therapy that has undergone additional training and testing to earn the designation of CHT or title Certified Hand Therapist. They are a trained specialist related directly to the upper extremity, which encompasses the shoulder to the fingers. The process to become a CHT requires the following:
  • Practice for at least 3 years
  • Complete 4000 hours of direct patient care related to hand and upper extremity
  • Sit for and pass the rigorous exam, which tests on the entire upper extremity

Working in this focused area of the body, CHT’s are more in tune with assisting your rehabilitation. They have a thorough understanding of the anatomy of the body, the mechanics of how each structure works, and how injuries complicate the healing process. Hand and upper extremity rehabilitation can become very intricate and complicated during the rehab process but a Certified Hand Therapist can direct you through this difficult time and get you back to everyday life.

Hand and Upper Extremity Therapists can treat a large variety of diagnoses: fractures, arthritis (osteoarthritis, psoriatic and rheumatoid), multi-trauma, compression syndromes, activity analysis of body postures and mechanics, tendon and nerve laceration, tendonitis, and an extensive list of other diagnoses. Learn more about The Milliken Hand Rehabilitation Center.

Help us in celebrating our Hand and Upper Extremity Therapist June 7-13, 2021 with Hand Therapy Week.

Our Aging Thumbs

Take a moment to assess your posture.  Did you immediately correct the position of your neck, back, and shoulders?  Although keeping those parts of our body in good alignment is important, there’s another body part that is just as important.  They are something small, but undeniably useful.   They are the two short appendages on your hands; your thumbs.

Our thumbs do quite a bit of work; they are responsible for at least 40% of our hand function.

Take another moment to see how useful they are to you right now.  Imagine how you would function in your daily life without your thumbs.  They are so important that if you were to lose one of them in a terrible event, another finger would be sacrificed to create a “thumb” in a procedure called pollicization.

Our thumb joint, like any joint in our body can wear down prematurely.  It may be due to genetics, wear, and tear, or trauma.   We can’t change our DNA or undo past injuries, but we can minimize wear and tear.  And if you are like me, you like to have control over your body.

Thumb posture has the same philosophy as back posture.  Good back posture means maintaining the natural curves of our spine.  Good thumb posture means keeping the thumb bones in a “C” curvature during use.

Reducing forces, and thus injury, to our back means practicing the no BLT rule.  Not Bacon, Lettuce, and Tomato, but Bending, Lifting, and Twisting.  That means the use of good back mechanics during lifting tasks.  Joint protection techniques for our thumbs have a similar philosophy of decreasing forces or stress to the thumb joint.  Joint protection techniques in its simplest form is just asking “how I can decrease wear and tear?”.  It is changing how you do things, but not stopping what you are doing.

Whether it is from an injury, recent surgery, chronic poor posture, or aging, recovery from a bad back requires adherence to a back exercise program.  Like our back, our thumbs have its own exercises to keep them in good shape.

It is inevitable that our thumbs will “mature” like the rest of our bodies and develop osteoarthritis.  However, early practice of thumb posture, joint protection techniques, and thumb stabilization exercises, will allow you to maintain your lifestyle as your thumbs mature.

The team at the Milliken Hand Rehabilitation Center is here to help your aging thumbs!

Pumpkin Carving Tips for Hand Safety

With Halloween being later this week, cht These injuries can require surgical repair and sometimes take multiple months to rehabilitate. Here are a few safety tips for carving your beautiful pumpkin creations:

  • Be sure that the tools you plan to use, as well as your hands, are dry before you begin carving. This will help prevent any injuries that may occur from slipping.
  • Purchase a pumpkin carving kit that includes a small serrated knife. This is safer than using a large sharp knife.
  • Cut away from yourself and use small, controlled strokes.
  • Be sure that the hand you are using to stabilize the pumpkin is not in a location that the knife could contact if it slips or pierces through both sides of the pumpkin.
  • Find appropriate ways for children to help. They can scoop the pumpkin seeds and draw the pattern on the pumpkin, but in most cases should not be handling the carving knife.   You can also consider painting or applying stickers to your pumpkins instead of carving them.
  • If you plan to put a lit candle inside your pumpkin, consider cutting a hole in the bottom of the pumpkin. This way you can place your pumpkin on top of the candle, rather than reaching into the pumpkin to light the candle (which may result in a burn).
  • If you cut your hand or finger, apply direct pressure to the wound with a clean cloth. If the bleeding doesn’t stop or slow after 15 minutes of continuous pressure, head to the emergency room.
  • This year the CDC recommends carving pumpkins outdoors if you plan to be with neighbors or friends. If you’d prefer to carve inside, it is safest to limit it to members of your household.
  • As a reminder, wear masks and socially distance if you with people outside of your household

If you do sustain a hand injury this Halloween our team at the Milliken Hand Rehabilitation Center is here to help!