P.T. For The M.F.

          Forgive me, I don't mean physical therapy for the mother fu...er. It's for the mallet finger. After having a consultation with the orthopedic specialist, he said that I didn't need surgery even though my middle finger was drooping slightly. He asked me if I needed physical therapy and I said yes, since I felt I needed more guidance with what rehabilitation exercises to do other than just sending me home with Theraputty® like the previous doctor did. 

 

          So I was given six sessions of physical therapy (three times a week for two weeks). During the first session, the physical therapist asked me about the history of the injury then proceeded test my grip strength

and make measurements of how much angle I could flex and extend the finger to get a baseline. She then told me to show her what types of exercises I had been doing with the Theraputty® and showed her two ways I would squeeze it. She showed me a few more things I could do which included digging into the putty with my fingers and other extension and strengthening exercises. In addition, I was shown exercises I can do with a rubber band and a dumbbell. Afterwards, she held my hand (without even buying me dinner first!), and started torturing me. OK, just kidding, but it sure felt that way initially. What she did was hyperextend the finger ever so slightly to the point of pain indicated by my yelling OWW! She did that a few times until the finger looked slightly straighter. She also did some passive range of motion exercises to the point of resistance which also resulted in some pain. Not that I wasn't expecting any pain at some point. Then she provided me some relief by attaching four electrodes on my fingers - two on top and two on the palm side. She connected the electrodes to a T.E.N.S. unit (transcutaneous electrical nerve stimulation) and turned up the power and started electrocuting me. Well not exactly. She turned the knob slightly and asked me to tell her when my fingers started to tingle and when I indicated as much, she stopped. The same was done for the electrodes on the palm side and a timer was set for twenty minutes. Oh I forgot, my hand was also wrapped with a heating pad. The T.E.N.S. treatment was supposed to improve circulation and break up scar tissue. 

          So I sat there and explored the room with my eyes to pass the time, wishing I had picked up a magazine to read from a rack at a corner of the room. Other patients came and went to do their therapies. Pretty soon the timer started beeping and I survived my time on the electric chair or Taser. The electrodes were removed and kept in a plastic bag with my name on it to be reused in the next session.

Lastly, they tried to make strike anywhere matches with my left hand which was dipped about 5 times in a container of lavender colored hot paraffin wax, then it was wrapped in white paper which somehow reminded me of fish and chips, then the papered hand was inserted in a terry cloth fingerless glove to keep the heat in. When the paraffin wax cooled in 5 to 10 minutes, off came the glove, the paper, and the wax had to be peeled off from the hand like a second skin. The lavender scent from the wax remained in my hand for a few hours and people were probably wondering why I was sniffing my hand so much despite the absence of white powder on it. 

          The session went for slightly more than an hour which I thought would last only half as long, although the time passed pretty quickly. Except for the initial measurements, subsequent treatment sessions were similar to the first. In my subjective assessment, after 5 treatments, my finger feels slightly stronger and more flexible, although I have more work to do by myself for further improvement after the 6th and final session.

          Much thanks are in order for the physical therapist and her assistant for guiding me and helping improve the function of my left hand and more specifically my healing middle mallet finger.  For privacy reasons, they declined to allow me to use their names. Even though the finger injury has been a major inconvenience to my daily activities, whenever I went in for physical therapy and was asked what my pain level was from 1 to 10, I always felt no pain. In contrast, the other patients who came in always mentioned some pain.

Left Middle Finger Injury Update - From Stax to Oval 8

From this makeshift splint
to

the Stax splint,
and now

the OVAL 8 splint

          The 8 week period for me to wear the splint on my left middle finger passed 2 weeks ago, and I was looking forward for the doctor to tell me it was okay to remove it and begin rehabilitating the finger. After 8 weeks of wearing the Stax splint as recommended for mallet finger injuries, the finger had become very stiff and swollen and I've been having a difficult time restoring the range of motion due to scar tissue that formed around the joints. Not only that, but the other fingers also got stiff because with the splint, I couldn't close my fist. I was given a week trial without the splint and was instructed to do active range of motion exercises and try strengthening my grip with Theraputty. When I returned to the doctor a week later, he didn't like the way the finger looked so he ordered the Stax splint put back on and also got authorization for an orthopedic specialist consultation. Unfortunately it would take another 3 weeks before the orthopedist can see me. Since I can't make a fist with my left hand and have a hard time grasping, at work, I am not able to assist my co-workers in case we have to restrain a patient.

          I've been searching for other kinds of splints and found the Oval 8 splint, but I've been holding off buying it myself hoping that 8 weeks on the Stax was enough to heal the torn tendon of the DIP (distal interphalangeal joint)or the knuckle near the nail. The advantage of the Oval 8 is that it's more open and less restrictive so that I could try bending the PIP (proximal interphalangeal joint) or the middle knuckle of the finger. When I learned that it would take more time to see the orthopedist, I finally measured my finger and ordered a set of 3 Oval 8 splints from Amazon.com. Since it was not supplied by the doctor, I had to pay for them myself. The set came in 3 different sizes and was recommended that way so in case my finger became swollen, I could switch to a bigger size or if the swelling went down, the finger would fit better in a smaller size. The Oval 8 also didn't require Coban tape to be used so I was able to wash my hands better. With the new splint, I could start to aggressively restore the range of motion to the PIP while the DIP remained immobilized and kept straight to hopefully continue to strengthen the healing tendon. I find that the joint is tight when I wake up in the morning, gets looser when I exercise it, then becomes more swollen in the evening thus more stiff. Meanwhile, I hope the orthopedist has better news when I see him in a couple of weeks.

A Freak Diaper Change Accident With Unforeseen Consequences

Stax Splint from Urgent Care

          No, it didn't happen while I was changing my own diaper, but this freak thing happened in the business of caregiving. In the annals of medicine, I challenge you to find anything close to what happened to me while changing a diaper (or continence care product, as my company wants it to be called). Sure, you can jam your finger at anytime or anywhere, but on a diaper or on bedsheets? Probably only I can experience that even though I don't consider myself accident prone. This happened at 3:00 a.m. While pushing a diaper under a residents' body to remove it and replace it with a clean and dry one, I heard a pop and thought it was just a sound made when you crack your knuckles. So I didn't think too much about it and continued to give care to the resident. It was only several minutes later when I finally took my gloves off that I noticed the topmost knuckle of my left middle finger was bent at a right angle. My first thought was that I broke my finger! I tried to straighten it back in place but it just returned to the bent position. So I went to my lead care manager, showed the finger to her and told her what happened. She went to find a tongue blade and some tape and fashioned a splint out of them (she is a nursing graduate from the Philippines).

Tongue blade splint

          I then filled out an employee incident report and asked her what I had to do next, like how to obtain a authorization for treatment form so I can be examined at the urgent care clinic that our facility uses. She didn't know and neither did the lead care manager a floor below, nor the maintenance/security person. The consensus was for me to go to the wellness office at 6:00 a.m. when the nurse arrives. In the meantime, I managed to finish my shift, being careful not to poke the residents with the stiff middle finger with the tongue blade splint, nor injure the finger any further. Fifteen minutes before the end of the shift, I called the acting coordinator for the unit or neighborhood I work in and left a voicemail message asking how I should proceed, since I'm not yet familiar about how they do things, having just started working there the month before. When I went to the wellness office, nobody there knew about obtaining the treatment authorization form and I was to call back at 8 or 9 a.m. to find out. So I clocked out and went home to get a few winks in. A couple of hours later, I got a call from the wellness nurse giving me a toll free number to the Nurse Hotline of Sedgwick, the company that handles workman's compensation claims. I was directed to go to an urgent care clinic closer to home. I had to wait for them to email me the authorization form (which was initially sent to the wrong email address) before proceeding to the clinic. The urgent care clinic was surprisingly empty and the doctor was trying to fix the TV antenna to get a better reception to the World Cup. Meanwhile the medical assistants were debating whether I actually got proper authorization since the place I work wasn't on their list, and they couldn't input my data on the computer. The doctor told them to just do it on paper and clear it up on Monday. Then he asked me to take off the makeshift splint and the moment he saw my finger, he said "Oh, that's a mallet finger". I spelled out m-a-l-l-e-t for him and asked, that kind of mallet? He said yes. I guess it's because the finger is shaped like a mallet (darn, I should have taken a picture of that!). Here is a pretty simple explanation of what it is: http://www.patient.co.uk/health/mallet-finger . X-rays were taken of my hand and there was no evident fracture other than the ruptured tendon. It appears like this is quite a common injury since there are prefabricated finger-shaped splints of different sizes in the urgent care clinic already, but I doubt that it's common in nursing or caregiving circles. So the doctor found one to fit my middle finger, attached the new brace, and recommended that I be on modified duty. Unfortunately, I found out later, he failed to specify what I'm allowed and not allowed to do on the release form.
          Meanwhile, I'm in trouble with my supervisor. In 34 years of working, I'm charged for the first time ever with a no call/no show at my job because the supervisor was not properly notified that I would not be at work on Sunday night. I never got a definitive answer whether they covered my shift or not after the injury. Apparently I called the wrong people, the incorrect number and left a message with the incorrect voicemail. My supervisor said I should have persistently called her cell phone until she answered. I didn't do that because I didn't want to pester her after thinking that one voicemail at her office phone was enough. Not wanting to be labeled as pushy or a pest, I didn't make repeated calls and just waited for a response that never came. I even called the unit a few hours before my scheduled time to check if the supervisor left any word about covering my shift. There was none. Now I know better. Because I didn't show up for work, I left my co-workers inconvenienced because they were short one person for the shift with more than 30 residents to look after in addition to their housekeeping, dining room, and laundry duties. In retrospect, I should have just shown up, did the work as best as I could, or gone home if someone was there to cover me. Let's just charge the miscommunication a result of the long 4th of July weekend.
          In any normal industry, when an occupational injury happens, the point person or department is Human Resources who coordinates with the supervisor, but in this job, things are different as I'm painfully learning now.
          I'm supposed to wear the finger splint for two months which is the amount of time needed for the tendon to reattach and heal. An initial follow up with the doctor is scheduled for July 14th. I'll be returning to work on the p.m. shift on July 10th and we will have to see what I'm be able to do without being too useless to my co-workers.

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