The often-injured upper extremity often needs a special touch

David Renzi

Monday, June 30, 1997 | 4:48 a.m.

The ball hit the top of his finger as he dove to make the save, and that's when it happened, Christian Melchor says.

The good news is, he made the save.

The bad news is, he fractured the finger.

But the bad news is abated by more good news: Melchor won't miss a game for his soccer club team, Neusport FC, which is in the middle of a tournament.

"Basically, we have the healing touch," says upper-extremity specialist Ellen McKinley, making a custom splint for the 14-year-old goalie's left ring finger.

The splint, made of a thermoplastic material, conforms to a person's hand or finger and hardens as it dries. In Melchor's case, the splint will provide the stability of a cast without encasing his entire hand and preventing him from playing.

McKinley says Melchor could reinjure the finger by playing, and Melchor himself acknowledges the possibility. But the athlete in him won't allow an unconditional surrender.

"No pain, no gain," he says.

We present this, the case of the fractured phalanx, to illustrate one of the many bad things that can happen to the hand. It is especially relevant now, what with the recent passing of Hand Therapy Public Awareness Week.

In recognition, a local hand-rehabilitation clinic last week invited hand doctors, hand therapists and hands-on journalists to an open house.

There were videos to watch, patients and therapists to interview, handouts to read and -- yes -- finger foods to eat during a presentation that was to enlighten the public about the benefits of certified hand therapists.

"It's vital to anyone with a hand injury or upper-extremity injury to make them aware of what is best available to them for their particular hand injury," says Audrey Lloyd-Davies, the clinic's site coordinator.

She adds that it's important for people with hand injuries to seek out a certified hand therapist rather than a physical or occupational therapist.

"They can treat the injury," she says, "but they don't specialize in hand injuries. It's kind of like going to a Buick dealer (for repairs) when you have a Honda. You want to go to people who specialize."

Lloyd-Davies, like McKinley, is a certified hand therapist and a licensed occupational therapist. Around the room, their patients: A bilateral carpal tunnel syndrome here, a reflex sympathetic dystrophy (or RSD) there, a broken wrist over at the therapeutic exerciser.

About 90 percent of the clinic's cases are workman's compensation, which Lloyd-Davies attributes to the booming construction industry.

"We tend to get a lot of severed digits," she says. "Now the hand surgeons coming to Las Vegas are better equipped to replant a digit, where once they used to send them out of town."

The clinic also gets a lot of cumulative-trauma cases, such as tendinitis and carpal tunnel syndrome, a condition brought on by a pinched nerve at the wrist. Carpal tunnel syndrome happens when pressure builds up from swelling in the wrist's carpal tunnel -- where the median nerve and nine tendons pass from the forearm into the hand -- and puts pressure on the nerve, causing pain in the arm, hand and fingers.

McKinley says computer operators and other workers who perform repetitive wrist motions are susceptible to carpal tunnel syndrome. Workers, however, can combat the repetition by performing decompression exercises on the job.

"They're stretching exercises, stretching in the opposite direction," Lloyd-Davies says. "Usually, people are in a flexed position. They're flexed over a keyboard or a desk, or they're talking on the phone and their neck is flexed. What we try to do is the opposite motion, so it allows decompression of nerves."

The exercises take about five seconds, but they should be performed at least once an hour.

"Just make a quick stretch back and hold it for a count of five," she says.

Depending on the severity, carpal tunnel syndrome can be treated surgically and nonsurgically. Electrician Robert Allen is opting for the latter, which combines heating, freezing, ultrasound and deep friction massage.

"If it's a mild problem (it can be treated nonsurgically), and if it's caught early enough," McKinley says.

Allen dealt with the pain for more than a year before he sought treatment.

"In my case, my right hand was throbbing -- like a dull toothache. It just kept nagging me," he says. "My nephew works for a hand surgeon, and he kept saying, 'Uncle Bob, you need to come over here and see what we can do for you.' I finally made up my mind. They're working fine (now)."

Lyn Montalvo wishes she could say the same about her left hand, stricken with RSD. Lloyd-Davies says reflex symptomatic dystrophy is an irritation of the autonomic nervous system and can result in discoloration of the skin, a shiny sheen to the skin, coldness and pain.

Often, a hand injury can cause RSD.

"One lady dislocated her finger and now has full-blown RSD," Lloyd-Davies says. "The fracture healed, but she's been in therapy for six months."

The disorder has contorted Montalvo's left hand into a claw, and left her unable to work as a scrub nurse. She now answers phones at the hospital, with difficulty.

"It's a very disheartening feeling," she says. "I can't get people to understand how it feels. The air from the air conditioning or a vent can irritate the hair follicles and set off all kinds of sensitive waves. Some days you can't even do your hair, or get yourself out of the bathtub. It's just so weird.

"The saddest thing about RSD is, there are very few doctors who know how to deal with it or know what the syndrome is, or, if they do, have the time or patience to."

Montalvo was diagnosed in March. She has been in therapy since.

"This does nothing for me as far as I'm concerned, but it's better than nothing," she says, referring to the Fluidotherapy treatment she was undergoing.

Patients place their arm inside a container and move their hand through a warm bed of ground corncobs, which provides slight resistance and serves to strengthen the hand. They can also squeeze a ball inside the yellowish mix.

"If it gets too hot," Montalvo says, "it hurts. If the grains hit it, it hurts. But it must be doing something; it looks better than it did a couple of months ago."

"We use it because it doesn't promote bacterial growth, and it desensitizes the extremities," Lloyd-Davies says of the corncobs.

Another rehabilitation machine is the Baltimore Therapeutic Exerciser, or BTE Work Simulator, for wrist-injury patients. It has interchangeable handles that are fashioned to a patient's particular injury, increases range-of-motion and progressively strengthens weaker muscles.

"The overall goal is to increase function," Lloyd-Davies says.

All in all, patients here give the Hand Rehabilitation Center a big thumbs up, and applaud Hand Therapy Public Awareness Week.

"I didn't know they had a clinic like this," says Ann Armeno, who is rehabilitating a broken wrist, the result of trying to break a fall with an outstretched hand when she fell down a flight of steps. "I think it's great that they zero in on your injury."