TREATMENT N O T ES T R E A T M E N T O F H A N D I N J U R I E S B y M is s J o a n E . Y o u t h e d , P r e t o r i a D i p . : M e m b e r N o r t h e r n T r a n s v a a l B r a n c h . Illustration: M is s J . C o e tz e e ( S tu d e n t m e m b e r). F o r t h e p a s t six m o n t h s I h a v e b e e n w o r k in g a t th e M p ile A f r ic a n H o s p it a l in B u la w a y o , a n d d u r i n g t h a t t im e I h a v e h a d a la r g e n u m b e r o f in d u s tr ia l h a n d in ju rie s t o t r e a t . T h e s e i n v a r ia b ly r e s u lt in t h e t r a u m a t ic a m p u t a ­ t i o n o f o n e o r m o r e fin g e rs o r in t h e s e v e ra n c e o f t h e fle x o r te n d o n s . B y t h e tim e t h e te n d o n s a r e s u t u r e d a n d th e w o u n d s h e a le d t h e h a n d s a r e i m m o b i l e — t h e n a t u r a l te n d e n c y o f t h e A f r ic a n b e in g t o n u r s e it v e ry q u ie tly ! I h a v e f o u n d t h a t a n e ffe c tiv e w a y o f d e a lin g w ith t h is is b y s o a k in g t h e h a n d in h o t s a lin e o r d e t t o l w a te r , r e m o v ­ in g a ll t h e h a r d s k in c a llo u s a n d d r y in g t h e h a n d w e ll u n d e r I . R . R . D e e p fin g e r k n e a d in g ( u s in g o il) a n d a c tiv e e x e r ­ c is e s o n o u r “ f in g e r m a c h in e ” f o llo w e d b y c la s s e x e rc ise s h a v e p r o d u c e d g o o d re s u lts . Page S P H Y S I O T F in g e r M a c h in e S ize o f F ram e: A p p r o x . : J 8 " + 10". O ver-head h ooks: F o r lu m b ric a l a c tio n , a n d fle x io n a n d e x te n s io n o f t h e M / P j o in ts . I h a v e a ls o f o u n d t h a t b a d s e p tic h a n d s h a v e r e s p o n d e d w ell t o s a lin e s o a k s in c o n j u n c t i o n w ith a l t e r n a t e U .V .R . a n d l . R . R . T R E A T M E N T N O T E . K E I T H N I C O L , m .s .a .s .p ., m .c .s .p ., h .t ., m .r .s .h ., S o m e r s e t W e s t, C a p e P ro v in c e . T h is c a s e is b e in g w r i t te n b e c a u s e it is a n u n u s u a l c o n ­ d i t i o n a n d o n e in w h ic h t h e P h y s io th e r a p is t w a s o ffe re d a c h a lle n g e o f h is k n o w le d g e in t h is f o r m o f m e d ic a l th e r a p y . C a s e H is to r y . . u u . M r s . F . , a g e d 28 y e a rs , c o m p la in e d o f p a i n in t h e r ig h t h a n d . O nset o f p a i n w a s 15 m o n t h s ’ p re v io u s . Cause: H e r s o n k ic k e d t h e d o r s u m o f h e r h a n d w ith his P .O .P . f o o t s p lin t. A e tio lo g y : M r s . F . c o m p la in e d o f p a i n d u r i n g t h e a c tio n o f g r ip p in g o r w h e n e x te n d in g t h e fin g e rs w h e n t h e p a i n b e c a m e lo c a liz e d t o t h e b a s e o f t h e m id d le fin g e r. P re s s in g t h e p a lm o f h e r h a n d d o w n w a r d s o n t o p o f a t a b l e o r a c tiv e ly e x te n d in g t h e w r is t p r o d u c e d re fe rr e d p a in u p t h e f o re a rm . T h e r e w a s n o p a i n d u r i n g t h e n ig h t. T h e p a in fe lt lik e a b r u is e o v e r t h e d o r s u m o f t h e h a n d a n d t h e re fe rr e d p a in w a s s h a r p in t o t h e fin g e rs . M e d ic a l A tte n tio n : M r s . F . s a w h e r D o c t o r w h o c o u ld n o t d e te c t a n y t h i n g a b n o r m a l u n d e r X - r a y , h e o ffe re d to giv e a n in je c tio n w h ic h sh e d id n o t a c c e p t b e c a u s e t h e D o c t o r d id n o t k n o w w h a t t h e c o n d itio n w a s . A s e c o n d D o c t o r w a s a p p r o a c h e d w h o p r e s c r ib e d r u b b in g in I o d e x b u t th is w a s w i t h o u t effe ct. M r s . F . a s k e d if s h e c o u ld b e a llo w e d t o re c e iv e P h y s io th e r a p y , t o w h ic h h e r D o c t o r a g re e d . P h y s io th e r a p y A tte n tio n : H a v i n g n o te d t h e c a s e h is to r y a s o u tlin e d a b o v e , a s o f t tis s u e e x a m in a tio n w a s c a r r ie d E x a m in a tio n : R e s is te d a b d u c t i o n ( r a d ia l d e v ia tio n ) o f t h e m id d le fin g e r c a u s e d p a in . R e s is te d la te r a l d e v ia tio n s o f a ll t h e o t h e r fin g e rs c a u s e d slig h t p a in o v e r t h e d o r s u m o f t h e p r o x im a l p h a l a n x o f th e m id d le fin g e r, e s p e c ia lly in to t h e r a d ia l s id e o f t h e h e a d o f t h e m e t a c a r p a l t o t h e m id d le fin g e r. O n P a l p a t i o n : T h e r e w a s p a in in t h e t e n d o n o f in s e rtio n o f t h e a b d u c t o r t o t h e m id d le fin g e r, w h e r e a th ic k e n in g a n d sw e llin g w a s e v id e n t d u r i n g t h e fin a l d e g r e e s o f fin g e r e x te n s io n a t t h e m e ta c a r p o - p h a la n g e a l jo i n t s . D ia g n o s is : I e x p la in e d t o M r s . F . t h a t s h e w a s e x p e r ie n c in g t h e effe cts o f a lo c a liz e d th ic k e n in g o f th e s e c o n d I n te ro s s e i d o r s a le s te n d o n t o t h e m id d le fin g e r, c a u s e d b y m in o r t r a u m a 15 m o n t h s a g o . T r e a t m e n t : D a ily t r e a t m e n t s w e re g iv e n f o r th r e e w e e k s d u r i n g w h ic h tim e t h e h a n d w a s re s te d . U ltr a s o n ic th e r a p y w a s g iv e n t h r o u g h o u t, p e r w a te r m e d iu m s t a r t i n g a t 5 m in u te s d u r a t i o n , p r o g re s s in g to 15 m in u te s a t t h e lo w e s t in te n s ity o u t p u t . A s f r o m t h e s e c o n d w e e k , in v ie w o f t h e f a c t t h a t th e r e h a d b e e n n o c h a n g e in h e r c o n d itio n , in a d d i t i o n to U l t r a ­ s o n ic t h e r a p y , m a s s a g e w a s i n tr o d u c e d in t h e f o r m o f d e e p t r a n s v e r s e f ric tio n s a c r o s s t h e a ffe c te d te n d o n . A t t h e e n d o f t h e s e c o n d w e e k f a r a d ic s tim u l a t i o n w a s g iv e n a s a n a d d i t i o n , a t a f a irly s t r o n g in te n s ity . P r o g r e s s : A t th is s ta g e th e c o n d i t i o n w a s s h o w in g s o m e i m p ro v e m e n t. T h e h a n d w a s fe e lin g e a s ie r a n d o n e x a m in a ­ t i o n re sis te d l a te r a l d e v ia tio n o f t h e fin g e rs d id n o t c a u s e p a in , b u t th e r e w a s still p a i n o n a c tiv e e x te n s io n o f th e fin g e rs a t t h e m e ta c a r p o - p h a la n g e a l j o in ts . A f t e r 17 tr e a t m e n t s , w ith in t h e p e r io d o f th r e e w e e k s , M r s . F . n o lo n g e r c o m p la in e d o f p a in b u t o n ly stiffn e ss . W h ile tr e a t m e n t s w e re d 'S - c o n tin u e d , s h e w a s i n s tr u c te d to r e st t h e h a n d f o r a f u r t h e r tw o w e e k s , n o t e v e n t o k n it w h ic h w a s h e r f a v o u r ite p a s tim e . F o llo w in g th is p e rio d o f r e s t M r s . F . r e p o r t e d t h a t sh e h a d b e e n f re e o f p a in a n d c o u ld n o w u s e h e r h a n d n o r m a lly . O n r e -e x a m in a tio n ^ t h e le s io n w a s n o lo n g e r e v id e n t. C o n c lu s io n : I n e x te n d in g m y a c k n o w le d g e m e n t t o th e D o c t o r w h o re fe rr e d th is c a s e f o r P h y s io th e r a p y , I w is h to p o i n t o u t t h a t th is is a n o t h e r in s ta n c e in w h ic h i f m o r e c a s e s w e re e n t r u s t e d t o th e P h y s io th e r a p is t w ith w h ic h to a p p ly h is o r h e r k n o w le d g e a n d a b ility , t h e n o u r p a tie n ts w o u ld b e n e fit a ll t h e m o r e . I t m u s t b e r e c o g n iz e d t h a t w e a r e c o n tin u a lly t r e a t i n g s o f t tis s u e in ju rie s t o t h e e x te n t t h a t o u r s o u n d t r a i n in g d o e s n o t c o n tin u a lly w a r r a n t p re c ise i n s t r u c t i o n a s t o h o w t o a p p ly o u r f o r m s o f tr e a tm e n ts . W e a r e t h e p e r s o n n e l w h o k n o w h o w m u c h tim e , o r a m p e r e s o r w a t t a g e p e r s q u a r e c m . t h a t is n e c e s s a ry t o b e g iv e n f o r a n y o n e c a s e , e s p e c ia lly if c o n s i d e r a t i o n is a lw a y s g iv e n t o t h e f o llo w in g p o i n t s o f a p p r o a c h : 1. T h e d ia g n o s is la b e lle d b y t h e D o c t o r in c h a r g e o f t h e c a s e . 2. I n t e r r o g a t e t h e p a t i e n t t o a s se s s h im o r h e r a s a n in d iv id u a l. T o a s s e r t t h e c a u s e , level o r l o c a t i o n o f th e le s io n . 3. T o c a r r y o u t a c lin ic a l e x a m i n a t i o n o n e a c h a n d e v e ry c o n d i t i o n re fe rr e d t o t h e P h y s io th e r a p is t. I f a little m o r e tim e is ta k e n o v e r t h e l a t t e r tw o p o in ts a n d r e c o r d e d o n a C a s e S h e e t w h e th e r in p r i v a t e p r a c tic e ( C ontinued on P age 13). H E R A P Y June, 1960 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) June, 1960 STUDENTS COLUMN P H Y S I O T H E R A P Y Page 13 W I T W A T E R S R A N D U N I V E R S I T Y W ith e r W its T h e first p a r t o f a U n i v e r s i t y y e a r is a l w a y s a b u s y t i m e f o r s t u d e n t s , m o r e o f c o u r s e in t h e so ci al t h a n a c a d e m i c field, as t h e t h o u g h t s o f e x a m i n a t i o n s a r e n o t as a c u t e . O n c e a g a i n t h e p h y s i o t h e r a p y s t u d e n t s p l a y e d a n ac ti v e p a r t in t h e A n n u a l “ R a g " he ld m e r c i f u l l y e a r l y th i s y ea r , o n M a y 6th. T h e t h i r d y e a r s t u d e n t s p r o d u c e d a m o s t a r t i s t i c a n d c o l o u r f u l f l o a t t o d e p i c t t h e g en e r a l t h e m e o f “ M e r r y M y t h s ” ; it w a s o f N e p t u n e , p r e s e n t e d by M r . T a i t z , o n e o f t h e t w o m a l e s t u d e n t s , a n d his a r r a y o f m e r m a i d s . T h e first y e a r s t u d e n t s a l s o h a d a float a s p i r i n g t o t h e r e a l m s o f Greek. M y t h o l o g y . S e c o n d a n d F o u r t h y e a r s t u d e n t s w e r e t o be s e en in v a r i o u s c o s t u m e s a m o n g t h e m a n y fr ee l a n c e w a l k e r s . I t is s u c h h a r d w o r k t o p r e p a r e f o r th i s d a y a n d a g r ea t d e a l o f t h o u g h t g o e s i n t o t h e p r o d u c t i o n , it is s a d t o h e a r t h a t th i s y e a r w a s n o t a s fi n a n c i a l l y p r o f i t a b l e as h a d be en h o p e d , b u t I t h i n k all e x - s t u d e n t s will a g r e e t h a t it is a l w a y s w o r t h t h e effort. T h e d e p a r t m e n t w o u l d like t o e x t e n d its bes t w i sh e s to M i s s B a l k i n d , a final y e a r s t u d e n t a n d Mi ss T a n k e l o w i t z , a t h i r d y e a r s t u d e n t , w h o b e c a m e re sp ec ti v el y M r s . S h e r a n d M r s . Z u k d u r i n g t h e E a s t e r v a c a t i o n . W e a r e a l s o h a p p y t o a n n o u n c e t h a t o n c e a g a i n th e P h y s i o t h e r a p y d e p a r t m e n t is p l a y i n g a p r o m i n e n t p a r t in t h e field o f s p o r t , as M i s s C o u n i h a n , a final y e a r , h a s b ee n ele ct ed as c h a i r m a n o f t h e U n i v e r s i t y H o c k e y C l u b f o r 1960. All t h e s t a ff a n d s t u d e n t s e x t e n d o u r s y m p a t h y w it h M is s C h a p m a n , final y ea r , in t h e re c e n t loss o f h e r f a t h e r . A t th e m o m e n t t h e s t u d e n t s a r e b u si l y t h i n k i n g u p w a y s a n d m e a n s f o r a n O l d S t u d e n t ' s r e u n i o n l a t e r t hi s y e a r w e si nc er el y h o p e we will h a v e a l ar ge a t t e n d a n c e . O v e rse a s T h e m o s t r e c e n t ol d s t u d e n t s t o h a v e s a i le d f o r t h e U n i t e d K i n g d o m a r e M is s D e n n y a n d M is s H o s k i n g , we se n d t h e m . o u r g o o d w i sh e s f o r a p l e a s a n t tim e. | r A l s o M is s B j o r k m a n is at p r e s e n t in S w e d e n s t a y i n g w it h her fa m i ly , w e u n d e r s t a n d s h e is s o o n t o b e m a r r i e d , a n d se n d h e r o u r b es t wi shes. O n h e r r e c e n t b r i e f visit t o t h e F r e e S t a t e , M i s s Bl air sta ye d w i t h M r s . E ste ll e D e a n e (n ee A l b e r t s ) a n d f a m i ly a n d h a d t ea w i t h M r s . A n n B e y e r (n ee J o s l i n ) a n d in f a n t so n. O n h e r r e t u r n j o u r n e y s h e ca l l e d o n M r s . B a r b a r a C a r l e a n (nee B r o w n l e e ) w h o w a s b u s y in h e r d e p a r t m e n t a t the H a r m o n y H o s p i t a l . P R E T O R I A H O S P I T A L S C H O O L O F P H Y S I O T H E R A P Y S c h o o l N ew s D ip lo m a C e re m o n y T h e c e r e m o n y o f t h e p r e s e n t a t i o n o f D i p l o m a C e rt i f ic a t e s w a s held in t h e S c h o o l H a l l , o n F r i d a y , M a r c h 19 th, at 2 p . m . D r . H . J. H u g o , D i r e c t o r o f H o s p i t a l Se rv ic es p r e s i d e d , t h e G u e s t S p e a k e r w a s M is s J. Blai r, S e n i o r L e c t u r e r in P h y s i o t h e r a p y at t h e W i t w a t e r s r a n d U n i v e r s i t y . M i s s A . M . B o d o a n o gave a r e p o r t o n t h e y e a r s w o r k a n d D r . S w a n e p o e l , S u p e r i n t e n d e n t o f P r e t o r i a H o s p i t a l g av e a v o t e o f t h a n k s . P a r e n t s a n d g u e s t s a t t e n d e d t h e c e r e m o n y a n d t h e S c h o o l w a s h o n o u r e d t o h a v e a s g u e s t s M r . R . S. F e r r e i r a , m . e . c . a n d M r s . F e r r e i r a . F o l l o w i n g t h e p r e s e n t a t i o n o f 20 d i p l o m a s , t h e f o l l o w ­ ing p ri ze s w e r e g i v e n : — A w a r d o f P rize s: Mis s J. L a w r a n c e — D i s t i n c t i o n in P a t h o l o g y , 2 n d C l a s s in P h y s i o t h e r a p y . M i s s R. S l o m a n — 2 n d C l a s s, K i n e s i o l o g y a n d E l e c t r o ­ t h e r a p y . Mis s M . C o u s i n s — 2 n d Cl as s, P h y s i o t h e r a p y a n d T r e a t ­ m e n t s . Mis s M. v a n W y k — 2 n d C l a s s, T r e a t m e n t s . M i s s N . H u m p h r i s — G e n e r a l h i g h s t a n d a r d . T h e P r i n c i p a l o f t h e S c h o o l ( c e n t re ) a n d D i p l o m a S t u d e n t s . (B a c k ro w ) J. M. W e l s h , E. G r o b l e r , H. M u l d e r , M. B o o m k a m p , T . G l i c k , J. L a w r a n c e , C. £ . D o u g l a s , E. P i e n a a r , M . A. E ll w o o d . ( F ro n t ro w ) M . C o u s i n s , D . A. G i b b s , R. S l o m a n , Mi ss A. M . B o d o a n o , P rin c ip a l, M . J. v a n W y k , J. R. W o o d , N . H u m p h r i s . T e a c h e r ’s C o u rse : M i s s E. J e n n i n g s , m . c . s . p . , o f t h e S t a f f o f t he P r e t o r i a S c h o o l o f P h y s i o t h e r a p y is t a k i n g a o n e y e a r P h y s i o ­ t h e r a p y T e a c h e r s C o u r s e at t h e U n i v e r s i t y o f P r e t o r i a . W e w i s h h e r e v e r y suc ces s, a n d lo o k f o r w a r d t o h a v i n g h er b a c k in t h e S c h o o l at t h e e n d o f t h e y e a r in a full t i m e c a p a c i t y . T h e S c h o o l is ver y pl e a s e d t o h a v e b a c k w i t h th e s t u d e n t s M i s s A n n e H e n d r y , a f t e r a l o n g a b s e n c e d u e t o s i c kn es s , w e c o n g r a t u l a t e h e r o n h e r p e r s e v e r a n c e a n d c o u r a g e , a n d w is h h e r ev e r y s u c ce ss in h e r F i n a l E x a m i n a t i o n . T R E A T M E N T N O T E S ( C o n tin u e d f r o m P a g e 8). o r in H o s p i t a l serv ice , t h e n it will b e t i m e well s p e n t b e c a u s e i n this w a y y o u will live w i t h a n d feel t h e c o n d i t i o n y o u a r e s u p p o s e d t o b e as s i s t i n g in its r ec ov er y . I f y o u a s t h e P h y s i o t h e r a p i s t d o n o t a g r e e w i t h t h e a b o v e p o i n t s o f a p p r o a c h t h e n y o u , h a v i n g a c c e p t e d a ca s e c a n n o t b e c o n f i d e n t o f y o u r a b i l i t y t o t a k e t h e ne c e s sa ry r e sp o n s i b i li t y o f c u r i n g y o u r p a t i e n t ’s c o n d i t i o n . S ur e ly w h e n a c a s e h a v i n g b e e n r e f e r r e d f o r p h y s i o t h e r a p y , y o u d o p o n d e r t o c o n s i d e r w h e t h e r o r n o t y o u e x p e c t to p r o d u c e sufficient i m p r o v e m e n t t o sa tis fy y o u r s e l f a s well a s t h e p a t i e n t . R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )