- By Valerie Weadock
- Jun 01, 2003
A vast range of human activities--from writing to laying bricks, to opening a
can of soda--would be impossible without the healthy functioning of the elbow,
wrist, and hand. Yet this area is one of the most intricate and one of the most
vulnerable to injury in the human body.
Occupational physicians and therapists are no strangers to these types of
injuries; they can't afford to be. Among the most severe injuries, measured in
lost workdays in all major industry divisions in Texas alone, carpal tunnel
syndrome, tendonitis, and other wrist injuries ranked as the top three,
according to the 2000 Bureau of Labor Statistics Annual Survey of Occupational
Injuries and Illnesses.
In addition to repetitive motion activities, one of the most common
mechanisms of wrist injury is a fall onto an outstretched hand, usually
occurring when an individual tries to break his fall or catch himself with his
hand. Strains, sprains, and even fractures often result. A scaphoid fracture is
one of the most common broken bones in the wrist area. Scaphoid bones are
particularly delicate due to a notoriously poor blood supply. When the scaphoid
bone is struck, the already poor blood supply to the bone is damaged, which can
interrupt the flow of healing nutrients. This has a negative effect on the
healing process, and a subsequent fracture or break frequently occurs.
A Unique Learning Tool
The American Society of Hand Therapists (ASHT)
recognizes the prevalence of scaphoid fractures and other wrist injuries and the
subsequent need for information on their treatment, rehabilitation, and
prevention in its CD-ROM, Surgical Demonstration & Therapeutic Management
II: The Wrist. The CD and its predecessor (which covers one discussion each
on the shoulder, elbow, wrist, and finger) feature lectures and surgical
demonstrations taped live at a pre-conference institute held in conjunction with
ASHT's 25th annual meeting in September 2002.
While it is aimed at individuals and organizations involved with hand and
upper extremity rehabilitation and/or injury prevention, Diane Muller, director
of education and development for ASHT, says the CD-ROM-based program also is
beneficial to those who need to understand surgical and therapeutic protocols
for affected workers. This includes risk managers, case managers, ergonomists,
and others, she said.
"As one of the lecturers says in the video, 'anatomy is power.' This CD
demonstrates anatomy beautifully, which is paramount to anyone attempting to
understand what an individual goes through in trying to recover from an injury
or condition," Muller said. "It also provides valuable insight into the delicate
nature of the hand and upper extremity and the importance of protection of
workers--with both full functional and basic quality-of-life implications."
The CD begins with a lecture on Wrist Basics, which reviews the
skeletal components of the wrist, its primary ligaments, and its movements. The
lecturer, Rachael Jaffe, OTR/L, CHT, uses several slides during her
presentation, but many are hard to read in the CD-ROM format. Still, the
information presented is useful as an introduction to the later surgery.
Before diving into the wrist surgery demonstration, Dr. Paul C. Dell leads a
discussion on scaphoid nonunion, or fracture, including an explanation of stable
versus unstable fractures, indications for surgery, diagnosis, and
The program's strength is definitely in the wrist surgery demonstration, but
users beware, this portion of the CD is not for the weak of stomach. Using the
arm of a cadaver, Dell demonstrates both a dorsal and volar (front and back)
approach to screw fixation of a scaphoid fracture. With a little bit of humor
and an obvious passion for the subject, he also goes through a capsulodesis of
the scapholunate ligament, a treatment for an injury to a ligament that often
occurs in the same manner as a scaphoid fracture.
After the surgical demonstration (and every other section), people attending
the taping of the program were given a chance to ask questions. While it's hard
to make up for a CD-ROM user's not being able to ask for clarification, the
questions asked during taping are answered thoroughly, often with further
surgical demonstration, truly adding to the program's value.
Ruthie Dell, MHS, OTR, CHT, finishes the program with a lecture on the
Therapy Considerations Following Wrist Surgery, including immediate
post-operation management and post acute treatment for the spectrum of scaphoid
fractures. After working through the program, health care practitioners can earn
continuing education hours (0.5 CEUs) by satisfactorily completing the brief
post-CD self exam.
The CD's largest faults lie in some audio and video difficulties that
occurred during taping, which ideally should have been edited out but do not
interfere with any of the sections' content.
Through the use of lectures, slides, and live
surgical demonstrations, this CD-ROM-based program gives the user an in-depth
lesson that he/she would be hard pressed to find even in a series of upper-level
college courses. "Few practitioners--and even fewer occupational health and
safety professionals--have the luxury of regularly observing live surgeries,"
Muller said. "The insight into a patient's recovery process such as a
demonstration provides can make a marked difference on patient outcomes, work
environment improvement, and worker understanding."
The best part is that, unlike a college lecture, this program can be stopped
and rewound or watched as many times as needed.
The Surgical Demonstration & Therapeutic Management II: The Wrist
CD-ROM is available to ASHT members for $150 and non-members for $250. It is
available for sale with the first edition, Management of Upper Extremity
Problems: Cadaver Demonstrations and Therapeutic Management, at a discounted
package price of $275 for members and $425 for non-members. To run the program,
users will need a CD-ROM drive and RealPlayer® software (available for free
download via an Internet link imbedded within the CD or at www.real.com).
This article originally appeared in the June 2003 issue of Occupational Health & Safety.