PLATTSBURGH — The pain Kathy Wyckoff had to endure was unbearable.
Repetitive use of her hands as a physical-therapy assistant had weakened Wyckoff's thumb joints, causing the thumbs to painfully pop out of place on a regular basis.
"The pain was excruciating," she said. "It would bring me to my knees, it was so debilitating."
As the osteoarthritis that was wearing away the tiny bones in her thumb joints worsened through constant use, Wyckoff faced reconstructive surgery to reduce the pain and hopefully return more regular use of both hands.
"The procedure involves taking tendons out of the forearms, splitting them, rolling them and placing them in the joint so it doesn't slip and slide anymore," said Rebecca McCambridge, a certified hand therapist and senior occupational therapist for the CVPH Medical Center Rehabilitation Unit.
Hand specialists at Fletcher Allen Health Care in Burlington scheduled one of the procedures in January and the second in June, allowing Wyckoff the use of one hand while the other waited for surgery or recovered from the procedure, including extensive rehab to return mobility for both appendages.
"We needed to work on range-of-motion exercises and then strengthening exercises to help get Kathy back to work," McCambridge said.
STILL ADAPTING
Wyckoff's rehab began about three weeks after the first procedure for the right thumb after a permanent cast was replaced by a removable splint.
"Range of motion for the thumb is extremely important," McCambridge added. "Without our thumbs, the use of the hand is limited."
Strengthening was also key. Wyckoff followed several exercise routines that included the use of equipment and small weights geared toward improving the hand's muscles after the extended period of non-use.
"It's going much better," she said of her ability to use her hands following the recovery process.
She admitted, though, that she has had to learn different techniques for grasping heavier items and recognizes that she will not achieve full recovery of her hands.
"We're still trying to adjust to learn what exactly I can do (to return to daily work activities)," she said.
"This surgery is more commonly done for older people to reduce the pain," McCambridge said. "Physicians will often feel that with pain reduction, the procedure is successful. But with Kathy, we want to help her get back to some type of working condition.
"It really takes a year before we're sure how much use of the hands we can recover," she added.
Science has not perfected a process for replacement surgery for thumb joints the way that knee and hip replacements have become so successful, McCambridge said. Wyckoff's other option was for thumb-fusion surgery, which significantly reduces the use of the thumb following the procedure but does limit the pain.
She quickly chose the reconstructive option, confident that she would be able to continue with her career.
RARE SPECIALTY
McCambridge is the only hand therapist in the region. She received her specialized training eight years ago to provide local therapy services for patients who travel to Burlington or Albany for several types of hand-related procedures.
"We treat injuries from the shoulder to the hand," she said of the hand therapist's workload. "It's rare in rural areas to have this kind of specialty, but people being treated outside the area had nowhere locally to go for rehabilitation."
Many of her patients are recovering from broken hands or wrists as well as damage to tendons. Often, they have suffered repetitive-stress injuries such as carpal tunnel syndrome and tendonitis.
Nationwide, there are fewer than 5,000 certified hand therapists. Eighty-five percent of them are occupational therapists, 15 percent are physical therapists and a handful have combined OT and PT certification.
Hand-therapy techniques often combine occupational- and physical-therapy skills, focusing on comprehensive knowledge of hand and upper extremities of the arm. The hand-therapist's efforts focus on restoring function and reversing damage to the appendages caused by injury or disease.
E-mail Jeff Meyers at: jmeyers@pressrepublican.com
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