Rotating Rhonda

1. Rotating Rhonda Group 6 John Cooke, Sybil DeJonge, Andrew Mason, Kevin Repay, Heather Shantz, Chris Thorpe

2. Profile Personal • 25 years old, a single female • very social, a love of partying and social dancing • a binge drinker • she smokes a pack of cigarettes per day • poor eating habits – afraid of gaining weight (eating disorder) • during high school she loved art and design, ballet, jazz and tap • has not formally danced since she began university

3. Profile Physical • 5 foot 6, 100 lbs • has a low pain threshold • lacks muscle tone and strength • Is currently sedentary, excluding social dancing

4. Profile Work History • designer at GMC for 2 years • CAD work requires considerable use of the mouse and leaves Rhonda deskbound • spends time working at home, ie. has multiple work stations

5. Rhonda’s Injuries • Has suffered supracondylitits and carpal tunnel of right arm over the last 6 months • As work revolves around mouse work Rhonda experiences a great deal of pain and discomfort • WSIB claim lead to an ergonomic assessment of her workplace and direction to receive therapy • Rest and rehabilitation have diminished and eliminated Rhonda’s symptoms; she is worried of a relapse • Accordingly Rhonda is interested in preventive therapy in combination with a reassessment of her workplace

6. Supracondylitis • Excessive and repetitive extension of the wrist, twisting of the forearm and/or grasping leads to inflammation of the lateral epicondyle • Common symptoms include tenderness and pain at the lateral epicondyle, which is often made worse by extension of the wrist of digits.

7. Treatment for Epicondylitis • Rest is a required part of treatment for any form of inflamation caused by overuse • NSAID (non steroidal anti-inflammatory drugs) such as ibuprofen can provide relief • Tape or a strap can be used distal to the elbow to reduce loading on the epicondlye. This allows the forearm muscles to pull against the tape or strap instead of the periosteum of the epicondyle. • If rest and NSAID’s fail to reduce inflammation, a cortisone shot may be administered to the elbow. Although not a permanent solution, cortisone can allow an inflammation free period to begin rehabilitation exercises which will be discussed in a combination with the exercises for the treatment of carpal tunnel syndrome.

8. Carpal Tunnel Syndrome • Caused by Median nerve compression at the wrist. • Compression caused by thickening of tendon sheaths or tendons within the carpal tunnel, swollen structures compress the nerve in the confined tunnel. • Common symptoms include tingling, burning, itching or numbness in the palm of the hand and the fingers, particularly the thumb, index and middle fingers. Decrease in grip strength is also a symptom of carpal tunnel syndrome

9. Treatment for Carpal Tunnel Syndrome • Rest is the key element in reduction of inflammation. Splints can be used at night to immobilize the wrist and reduce pressure on the median nerve • NSAID’s and cortisone are used to reduce swelling in the wrist. • Exercises are also helpful in the treatment of carpal tunnel syndrome and will be discussed in the exercise program.

10. Range of Motion Measurement • Flexion/Extension • Goniometer measurements of full flexion and extension • Flexion 0-80 degrees; extension is 0-70 • Radial/Ulnar Deviation • Goniometer measurements of full deviation • Ulnar deviation is 30 degrees; radial 20

11. Muscle Testing • Wrist flexion, wrist extension, pronation, supination, finger extension, finger flexion, thumb flexion, extension, abduction and adduction

12. Objectives for Rhonda’s Program • Reduce stress on and increase strength of muscles in the forearm, which will reduce inflammation in the carpal tunnel and at the epicondyles. • Increase body weight through increased activity and proper nutrition. • Decrease number of cigarettes smoked. • Decrease alcohol consumption. • Encourage assessment of both office and home work stations.

13. Stretching Program- Weeks 1-4 • Wrist range of motion: • Active Flexion and Extension • Bend your wrist forward and backward as far as you can. Do 3 sets of 10.

14. Stretching Program- Weeks 1-4 • Wrist stretch: • Passive stretch • With your uninjured hand, help to bend the injured wrist down by pressing the back of your hand and holding it down for 15 to 30 seconds. • Next, stretch the hand back by pulling the fingers posteriorly and holding it for 15 to 30 seconds. • Do 3 sets.

15. Stretching Program- Weeks 1-4 • Pronation and supination of the forearm • With your elbow bent 90°, turn your palm upward and hold for 5 seconds. Slowly turn your palm downward and hold for 5 seconds. • Make sure you keep your elbow at your side and bent 90° throughout this exercise. • Do 3 sets of 10.

16. Carpal Tunnel Exercise • Grasp a ball with hand, attempt to squeeze ball as much as possible • Hold grasp for 15 seconds • Repeat 3 times

17. Strengthening Program –Weeks 4-7 • Wrist flexion exercise: • Hold a weighted object in your hand with your palm facing up. • Move wrist into flexion. • Slowly extend wrist returning to the starting position. • Do 3 sets of 10. • Gradually increase the weight over time.

18. Strengthening Program –Weeks 4-7 • Wrist extension exercise: • Hold something with mass in your hand with your palm facing down. • Slowly extend wrist. • Slowly lower the weight down into the starting position. • Do 3 sets of 10. • Gradually increase the weight of the object you are holding.

19. Strengthening Program –Weeks 4-7 • Wrist radial deviation strengthening: • Put your wrist in a neutral position with thumb up. • Hold a weighted object and move thumb posteriorly toward bicep. • Slowly lower back to the starting position. • Ensure forearm is isolated throughout exercise. • Do 3 sets of 10.

20. Upper Body Exercises: • Arms – bicep curls, triceps extensions (with surgical tubing) • Shoulders – lateral raises, anterior raises (with surgical tubing) • Chest – dumbbell chest press (floor or ball) • Back – superman and cat stretches (floor or ball)

21. Lower Body Exercises: • Lower leg – squats (quadriceps) • lunges (hamstrings). • calf raises (seated or standing).

22. Core Strength Exercises • Abdominals – crunches, oblique crunches, lower back extensions (stability ball), bridge

23. Cardiovascular Exercise • Aerobics classes, dance classes, strip-aerobics • Kick boxing, yoga, spinning • Though these activities normally support weight loss, it is recommended for everyone as it improves cardiovascular fitness

24. Ergonomic Recommendations • Changes with computer mouse (wider grip) • Raise key board (proper angle) • Ergonomic chair (incline/decline and leg support or foot rest)

25. Lifestyle Habitual Changes • Strength Program- educate the client about the strength training program and how often it should be done • Performing stretches and strengthening exercises at home and in the workplace • Encourage Rhonda to quit smoking; refer her to doctors or websites that could provide her with further information.

26. Nutritional Recommendations • Educate Rhonda about the eating properly and the benefits that come with it. • Educate about the negatives of binge drinking and encourage a decrease in consumption. • Referral to a dietician for Rhonda to get advice on her eating habits. • Supply and review a copy of Canada’s food guide.