Physiotherapists in Bristol treat many different conditions including the issues profiled below.

Hand Injuries - Diagnosis

The diagnosis of most hand injuries is not difficult as the damage is usually readily apparent to the examiner. There will typically be a history of trauma and this should be carefully attended to as it may give clues to a more complex injury than first appears. Bruising and swelling are very typical signs apparent on initial inspection, with pain a common and often localising feature. There may be an obvious deformity if the joints are dislocated or bones fractures with displacement, the patient will have lost the ability to grip firmly and there may be reduced range of movement in the fingers and thumb.

Examination starts with a visual examination of the hand which guides the doctor as to further required tests and investigations. The doctor will palpate the hand systematically to look for areas of particular pain or abnormal movement which would point to an underlying injury. The ranges of movement of the shoulder, elbow, wrist and hand is assessed and recorded, with the tendon actions tested in turn to search out any tendon involvement. Circulatory function will be checked to exclude blood vessel damage. Investigations will routinely include x-rays to look for fractures, dislocations or embedded objects such as glass.

Activity and Muscle Strength

When a person starts to train for strength or power they start exerting high forces for short periods of time, i.e. they use heavier weights for smaller numbers of repetitions. This causes large changes in the fast twitch type 2 muscles fibres, increasing their size but not changing their number. This process is known as mechanically induced hypertrophy and results from the muscle cells synthesising increased amounts of muscle proteins to build into larger muscle. Muscles can also add new sections to the areas where they join the tendon if they are subjected to stretching forces.

In contrast, if muscles are inactive they reduce the making of muscle proteins within a few hours and the muscle starts to atrophy, to lose size and strength. In injuries if a muscle is immobilised in a shortened position both its size and its length will be reduced, with non-contracting substances becoming more dominant. This leads to a muscle which is shorter, more stiff and less easily lengthened, a significantly negative outcome in that immobilisation for fractures will have unwanted effects on the local muscular structures. Modern methods concentrate on immobilising a joint only if essential and only for the shortest necessary period.