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Managing Post-Operative Edema
334 Plays11 days ago
Miranda and Josh talk about managing post-operative edema. They offer some of their favorite tips and tricks.
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Transcript
Introduction to Hosts and Ham Therapy Academy
00:00:05
josh MacDonald
Hi, I'm Josh McDonald.
00:00:07
Miranda Materi
And I'm Miranda Materi and we are Ham Therapy Academy. Almost forgot who I was.
00:00:11
josh MacDonald
It changes all the time.
Understanding Post-Operative Edema
00:00:15
josh MacDonald
Let's talk about post-operative edema. um They're just off of surgery. Maybe they come to you a couple of weeks out from a distor radius fracture or flexor tendon injury, and they've got that edema.
00:00:26
josh MacDonald
What's your go-to? Like, what do you start with? Miranda, what do you think?
Elevation Techniques and Importance
00:00:29
Miranda Materi
Well, I just remember from my CHD exam, the most important thing they can do is elevate their arm, right? So usually the first thing I'm talking to them about is like making sure they're doing um exercises where they're reaching over their head and getting their arm moving to help with the edema.
00:00:35
josh MacDonald
Yeah.
00:00:45
Miranda Materi
And then when they rest it, that they're resting it in a slightly elevated position, not in a dependent position. So that's number one. And I always do that. And I think it's based on just, yeah, reading the what the research says.
00:00:58
josh MacDonald
Yeah. That's been hammered into our brain so many times it's elevation. And then second on the list is compression. Yeah.
00:01:04
Miranda Materi
yeah So we're always elevating first and I tell them that, you know, it's always in my spiel and
00:01:04
josh MacDonald
Yeah.
00:01:07
josh MacDonald
Yeah. Yeah. um I like to educate patients on what elevation actually means. And so they think that walking with their hand in front of their face is elevation. And that doesn't count because then fluid pools and backs up at that elbow bundle of lymph nodes.
00:01:22
josh MacDonald
So I tell them if I put a drop of water on your fingertip, it should roll downstream to your shoulder the whole way. So doesn't have to be dramatic elevation. You have to walk around with your hand up over your head like you have to go to the bathroom. But, um you know, when you're sitting on the couch, put that arm on the armrest with maybe a pillow and just a slight downgrade from fingertip all the way to shoulder. That's going to help that fluid drain out with gravity.
00:01:42
Miranda Materi
Yeah, yeah, that's a good, I like the water. That's a good one, the drop of water.
00:01:45
josh MacDonald
Yeah.
00:01:45
Miranda Materi
It's a good tip.
00:01:46
josh MacDonald
Yeah.
00:01:46
Miranda Materi
You can really visualize it
00:01:48
josh MacDonald
yeah and and i like to encourage like to educate them that they don't have to live life like that like when you're sleeping if your arm is just on a pillow next to you that's still draining downstream if i say if you're going to walk to the fridge it's okay to have your arm down so they don't develop that like crps arm guarding position like let your arm hang down if you're walking to the car or walk into the refrigerator but then when you're going to be stationary in bed at the couch at the kitchen table then put it in a position of elevation just to let that fluid drain out. But three seconds it takes you to walk. You don't have to hold your arm in the air.
00:02:20
josh MacDonald
It's unnecessary.
00:02:22
Miranda Materi
Yeah, definitely.
Breathing and Anxiety Management in Edema
00:02:23
Miranda Materi
Another thing I like to tell these patients to do is some deep breathing, you know, get their, so like, I want you to just take some deep breaths in you know, make sure even if they're have to feel, you know, their diaphragm and feel the air coming in and out, that can be huge. And then educating on why that's so big for edema management.
00:02:40
josh MacDonald
Yeah, yeah. That deep breathing thing is something I think we overlook that says it's not just going to manage edema, but it can help with their anxiety about the injury. It can help with stress about the situation and getting back into life again. That's just taking them through that. It feels like I'm here for my hand. Why are we working on breathing? Like, trust me, everything's going to go better if we can just get your system regulated.
00:03:01
Miranda Materi
Yeah, and it's just like, oh I just need you to take a couple of deep breaths. And who doesn't need that? That feels so good for everyone.
00:03:05
josh MacDonald
Yeah. Yeah, yeah. Set your phone down, take a couple deep breaths, it'll all be okay.
00:03:10
Miranda Materi
My favorite is when my watch tells me to take a deep breath. I'm like, you're right, take a couple of deep breaths.
00:03:13
josh MacDonald
Can you shut up, watch, you don't know me.
00:03:18
Miranda Materi
I don't know, mind I don't mean deep breaths.
00:03:18
josh MacDonald
you
Intrinsic Activity and Protocols
00:03:22
josh MacDonald
um Okay. So some of the things we want to do that help help manage edema the best may not be allowed within their precautions. So intrinsic activity is a great way to get some of the edema pumping out of the hand.
00:03:34
josh MacDonald
Digit abduction and adduction can be a great way to use those intrinsic muscles, the interosseum, to pump fluid out of the hand, but that not may may not be allowed if they're on a flexor tendon protocol or collateral ligament or fractures or whatever, but that's another good way to get that fluid pumping if they're allowed to do that.
Edema vs. Lymphedema Differentiation
00:03:52
Miranda Materi
Yeah, that's a great one. What about, are you doing any retrograde? are
00:03:57
josh MacDonald
Yes. um
00:03:58
Miranda Materi
I know now it's called something else.
00:04:00
josh MacDonald
Yeah, i try to document carefully what I'm doing. I'll document it as edema reuptake, or but I am not doing, I'm not trained in, and I am completely like unskilled in lymphedema massage.
00:04:13
josh MacDonald
And so I try to be careful to not make my documentation or my treatment look like I'm doing that because I'm clearly not skilled in that. um I should be probably more skilled in that. um But I'm not doing the full like start proximal work to distal.
00:04:27
josh MacDonald
That's a very long process. So yes, we do a lot of edema reuptake stuff just to get the lymphatic vessels communicating fluid proximally. um But I don't know lymphedema stuff. So I stay away from some of that.
00:04:39
Miranda Materi
Yeah. And just so p our audience knows, lymphedema, you know, it's a special certification that you can go through and um it's kind of its own beast.
00:04:47
josh MacDonald
Yeah, yeah. And can be highly effective with our distal raised fracture population, with some of the patients we have, if that fluid is getting caught up, maybe the system is not functioning well.
00:05:00
josh MacDonald
But i'm I'm not skilled in that, so I'm dealing more with the acute localized area.
00:05:04
Miranda Materi
Right. And then, then different lymphedema and edema are different things. So,
00:05:09
josh MacDonald
Yes, yes, yeah, very different things. And so the edema they have from an acute injury can very much be managed with just mobilizing the fluid. You know, you've got pitting edema on the back of the hand.
00:05:20
josh MacDonald
I just spent some time breaking that fluid up, making it...
Compression Methods and Clinic Management
00:05:24
josh MacDonald
more viscous and getting it moving a little better, sorry, less viscous. I always get that wrong, making it less viscous, getting it flowing and moving and just trying to get some activity in that hand.
00:05:33
josh MacDonald
And then I'll roll into apple picking and maybe the foam roller, rolling it up the wall, just trying to get some overhead reach to tension and stretch all those lymphatic vessels, get him, get moving.
00:05:44
Miranda Materi
Yeah. Okay. So elevate, we said elevation range of motion and then compression. what are you doing for compression?
00:05:51
josh MacDonald
um If I can, my easiest and most simple solution is an edema glove. If I can get away with that, that I feel like gives a good uniform pressure. It's something they can do easily at home. And it's simple to understand for the patient.
00:06:05
josh MacDonald
um If I can get away with that, great. If they've got a flexor tendon, I can't put it on. If they're ginormously swollen or incredibly painful, can't move their thumb to get that thumb in that thumb hole, then I can't do that. But that's kind of my starting point.
00:06:18
Miranda Materi
Yeah, and feel like those are inexpensive and you know usually something that insurance doesn't cover, but you know they're like six, seven bucks.
00:06:20
josh MacDonald
Yeah.
00:06:24
Miranda Materi
Yeah.
00:06:25
josh MacDonald
Yeah. For us, for, um, at our clinic, that's one of those things that we give out the first one. If they need a replacement, we show them where to find them on Amazon and they can buy one from us for like $11. Um, but I just consider that cost of doing business because it's such a cheap thing to give them.
00:06:38
josh MacDonald
It wears out in two weeks if they're active with their hand, but they can find one Amazon super easy.
00:06:41
Miranda Materi
yeah Yeah, I think that's hard to justify when their insurance is maybe paying us $45 a visit and we're paying our therapist $50 an hour. Like, I don't know. Sometimes I'm like, I don't even know how we justify this, but here we are giving you some free stuff.
00:06:53
josh MacDonald
Yeah, yeah. I know. And I do that more often than I should. Maybe that's a whole different topic about what things I give away and why. And I'm trying to be better about not giving away too much. But I feel like some people are in that crisis mode and I don't want to say like, here, you need to go by this, by this, by this, by this. I want to say like, here's just a solution.
00:07:12
josh MacDonald
here's Here's a solution.
00:07:12
Miranda Materi
Yeah. Yeah.
00:07:13
josh MacDonald
Yeah.
00:07:13
Miranda Materi
And I agree with you don't want to like nickel and dime our patients. And when they're there, it feels good to be able to give them stuff.
00:07:19
josh MacDonald
Yeah.
00:07:20
Miranda Materi
But I don't know, as reimbursement gets cut, it's like harder and harder to think like, how do we maintain, you know, ah profit even just a profit margin, even not even like a huge one.
00:07:29
josh MacDonald
yeah
00:07:30
Miranda Materi
You just want to how do we pay our therapists and keep everyone happy? Yeah.
00:07:35
josh MacDonald
Yeah. Yeah. Yeah. That's tough. right. That's a whole different topic. like Let's take to edema. Okay. So if you're not doing an edema glove, what are some of your other ways to do compression?
00:07:46
Miranda Materi
Um, tuba grip. I love them tuba grip. I think that's awesome. You can double it up. I think the key with tuba grip is not making it too tight, right? If it's too tight, they're going to have throbbing.
00:07:55
josh MacDonald
Yeah.
00:07:56
Miranda Materi
They're going to have a lot of pain. So, um, and most people don't know there's measurements for edema gloves and there's measurements for tuba grips. So, you don't just have to like try it on and say oh does it feel good you know do the measurement and see if it's the appropriate size because that's ah based on how much pressure because there is such a thing as too much pressure and that causes more pain and more swelling so making sure you have the right amount of pressure is key um if the gloves so tuba grip i really like and
00:08:10
josh MacDonald
Yeah.
00:08:18
josh MacDonald
Yeah.
00:08:25
Miranda Materi
Tubagrip is funny because I was telling a therapist, go grab the tubagrip and they were grabbing the tubing for the handles you put on like the built up handles. I think making sure you have a universal language for the stuff you're using is it good.
00:08:36
josh MacDonald
Yes. Yes. Yep. Yep.
00:08:40
Miranda Materi
um
00:08:40
josh MacDonald
um I prefer the, what we call it cause it's what the box is. The box says TG grip. So I prefer the TG grip two that is less dense and compressive than the TG grip
00:08:50
Miranda Materi
oh
00:08:51
josh MacDonald
normal the standard i feel like the standard even when i do the measurements everybody talks about it so tight it's hard to stretch onto the patient um and i know the tg group 2 was made to be doubled up on itself i find i get way better outcomes if i give a patient a tg group 2 let's say level C, and I just do a single layer of it, i don't double it up, and I cut a little thumb hole, and I let it come out to like MCPs with maybe a little fold over, um I feel like I get good results out of less is more on the amount of compression. I feel like the TG grip is just so dense that I prefer the two.
00:09:27
Miranda Materi
Yeah, that's interesting. I think you bring up an interesting point. There's a lot of different types of compression and and what TG or all the other ones, like making sure you are buying the same one in the brand because they all differ.
00:09:39
josh MacDonald
Yeah, yeah. And it doesn't matter what any other clinic is using, as long as you have a standardization to what you're using, even between your clinics, if you have multiple, um just so you are all speaking the same language and finding like, here's a universal way that we find success with.
00:09:53
josh MacDonald
um there's We say it all the time. There's lots of good answers to the same question.
00:09:56
Miranda Materi
Yeah. What about, are you doing any like chip bags, um,
Innovative Techniques and Limitations
00:10:00
josh MacDonald
i I, yeah, I love the chip bag.
00:10:00
Miranda Materi
things like that tape?
00:10:02
Miranda Materi
Yeah.
00:10:03
josh MacDonald
I find it super effective, but I find the number of people for whom I can use it is pretty limited because if it's a distal radius fracture, they have to have their wrist support on. Well, do I make it around a chip bag?
00:10:14
josh MacDonald
And then there it's, it so I feel like there's a group of patients for whom it works great, but then there's a bunch of things that where I can't use it because logistically it doesn't fit within their protocol, but I love it.
00:10:25
Miranda Materi
yeah
00:10:25
josh MacDonald
It's a fantastic option.
00:10:27
Miranda Materi
Yeah, I really like the chip bag too. And it's basically just different densities of foam that you put in a stockinette or you put in um some type of ah kind encompassing thing that holds all the foam pieces together.
00:10:39
Miranda Materi
And it works really well. I think it works really well for people that have like major trauma and major swelling.
00:10:45
josh MacDonald
Yeah. Yeah. and And I try to find some way to make that work, especially if it's like this big poly trauma and they've got to be in some wrist thumb support spike a monster thing. I try to find in some way to get just that constant. it The idea is as they move just a little bit, the little foam indentations cause the light edema reuptake kind of massage all the time. So it's great if you can use if you can make it fit within their protocol.
00:11:10
Miranda Materi
Yeah, that's that's very true.
00:11:10
josh MacDonald
yeah
00:11:11
Miranda Materi
I feel like when when you and I were working at that, we're the trauma hand surgeons, we did a lot of those, and now I feel like I don't do nearly as many.
00:11:18
josh MacDonald
Yeah, yeah, yeah.
00:11:19
Miranda Materi
so What about, are you doing any kinesio taping for...
00:11:23
josh MacDonald
um No, not really. I just don't see a ton of those, what I'll call more chronic um edema patients. I feel like that's something, and i don't think it's only for chronic. That's just kind of where I've categorized for myself for my treatment planning.
00:11:35
josh MacDonald
um I'm not a huge fan of kinesiotape on the hand. um I feel like we're so active with their hands that if a patient is active, it sloughs off and rolls off and sweats off so readily.
00:11:48
josh MacDonald
I feel like most patients that I put kinesiotape on their hand, they come back the next visit, like it was off within an hour or two or a day, it didn't stay on. But if a patient is super swollen and they're not using their hand, that may be a better option for it where it's, you know, it's going to stay on because they're not bumping into stuff and it's not going to roll off as easily.
00:12:04
Miranda Materi
Yeah, I think those are all
00:12:05
josh MacDonald
Yeah.
Importance of Early Edema Management
00:12:06
Miranda Materi
great options.
00:12:06
Miranda Materi
I think with the demo, we want to get rid of it. One thing we didn't say, we want to get rid of it as soon as possible because we know it can lead to a lot of other problems if you don't get rid of it. So I think early on as a new grad, I didn't really think of a DEMA as being that big of a deal, but I think it's a pretty big deal and we should manage it early.
00:12:23
josh MacDonald
Yeah, yeah. Lots of good options to manage it. Kinesi tape is definitely good option. Maybe nothing. Your wheelhouse co-banding, we didn't talk about that one, but tons of good options for managing edema. But like Miranda said, get it under control as quickly as possible so it's not um clouding movement and limiting range of motion and limiting function.
Community Engagement and Feedback
00:12:40
josh MacDonald
Yeah.
00:12:42
josh MacDonald
Well, if you have other favorite things you do, we couldn't cover all of them here, but if you have some other favorites, definitely comment below. You can also reach out to us on social media at Hand Therapy Academy or our email info at handtherapyacademy.com.