Transcript
josh MacDonald: Hi, I'm Josh McDonald.
Miranda Materi: And I'm Miranda Maturi and we are Hand Therapy Academy.
josh MacDonald: Let's talk about a tricky area to come up with activities for strengthening or mobilizing or activating intrinsics, maybe stretching them, getting those intrinsics to move in a better way. So it can be a tough area. Miranda, did you have any like go-to's on what you would start with?
Miranda Materi: Um, you know, it depends on what we're trying to accomplish. If it's something as simple as getting, you know, eighty and AB duction, then one of my favorite things is like putting their hand flat on the table and then using Velcro slides.
Miranda Materi: So I just take a hook Velcro and put it on their fingers or, you know, something that gives them a little bit of movement underneath.
josh MacDonald: OK.
Miranda Materi: So I've seen people where they'll take a piece of tape and stick it on the finger and just slide it on the table. That way you're not getting the drag or the resistance from the table. Um,
josh MacDonald: Yeah, yeah.
Miranda Materi: I use that one a lot and I use it a lot for our EDS patients.
josh MacDonald: Oh, cool. I like that.
Miranda Materi: Especially because for some reason, that particular, you know, they may have a hard time understanding intrinsics and firing those muscles.
josh MacDonald: OK.
Miranda Materi: I think they compensate a lot with their long flexors.
josh MacDonald: Okay. Okay. Very good. um Maybe we should back up for a minute. Why do we need the intrinsics to get mobile? What what are some big things we're accomplish we're trying to accomplish with that? We've talked before about stiffness, that they may be having intrinsic tightness. And so we need to work on stretching and mobility. They may have some adhesions.
josh MacDonald: They may have like a saddle syndrome where they're having adhesions between them. Or if they have something like some significant hand edema,
Miranda Materi: Mm-hmm.
josh MacDonald: mobilizing the intrinsics can really help pump that fluid that lymphatic fluid back out of the hand so i really like doing that abduction adduction to help pump fluid out of the hands and the same motion you were talking about with the velcro strips or the tape on the fingers i'll take our little chopped up like one by one or smaller slow foam cubes and i'll put them on the table and they have to keep their palm flat on the table abduct their digits, slide their hand so that that cube is in maybe the second web space, pinch adduct to pick it up and drop it in a bucket. And then the third web space and the fourth web space. So we're just abducting and adducting, trying to pick up and move cubes or whatever.
Miranda Materi: Yeah, that's a great one too. And then going back to, you know, the immediate why we want the intrinsics to fire too, I think specifically with the EDS population, I know that's not what this podcast is about, but they may have swan neck deformity.
josh MacDonald: Okay. Okay.
Miranda Materi: So any patient that has a swan neck deformity may, you know, have problems firing their intrinsics.
josh MacDonald: Yeah, I think that's a fantastic takeaway from this whole thing. Whatever we we wander with these topics all the time. I think the idea that getting intrinsics active is a way to rebalance the PIP joint and distal to address a swan neck deformity and get things tightened back up. So you don't have that hypermobility that collapses you into PIP extension. Intrinsic activity is a great solution for that or a way to help address that.
Miranda Materi: Right, because when the swan neck, it starts as basically a laxity in the the ligament structures, right? Or in that volar plate, it becomes lax over time with the swan neck. So inevitably, then a secondary problem is the intrinsic, right? So you know sometimes you can have the intrinsic problem that leads to the swan neck, or you can have the swan neck deformity that leads to the intrinsic problem.
josh MacDonald: Yeah, yeah. And so getting lumbricals, palmar neurasii, certainly dorsal neurasii to a lesser extent, um getting those to be shorter and and have more resting tension will help correct for some of, if not all of, that PIP hyperextension that can be really useful.
josh MacDonald: Yeah, yeah.
Miranda Materi: Right. Yeah, definitely.
josh MacDonald: um For lumbricals specifically, um I like to do EDC glides for patients. I feel like, you know, if they're holding a Sharpie, and maybe a highlighter if they don't have as much mobility and seeing if they can get MCP flexion and extension while they keep those eyepiece flexed, it's kind of, it's almost as hard to teach as dart throwers motion sometimes. Like they just don't understand like a hook fist, what I'm trying to get them to do, but a pen can make it happen.
josh MacDonald: um But I feel like that's a good way to both pump fluid out, get those intrinsic stretching and active and yeah
Miranda Materi: Yeah, that's a great one too. And like you said, that one's hard for people to grasp, but I like that too. And like doing different markers and different size highlighters, depending on what their needs are. And then all the way down to like a small pencil.
josh MacDonald: yeah yeah um even some functional things that we don't think are of specifically as intrinsic when we think intrinsics we think of almost like rotator cuff exercises you have to pull out bands it has to be like
Miranda Materi: Yeah.
josh MacDonald: like three by 10 or something like that. But I like doing the um like the little Chinese medicine balls or bowding balls that chime when you spin them. That's not long finger flexor and extensor. It's abduction, adduction and subtle movements and coordination and what in pediatrics we call individuation of the digits, making these digits move as separate units, not a whole open and close. And that's all intrinsic based.
Miranda Materi: Yeah. And we use those all the time in our clinic.
josh MacDonald: Yeah. Yeah. Yeah. We have like, we we just added a set of patient brought in. We have the ones that are the little like siliconized rubber star shaped things.
Miranda Materi: Uh huh.
josh MacDonald: We have two different sizes of the chiming ones. And then a patient just brought in these little, they're small, they're like three quarter in diameter and they're magnetic.
Miranda Materi: Oh yeah, are they spiky?
josh MacDonald: ah No, they're they're textured, but not spiky.
Miranda Materi: is
josh MacDonald: um But they stick to each other. They just got recalled because they're a choking hazard. So the patient brought them to us because your kids can't have them. but we we So we do it where they don't touch, like don't let the magnets touch kind of thing. But just lots of in-hand movement is great.
Miranda Materi: Yeah. And the good thing about those balls too, you can make them out of your scrap thermoplastic too. So make it sometimes we'll make them for patients.
josh MacDonald: Yeah.
Miranda Materi: Hey, why don't you take this home? And then, you know, you can vary the size significantly. They can be big or small or kind of depending on what the patient's needs are.
josh MacDonald: Yeah. Yeah. We also, particularly our office that's near all of our retirement communities in Phoenix, I just tell them to use their golf balls.
Miranda Materi: Oh yeah, that's a good one too.
josh MacDonald: So we have ah we have a ton of those. I even like, cause we live close to a golf course. If we see golf balls when we walk by, we'll just snag a couple in our pockets. And so at any given time I have golf balls for patients who don't have them, can't afford them, whatever.
josh MacDonald: I just give them cleaned, but marked up golf balls and they're happy. Yeah.
Miranda Materi: Yeah, perfect.
josh MacDonald: Yeah. Yeah.
Miranda Materi: Those are easy to find.
josh MacDonald: Um, Yeah, yeah. So it's important to get intrinsics moving. um It's tough sometimes to get them to stretch. So we just talked in our last podcast, or at least one recently, where we were talking about like a splint that is kind of an exercise splint. That's an ulnar gutter splint. MCPs blocked in extension and IPs free. to either do active range of motion IP flexion to stretch lumbricals actively or to do passive range of motion while this is blocking those MCPs to help get a little bit more movement through self passive range of motion outside the clinic.
Miranda Materi: Yeah, that's another but one One other one I thought about when you were talking is if you make the, do you ever make the taco design out thermoplastic?
josh MacDonald: Yes.
Miranda Materi: So basically you're making a piece of thermoplastic that's shaped sort of like a taco shell. And then you have the patient do, where they're doing the intrinsic plus position and they're squeezing that taco without curling their fingers.
Miranda Materi: And I think that's a great one. And you could put different sizes of foam cubes in it to make more resistance or less resistance.
josh MacDonald: Yeah. Yeah.
Miranda Materi: That's like a simple one for the clinic too.
josh MacDonald: And we're using that like tongs to move cubes or little balls or something to give it some objective goal oriented aspect to the task.
Miranda Materi: Oh,
josh MacDonald: um Yeah, but that's a great one. And we have like, I usually well like if we have to give one to a patient, I'll grab like the handle of our hammer and just drape thermoplastic over the handle of the hammer. So it has a nice like curve to it.
Miranda Materi: that's good idea.
josh MacDonald: And so, yeah.
Miranda Materi: Yeah,
josh MacDonald: And so it just hangs straight down while it cools. And then when they're done in heat, we pull it out and say, here's your new toy. And we show them a couple activities with it.
Miranda Materi: yeah and then they have something to do at home that they like.
josh MacDonald: Yeah. Yeah. I don't like throwing scraps away because we can always make something out of them. But at some point you got to throw away the little ones. There's there's some you got to throw away, but we can make a lot of like functional things for our patients out of these thermoplastic scraps.
Miranda Materi: Yeah, definitely in pegs. We've been making a lot of pegs lately for people.
josh MacDonald: Oh, okay. All right. I like that. Like what, like to put in a peg board or you putting them in like something.
Miranda Materi: Or like they put them in, like they they do like twirling with their fingers with the pegs so we can do different linked ones.
josh MacDonald: Okay.
Miranda Materi: Or, you know, a lot of times patients will just go, even though we are not telling them to, but go and buy putty for home. And then we'll make the pegs where they can bury it in the putty and try to find Yeah.
josh MacDonald: Yeah.
josh MacDonald: Yeah. Yeah. That's cool. I like that. Very good. Yeah.
Miranda Materi: yeah
josh MacDonald: We have all these patients who want to go buy all the tools for at home. And then when they come into the clinic, it's like, oh, I already do that at home. I already do that at home. Like you gotta leave me something.
Miranda Materi: he's
josh MacDonald: Yeah. Yeah. You keep buying all these toys at home. Then you got nothing to do here. This is where you do the fun stuff.
Miranda Materi: I know. Well, and then sometimes they'll buy them and you're like, we're only going to be doing this exercise for a week. So I'll be like, well, I just bought that.
josh MacDonald: Yeah.
Miranda Materi: So can we continue? it you're like, well, you don't really need it anymore.
josh MacDonald: Right, right.
Miranda Materi: We're dancing now.
josh MacDonald: Yeah. If you bought on Amazon, you can return it.
Miranda Materi: Yeah, there you go. Okay.
josh MacDonald: Yeah, yeah. Well, hopefully those are some helpful ideas for getting the intrinsics moving actively, passively, stretching them, all different kinds of options. But definitely don't overlook moving the intrinsics for edema management, swan neck, all kinds of useful things. They're an underappreciated role player in hand therapy. So if you have any questions or need anything, you can email us at info at handtherapyacademy.com.
