#TherapyLive 2024 is here! Hope everyone enjoys my talk! 👍🏼 @TPMPodcast

Survey for UK Hand Therapists. @BAHTHandtherapy #bsshbaht2025 #handtrauma #PROMS

Fun experience presenting at the #BSSHBAHT2025 conference in Birmingham! Already looking forward to Bristol next year 🤚🏼

Fantastic first day at the #bsshbaht2025 conference yesterday! Looking forward to what day 2 has to offer!

#BSSHBAHT2025 workshops are in full swing covering all things around managing the stiff hand! From functional tips and tricks, exercises and joint mobilisations as well as CMMS - we are having some great discussions and knowledge sharing for treating this challenging condition!

3 weeks until @BAHTHandtherapy conference! Breakout room prep well underway 🙌🏻

Even got to perform my first surgery … a Rolando Fracture Fixation (on a plastic hand but hey ho)!

Great 2 days at the @BSSHand instructional course in Manchester. Lots of great lectures and catch ups with colleagues!

Great first day @BSSHand ICHS hand fracture course. Good to see so many hand therapists there 🙌🏻 @SCOPhysio @SCO__OT @sarahballht @DavidOTHands @zafnaqui @PhysioConnor @miriamparkins0n @brightchicky @BAHTHandtherapy

Interesting case discussed with a colleague today: “Vascularised toe to hand PIP joint transfer” Wondering if anyone on here has had any experience treating patients that have undergone this operation and would be happy to share the interventions they used post operatively?

Fantastic presentation by @james_bedford , delivering a comprehensive talk on “Decision making for patients presenting with Spasticity” at #BAHT2024

Really interesting morning so far at #BAHT2024 hearing talks on Carpal Instabilities and Entrapment Neuropathies!

🔟Beneficial reading list 🔹 https://t.co/KIncuOkFZP 🔹 https://t.co/Z9I52s3LIC 🔹 https://t.co/RMOhknvB6C 🔹 https://t.co/FklmyHkjVP 🔹 https://t.co/rrC69OGhMD 🔹

9️⃣Surgical Approach A1 pulley released through small incision, thus allowing FPL tendon gliding Definitive treatment, >95% resolution rate, often used when: 🔸Conservative measures fail 🔸Condition painful/limiting function Low complication rate, consideration still required.

8️⃣Splint & Stretch Approach Combination of extension stretches and extension splinting. Resolution rates vary between 59%-92%. Again, exact reason as to why this causes resolution of symptoms is unknown as we are not directly affecting nodule or pulley size.

7️⃣Wait & See Approach Spontaneous resolution reason unknown. A theory: as a child grows, the A1 pulley area increases, allowing smooth tendon gliding. Resolution rates 32%-75%. Studies suggest resolution higher in: 🔹Type 1-3 🔹Presentation <2 years of age 🔹IPJ flexion <30°

6️⃣Treatment Options There are 3 recognised management routes: 🔸Wait and see 🔸Splint and stretch 🔸Surgery Management route depends on patient presentation, child/parent preference and consultants management desire.

5️⃣Sugimoto Classification Type 1️⃣: nodule present but not triggering Type 2️⃣: intermittent triggering present but can be actively released Type 3️⃣: intermittent triggering present, unable to actively release but passive mobilisation can Type 4️⃣: Locked IPJ - unable to release

4️⃣Assessment Physical assessment is adequate: 🔹Palpation will uncover Notta’s nodule +/- pain response 🔹Intermittent/permanent loss of IPJ extension 🔹Occasional MCPJ hyperextension (compensatory mechanism if IPJ locked) Differential diagnoses include CCT & #/dislocations.

3️⃣Causes The reason as to why it happens to an individual is unknown The biomechanical causes relate to a nodule (notta’s nodule) forming on the FPL tendon This nodule, dependent on size, cant pass through the A1 pulley. FPL tendon glide is lost and thus IPJ extension reduced

2️⃣ Thumb Pulley Anatomy recap A pulley is a fibrous band that allows tendons to glide beneath it, they preventing bowstringing. The thumb has 3 pulleys that the FPL glides through: 🔹A1 - over the MCPJ 🔹A2 - over distal aspect of proximal phalanx 🔹Oblique - between A1 & A2