Month: August 2021

Finger injury series – Trigger finger

Trigger finger

What is it:

A condition where a finger or thumb becomes painful and difficult to straighten. In severe cases the finger may get stuck in a bent position.




The precise cause of trigger finger is still unknown however repetitive finger movements such as occupations requiring extensive gripping, prolonged writing or grasping of small tools or objects are possibilities. This can cause thickening and narrowing of the space the tendon responsible for bending the finger travels through. This can cause the tendon to get caught in the space when straightening or bending the finger.


Clinical presentation:

  • Finger stiffness and swelling especially in the morning
  • Pain and poor movement in the finger
  • A clicking or catching feeling in the finger
  • Finger locking or clicking in a bent position, which suddenly pops straight
  • Finger locking in a bent position and inability to straighten.



  • Activity modification
  • Custom thermoplastic splinting to prevent the friction caused by the tendon movement most commonly at the metacarpophalangeal joint (joint between the palm and finger)
  • Home exercises to improve strength and range of motion.

Finger injury series – Swan-neck deformity

Swan-neck deformity

What is it:

Deformity of the finger characterised by hyperextension of the middle finger joint and flexion of the fingertip.



Initially caused by damage to the attachment of the finger extensor tendon which may be due to a traumatic laceration, avulsion fracture from a direct blow to the fingertip while finger is straight or due to weakening of the tendon caused by inflammatory disease e.g. rheumatoid arthritis.


Clinical presentation:

  • Swelling and stiffness of finger joints
  • A difficulty in flexion at the middle finger joint
  • A snapping sensation may also occur during flexion.



Non surgical:

  • A custom thermoplastic extension block splints to correct hyperextension at the middle finger joint.
  • A progressive thermoplastic extension splint can help improve the fingertip flexion deformity.
  • Passive stretching.


May be indicated for severe or long-standing deformities as these will not likely achieve true correction without surgery.



Some degree of deformity or limitations in range of motion are common.

Finger injury series – Boutonniere deformity

Boutonniere deformity

What is it:

Deformity of the finger characterised by hyperextension of the fingertip and flexion of the proximal interphalangeal joint.



Can be caused by the extensor tendon of the finger being severed due to trauma or tearing/weaning of the extensor tendon due to an injury or condition e.g. rheumatoid arthritis.

Most often it is due to a forceful blow to the top side of a bent middle finger joint.


Clinical presentation:

  • Loss of extension at the middle finger joint and hyperextension at the fingertip.
  • A weak grip
  • Inability to grasp and manipulate small objects with the top of the finger.
  • Swelling and pain.



Non surgical:

  • The creation of a custom thermoplastic splint that will hold middle finger joint into extension full time for around 6-8 weeks. When full extension of the joint can be maintained throughout the day progress to night splinting.
  • Thermoplastic splinting of the fingertip into slight flexion may be indicated.
  • Exercises can be gradually incorporated after splinting to improve range of motion and strength.



May be indicated when the deformity results from rheumatoid arthritis, the tendon is severed, a large bone fragment is displaced from its normal position or the condition does not improve with splinting.

Finger injury series – Mallet Finger

Mallet finger

What is it:

Deformity of the finger characterised by inability to straighten the fingertip unless assisted by an external force.



Often due to forced flexion at the furthest joint while the finger is actively extended eg ball hitting the fingertip.

There are two main ways this injury occurs – either the extensor tendon pulls away a small fragment of bone (avulsion fracture) or the extensor tendon itself ruptures.


Clinical presentation:

  • Pain, tenderness and swelling on palpation at the distal joint of the finger if an avulsion fracture. Usually relatively painless when tendon ruptures.
  • Inability to actively straighten the affected fingertip.



Non surgical:

  • The creation of a custom thermoplastic splint that will hold fingertip into extension full time for ~6-8 weeks. Can gradually wean out of splint once tendon is strong enough to hold fingertip straight.
  • Can usually resume sport with either taping fingertip into extension or wearing splint with tape to strap it on firmly.
  • Gradual introduction of exercises to increase movement at the distal finger joint



Good if treated prompt with splinting. Most individuals will regain their full strength and range of motion of their finger.

Working from home

In light of the current COVID-19 restrictions across the country many Australians are now working from home. Albeit working from home has its own perks, it also comes with its own disadvantages. This change of routine often comes with prolonged working hours and undesirable work set-ups leading to the onset of aches and pains most commonly in the neck and back.


Tips for avoiding neck and back pain

  • Make sure your desk set-up mimics yours at work and is ergonomically correct.
  • Take regular breaks. Sitting for prolonged periods of time can overload the muscles in your neck and back causing pain. Setting an alarm on your phone or computer can help remind you to get up and move your body.
  • Regular stretches throughout your working hours can help break up your long working days and prevent build up of tightness in your muscles from prolonged sitting.
  • Daily exercise. Try to find 30-45 minutes per day doing any exercise you enjoy. This will help maintain your cardiovascular fitness and help strengthen your muscles and joints.


Daily stretches

  • Lumbar extension: Stand and lean your shoulders back, gently stretching your upper body backwards to reverse the flexed sitting posture.
  • Head rotations: Turn your head slowly to one side as far as comfortable then turn to the other side.
  • Shoulder circles: Slowly move your shoulders in a circular motion; upward, forward, downward and backward. Reverse the direction for backwards circles.
  • Lateral flexion: Interlace your fingers and with palms facing upwards above your head, press hands upward, stretching your arms. Gently stretch to one side, hold then return to centre and complete on the opposite side.
  • Shoulder stretch: Extend one arm at shoulder level across your chest. Place your opposite hand on your elbow and gently apply pressure stretching your arm across your chest. Repeat, alternating sides.
  • Calf stretch: In a standing position place your hands on the wall for support and move one foot back about two feet. Shift your weight forward over the foot in front bending the forward knee. Hold then slowly return to standing position. Repeat and alternate legs.
  • Quad stretch: In a standing position place hands on a wall or object for support and bend one knee bringing your foot up toward the back of your thigh. Grasp your foot and gently stretch your knee, moving your foot towards the back of your thigh. Repeat and alternate legs.


Perfecting your WFH work station

  • Position the top of your screen at your eye level and directly in front of you.
  • Have an adjustable chair so you can change the height and angle of the back support. Your chair should be close to the desk so you do not have to reach for the keyboard or mouse.
  • Desk height should allow sitting with shoulders and arms relaxed with elbows at a 90 degree angle and wrists in a neutral position.
  • Sit with hips and knees at close to 90 degree angles.
  • Feet should be flat on the floor or use a foot stool to achieve a comfortable position.
  • If working from documents for prolonged periods, these should be placed on a document holder positioned either between the keyboard and monitor or at the same eye level as the screen and close to the monitor.
  • When using the computer mouse, keep the mouse close to the keyboard. Use keyboard shortcuts instead of the mouse, minimise the amount of time you spend using the scroll button and alternate which hand uses the mouse.
  • If you use your phone a lot, never cradle the phone i.e. put it in between your neck and your shoulder.
  • Place the keyboard flat on the table – wrists should be in a neutral position.


If you are experiencing pain or symptoms that may be related to your posture and work set-up at home, book an appointment to speak to or see one of our physiotherapists today.

Staff profile – Nelson Abela

Nelson is a Mackay local, having grown up and gone to school in the region.  Following school he headed to Townsville to complete his Physiotherapy degree at James Cook University where he graduated in 2010 with a Bachelor of Physiotherapy. Following graduation Nelson and has worked in a number of different settings including in the Mackay Hospital and Health Service and in the United Kingdom. He has worked extensively in acute hospital, rehabilitation, chronic pain and musculoskeletal settings, in both the public and private sectors.
The Physio Plus team was lucky enough to have Nelson join the team in 2018.  Areas of particular interest for Nelson are musculoskeletal injuries, sporting injuries, chronic pain and as well as post surgery rehabilitation.  He has a particularly special interest in the shoulder, lower back and knee.  No matter the goal, whether it be returning to the work place or the sporting field, Nelson can help you out.
Outside of work, Nelson is the loving father of 2 and works as hard at home as he does at work to support his lovely wife. He has a strong interest in sport and travelling the world (when we were allowed to travel!). He also enjoys outdoor activities such as hiking and hanging out at the beach which is lucky considering the great access to beautiful beaches around Mackay.  Besides his family and friends, his other main loves are the North Queensland Cowboys and the Red Hot Chili Peppers.

Thoracic Outlet Syndrome

What is Thoracic Outlet Syndrome?

The thoracic outlet is a small opening made up of soft tissue and bony structures including the ribs, the collarbone and the musculature of the neck and shoulder that allows a variety of neurovascular structures to pass down from the neck and supply the arm, chest and shoulder blade. Any narrowing of this small space can cause these nerves and blood vessels to become compressed which is commonly referred to as “Thoracic Outlet Syndrome”.


What are the signs and symptoms of Thoracic Outlet Syndrome?

Signs and symptoms vary from patient to patient depending on what structures are affected. In most cases the brachial plexus is affected – a cluster of nerve roots exiting from the cervical spine.

If neural tissue is compressed as it exits through the thoracic outlet symptoms may include pain anywhere between the neck, face, chest, shoulder and arm, altered or absent sensation, weakness and fatigue or feeling of heaviness in the arm that increases when the arm is in an overhead position.

If veins or blood vessels are affected, the skin can be blotchy or discoloured and due to decreased blood flow a different temperature or pulse may be observed in the arm or hand.


Who is usually affected by Thoracic Outlet Syndrome?

Thoracic Outlet Syndrome has an average incidence between 3 to 80 cases per 1000 people and is 3-4 times as common in women compared to men between the ages of 20 and 50. There are several factors that are often associated with Thoracic Outlet Syndrome including tightness or shortening of the musculature in the front of the chest and the neck including the pec minor and scalenes, anatomical abnormalities present from birth such as extra ribs, postural factors such as rounded shoulders or altered spinal curvatures, dropped shoulders or a whiplash or hyperextension injury of the neck.


How can physiotherapy help with Thoracic Outlet Syndrome?

Physiotherapists can help with the management of your Thoracic Outlet Syndrome through correcting your posture, stretching and strengthening various muscles around the neck and shoulder to help reduce compression of the neurovascular structures and manual therapy techniques such as taping, soft tissue massage and joint mobilisations.

If you would like some personalised advice regarding your discomfort book an appointment with you Physiotherapist today.