phalange SOS

April 28, 2011 6:55 PM

please forgive my typing. i had a crush injury to my index finger one month ago. my question involves trying to figure out a way to minimize involuntary hand movements at night which only exacerbate the pain. there has to be some clever way to do this?

i had surgery a month ago on my index finger on my dominate hand. the tip of my finger is basically bone fragments which will not congeal (two small bone pieces are trying really hard but the rest are a lost cause) and instead will eventually be absorbed by my body. i am ok protecting my finger by day but at night (sleeping) my hand/finger has a life of its own. picture a dog whose paws are twitching while dreaming. i have to keep my hand elevated at all times so i have constructed all sorts of comfy blanket "ramps" to rest my hand on. no matter how soft these ramps are, the constant involuntary movement of my finger thumping against them is VERY painful and prevents sleep...and healing? i am very frustrated and am looking for a creative solution. difficulty: it is not just my hand. it can also originate from my elbow which causes an even more painful slam. yes, i have pain meds and i also take a muscle relaxer before bed. my surgeon dismissed me about this. my nurse practitioner has been wonderful but has no solution. ideas welcome!

posted by futz to health & fitness (16 answers total)

Is there a splint on the affected finger?
posted by Orinda at 7:02 PM on April 28, 2011

yes. taped and gauzed up. i have tried sleeping with and without the splint and it makes no difference.
posted by futz at 7:08 PM on April 28, 2011

Splinting should help minimize any damage you do when twitching. If it were me I'd tell my doc to take me seriously when I discuss pain issues with him. I HATE when docs are dismissive of pain issues! It's their job to help you through this - you PAID for complete care, demand it! I'd also ask about a product called BMAC (Bone Marrow Aspirate Concentrate) to try to save as much bone as possible in that finger.
posted by PorcineWithMe at 7:10 PM on April 28, 2011

And, there are pharmaceuticals that deal with nerve sensitivities, which is what you're dealing with, that your doc should be able to Rx. You're not necessarily looking for a muscle relaxer or a pain med. Perhaps talk to a pharmacist and then approach your doc armed with some info. If that doesn't work to get him to take you seriously then you might want to ask for a referral to a neuro.
posted by PorcineWithMe at 7:13 PM on April 28, 2011

Is your finger twitching, or is this just the natural movements from tossing and turning in bed? If it's the latter, you might have luck by getting some stiff wrist braces, then splinting all of your fingers together and attaching the splint to the brace with a wrap or something.
posted by schroedinger at 8:16 PM on April 28, 2011

Have a thermoplastic splint formed for the lower arm and hand that extends the wrist back to elevate the finger.
posted by nicwolff at 8:16 PM on April 28, 2011 [1 favorite]

Can you rig up some thing (with pillows, etc) so that your arm is resting on a pillow but your hand is overhanging it, so that if it twitches it's in midair and has nothing to hit? It might be easier to keep your hand in the right position if you have a splint or brace on your wrist to keep your hand straight out from your arm?
posted by Kololo at 8:37 PM on April 28, 2011 [1 favorite]

not natural at all.

thermoplastic splint formed for the lower arm and hand that extends the wrist back to elevate the finger

interesting idea! but the finger is gonna move on its own and knock about whatever encases/restrains it. ZOMBIE phalange. also,

had one made just for my finger and it just seemed to knock harder. finger twitches crazily and knocks the thermoplastic splint, double whammy. ouch. also, i lost my health ins. just before this injury.

the finger moves on its own. whatever is restraining or protecting it adds to the problem...like reverberation. but removing the restraint just allows for for all sorts of instability that is worse. barely.
posted by futz at 8:40 PM on April 28, 2011

kololo, hmm. you have got me thinking. gravity is the enemy of an injury like this but...you might be on to something. also, my surgeon said that in his 24 years that he had never heard of this situation and that there was no literature to support it. a brief google proves him wrong.

i wish i could wrap my hand in cotton candy.
posted by futz at 8:55 PM on April 28, 2011

You could buy a pre-molded thermoplastic splint http://goo.gl/l6oUt and reshape it – you just dip it in hot water for 1-2 minutes then bend it and let it cool. And you can cut the parts you don't need away with scissors.

http://www.multi-cast.info/html/orthoticintervention.htm

I had the tendons in one wrist reattached last year after an injury and was sleeping in a series of these splints for months to stretch them out, I'm thinking that you could use something like the last ones I had, which were secured around the forearm and bent the hand backward at about 45º – you could make one that had a shelf for the fingers that then bent away after the first phalange to form a guard, creating a safe space for the fingertips to move around. They're really malleable while warm, you could make whatever shape works, and you can reshape them repeatedly to improve them.
posted by nicwolff at 9:34 PM on April 28, 2011 [2 favorites]

nicwolff, awesome info. thanks!
posted by futz at 9:48 PM on April 28, 2011

I would think just a plain carpal tunnel splint from the drugstore would work as well. It goes from your wrist about halfway up your hand (the piece of metal does) and then it has finger holes. You could cut the first fingerhole to make it bigger if you needed to. Then wear the splint on top of that.

I sympathize, I had a benign giant-celled tumor of the tendon sheath in my right index finger removed in 2002. But sleeping with the finger splint was fine for me. Fun fact: When I first got my bandage off (1 week after surgery), the tumor had so compressed the rest of the tissue that my finger was about as thick as 2 credit cards set on top of each other. A lot of lockpicking jokes ensued! It's much thicker now but still a bit "deformed," in that it's slightly flatter and has a curve where my other index finger doesn't. Also had a huge black scab (dried blood) over the incision that took a few weeks to fall off. And the skin on my entire finger peeled off (like a sunburn) down to my hand, even though only the tip was operated on. My mom was really freaked out by that but we called the doctor and he said it was normal. It didn't hurt any more than a sunburn peel either.

Good luck to you!
posted by IndigoRain at 1:42 AM on April 29, 2011

I think I would take a different approach. I would rig up a foam glove to fit over my hand to cushion it when it flops around. Think: super-soft boxing glove. You might try a simple cotton bag with a lot of shredded foam inside that you can place your hand into and then tie loosely around your wrist. It won't stop you from moving your hand, but it will soften the impact when you strike a surface.
posted by Old Geezer at 7:55 AM on April 29, 2011

If it's just the tip that is painful, my idea would be to get some firm foam and cut out a disc, with a hole in the middle large enough for your finger(s). This way the actual tip is raised from the surface or the bed and shouldn't be able to hit anything at all.
posted by InsanePenguin at 9:40 AM on April 29, 2011

wow. some really great ideas. just what i was looking for. i'll follow up when i find out what worked best. last night i slept with a sock on my hand and it seemed to help but that may have been a coincidence.

IndigoRain, yikes. i doubt my finger will ever look the same again either. i also have the peeling skin.
posted by futz at 10:13 AM on April 29, 2011

If off the shelf splints won't work, pick up a tub of Instamorph or Shapelock (same stuff) and custom make splits of arbitrary form and complexity. It's a quick set thermal plastic that softens around 150F. You can mold it with your hands and the resulting object is quite hard. You can reheat it to reshape it. It would not be hard to place layers of cheesecloth or felt on your finger then form a split on top of that, possibly joining to adjacent fingers or whatever you feel might work.
posted by chairface at 1:16 PM on April 29, 2011