The anatomy of the carpometacarpal joint of the thumb allows us to perform numerous movements which position the thumb, preparing it and assisting it in performing a variety of functions necessary for daily task execution. The thumb forms an integral part of hand function and the carpometacarpal joint is the key.

Manual Edema Mobilization (MEM) is a technique to decrease sub- acute persistent and chronic hand edema post surgery, trauma or stroke. Clinically this edema presents as thick, spongy, slow to rebound when pitted, and eventually becomes hard and fibrotic. It is an edema due to an overload and/or compromise of the lymphatic system. Therapists often become frustrated treating this type of edema because it “returns” even after using their best efforts with traditional edema reduction methods. A hand therapist can easily reduce or prevent this type of edema if he/she is aware of the anatomy of the lymphatic system, can distinguish types of edema, and knows how to specifically activate the lymphatic system.

This article has been written as a follow-on comment to R. Nicholson’s article from a therapy perspective. Rehabilitation of a crush injury of the hand requires, by nature, and individualized and step-wise approach to maximize a successful functional outcome. The comment briefly discusses the contradictions in the therapy priorities for a crush injury, as well as the essential components of rehabilitation. The patient with a crush injury to the hand should be treated by a therapist with expertise in understanding the surgical strategies and in planning the therapy process.

Severe crush injuries are a complex problem that surgeons and therapists sometimes treat. When compared to penetrating injuries, crush injuries result in a broader area of injury, with a whole spectrum of tissues, skin, subcutaneous tissue, tendons, nerves blood vessels, joints and bone being involved. This complexity of injury, tissue necrosis, oedema and resultant stiffness make them difficult to treat, and functional results are often less than ideal.

Nobody wants the curse of pain. The feeling is sore, obnoxious, depressing and incapacitating. It negatively affects our emotions, logic and attitude. On the other hand, the ability to feel pain is a blessing; it is essential for all well being, for life itself. People without this ability, this gift to sense pain (e.g. familial pain insensitivity, leprosy) mutilate themselves, have fractures and severe infections without the slightest discomfort. But PAIN is the alarmbell that starts ringing. It tells us that something is wrong, that damage is being caused. Pain “screams”, it begs to stop whatever activity causes the hurting. Pain even has various characteristics. It comes in various forms. Cholicky pain indicates an obstruction of a hollow organ e.g. stone blocking and ureter, deep burning, constant agony pain, points to ischaemia of a muscle. Throbbing pain indicates vasodilatation e.g. migraine or inflammation. Nerve pain is not alleviated by painkillers, whereas pain due to inflammatory irritation (e.g. osteoarthiritis) respond to antiinflammatory drugs.

I sat in a doctor’s waiting room and paged through some old magazines when I came across a column by one of SA’s foremost philosophers, Nataniël. As I was reading what he had to say regarding the power of words, I realised that the hand has much the same powers and what better philosophy to start off with for my first ever editorial...