Avoiding the ER

This is not medical advice.

This article is not suggesting you avoid the emergency room. And no, that’s not my finger. I have pictures of mine below. That was just to grab your attention.

And in some ways this injury means literally nothing, and is even embarrassing to mention. I see patients with much bigger problems.

I am just relaying a story on how I avoided the ER, and the line of thinking I used to do so, and what rehab is going to look like going forward. Some of my considerations apply to the big picture of other injuries.

This morning I was working out at the gym, jumping up on these platforms (plyometrics). On one of the attempts, I hit the foam block with my hand, and dislocated my finger.

I wish I had the presence of mind to take a picture then, but there was some mild shock, and moderate pain. It was hyperextended, straight out, and angled to the side.

Right away I knew I couldn’t bend it, which is the major problem. The muscles are starting to seize up to protect the injured structures, and the longer the joint is dislocated, the harder it is to put back in.

I knew this would hurt more, but I pulled on the finger long enough, maybe 5 seconds, and felt it go back in. I can now bend the joint slightly, which is a good start. Again, I am not recommending anyone else do this, I am a professional idiot.

Did I stop working out? No. I just picked something different. I couldn’t grip, but I could push a bar on a seated machine. The endorphins from the workout helped decrease pain, and smooth over my regret of injury.

RICE?

Rest - No. I don’t want to stop moving it. I want to keep moving it slowly, and gently, even if it’s only 20 degrees.

Moving with easy putty helps

Ice - I might ice it a little initially, but I also don’t want the joint to stiffen further. Inflammation is what heals our bodies.

Compression - Maybe, but not if that means immobilization. I’m not going to splint it. I don’t thinks it’s fractured. I don’t need a splint to make it stick out even further, and risk hitting it again.

Elevation - Elevation usually coincides with immobilization. If someone has a healing leg fracture, and severe lower leg swelling, elevation might be part of their plan, for a part of their day.

Meds

If this was my foot or ankle, and I was limping so much that it increased problems, then I might consider anti inflammatories for a few days. But the plan to is to normalize gait as quickly as possible and get off the meds.

The big picture vs radiology picture

Do I need xrays? Probably not. Even if there is a small fracture, if alignment appears ok, it’s just going to have to heal.

When my kid dislocated his thumb this summer, we took xrays, even though we thought it was fine. But he’s a different circumstance. There’s the parent guilt of, what if something is really wrong and we did nothing?

Rehab going forward

I’m going to keep moving it for hundreds of reps per day, even if it’s limited motion. When I wake up tomorrow, it’s likely to be more stiff and painful. These injury processes are always 2 steps forward, 1 step back, everyday. Stiffness, move, stiffness, move, etc.

The single most important thing I have to do is keep progressing with range of motion. So long as motion gradually increases over time, I should make a full recovery. If I don’t do this and the joints become stuck, I have much bigger problems. This is a common theme among many injuries and post op protocols.

Out in the wild?

I’m stubborn, and decided to skip the $1000 ER visit for a splint and some Ibuprofen. But what if we are hours away from an ER? What are we going to do? I usually hike with a roll of duck tape in case I roll my ankle. What can we do to help ourselves?

One less customer…

More importantly, I was one less customer in an overwhelmed, and over inflated system of billing and industry malaise…

For the new subscribers, this is one of my favorite articles,