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I t p a y s t o b e A B M P C e r t i f i e d : w w w. a b m p . c o m / g o / c e r t i f i e d c e n t r a l 33 TABLE LESSONS best practices K. visited me for help with her right index finger, which had not recovered mobility after a minor injury. "How long ago did this happen?" I asked. "About seven weeks ago. The doctor said there was nothing broken or torn, but the joint was clearly swollen. As you can see, it still looks different than the other side," she said, pointing to the metacarpophalangeal (MCP) joint. "The doctor said I could splint it, but she wouldn't necessarily recommend that approach. Her suggestion was to move it as much as possible, which is what I have done. The problem is, I still cannot move it completely and the finger just doesn't feel right." "What was the mechanism of the injury?" I asked. She looked sheepish, but finally told me the story. While rushing to the bathroom at a conference, she had jammed her hand against the toilet paper holder. "Wow, we need a new story. We'll get to that later," I couldn't help saying. "Show me what movements you can or cannot do." She made a fist, revealing full flexion range of her index finger. The damaged finger's extension, however, was clearly limited in comparison to the other fingers of both hands. "Mostly, I notice that I do not have strength in this finger. When I try to press on anything, such as a spray bottle lever, my finger is really weak. I've painfully learned how much I use my index finger," K. revealed. I reviewed the game plan. "There are three areas of concern: the finger flexors, the extensors, and the ligaments at the joint itself. What I am going to do is reason through each of these possibilities until we understand where the problem lies. "You have full flexion range. That means that the extensor muscles will allow the motion, even though you don't have strength. But your extension range is reduced, which could be caused by flexor shortness or extensor weakness. "Another possibility that would explain both the reduced extension and the reduced strength is something called arthrokinetic inhibition. This is a protective mechanism in which an injury to the joint sends a message to the muscles that cross it to not contract The Point of It By Douglas Nelson Muscles can heal relatively easily, but joint injuries can last a lifetime, so the brain will always sacrifice a muscle to protect a joint.