01 June 2026
Joint Stiffness: Causes, Stages and How It's Treated
How stiffness develops through bleeding, oedema and fibrosis — and why timing changes the outcome. A grounding for every stiff-hand case.
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15 May 2026
Therapeutic Casting in Hand Rehabilitation
Serial casting versus the CMMS technique — how each restores motion in the stiff hand, and when to reach for which.
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01 May 2026
Mechanoradicals: The Molecular Link Between Force and Healing
The 2020 discovery that explains why gentle, sustained loading heals connective tissue — and forceful stretching can harm it.
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01 April 2026
Contracture: Conservative Management Explained
Every non-surgical option for joint contractures of the hand — stretching, orthoses, casting, CMMS, botulinum toxin — and when each is used.
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23 August 2024
Centre of Advanced Medicine Welcomes Hand Therapy Consulting
I'm thrilled to announce that I have been invited to join the Centre of Advanced Medicine in Waverley, Johannesburg and will open my practice doors in September 2024.
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28 June 2022
Claw Deformity? Try a New Technique
Kantessa Stewart attending individual mentoring with Robyn Midgley to assist her patient following tendon and nerve repairs in Zone 6. In this mentoring session, Robyn explains how
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17 April 2020
How to Set Up A Virtual Hand Clinic
Robyn Midgley hosted the world's leading authority in Teletherapy, Michelle Coil, on a live webinar. They presented how to set up a Virtual Hand Clinic — a huge success with 92 the
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17 March 2020
COVID-19 - Changes to Practice
As of Monday 23rd March important changes were made to the Hand Therapy Service in light of the Covid-19 pandemic — including online initial consultations and a strict hygiene poli
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14 October 2019
Flexor Tendon Repairs - Old Protocol, Poor Results. Why small changes can make a big difference.
Elizabeth Hands is a chef on a yacht in the Caribbean Islands. She lacerated her digital nerves, FDS and FDP tendons of her left index finger with a knife. After a poor initial pro
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25 September 2019
PIPJ Dislocations -Late Presentation management
PIPJ dislocations frequently present at a late stage - usually 3 months following the injury. The GP generally diagnoses a finger sprain and suggests that the patient buddy straps
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25 September 2019
PIPJ Boutonniere Deformity - Serial Casting
The most effective means of reducing a fixed flexion deformity is through the use of serial casting. The cast is fabricated, bearing in mind the necessity for a 3 point pressure to
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20 September 2019
CMC I OA Splint
CMC I OA splint provided to support the base of the thumb during play and at rest musicianshand #violin #hand #dystonia #rehab #tension #orchestra #music #cubitaltunnel #osteoarthr
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20 September 2019
Rehabilitation of Dystonia
My phenomenal colleague Katherine Lee is a highly esteemed Hand Therapist and specialist in the field of the musician's hand. This article explains task-specific focal hand dystoni
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20 September 2019
Violinist - Assessment Findings
Follow-up from the Violinist players assessment video.Objective Findings:💠 Positive shoulder sign bilaterally.💠 Positive crank and grind test bilaterally.💠 Small joint OA.💠 de Quer
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09 September 2019
Dupuytren's Fasciectomy - Are we rehabilitating correctly?
Dupuytren's Disease - How are we rehabilitating chronic joint stiffness following a Dupuytren's Fasciectomy? This week we will be presenting Ian's case. Follow his journey and let
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31 August 2019
Can WALANT be used for complex procedures? Robyn Midgley talks to Dr Alistair Philips, Co-Founder of
There is no actual limit to extremity surgery that can be performed with WALANT but the benefits are very different for different surgeons and the different healthcare systems in w
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08 July 2019
Free Masterclass
Join me for a FREE live webinar and learn the number one technique to treat and prevent chronic joint stiffness. 70% fast than through traditional methods. Spaces are limited so ma
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15 April 2019
Thumb Polydactyly
This 9 month old baby girl has a congenital duplication of her right thumb. The commonest duplication type is where the proximal phalanx is split in two. Normally there is a domina
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02 April 2019
Epitendinous Suture
Choosing the right Epitendinous Suture Design is a matter of personal preference. Its a decision made that aims to achieve a balance between
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01 April 2019
Cricket Bat Injury
A 9-year-old girl sustained a cricket bat injury over the 3rd Metacarpal, resulting in an osteitis from the compound fracture due to a delayed treatment. The osteitis has been trea
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18 March 2019
Glass cut to the palm of a 1 year old
This is the story of a 1 year 4 month old twin who was playing with his brother when the glass he was carrying fell and shattered. As this happened the little one fell onto one of
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16 February 2019
Online CMMS Course
Do you want to empower yourself to be able to treat the stiff hand using the CMMS technique? Join our mailing list today by sending an e mail to cmms@robynmidgley.com
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16 February 2019
An experienced equestrian is run over by a horse
Shari's family had purchased a new horse and Shari was walking the horse when it got a fright and galloped forwards running over her in the process. They were on their private farm
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07 January 2019
Fractured Elbow & Wrist - Secondary problems develop
Susan fell onto her right wrist and elbow, fracturing both resulting in the need for Open Reduction & Internal Fixation (see Images 1 & 2). Susan was referred for Physiotherapy but
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10 December 2018
Archery Grip - Providing solutions to ensure joint protection and career longevity.
Archery is the art, sport, practice or skill of using a bow to shoot arrows. Most Archers make the mistake of holding the bow too tight. When archers first grab a bow and step to t
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03 December 2018
Finger Fractures - you can change your mind about the management.
A young 16 yr old basketball player sustained a middle phalanx condyle fracture. After first trying a conservative splint the condylar fragment did not position adequately and so a
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25 November 2018
Mole Snake Bite
A 55 year old man was bitten by a Mole Snake in Zambia on his thumb. These are the things that were done right by the family and medical team after the bite: 1. The snake was kep
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12 November 2018
Necrotic Wound & Fractured Finger - Progress Images
The Casting Motion to Mobilise Stiffness Technique (CMMS) was used to treat this lady's stiff and oedematous hand. Initially, an intrinsic minus cast was applied to the hand. This
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05 November 2018
Necrotic Wound & Fractured Finger in an Elderly Lady
This elderly lady fell on the 17-08-18 and fractured her left little finger as well as lost skin over the dorsum of her wrist and hand, which became necrotic. On the 11-09-18 she h
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04 November 2018
Causes of Forearm and Wrist Injuries in Rowers
Forearm and wrist injuries can usually be traced back to poor technique or fatigue, through excessive wrist motion during the action of feathering the oar (turning the oar so that
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02 November 2018
Therapeutic Management of a 14 year old Rower
Cubital and Carpal Tunnel Syndrome in a 14 year old rower:While treatment to relieve the symptoms, including ice and analgesia, may prove adequate acute pain relief, long-term mana
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30 October 2018
Training Volume & Injury Recurrence Rates in Rowers
Training Volume in rowers injuries has a direct relationship with injury recurrence and the severity of the injury. Research indicates that land training and use of the Ergo is res
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29 October 2018
Cubital & Carpal Tunnel in a 14 year old Rower
This is an image of a 14 year old girls hand. She is an avid rower. She has had a Carpal Tunnel Decompression and was referred to hand therapy for the management of left upper limb
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28 October 2018
Double Crush Syndrome
The original definition of Double Crush Syndrome (DCS), although based on sound pathophysiologic processes, may be limited in scope because investigators have shown that compressiv
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24 October 2018
Junior Rowers
Junior rowers (age under 19 years) compete at the same race distance and train with similar frequency and duration as elite senior rowers, yet data related to injuries are scarce.
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23 October 2018
Approach to Injury
Assessment of changes in the training process (intensity, volume, or frequency) along with equipment, technique, and biomechanical issues (muscle imbalances, alignment, and length
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22 October 2018
The Rowing Discipline
Rowing consists of three main disciplines: flatwater (e.g., traditional Olympic and collegiate style racing), open water (coastal rowing), and indoor. Rowers use two oars each (scu
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21 October 2018
Rowers Injuries
The focus for this week will be on Rowing injuries in young adults. The rowing stroke is a repeated continuous cycle, from a position with the legs flexed, elbows straight to a ful
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17 October 2018
Mallet Injuries - uncomplicated yet no clear consensus on best practice
Mallet finger, or thumb, is a common traumatic injury to the hand. Mallet injuries result from disruption of the extensor tendon mechanism at the distal interphalangeal joint (inte
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09 October 2018
Theun's Journey: Results after 1 week of CMMS
The results were impressive as the patient gained 50 degrees of flexion in the MCP joints. The scar tissue also improved and is softer and more mobile. The pattern of motion has im
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09 October 2018
Theun's Journey: Initial Presentation
Theuns attended Physiotherapy for 1 year and had 64 sessions of dry needling (Image 1) before he was referred to hand therapy. Prior to deciding on using the CMMS technique, Theuns
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08 October 2018
Theun's Journey: Degloving Injury
Theun was involved in a car accident (Image I) in August 2017. His right, dominant hand got caught between the car seat and the door. As he pulled his hand up to release it, the do
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01 October 2018
Cubital & Carpal Tunnel in a 14 year old Rower
This is an image of a 14 year old girls hand. She is an avid rower. She has had a Carpal Tunnel Decompression and was referred to hand therapy for the management of left upper limb
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27 September 2018
Joe's Journey: Post Op Results
Joe has had a successful outcome following surgery. Image I shows the web space release result. Image II shows the palmar view of the thumb flap. Image II shows the MCPJ flexion re
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27 September 2018
Joe's Journey: Operation I Superficial Iliac Artery Groin Flap and Web Creep Release
Joe underwent surgery to release the web creep and improve MCPJ flexion of the left hand. Image I demonstrates the hand prior to surgery with first web space contracture, poor MCPJ
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12 September 2018
Fireworks Injury - Results
A full fist was achieved within 2 weeks of applying the cast to Kwame's hand. A second cast was applied to assist with achieving full AROM of the fingers and thumb. Kwame was extre
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12 September 2018
Fireworks Injury - Joint Stiffness
After 4 months of traditional therapy, Kwame was still unable to achieve a full fist and there was residual oedema. We agreed that the Casting Motion to Mobilise Stiffness Techniqu
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12 September 2018
Fireworks Injury - Initial Injury
Kwame lives in Ghana and was protecting his son from a firecracker when it exploded in his hand. Unable to regain full range of motion with traditional therapy, he flew to South Af
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03 September 2018
Syndactyly
Syndactyly is a congenital/birth condition of the hand is which there is webbing between fingers keeping them together. Syndactyly's can affect all off the fingers together or cert
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27 August 2018
Insect Bites and Hand Infections
Hands are a common site for insect and spider bites. Not all bites are dangerous and result in tissue damage. Most bites will result in swelling, redness, itchiness and pain on m
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20 August 2018
How to Manage Hot Water Burns
Most superficial and superficial partial thickness burn wounds will heal on their own. These are typically hot water or hot liquid contact burns, steam burns and such like, where c
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06 August 2018
How do you store an amputated digit?
A right handed factory worker was injured with an circular saw which left him with an amputated index finger in what is called zone II or \"no-mans land\". There are many consider
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29 July 2018
Finger Joint Replacements
Finger Joint Replacements Finger joint replacements are synthetic manufactured treatment options for certain stiff and non functioning finger joints. Jeoints can be stiff from trau
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08 July 2018
Raynaud's Disease - Patient's self diagnosis.
We love the ingenuity of patients. This lady noticed that her fingers on her left hand were unusually cold. So she bought nail polish that changes colour when the temperature in he
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01 July 2018
Radial Nerve Glide Exercises
Treat nerve compressions by doing this home exercise, and reduce the risk of needing surgery. Radial Nerve: Extend your elbow, look away from the arm, bend your wrist upwards and p
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01 July 2018
Elbow Fracture - Turnbuckle Splint
This young man sustained an elbow fracture. He had been attending Physiotherapy for 6 weeks, but he was still unable to fully extend his elbow. He was referred to me to resolve the
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25 June 2018
Rugby Injury
Young boy sustained a rugby injury to the left index finger. His bone fractured and the fracture went through the growth plate. Angulation deformity of the finger can be seen on th
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18 June 2018
A Middle finger crush injury
A middle finger crush injury for a manual labourer can be debilitating and require a significant amount of time off work. Good follow up with the treating surgeon and compliance wi
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11 June 2018
How a small incident can cause a lot of damage.
This #handjournal shows how a simple movement can cause some serious damage.Laurel hit her hand sideways on a punching bag with relative force - she was trying to show her trainer
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08 June 2018
Median Nerve Glide Exercises
Median Nerve: Perform this stretch if you have tingling in your thumb, index, middle and half your ring finger. Your elbow is straight, your head is tilted to the opposite side and
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04 June 2018
5th Metacarpal Fracture with angulation deformity
Young man with a fracture of the 5th finger metacarpal bone with angulated deformity. He was treated without surgery. His fracture was straightened as best as possible under local
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30 May 2018
Hand injuries in children
A 4 year old child presents with a swollen middle finger which is slightly painful. Paronychia or infection of the skin around the nail is a common presentation in children. Someti
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21 May 2018
Finger Injuries in Children
Little kids often get their fingers stuck in doors, gym equipment or jammed in furniture. Sometimes these injuries may result in fractures of growing bones. As in this case were a
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14 May 2018
Brachial Plexus Injury
A young 24 year old man sustained a massive injury from a motorbike accident leaving him without the use of his left arm. He was referred to us for possible reconstruction. The ner
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07 May 2018
Intra-Operative View of the Median Nerve
Intraoperative view of the median nerve in the carpal tunnel after the tight overlying fibrous tissue has been released. The red streak is a blood vessel on the nerve. The nerve it
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23 April 2018
Musician Injury - Thumb UCL
Hand based thumb MCPJ splint fabrication to reduce the strain on the Ulnar Collateral Ligament of the thumb and enhance playing endurance and performance in a professional musician
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16 April 2018
Tendon & Ulnar Nerve Injury
Pic 1 : A young man slipped and cut his hand with glass over the wrist. His tendons and ulnar nerve were cut. Nerve injuries can be easily missed at initial presentation if not ass
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09 April 2018
Proximal Interphalangeal Joint Injuries
Proximal Interphalangeal Joint Injuries frequently occur from sporting injuries such as basketball or football. The joint may dislocate, with or without soft tissue damage. These s
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29 March 2018
Burns - Hot & Cold
Burns – Hot and Cold substances can cause burns. Blistering indicates an injury which has caused the outer layers of skin to peel off. If the blisters are closed and small they can
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27 March 2018
Crush & Laceration Injury
Crush & Laceration injury to the dorsum of his left non-dominant hand Antwan sustained a crush & laceration injury to the dorsum of his left non-dominant hand and was referred to H
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23 March 2018
Brachial Plexus Injuries
Brachial Plexus injury are nerve injuries that may result in partial or total paralysis of the arm and hand. They most commonly occur in adults in high speed injuries such as motor
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16 March 2018
Therapists Management of the Stiff Hand
Listen to Robyn Midgley's talk on the Therapist's Management of the Stiff Hand at the South African Society of Surgery of the Hand Refresher Course in February 2018.
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14 March 2018
Rugby Jersey Finger
Image 1 - See the bruising on the tip of the finger. This indicates a rupture of the tendon from the bone. Also known as a jersey injury it typically occurs with a forced grip with
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05 March 2018
Flexor Tendon Hand Inury
Cut injuries in the hand can injure many structures. Complete healing often takes months. Nerve and artery injuries are often missed. Microsurgical repair of these structures in ne
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26 February 2018
Thumb Re-Plantation
Simphiwe cut his right thumb off with a meat saw at a butchery. Amputations of digits or parts of the hand and upper limb can be replanted if referred early to a centre that has th
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05 February 2018
High Pressure Plastic Mold Injection Injury
This is a 43 year old gentleman who had a high pressure plastic mold injection injury on the dorsum of his right dominant hand.
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16 January 2018
Mallet Finger Injury - Splint Position
Mallet Finger Injury IMAGE 1 - Initial X-Ray IMAGE 2 - Image shows Swan Neck deformity as a result of the Mallet Injury. IMAGE 3 - Thermoplastic splint positions the PIPJ in 20 deg
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11 December 2017
How to Treat Hot Water Burns
Hot water or hot liquid burns are a common occurrence in the holidays especially when the little ones are at home. Immediate treatment should always consist of running the affected
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05 December 2017
Fish Hook Injury
Bryan was fishing in Mozambique when he sustained a fish hook injury, which pierced the thumb extensor tendon. Bryan was treated by a General Physician in Mozambique who cleaned an
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05 December 2017
Excision of Gouty deposits from the soft tissue of the hand.
Excision of gouty deposits in soft tissues of the hand. The gouty deposits are being removed from the flexor tendons whilst release of the pulleys has also been performed in order
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04 December 2017
Fractured Hand
Brent had a previously fractured the 4th Metacarpal of his left hand. The plate and screw was in situ. When he punched a wall, he re-fractured the same bone at the plate site. It w
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29 November 2017
Removal of Distal Radius Plate
Julia had originally fractured her wrist and a distal radius plate had been placed to stabilize the fractures. It has been a few years now and the fracture has healed well but Juli
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21 November 2017
Finger Avulsion Injury - Outcome
Tim was throwing a set of keys over a palicade fence when his right ring finger was avulsed. Unfortunately the finger had to be amputated. He sustained a ring avulsion injury of hi
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20 November 2017
Finger Avulsion Injury
Tim was throwing a set of keys over a palicade fence when his right ring finger was avulsed. Unfortunately the finger had to be amputated. He sustained a ring avulsion injury of hi
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13 November 2017
Dupuytren's Fasciectomy
Over time, Dupuytren's contracture can cause one or more fingers to stay bent toward the palm.This can complicate everyday activities.Treatment, if required, includes using a needl
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08 November 2017
Rare Lipoma of the Tendon Sheath of the Fifth Extensor Compartment of the Hand
Lipoma of an extensor tendon compartment is an extremely rare tumour of the hand. Although benign, it can cause pain, finger stiffness and nerve compression, necessitating surgical
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06 November 2017
Rheumatoid Arthritis
Rheumatoid Arthritis can be a painful and debilitating disease if it is not managed correctly. Marjorie had RA since she was 7 years old but only developed joint deformities in her
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30 October 2017
Swan Neck Deformity
For a swan neck deformity to occur, abnormal stress must be put on the ligament around the PIP joint of the finger. The stress causes the ligament to loosen, which then causes hype
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25 October 2017
Crush & Degloving Injury of the Hand
Bryce was enjoying a family outing when his open roof 4 x 4 overturned. Bryce instinctively put out his hand to protect himself, which becam
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17 October 2017
Wrestling Injury
32 year old male, Nicholas, was wrestling with a friend when he fell onto his right ring finger resulting in a fracture of the distal phalanx. A thermoplastic splint that immobiliz
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17 October 2017
Hockey Injury
Tim was playing Hockey when the ball connected with his finger and caused the little finger to fracture and dislocate. It is quite frightening to see your finger dislocated in this
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17 October 2017
Violin Spider Bite
Few spiders are dangerous, but the Violin spider has a cytotoxic venom which causes skin necrosis and requires urgent surgical intervention. Bryan was bitten on his left index fing
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