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Month: September 2015

Conditions General

What to Know about Cubital Tunnel Syndrome

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Have you ever bumped into a piece of furniture and knocked your “funny bone” so that you feel immediate tingling pain? What we refer to as a funny bone isnt the bone itself at all. Instead, it is the ulnar nerve. It runs from the upper arm over the elbow and down to the lower arm through something called the cubital tunnel. As it wraps around the outer part of the elbow, it is especially susceptible to getting bumped, leaving pain, tingling, and numbness to the lower arm and hand.

Some people develop cubital tunnel syndrome, which is similar to carpal tunnel in the wrist, but affects this ulnar nerve specifically. When the nerve becomes compressed or inflamed, you will feel the same pain you would if you had bumped your funny bone, but in a more severe and ongoing basis. This is cubital tunnel syndrome and it can be caused by a few different issues.

Causes of Cubital Tunnel Syndrome

The main cause of cubital tunnel syndrome comes from pressure on the funny bone area. If you feel your elbow on the outside, you will notice a groove between two bone endings. This is where the cubital tunnel lies. If direct pressure is placed on this area, it can compress the nerve and you will start feeling tingling and numbness in the ring finger and pinky finger. Over time, the constant compression of the area can lead to inflammation on the ulnar nerve.

If you keep your elbow bent at an intense angle for a long period of time, this can overstretch the cubital tunnel and ulnar nerve until it becomes inflamed and swollen. This is most often a problem when people sleep at night.

For some people, there is something off with their anatomy and this leads to the ulnar nerve sliding over the bump of bone in the elbow. This repetitive motion will result in damage to the nerve and inflammation in the soft tissue around it.

The Symptoms of Cubital Tunnel Syndrome

The most common symptom will feel as if the ring and pinky fingers on the hand have gone to sleep. The experience of “pins and needles” is a regular complaint as well. It may worsen if you need to hold your elbow bent for a long time. Many people notice this when they hold their phone to their ear. This is often a common reason fingers go to sleep. Other symptoms besides the asleep feeling include:

  • Weakness in the hand
  • Clumsiness in the hand
  • Loss of strength
  • Loss of sensation in the hand

Sometimes, cubital tunnel syndrome can be treated by splinting the arm to keep it straight while you sleep. You may also need to go to therapy and learn ways to avoid putting pressure on your elbow. If the problem is severe, then you may need surgery to release tendons and relieve pressure on the ulnar nerve.

Cubital tunnel syndrome most often occurs when you put constant pressure or strain on the funny bone portion of the elbow, but it can be relieved with treatment.


Conditions General

What is DeQuervain’s Syndrome?

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DeQuervain’s syndrome is not nearly as well-known as other conditions of the hand and arm, but it does affect patients every year and is found in the tendons located on the side of the wrist closest to the thumb. When these tendons get compressed because the tunnel they run in narrows, this will cause the syndrome. The most common symptoms of deQuervain’s syndrome include pain in the thumb and hand when grasping objects or grasping and twisting, such as when opening a door knob.

The Causes of the Syndrome

It is unknown why people develop the problem, but it is not an inflammatory condition. Instead, it is simply a compression of tendons used in the hands. Anyone of any age can develop the problem. However, it is actually more common in women who have just given birth to a baby. Usually, in postpartum women, the syndrome appears when the baby is about four to six weeks of age. Doctors believe that this is due to hormones and physical swelling of the hands and feet in women that have had a baby.

So, there is no real way to predict whether or not a person will develop de Quervain syndrome. However, there are treatments available.

Available Treatments

Generally, the first thing that will be done to treat the condition is a simple regimen to stop use of the wrist and hand. You will need to take over the counter pain relievers like Tylenol or Aspirin, and then you will need to wear a splint for a certain amount of time. From minor cases of de Quervain syndrome, this is the easiest way to cure it.

If that doesnt work, then doctors may recommend something different and more drastic:

  • The area can be injected with a cortisone medication that will help to relieve swelling in the area.
  • In severe cases, surgery may be needed. The surgeon will cut tendons on one side of the nerve channel to relieve pressure from it. This surgery is only saved for more severe cases that have not responded to other types of treatment.

The condition can be reversed through these treatments and most people see relief in a few weeks.

How Do I Know if I Have de Quervain Syndrome?

Only a doctor can diagnose the condition, but you can try an exercise to see if you feel pain. Curl your hand up in a fist and tuck your thumb inside of it. Now, do not move your arm, but bend your wrist down as if you were hammering a nail. People who have de Quervain syndrome will feel pain when making this motion.

If you believe you may have the syndrome, then you will need to make an appointment with a doctor. It will likely not heal on its own and you will probably only continue to feel more discomfort. However, with treatment, the syndrome can be managed or completely reversed so that you dont feel any discomfort anymore at all.


Conditions General Wrists

Understanding Carpal Tunnel Syndrome

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You have nerves in your wrist that play very important roles in your hands. One of these nerves, called the median, runs through the wrist and can become compressed or pinched. As a result, carpal tunnel syndrome may occur. When this happens, you might experience pain, swelling, numbness, and tingling. Eventually, as the swelling gets worse, you could lose partial use of your hand.

Because carpal tunnel syndrome can be caused by a variety of different issues, your doctor may not be able to pinpoint your specific problem. Causes can include:

  • Swelling to tendons and their lining in the arm and wrist
  • Dislocation of the joints in the wrist or hands
  • Arthritis
  • Holding the wrist in a bent position for extended periods of time
  • Fluid retention during pregnancy
  • Thyroid problems

Again, though, your physician may not know the exact cause, but can still diagnose carpal tunnel syndrome.

The Symptoms

As mentioned, as the median nerve is put under more and more pressure, you will experience pain, tingling, and numbness in the hand. You will notice that it effects the thumb, ring, index and middle fingers specifically. Generally, these symptoms will be more noticeable at night.

Other symptoms of carpal tunnel syndrome includes weakness in grip, hand clumsiness, and loss of sensation in the thumb.

Treatment of Carpal Tunnel Syndrome

Depending on the severity of the condition, different treatments can be used. For example, a doctor may recommend that you change how you use your hand and hold your wrist. You may also need to splint your wrist so that it remains straight. This will relieve pressure on the median nerve and allow the inflammation to subside.

Sometimes, your doctor may recommend that you have a steroid injection directly in the wrist. This will reduce swelling and inflammation, easing the discomfort. If your doctor has gone through all of these things or your carpal tunnel syndrome is very severe, then surgery may be needed to rectify the issue. When surgery is chosen, the procedure is simple. The surgeon will need to make an incision on the palm side of your hand and then cut through some of the ligaments around the nerve. This will relieve pressure.

Recovery from surgery will mean a few weeks of discomfort at the incision site. Numbness and tingling that you experienced from the carpal tunnel syndrome may disappear almost immediately, or it may slowly get less and less until you do not notice it anymore. You can expect several months of recovery before you regain full use of your hand. In some, isolated cases, surgery may not fully relieve all symptom of carpal tunnel syndrome.

Many people develop carpal tunnel syndrome because they have to bend their wrists for extended periods of time. For example, people who type on a computer regularly are at high risk. However, no matter what you may do, you could develop the condition. Depending on symptoms, there are different ways your problem can be treated so that any pain or discomfort can be relieved.


General Hands

Injuries to Flexor Tendons

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Whenever you use your fingers and they bend different ways, then your flexor muscles are at work. These are muscles in your hand that are connected together by tendons. The muscles themselves are located in the hand and go all the way up to the forearm right near your elbow. Where the muscle ends in the hand, flexor tendons take up the job, run the length of your fingers and then connect to smaller muscles in your fingertips. They are located on the palm side of your hand, running up through your wrist, and since there isnt much tissue covering them, they can be injured fairly easily.

What Causes Damage to Flexor Tendons?

The tendon could become severed if a deep cut occurs to the palm or wrist. The tendon will pull away from itself as soon as it has been cut or torn, and that means your finger will not be able to bend. If the tendon has not been completely cut or torn, then the finger may still bend, but the bending may be very painful and the tendon will eventually tear all the way.

You can also develop tendonitis in the flexor tendons, which means they have become inflamed and painful. Tendonitis will heal over time and not cause any permanent damage.


Tendons, like other tissues in your body, can heal themselves if the two cut ends are brought together through surgery. There is no way a completely cut or torn tendon will heal on its own. Your doctor will need to determine the nature of the cut or tear and then choose the right surgical method for repairing it. Often, when the tendon has been damaged, tissues in the area will be damaged as well, and they may need repair during surgery also.

After you have had surgery to repair the tendon, then you will need to keep the finger immobilized and that is why you will need to wear a splint. After several weeks, you will be able to move your finger, but only when you are going through hand therapy. Generally, you will need to wait up to six weeks to move your finger much at all and three months before you can use your finger as normal.


However, you will likely never gain proper use of your finger if you do not go through therapy. This therapy is required to help build up strength in the hand, prevent scars from stiffening, etc. So, if you have a torn tendon repaired, be sure to follow up with therapy as advised. This therapy could last anywhere from a few weeks to a few months depending on your injury.

Your hand is an intricate thing, and each tendon within it plays a very important role. If the flexor tendons have been damaged, then you will not be able to bend your fingers as needed. It will be important that you seek the help of a physician so that the damage can be properly repaired and so that you can use your hand properly again.


Conditions General

Understanding Dupuytren’s Disease – Arora Hand Surgery

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This disease can affect hands and feet. It involves a thickening of the tissues on the palm, fingers, and soles of the feet as well. Essentially, the tissue begins to thicken on the palms and then moves on to the fingers. It generally creates Dupuytrens contracture, which means cording in the finger contracts, keeping it bent oddly. In addition to the palms of the hands, the disease can also cause thickening on the front of the hands, resulting in nodules or lumps on the knuckles.

Doctors dont really know what causes the problem, but it does occur more in men over the age of 40. It has also been connected to people with northern European ancestors. Some believe that injury or certain types of jobs can contribute to the development of the condition, but there is no actual scientific research to prove this.

The Symptoms

The symptoms of Dupuytrens disease include lumps and pitting in the palm of the hand. The lumps have a firm feel to them and cording may develop that runs from the palm to different fingers. Generally, the disease affects the ring and little fingers the most, but it can develop in any of the fingers. Many people may see the cords and assume they are contracted tendons, but that is not the case. In fact, the tendons and underlying tissues are rarely affected by the disease.

Here are some other things to note about the presentation of the disease:

  • It usually affects both hands to some degree.
  • It is not a painful disease.
  • Fingers will slowly be drawn more to the palm, making it hard to place a hand flat on a table, wear gloves, or do other things with the hands.

Some people experience nothing more than a few small lumps. However, some people experience fingers bent to the point of deformity. At this point, doctors do not really have a way to predict how the disease will progress and why it progresses so differently from one patient to the next.

How Is It Treated

Generally, nothing will be done if the disease is very mild. However, if the patient cannot straighten the fingers and this is interrupting their quality of life, then there are treatments available.

Surgery can be used to remove the nerves from the cords where they have likely become intertwined. In many cases, a skin graft will need to be performed in order to replace skin in areas where there is simply not enough. There are times when it is impossible to completely correct the problem, but the fingers can be straightened to some extent. After surgery, the patient will need to wear a splint for a while to ensure the hand stays in the proper position for healing.

While Dupuytrens disease may not be very common, it can be a frustrating condition since it can seriously affect the use of your hands, especially if it grows too severe. While you may not experience pain, it is still a good idea to visit a doctor.


Fingers General

A Look At Thumb Sprains

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Our thumbs are one of our greatest assets, and they allow our hands to perform an almost endless array of tasks and functions. Thumb sprains or other thumb injuries can immediately jeopardize our ability to use our hands to the fullest extent possible, and so there is no such thing as an insignificant or minor injury to the thumb. This is why you must never hesitate to head to a hand doctor if you feel you have sustained injury to any part of the hand, but especially the thumb.

We are often told that sprains are a minor issue, and so we don’t panic if someone says, “it is probably just a sprain.” This is not the best advice when it involves any part of the hand. The hand and wrist are a delicate balance of bones, nerves, cartilage, tendons, and other tissues, and if one small area is damaged, it offsets the rest of the hand. When you sprain your thumb, it is a very serious matter and should be dealt with immediately – even if it does not seem like a major issue.

Of course, we should understand what is meant by a “sprain” to better understand why a thumb sprain is serious.

Sprains Explained

Sprains are simply a tearing or over-stretching of the ligaments or tendons that connect muscle to bone. They happen when that limb or digit is put under extreme force or pressure, and is bent to an unnatural degree. In the case of the thumb, a sprain is often due to falling or sports injuries.

For example, we may fall and jam the thumb into the ground or another resistant surface. This forces the thumb into an unnatural position, often an extreme one. Not only do we feel immediate pain, but it also usually puts too much pressure on two main ligaments in the thumb – the ulnar collateral and/or the radial collateral ligaments.

These stabilize and support the movement of the thumb joint and when they are sprained, they prevent you from moving the thumb comfortably, smoothly, and without pain. There is often immediate swelling, and this is a key indicator that you must get to a doctor. (, 2015)

Diagnosing and Treating Thumb Sprains

Your hand doctor is going to X-ray the hand to be sure that there are no broken bones, and they will then do a few tests to determine which ligaments are damaged, and to what extent.

The treatment can range from casting or splinting, but if the ligaments have been torn, they tend to require surgery to reattach them properly, and in some cases a reconstruction may be required. Should you delay in seeking treatment, surgery is often the only remedy for what is known as a “chronic” sprain injury. This is often accompanied by weakness of the hand and pain when attempting to use the thumb.

Don’t delay if you sustain a sharp force or falling injury to your thumb. The faster a sprain is dealt with, the better the long-term outcome for this essential digit.

Conditions General

Understanding Complex Regional Pain Syndrome – Arora Hand Surgery

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Also referred to as CRPS, complex regional pain syndrome causes consistent pain over a long period of time and is directly connected to a problem in the nervous system. It most commonly affects an extremity such as the hands and fingers. Usually, CRPS develops due to an injury that causes the nervous system to malfunction, but the injury doesnt have to be severe. In fact, people have developed CRPS from something as minor as a paper cut. When the nervous system reports pain, it could misfire and act in the wrong manner, leading to complex regional pain syndrome.

Most cases of CRPS come from a minor injury, but can develop after a major injury as well. The direct cause may never be diagnosed. Generally, complex regional pain syndrome develops in individuals between the ages of 25 and 55, and it is much more common in women.

Symptoms of CRPS

Of course, the main symptom that develops in CRPS patients will be constant pain that can range from burning to intense. Specific symptoms include:

  • A pain that feels like burning sensations
  • Sensitivity of the skin in the area
  • Skin that feels warmer or colder to the other hand
  • Skin that turns purple or red and becomes blotchy
  • Skin that becomes shiny, sweaty, or thin
  • Hands that become swollen or stiff
  • Inability to use the hand properly

The pain may remain in the hand that was injured, but in some cases, it spreads throughout the arm and can even effect the other hand and arm as well.

Treatment for CRPS

The actual treatment used will depend on each individual case. Doctors may use one or more of the following treatments based on the severity of the CRPS and the patient themselves.

  • Physical Therapy
  • Psychotherapy
  • Nerve Blocking Medication or Nerve Block Injections
  • Medications for Anxiety, Depression, and Sleep Problems
  • Surgery

In some cases, the CRPS develops because a nerve in the hand or arm has been compressed to the point that it becomes inflamed and swollen. If this is the case, then surgery can be done to release the pressure off of the nerve by cutting a surrounding tendon. In severe cases of CRPS, a drug pump may be installed, which allows the patient to have a constant course of pain medication.

Because every case of CRPS is different, the actual prognosis for the patient can vary immensely. In some cases, the pain can be completely reversed. In other cases, it is a continual problem despite efforts to repair the injury or correct the nerve malfunctioning.

Complex regional pain syndrome can be very tricky since it may develop out of the most minor of injuries. Due to this, the patient may have no idea what happened or when. Since there are numerous different treatments for the condition, most cases can be managed, though. If you believe you are showing the symptoms of CRPS, then it is important that you make an appointment with a physician to determine what might be wrong and what course of treatment will help.



Choose an Experienced Hand Surgeon for the Best Results – Arora Hand Surgery

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There are so many conditions that develop in the hand, wrist, arm, and elbow that it would be almost impossible to list them in one place. From issues with circulation and the conditions of the skin to fractures and disorders, people of any age may require the skillful care of hand surgeons, doctors, and therapists.

As is the case with almost any sort of service or care providers, not all are alike. It is not difficult to find medical experts familiar with hand care, but once you realize the complexity of the upper extremities, you realize that you should turn to only the most qualified providers. After all, your hands are two of your most important limbs, and they provide you with your ability to work, to enjoy life, to create, and even to communicate.

The Range of Treatment

This is why you should put your hands in the hands of experts. When choosing a hand surgeon, be sure they are focused strictly on the upper extremities and offer help with:

  • Acquired disorders
  • Arthritis
  • Cast care
  • Hand therapy
  • Nerve disorders
  • Tendon disorders
  • Trauma injury
  • Wrist disorders

The best hand surgeons will be able to treat people of all ages, and will provide both in-office (outpatient) and full-blown surgical remedies for all types of hand or upper extremity related conditions.

Dont Overlook Diagnostics

Remember too that, although all physicians are required to remain current in their field, not all physicians get the kind of skills and qualifications that make them the best at diagnosing patients in addition to treating them. For example, arthroscopy is a major diagnostic and treatment tool in the world of hand, arm, elbow, and wrist surgery and care. Be sure you are working with a team that provides only the most modern and up to date options as this guarantees that the latest research and advances are being used to treat your condition or injury.

Therapy is a Part of Recovery

We did mention therapy in the list above, but this too cannot be overlooked. From physical therapists to occupational therapists, the ability to have your hand or upper extremity condition remedied through the most effective therapies and modalities is of major significance. In fact, few surgical treatments and almost as many non-surgical treatments for the hand must include at least a small amount of therapy to ensue the best results.

This means you want a hand surgeon who can also provide you with a team of experts and professional care that delivers only the most beneficial outcomes. This is what you will get when you turn to Dr. Avery Arora.MD and Arora Hand Surgery. As an experienced and deeply committed Board Certified hand surgeon, Dr. Arora is a hand, wrist, forearm, and elbow specialist, with a practice offering the best diagnostic services, surgical treatments, rehabilitative options (including therapy) and post-treatment maintenance and care.

Patient centered care is the best choice when dealing with something as significant as your hands and upper extremities, and Dr. Arora is known for ensuring his patients are fully informed, well educated about their condition and treatment options, and play a part in their own treatment plan.

Contact his friendly and knowledgeable staff today at 248-485-8300 OR 734-943-3838 to make an appointment.


American Board of Orthopaedic Surgery. Subspecialty Certificate in Surgery of the Hand. 2015.

General Wrists

What to Expect With a Wrist Sprain

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We are often told that a sprain is a minor issue, but when we know just what a sprain is, we understand that it deserves good care and adequate time to heal. This is particularly true when it is a wrist sprain.

A sprain, according to the technical definition, is, “A stretching or tearing of muscle or tendon.” That alone sounds pretty serious, but when you realize that it is those torn or stretched tendons that hold the muscle to the bone, you understand that this is no laughing matter.

Essentially, a wrist sprain is when the tendons that hold the wrist together have been over extended or damaged, making it very hard for you to use your hand properly. The most frequent way that a wrist sprain occurs is in a fall or during active sports. The hand is usually bent backward or forward at a extreme angle, and this tears or overextends the tendons.

The immediate response is pain, and this is rapidly followed by swelling. The hand becomes painful and difficult to move. Generally, it is not all of the tendons in the wrist that are harmed. There are two ligaments that seem to take the brunt of falls and injuries of this kind, and they are the scapho-lunate ligaments, which are tucked between the scaphoid and lunate bones in the hand/wrist area.

Though other sprains can occur, it is most common to experience this particular type of sprain, but it can also range from mild to severe, with some instances of ligament rupture occurring.

Dealing With a Wrist Sprain

Should you fall or sustain any sort of injury that leads you to believe you have injured or sprained the wrist, do not hesitate to get to a hand doctor. They are going to be able to determine what has happened by taking x-rays, doing a thorough exam, and discovering if there are any fractures in addition to the sprain.

The most conservative treatment is immobilization in a splint or a cast. If there has been more extensive injury, it may be necessary to perform surgery in order to repair damaged ligaments or bones. The scaphoid bone is the most frequently broken bone in the hand, and it can be difficult to heal, meaning even a minor sprain that includes a broken scaphoid bone may need surgery.

As with many types of hand injury, a wrist sprain is best dealt with immediately. If the injury is ignored, it becomes a chronic concern. After several months or years, the ligament may still need repair, but in many instances the chronic condition worsens and can allow arthritis to set in or for the joint to become very stiff. Treatment can range from surgery to steroid injections and therapy. As the American Society for Surgery of the Hand indicates, “Despite optimal treatment, wrist sprains occasionally result in residual long term pain, stiffness, and swelling.”

The complexity of the wrist makes it difficult to rebalance the many bones and tissues after injury. Instead of waiting to see how the wrist heals after an injury or fall, head to your hand doctor and get the best possible treatment and results.

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Dr. Aroras office from my first call to schedule my appointment was friendly. Walking in the first day, I felt like I was in a nice atmosphere. Dr. Arora was EXCELLENT in taking great care of my hand injury. He was gentle and very understanding to the concerns I had about my hand. His expertise was admirable and I would recommend anyone with an injury to their hand to his office to be under his care. Because of him, I have healed faster than expected and will make an 100% recovery! Thank you Dr.

Jackie S.

I first thought I was going to have to have painful injections or surgery, but Dr. Arora suggested physical therapy may do the trick. I was doubtful, but I agreed to do it. Now, my pain is gone, and with the help of an ergonomic keyboard at work to keep my hands in the correct position, I am virtually pain free. The therapy strengthened my wrists and shoulders, and built more flexibility into my wrists.

Jerry T.

My experience with this doctor was positive from the outset. Dr. Arora was kind and spent a great deal of time with me. Staff was friendly. The office was nice and bright.

Ariel G.

Very friendly and helpful Great staff!!! Doctor Arora was very professional and did great work. I was very happy with everything!

L B.