Blog Category

Month: October 2015

Categories
Conditions General

Understanding Reflex Sympathetic Dystrophy and Your Hands

Read Blog

The word “misfire” is an appropriate term to use when discussing reflex sympathetic dystrophy or RSD. This is a condition in which the nerves send inaccurate signals to the brain, and create what many describe as an abnormally high pain response to a minor or even non-existent issue. For example, it is not unusual for someone with RSD to get a paper cut or small injury to a finger and feel a tremendous amount of pain or discomfort from such a minor issue.

So, just why does this happen? The disproportionate pain of RSD is due to some sort of malfunction in the nerves following an actual injury, surgery, or trauma. What experts believe is that injury or damage to a nerve may have been sustained and this provokes the future overreactions and hyper responses to any pain stimulus in the future. Experts tend to break RSD into to “types” – the kind after an injury, which should not have affected the nerve and an actual injury to a nerve (AAOS.org, 2015).

Indicators of RSD

Knowing that RSD can result from actual nerve damage or following an injury is helpful in recognizing it when it appears. Additionally, knowing that the experience of pain is far out of proportion with the incident is another useful indicator for diagnosing the condition.

Many with RSD also describe pain as constant or burning when an injury occurs, and generally lasting much longer than what one would expect from the specific injury received. When it occurs in the hands, it comes with a set of additional characteristics that help to make the diagnosis.

For one, the extremity is often swollen and quite warm to the touch. There may be pronounced perspiration and a shiny appearance to the skin, and hands with RSD may also be immobile or limited in their range of motion.

Unfortunately, the symptoms of RSD can vary quite widely from one person to the next, and so it is impossible to draw a conclusion without a more in-depth analysis by a hand doctor. One thing that does seem to apply to all cases is that the earlier the treatment can begin, the better the outcome. Anyone concerned that they are experiencing disproportionate pain in their hands after an injury should, therefore, head to the physician as soon as possible.

They will explore the patients history while also using diagnostic tools such as bone scans, thermography, and X-rays.

Treating RSD

Once it is confirmed that RSD is indeed an issue, there are a few ways it can be treated. The primary goal is to reduce or eliminate pain. This can be done in several ways that include medications such as topical pain relievers, steroids, and others. There is also basic therapy that can restore function and reduce pain. There is a process that is used to numb the stellate ganglion, which is a group of sympathetic nerves. This allows therapy to be more effective by eliminating pain temporarily while treatment is done. There is also psychotherapy as well as surgery.

It is impossible for a hand doctor to predict the outcome of any treatment, but all agree that it is a “sooner the better” sort of issue. So if you feel you have RSD or suspect a loved one has developed it, get to your hand doctor immediately.

Source

AAOS.org. Complex Regional Pain Syndrome. 2015. http://orthoinfo.aaos.org/topic.cfm?topic=a00021

Categories
Elbows General

Understanding Tennis Elbow Treatment and Causes

Read Blog

Many people diagnosed with “tennis elbow” are surprised to learn about their condition because they may not play tennis at all. In fact, most cases occur in non-tennis players! (Mayo Clinic, 2015).

Technically, it is known as lateral epicondylitis and it is when tendons that anchor the muscle to the bone in one area of the outer elbow degenerate. This degeneration creates a weakness at the point where the muscles join, and this causes pain whenever the muscles are put to use. So, you might experience pain in your wrist when you are gripping something or lifting it, and this would be due to tennis elbow.

Causes of Lateral Epicondylitis

Tennis players aren’t the only ones who can experience the discomfort of tennis elbow; it can be caused by many things. Generally, any activity that continually puts stress on the point where the tendon attaches the muscle to the outer elbow can lead to problems. Ongoing stress from grasping and swinging a tennis racket can be to blame, but so can almost any repetitive movement with a similar nature. For example, house painters, plumbers, and even butchers and weavers have often experienced tennis elbow.

It is entirely possible to have tennis elbow from a single incident of trauma to the muscle-tendon unit. For example, a hard hit to the outer elbow can cause inflammation that leads to weakening of this area, or a single instance of force or extreme stress can injure the tendons.

People of almost any age can experience it, but it is most common in those between the ages of 30 to 50.

Tennis Elbow Treatment and Signs

How can you tell if the pain you are feeling is tennis elbow? It is rare for someone with tennis elbow to feel pain with any movement of the elbow. Instead, your discomfort may range from a noticeable tenderness in the area around the elbow to a pain that occurs whenever you grip or lift. Pain tends to radiate outward from the elbow, up the arm and may even be experienced in the hand.

Any pain of this kind should be dealt with immediately, and a hand surgeon or expert should be your preferred medical provider for tennis elbow treatment. They will assess the situation and consider whether to use non-surgical treatment or to use a less conservative, surgical treatment immediately. Generally, surgery is the course chosen if the issue has left the patient incapacitated or in pain for more than six months.

Before surgical remedies are used, the patient will usually be treated with a range of options. The mildest is simply modification of activity or grip to relieve the problem and allow the tendon to strengthen. Anti-inflammatory medications, including steroid injections may be used. Braces are also considered a good approach as they support the muscle and allow healing of the tendon. Physical therapy can be useful as this will allow the area to be strengthened, and can include other modalities such as heat and ultrasound.

A last resort before surgery is shockwave treatment, though this is not always available. Surgery is used to remove the damaged tendon and trigger healing and strengthening. This would be followed up by further physical therapy to ensure full range of motion and strengthening.

The good news is that there are many ways to deal with tennis elbow, and the first step is getting in touch with your qualified hand specialist or surgeon.

Categories
General

What Can Be Done About Scaphoid Non-Union Injuries – Arora Hand Surgery

Read Blog

Your hands and wrists contain a lot of bones, and in the wrist alone are eight individual bones. Set in two rows, they are linked by one bone known as the scaphoid. Unfortunately, due to its position and the role that it plays in the hand and wrist, it is the most commonly fractured bone in the hand. Even worse is that a fracture of this bone is not always easy to diagnose, and some people are unaware of the severity of an injury to their hand for days or even weeks afterward.

This is particularly troublesome because the location of the bone already makes it challenging to heal. It is well known that the blood supply to the scaphoid is fragile even before any breaks may occur, and afterward it may be completely impaired. This can make it almost impossible for it to heal, and when this happens it is known as a non-union injury.

And though it is a tiny bone, the scaphoid non-union can lead to diminished or lost movement of the wrist and even to arthritis.

Diagnosis and Treatment

A fractured scaphoid is often due to a fall, and though it might hurt initially, it often seems to get better quickly, and this is why diagnosis can be tricky. As the American Association of Orthopedic Surgeons explains, “A scaphoid fracture is usually caused by a fall on an outstretched hand, with the weight landing on the palm.” (AAOS.org, 2015)

Thus, you may think you have merely sprained the wrist, and once the discomfort ends you may forget the incident, even though movement of the wrist now seems limited. This is why no falls of this kind, and no hard blows to the wrist can be ignored or overlooked.

A visit to the hand doctor is the only way to determine if a fracture has occurred, and if it is of the difficult non-union variety. In fact, you may find yourself getting in touch with them soon afterward because the non-union fractures so often follow a very common pattern. The wrist begins to lose range of motion, stiffness sets in, and even arthritis symptoms may start to appear because of the persistent inflammation to the tissue.

If your case is not advanced, you may be able to have the most conservative treatments such as therapy or surgery to align the bones and trigger healing. However, you may also need the use of surgical pin or bone grafts if the absence of blood has caused bone death.

In advanced cases, surgery is still an option but it will be to help manage pain and preserve what movement remains. It is always a case of “the sooner the better” in such cases. So, if you have recently taken a fall that may have harmed the scaphoid bone in your wrist, or you feel that an old injury is causing problems, dont hesitate to phone your hand doctor for a thorough exam and discussion of your options.

Source

AAOS.org. Scaphoid Fracture of the Wrist. 2015. http://orthoinfo.aaos.org/topic.cfm?topic=A00012

Categories
General Treatments

When Replantation is an Option

Read Blog

Most of us have read news stories or headlines about replantation, or may even know someone who has had this procedure done. What is it? In the world of hand surgery, it is the surgical reattachment of a finger, hand, or even an arm after it has been severed from the body.

Unfortunately, replantation is often an emergency surgery and this can make the decision-making process around it a bit complicated. Generally, a limb or digit can be reattached if:

  • It will work better than a prosthetic, or just as well.
  • It is in good enough condition to safely attach.
  • The patient feels that the lengthy recovery and rehabilitative process warrants the procedure.

It may seem obvious that a somewhat functional hand or arm is better than none at all, but there are many instances when a prosthetic will actually work far better and not cause the individual any further pain or discomfort. These are all things that must be taken into consideration before replantation surgery is done.

Of course, when it is the arms or hands in question, the need for these limbs is extreme, and so it can be very challenging to make the right decisions. This is why an experienced and knowledgeable surgeon must be consulted if possible.

How is it Done?

There are many things that have to be done before the procedure can be accomplished. First and foremost is an examination of the finger, hand, or arm that has been severed from the body. The damaged tissue has to be taken away; bone must be assessed and even trimmed if needed. All of the nerves, tendons, muscles, veins, and arteries have to be reconnected and new tissue may need to be grafted over the areas where it was lost or destroyed. (AAOS.org, 2015)

There are no guarantees to replantation success, and it is a very long period of recovery. However, it should be noted that the further down along the arm the replantation occurred, the more likely it is to be restored to its former use and condition. Additionally, joint injuries are less likely to heal quickly than non-joint injuries. And no replanted digit or organ can ever be “100%” due to the likely nerve and tissue damage.

It is up to the patient to do the hard work of recovery and use therapy and rehabilitation to get the best results. The first phases of recovery involve nerve healing and tissue growth. Once this has stabilized, the use of physical or occupational therapy can ensure that the limb is slowly and carefully restored to the fullest use possible.

There are also some complications that can arise, including emotional struggles with the loss of the limb if the replantation process does not succeed. Working with a qualified surgical team is the only way appropriate path. They can help a patient and their family through every part of the process and will explore every option for the fullest recovery possible.

Source

AAOS.org. Replantation. 2015. http://orthoinfo.aaos.org/topic.cfm?topic=A00314

Categories
Fingers General

When You Have Trigger Finger

Read Blog

If you understand that your fingers are constructed of pulley-like tissue known as tendons, and that these are what bend and flex the thumb and fingers, it is a very helpful visual for a diagnosis of trigger finger. This is because the condition, which is technically known as sten0sing tenosynovitis, occurs when one of the pulleys at the bottom of a finger (or thumb) thickens and can no longer move fluidly. Essentially, it will lock the finger in an unnatural, curved position, and become an ongoing and worsening condition.

To envision what is happening when you suffer trigger finger, try to envision a series of pulleys, which are ring shaped structures through which ropes run in order to lift or move objects. So, your finger is a series of bones, and connected to them are those pulleys, and through those pulleys run tendons that connect to muscles and which cause the fingers to bend and flex when needed.

Imagine if a pulley at the bottom of a finger got clogged with a sticky residue that caused the tendon to catch or be unable to glide freely through the pulley. This would cause the tendon to become irritate with repeated catching issues, and this irritation would lead to swelling. This is what happens with trigger finger, and eventually, the tendon below the lowest pulley will swell to such as degree, or even form a nodule, that it cannot pass back upward through the pulley. This locks the finger in that hooked position, that looks similar to someone pressing the trigger of a pistol.

Why Does This Happen?

Obviously, it makes many wonder why the pulley would swell in the first place, and experts are not quite sure on the underlying cause. (ASSH.org, 2015) Some patients with arthritis may get this condition, and some with diabetes or gout will develop it. However, there are some who suffer trigger finger without any apparent cause, though trauma to the hand does seem to be related to the development of some cases.

It doesnt happen instantly, though, and there are indicators that you may be developing trigger finger. You may have discomfort in your palm or tenderness when pressure is applied. Additionally, the sensation of the middle or large knuckle catching is often an indicator (though it is not the precise location of the problem) that trigger finger may be developing.

Treating the Problem

How does a hand doctor unlock this caught tendon? The first steps are to attempt to reduce the swelling and allow the tendon to begin moving freely again. This can often be done with a combination of splinting and anti-inflammatory medications. Injectable steroids may also be used to release or reduce the swelling. Should these conservative efforts fail, the next step is to perform a surgical release that opens the pulley and allows the tendon to return to its normal position.

Any treatment must be done by a hand doctor, and therapy is often required to ensure that the problem has been resolved and that the pulley is no longer causing the tendon to be captured.

Categories
General Wrists

You Have a Scaphoid Fracture…What Does That Mean?

Read Blog

We all know that there are a surprising number of bones in our bodies, and when you start to look at the hand, it is even more astonishing to discover the amazing number of bones there as well. Just the area we know as the wrist contains a few groups of bones, including the carpal bones. They are composed of two rows of tiny bones, and these are linked by the “scaphoid” bone.

Because the scaphoid holds such a prominent position it ends up being the most commonly fractured carpal bone.

The Hidden Injury

The wrist is put under a lot of stress and strain in general, but one of the most common is intense pressure from a fall or a sharp blow with the hand. These types of incidents are what lead to a scaphoid fracture. For instance, someone is falling towards the ground and the natural instinct is to reach out with the hands to stop the impact. The pressure of the hands striking the ground can easily fracture the scaphoid.

The problem is that a fracture of this bone is not always obvious, and though there may be pain or bruising and tenderness at first, it may subside so quickly that the individual does not seek medical care. This is why many scaphoid fractures go undiagnosed for days, weeks, months or even years.

How is it diagnosed? Generally, it requires an x-ray to determine if the small bone has been broken, and even then it can be hard to detect. There is one key indicator, however, and that occurs in the area of the wrist known as the “snuffbox”, which is the noticeable hollow that appears at the outer base of the thumb at the wrist area. (AAFP.org, 2014) Should this area have tenderness, it is generally diagnosed as scaphoid fracture and the patient is then treated accordingly.

How Scaphoid Fractures Are Treated

There are two ways that the fractures of this bone occur – displaced and non-displaced. The non-displaced are the tricky fractures because they are not so obvious or even visible on an x-ray. The displaced are just as they sound – the bones are clearly displaced due to the fracture.

If diagnosis is not certain, the wrist is put into a splint and kept immobile until further x-rays or scans can detect the break. Treatment is ongoing immobilization using a cast over the entire forearm, hand, and thumb area. Generally requiring up to ten weeks (in some cases more) to heal, the treatment can be complicated by bone death.

Because a fracture to the scaphoid can interrupt the blood flow to the bone, healing may be a challenge. Surgery can be required to pin the bone together with a screw or bone graft, and even then healing is not guaranteed. The most common problems arising during or after treatment are non-union of the bones, death of the bone, and arthritis.

Though a tiny bone like the scaphoid may not seem all that vital or critical, it can cause many problems if broken and left untreated. Visiting a hand surgeon or expert immediately after any injury to the area is key to the best outcome.

Source

AAFP.org. Diagnosis and Management of Scaphoid Fractures. 2004. http://www.aafp.org/afp/2004/0901/p879.html

Categories
General Treatments

Amputation and Your Hand

Read Blog

Traumatic injury and disease are common reasons for amputation, which is the removal of a body part. For example, amputations of the hand or fingers could be a method of keeping infection from spreading into the body. Occasionally, unplanned amputation occurs, as in an accident that leads to the loss of fingers or a hand. In some cases, fingers that were accidentally amputated can actually be reattached, but this is not always feasible for the comfort of the patient.

The Amputation Procedure

Before any procedure is completed, the surgeon will take the time to examine the body part that is expected to be removed. They will use tests, such as x-rays, to determine the damage and its extent so that they can better prepare for the procedure ensuring that they remove the right amount of hand or fingers.

Depending on the extent of the surgery needed, the physician will use one of two methods to close the wound:

  • The existing skin and tissues will be used to close the wound at the amputation site.
  • Skin, tendons, or muscles will be taken from another part of the body and then used to close the wound at the amputation site.

Generally, the surgeon will do their best to leave the remaining tissue shaped in a way that a prosthetic will easily be fitted for the patient.

Recovery from Surgery

In the few weeks after surgery, you will feel some discomfort at the amputation site. Pain medications will be used to control the discomfort while you go through the healing process. You will need to keep your hand properly bandaged and cleaned until the doctor states bandages can be removed.

During recovery, you will need to perform certain exercises and processes so that you can strengthen your hand and ensure you keep the muscles and tissues flexible.

Anytime someone loses a body part, they may go through some emotional difficulties and they may find it hard to adapt to the new changes. You may even wish to consider counseling to get you through the difficult time. Its a good idea to seek help if you are feeling emotionally distressed or stressed in the wake of your amputation. You may be able to get that help from resources like the Amputee Coalition of America, found at www.Amputee-Coalition.org.

In many cases, you will be able to get a prosthesis to replace your amputated body part. The exact type of prosthetic will depend on what part is missing, what remains of the hand or finger, and what you prefer yourself. Prosthesis for amputated or partially amputated fingers usually are for looks and to provide opposition so that you can still use your thumb and fingers normally. Prosthetic hands can be used with bendable fingers. Finally, prosthetics for the full arm can include electric and mechanical parts to create a usable hand.

If you have to go through the amputation process, keep in mind that you will have options during healing. While this is a stressful and emotional procedure, you dont have to live with the consequences, thanks to prosthetics.

Resources:

https://amputee-coalition.org/limb-loss-resource-center/resources-by-amputation-level/partial-hand-fingers/index.html

Categories
General

Hand Burn Treatment in Southeast Michigan

Read Blog

Burns can vary wildly from very minor to very serious depending on the temperature of the heat and how long the skin was in contact with that heat. Other types of burns are caused by chemicals and toxins that do damage to the skin as well. The extent of the burns will have a direct impact on the treatment needed and the healing process.

Burn Injuries in Degrees

When your skin is burned, the injuries will be denoted by a degree that shows how bad it is. These degrees include:

  • 1st Degree, which means the burn is very minor. The skin is red and uncomfortable but there are no blisters.
  • 2nd Degree, which means there has been some damage to the skin and there are blisters as well.
  • 3rd Degree, which means the skin has been damaged deeply and it appears white or leathery in texture.
  • 4th Degree, which means the skin and deeper tissues have been damaged, including tendons, muscles, and bone.

Obviously, a very minor 1st degree burn to the hand can be treated with a burn cream at home. However, anything worse can result in infection, so it must be treated properly.

Treatments for Burn Injuries

Immediately following the burn itself, the hand should be cleaned and then the victim should be taken to a doctor or hospital. As a general rule, burns to the hand will be treated and then the patient will be allowed to go home. However, if the burns are severe or infection is present, then the patient may need to stay in the hospital.

1st degree burns are usually treated with just pain medications and they will heal within a few days to a week.

2nd degree burns may require that the hand be splinted to protect from stiffness. Open surfaces will be cleaned properly and the victim will be told how to clean them at home. In some cases, damaged skin may need to be removed and skin grafts may be required. Usually, 2nd degree burns take a few weeks to heal.

3rd degree burns will need more extensive work. Dead or severely damaged skin will be removed and then skin grafts will be used to replace the lost skin. Then, the hand or forearm will be splinted so that it can heal properly.

If the burn goes all the way around the arm or hand, then this could constrict the blood flow and cause further damage. In these cases, a surgical procedure may be needed to correct the issue.

If burn injuries are severe, then rehabilitation will be needed to ensure the patient gets full use of their hand back. This is especially important if the burns are very deep or if other injuries happened in conjunction with the burn itself. Further surgeries may be needed at times depending on the severity of the burns and how they have healed up. It is important to follow through with therapies and further appointments to ensure use of the hand is restored.

Categories
General

Golfing Injuries to the Hand and Wrist

Read Blog

Golfers know that certain parts of their body are more at risk of injury than others, including the back, the elbow, and the hand. The hand and wrist area is the third most common injury to happen to a golfer, and if you know how a swing takes place, you will understand why. As a golfer swings for a drive, they will snap their wrist. In short chip shots, the wrist is often used as a hinge. As a result, wrist and had injuries are common. The leading wrist and hand will be the one most in danger. In other words, the left hand for right handed golfers and the right hand for left handed golfers.

The Injuries

There are different types of injuries that can arise in golfers, including:

  • Trauma that comes from impact and jarring injuries. If the golf club hits a rock or hard surface, this will jar the wrist and hand. This often causes sprains.
  • Tendonitis that occurs from making the same motion over and over again.
  • Fractures from a traumatic blow while using a golf club.
  • Hamate fractures often occur. The hamate is located on the palm side the wrist and it protrudes upward. It essentially forms the heel of the palm and it is especially vulnerable to golfers. This type of fracture can actually cause problems with the ulnar nerve, which is also located in the area. People with his injury may experience numbness, tingling, and pain in their pinky and ring fingers. Additionally, moving the wrist may cause a distinctive clicking feel.
  • Injuries farther up on the arm, such as tendonitis in the elbow, can occur from overuse and repetitive motions.
  • Misuse of golf carts can lead to hand damage if the golfer were to wreck the cart or fall out of it.

Essentially, golfing on a regular basis opens you up to sprains and strains throughout the hand, wrist, and arm.

Treatment

Treatment for hand and wrist injuries from golfing can vary based on the injury itself. For example, tendonitis is often treated with pain medication, ice, and splinting. Ice and pain medication can also be used for strains and sprains. At times, if the injury doesnt heal on its own, then your doctor may choose to use steroid injections in the area.

If the wrist or hand is fractured, such as with a hamate fracture, then you may need to wear a cast to allow the bone to set properly. If the damage is severe, then surgery may be needed. Sometimes, bone fragments will press up against a tendon, and they will need to be removed so that pain can be relieved.

While golf is a beloved pastime to many and it doesnt seem as dangerous as other high-impact sports, it can still lead to injury. Your wrist and hand will be especially prone since they will be put under stress every time you pick up the golf club. Most of these injuries can be treated with medication and immobilization, but in the case of severe fractures, more treatments may be required.

Resources:

http://www.scpga.com/teachers-forum/getting-to-the-%E2%80%9Croot%E2%80%9D-of-wrist-injuries-in-golf/

Get on the List

Subscribe

Patient

Stories

Read All

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.