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Month: November 2015

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General Treatments

Why Your Hand Surgeon Prescribed Steroid Injections

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There are so many mysteries around the use of steroids, and far too many negative rumors; many patients panic when they hear that they need injections to treat a condition. If you are a patient of a qualified hand surgeon, you may have been told that your condition can benefit from steroid injections, and you will definitely want to follow this advice.

Why? Steroids are a very common treatment for many “inflammatory” conditions in the hand and wrist area. The term inflammation (when used in a medical setting) means that the bodys immune system is trying to protect and heal the body (MedicalNewsToday, 2015), but when inflammation goes unchecked, it can often cause more inflammation in surrounding tissue, and this can lead to many problematic issues.

When tissue of the hand is irritated and then chronically inflamed, it can cause a host of problems. Many of them can be treated with steroid injections. This is because steroids contain anti-inflammatory compounds that begin to reduce inflammation immediately.

What Are Steroids?

Steroids should not be used as a generic term, since they are found in different strengths and formats. When they are given to patients with specific hand or wrist conditions, they are most often the “cortisone” steroids, which may vary in their duration and their strength.

Usually, they are blended with a bit of local anesthetic to reduce any discomfort during the treatment, and the most common conditions treated with steroids include:

  • Arthritis
  • De Quervains Tendonitis
  • Carpal Tunnel Syndrome
  • Trigger Fingers

Naturally, there are other conditions that benefit from such injection, but where hands are concerned these are the most common.

How Will Steroids Help My Hand Condition?

In all instances, the steroid injection is going to be given at the point where the inflammation is most severe, or at the source of the problem. The physician will make sure that the injection produces the least amount of discomfort possible, and usually the steroids begin to work within one to two days. There is no universal time line for when the steroids begin to reduce inflammation to a noticeable level, nor is it a guarantee that the injection will last as long as the physician hopes.

Fortunately, the general result of a steroid injection for a hand condition is long lasting, and capable of reducing or fully eliminating the inflammation that is causing pain or loss of function in the hand or digits. However, injections may be given in conjunction with other treatment – such as with trigger finger. This condition may respond favorably to the injection and release the tendon allowing it to glide freely, but it may eventually require surgical release, as well.

When you have any inflammatory condition of the hand or wrist, it is best to work directly with a hand surgeon to have it both diagnosed and treated. In many instances, steroid injections can be used as a long-term solution, but only when administered by an expert who monitors the condition and the results.

Categories
Fingers General

How To Treat Fingernail Injuries

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We use our fingers all of the time all throughout the day. As a result, they are always at risk of some type of injury. Your fingertips are packed with nerve endings, more than almost anywhere else in the body. Thats because you need all of those nerves to fine tune your ability to feel and use your fingers. Of course, with all of those nerve endings hanging out in your fingertips, an injury to this area can be very painful.

Fingertips can be damaged in a number of different ways, ranging from very minor to extremely serious. Because the fingertip skin is so unique, if it becomes destroyed, it usually cannot be replaced.

Some common examples of injuries to the fingertips include:

  • Crushing damage if the finger is closed in a door, hit with a hammer, or has something heavy dropped on it
  • Cuts from knives, power tools, etc.
  • Bent and broken from being caught in equipment, ropes, or nets.

If you have a fingertip injury, the first thing your doctor will do is examine the area, check for mobility in the finger and then get x-rays. It will need to be determined if any of the bones in the finger have been broken.

Treatment of Fingertip Injuries

How the injury will be treated depends solely on the type of injury itself. Here are some examples:

  • Severe crush injuries may mean that some tissue needs to be removed or the whole finger has to be removed.
  • It bone has been exposed, then skin grafts may be used to cover the injury.
  • If soft tissue has been lost, then this may be replaced along with skin grafts to cover the area.
  • At times, a flap of skin is lifted from the adjacent finger and used to cover the injury and provide blood flow while the finger heals. Once the wound is healing, the flap can be stitched back down to its original finger site.
  • If the finger has been fractured, then a splint will be used to stabilize the area.
  • If the fracture is severe, then pins may be placed within the finger bone to help it set in the proper manner.

If damage to the fingertip is extremely severe, then likely, amputation will be needed. Thats because it is very hard to replace tissues in the finger when most of the existing tissue has been destroyed.

Injuries to the fingertip can mean loss of sensation for a long time. In fact, some people report it taking several months to get full feeling back in the finger. Scarring to the nailbed may mean the fingernail grows back deformed or does not grow back at all.

Every day, your fingers are exposed to injury. So, it should come as no surprise that fingertip injuries are common. Depending on the type of injury or trauma, there could be ways to treat the situation and return the finger to normal function, but in severe cases, the finger may be lost altogether.

Resources:

http://orthoinfo.aaos.org/topic.cfm?topic=A00014

Categories
Conditions General

Understanding Ganglion Cysts

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As you may already know, cysts can form on different parts of the body. They are usually benign and can be a frustration more than anything. This is definitely the case with ganglion cysts, which can form on certain parts of the hands. Generally, they appear on the outer side of the wrist, on the palm side of the wrist, at the base of the finger, and on the farthest joint in the finger.

Ganglion cysts are filled with clear fluid and they can change in sized at different times. Sometimes, they may seem to disappear before reappearing. Because they are filled with clear liquid, many people describe them as looking as if a water balloon is trapped under the skin.

They do not spread to other parts of the body, although some people may have more than one ganglion cyst on their hands.

The Causes of the Cysts

There is no specific cause of a ganglion cyst and they can develop on anyone at any age. Some doctors do believe that injury to the joint or excess use and stress on the area may contribute to the development of the cysts.

The Symptoms

A ganglion cyst is usually fairly easy to diagnose by a hand doctor. Symptoms may include:

  • A round or oval rise or projection on the parts of the hand as mentioned.
  • The bump will have a clear quality, and a light beam will pass through it.
  • The lump may or may not be painful, and some people state that they only feel pain when the lump is bumped or hit on something.
  • A times, a ganglion cyst can be accompanied with a bone spur, especially if it occurs near the tip of the finger.

Many people experience no discomfort or pain from the cyst, so treatment usually isnt needed. However, if the cyst is causing problems, is limiting mobility, and is painful, then a combination of a splint and anti-inflammatory medication may be used. At times, the cyst may be aspirated with a needle. If all else fails, then surgery may be needed. During the surgery itself, the cyst will be removed and so will part of the joint capsule. While surgery is usually successful, there is still a chance that the cyst may come back over time.

A ganglion cyst is not just a bubble under the skin. It usually has something called a root that connects to the nearby joint. This is why they can, at times, interrupt usability of the finger or hand. However, in most cases, the cysts are left alone as they do not cause any problems whatsoever. Additionally, they have been known to disappear all on their own with the patient doing nothing at all. No matter the case, if you believe you have a ganglion cyst, it would be a good idea to see your physician. Together with your doctors help, you will be able to determine whether or not you should pursue treatment for the problem.

Resources:

http://www.emedicinehealth.com/ganglion_cyst/article_em.htm

Categories
General Hands

Injuries to the Extensor Tendon

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You have a number of important tendons throughout your hand. One of these is the extensor tendon, which is situated on the back of your hand and which allows you to straighten your fingers. The extensor tendons are all connected to muscles located in your arm and they extend all the way down the whole finger. Once in the finger, where space is smaller, the extensor tendons attach to smaller tendons that are, in turn, attached to small muscles. All of this works together to give you control over your fingers. At times, these tendons can become injured and can cause problems as well as pain.

Types of Extensor Tendon Injuries

Extensor tendons in your hand are very close to the surface of your skin. In fact, you can probably see them moving from time to time. Almost any injury to the back of the hand can do damage to the tendons, including:

  • Jamming your finger
  • Cutting the back of your hand
  • Bruising the back of your hand

Essentially, any injury can cause damage. Whenever the extensor tendon is injured, you may find it difficult to straighten your fingers properly. Tendon damage can be painful as well.

There are a few very common injuries to the extensor tendons, including the following:

  • Mallet Finger is a condition in which the extensor tendon is no longer connected to the bone in the finger, whether it was cut or torn away. When this happens, the fingertip will not be able to straighten. It happens most commonly through a cut or through jamming the finger and will require stitches to the tendon itself. Splinting will also be needed to ensure the finger stays straight.
  • Boutonniere deformities occur when the tendon is damaged at the middle joint of the finger, meaning the majority of the finger itself will not straighten out. If the tendon has been cut or torn, then it will need stitches. If it is just injured, then splinting will be used.
  • Cuts to the back of the hand can often sever one of the extensor tendons since they are so close to the skin. In this case, one or more fingers may not straighten. Splinting will need to extend from the wrist all the way down the injured finger.

Because the extensor tendons are so close to the surface, injury can happen very easily. It only takes a small amount of hand trauma to affect the tendons directly.

Treatment may change as well if there is other damage to the fingers, such as fractures or infections.

If you think you have an injury to an extensor tendon, then you will notice that you cannot straighten out one or more of your fingers. Additionally, if you have had damage or injury to the back of your hand, this will let you know the extensor tendons could be involved. You will need to see a doctor for treatment because a torn tendon will always require stitches. Additionally, you will need to learn how to properly splint your hand for healing.

Resources:

http://www.orthobullets.com/hand/6028/extensor-tendon-injuries

Categories
Conditions General

A Deeper Look at Rheumatoid Arthritis

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Most are familiar with the term “arthritis,” but many of us do not know that there is more than one form of this condition. Generally, it is meant to describe an inflamed joint (as that is what the word arthritis actually means), but there are a few different ways this can happen.

For example, there is osteoarthritis, there is arthritis that develops following an injury or trauma, and there is arthritis that can develop after an infection, due to gout, and from the skin condition known as psoriasis. There is also rheumatoid arthritis.

Though this does cause inflamed joints, rheumatoid arthritis is a systemic condition, meaning it can appear anywhere in the body – and even spread over time. In any sort of arthritis, the surfaces of the joint cease to move fluidly against one another. When it is rheumatoid arthritis, it can affect any of the bones in the hand, wrist and forearms. It will begin by attacking the synovial tissue, which is composed of cells that lubricate the joints. The synovium will be irritated, inflamed and swollen due to the condition, and this is going to quickly damage the bones and cartilage.

Though it is very common in the hands, it can happen anywhere, and is often found on both sides of the body. In the hands, it will cause the connective tissues between the bones to swell and stretch. This leads to deformity, but so too does inflammation that appears in tendons holding muscles to bones.

Recognizing Rheumatoid Arthritis

It is not difficult for a hand surgeon or expert to recognize the signs and symptoms of rheumatoid arthritis, and the sooner you begin addressing the condition the better your chances at managing it and maintaining range of motion in the hands.

Will you recognize the condition? Firstly, it tends to strike the knuckles of the fingers and the wrist area. It manifests as swelling and stiffness, but can also present some pain. The fingers will often swell, though not uniformly, and one finger may be far more swollen than others. (WebMD, 2015)

You might also notice that individual fingers are suffering some deformity. There are two ways this appears: as a Boutoniere deformity that forces the middle joint of the finger upward or the sway-back deformity that forces the middle joint into a bent position that forces the fingertip downward.

There will sometimes be a noticeable sound during movement, a “drifting” of the fingers in a direction away from the thumb, development of carpal tunnel syndrome (in which inflammation of tendons causes numbness when fingers are bent), tendon rupture, weakness or instability in joints, and a lump at the back of the hand that seems to move when you use the tendons of the hand.

Diagnosis and Treatment

Clearly, that is a long list of symptoms, and few patients can identify all of the signs. The first thing to do when you notice pain or swelling in the hands, or even one joint of the hand, is to visit your hand doctor. They can perform a thorough assessment and even order x-rays and/or blood tests to determine exactly what is going on.

Once a diagnosis of rheumatoid arthritis is made, the emphasis of the treatment is on retaining or restoring function while reducing pain. Medications and therapies are available, but the first, and most important step is the diagnosis and work with your hand doctor.

Source

WebMD.com. Rheumatoid arthritis. 2015. http://www.webmd.com/rheumatoid-arthritis/guide/rheumatoid-athritis-symptoms-types

Categories
Conditions General Hands

Dealing with Psoriatic Arthritis of the Hand

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A lot of people know about osteoarthritis and rheumatoid arthritis, but not many realize that you can develop arthritis from the skin condition known as psoriasis. Psoriatic arthritis of the hand is somewhat rare, with around five to twenty percent of people with psoriasis developing arthritis related to it. However, it is common enough that it is very useful for anyone with psoriasis to learn about it, and its symptoms.

What Happens When You Have Psoriatic Arthritis?

If you have psoriasis, you are well aware of its appearance. Your skin takes on a very dry and scaly look, and it can often appear as if you have rashes in many areas of the body. The condition does tend to cause prolonged or even constant irritation to the skin, and it is this sort of irritation that eventually leads to the development of arthritis in the underlying bones and cartilage.

Because arthritis, which means “inflamed joint”, is something that can be due to chronic inflammation, it makes sense that psoriasis might eventually cause problems in the hands and wrists, where it is so prevalent. It does many of the same things that other forms of arthritis do when it does appear in the hands, and will lead to swelling, deformity of the joints, and a lack of stability in the wrist. The swelling of this condition, though, is more pronounced than any other form of arthritis (MayoClinic, 2015).

This is all due to the fact that the psoriatic arthritis is actually causing the lining of the joints to swell and to then degrade and allow bones to erode and rub against one another.

Many patients with psoriatic arthritis display many similar symptoms as those with rheumatoid arthritis. Their hands will appear swollen and with a red discoloration. They can be warm to the touch and will often have difficulty with stiffness and movement. However, unlike rheumatoid arthritis, psoriatic arthritis is usually asymmetrical (meaning it may appear on one hand and not the other), it causes skin lesions, and it tends to strike the PIP and DIP joint (the middle and end joints), rather than the middle joints or the wrist areas.

Diagnosing and Treating Psoriatic Arthritis

You must visit a hand doctor if you suspect that your psoriasis has now caused you to develop arthritis, especially if others in your family already have this condition. The physician will do a thorough history and exam. They may order a few tests and X-rays to determine if you do have the condition.

Should you be diagnosed with it, your doctor is going to focus on pain relief, alleviation of the swelling and inflammation, and function as the goals of treatment. This means you will work with more than just the hand doctor and may find yourself working with a therapist as well as other specialists. Medications and ongoing therapies are usually the most conservative treatments, and a hand doctor is likely to refrain from surgery until it is absolutely necessary. This is because it is a progressive issue, and surgery may be used as an intervention rather than an initial treatment of symptoms.

Dont hesitate to contact your doctor simply because the sooner you begin your treatment, the better the outcome.

Source

MayoClinic. Psoriatic arthritis: Symptoms. 2015. http://www.mayoclinic.org/diseases-conditions/psoriatic-arthritis/basics/symptoms/con-20015006

Categories
Conditions General

Dealing With Olecranon Bursitis

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You may have heard of a condition known as tennis elbow, but did you know that there is one called “students elbow”? (Patient.co.uk, 2015) Also known as olecranon bursitis, it is when the small sac of fluid, known as a bursa, that covers the elbow becomes irritated and fills with fluid.

The bursa over the elbow is in place to allow the skin to move easily over the joint. When in a healthy condition it is flat and unnoticeable, but when it fills with fluid it becomes extremely noticeable and can be uncomfortable. Interestingly enough, not all instances of olecranon bursitis cause pain or discomfort at all.

Why Did I Get This Condition?

What is the cause for this unusual swelling at the elbow? Generally, it is caused when the area is irritated. This can mean that a hard blow to the elbow occurred and the sac has filled with fluid due to that injury, but it gets the name “students elbow” because it also commonly occurs in those who lean heavily on their elbows for long periods of time – as in the way that many students put elbows on their desks while listening to teachers or studying.

Of course, students arent the only ones prone to leaning overly long and heavily on their elbows. Telephone operators, long distance drivers, exercise instructors and people in gyms, computer workers, and many people with “desk jobs” may find themselves putting their elbows on hard surfaces and applying too much weight or pressure.

Additional causes include certain diseases such as rheumatoid arthritis, or conditions like gout. Medical treatments like dialysis have been known to trigger olecranon bursitis, and infection is also a common cause – such as a cut to the elbow. Finally, there are also idiopathic cases where no cause can be uncovered.

Generally, it is the swelling that allows someone to discover they have the condition, and though mild swelling may be present there are also many cases in which the swelling can reach the size of a small golf ball.

Treating Students Elbow

Diagnosing the condition is straightforward, though a thorough medical history is taken to be sure it is not related to one of the diseases that olecranon bursitis is commonly related to. Should disease be present, this first must be managed before treatment for the swelling is done.

Generally, the most common course of action is to refrain from any further leaning or pressure on the joint. In some cases a “resting splint” is used to prevent further irritation, and compression may also be used to help alleviate fluid accumulation.

Should the swelling be too substantial, a physician may decide to remove fluid through an aspiration technique. This is commonly an in-office procedure that is followed up by antibiotics to prevent or remedy an infection. Should the condition prove difficult to manage or overcome, there are surgical and medical options such as cortisone injections and ongoing aspiration.

The key is to not ignore olecranon bursitis. It may seem like a harmless bit of swelling, but it should not be ignored. Your hand surgeon or specialist can help you deal with the condition and prevent it from becoming a problem.

Source

Patient.co.uk. Olecranon Bursitis (Students Elbow). 2015. http://www.patient.co.uk/health/olecranon-bursitis-students-elbow

Categories
General Treatments

A Look at Tendon Transfer Surgery

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In a report on hand tendon transfers, a group of physicians explained how this amazing treatment can be used to, “Create major improvement in the function of the extremity”, and that it was able to restore function in a new location. (Baumeister, et al, 2015).

Obviously, this makes tendon transfer surgery sound somewhat miraculous, and to those who need it and receive it, it truly can be. It is a surgical procedure in which a functional section of tendon is moved from its normal, natural position and attached to a new location in order to help restore function to that particular area.

It is as complex as it sounds and yet hand surgeons rely upon it for a long list of patients:

  • Babies born without specific muscle functions can benefit from tendon transfer surgeries.
  • Patients with nerve injury may benefit from the ability to use muscles disabled by the damaged nerves.
  • Muscles that have been lacerated or ruptured (and which are beyond repair) can benefit from the procedure.
  • Tendons damaged beyond repair can be replaced with a transfer.
  • Patients with nervous system disorders may lose muscle function, and yet tendon transfers may help them to regain some use of certain hand functions. This includes patients with traumatic brain injuries and stroke.

Clearly, this is a very useful procedure that can be a far more amenable option than many alternatives. For instance, the tendon transfer surgery can easily be used instead of surgery attempting to repair a nerve or muscle.

How a Tendon Transfer Surgery Works

It is difficult to summarize such a complex procedure, but to keep it a simple as possible: when a hand surgeon is going to use a tendon transfer, they begin by altering the point of contact between the tendon and the bone on which it originally resided. In its natural place, the tendon would always connect to a group of muscles that are, in turn, connected to their point of origin. In tendon transfer, the muscles are left alone, and it is the end point or terminus of the tendon that is altered.

The new connection point is chosen in order to create a very specific outcome. This is because the tendon can be attached to a different bone or tendon. This will allow the muscles to “fire” as normal, but their functions will now produce a different action or outcome.

This is why some stroke patients who have limited movement in the hands can have the most important functions, the pinching function, restored through a tendon transfer. This allows whatever muscle and nerve function remains to provide the pincer fingers with the ability to grip and move at will.

Your hand doctor will be able to determine if a tendon transfer is the best surgical solution for your needs. You will need to heal for a period of two months or more, get therapy to ensure the hand functions properly, and follow a rigid course of rehabilitation to get the best outcomes. However, the prognosis for most patients is usually good, and this procedure can provide you with a return of function that may have been lost.

Source

Baumeister, Steffen, et al. Hand Tendon Transfers. 2015. http://emedicine.medscape.com/article/1286712-overview

Categories
General

How Your Hands Reveal Systemic Diseases

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Whenever you see a thorough description of any systemic disease, which is, “One that affects a number of organs and tissues, or affects the body as a whole,” it will usually list a lot of the key indicators for diagnosing the disease in question. For example, we may read that disease of the liver can cause issues in the skin and the fingernails. This is often a surprising “symptom,” and yet many problems manifest in the hands.

Because our hands include so many different types of tissue – skin, nerves, bones, blood vessels, tendons, and ligaments among them, it is actually not a surprise that so many systemic diseases reveal themselves in the hands. Just consider the following issues and how they can begin to help a medical expert diagnose a deeper or broader condition:

Buergers disease – A disease that impacts the small arteries, it can often cut off the blood supply to the fingers. This can result in ulcerations, as well as gangrene.

Clubbed nails – Some endocrine diseases as well as heart and lung conditions can cause the fingernails to take on an uneven and clubbed growth pattern.

Diabetes – Because this is a disease of the endocrine system, it often has an impact on the ligaments and tendons of the body. The condition known as trigger finger locks the finger into a curved position (with the tip pointing towards the palm), and causes substantial pain and discomfort. It is often a key indicator that the individual also has diabetes.

Gout – We most commonly think of gout as something that manifests in the foot, particularly the “big toe,” but this condition can affect any digit. In the hands, the condition reveals itself in several ways, and may cause the skin to thin and drain, taking on an infected look. It can cause bone changes, and most often presents as “pincer nail”, which leads to an ingrown nail and nail deformity.

Kidney and liver diseases – The skin and nails are affected by many kinds of kidney or liver diseases, and one common issue is known as Terrys Nails in which the area under the nail loses its healthy pink coloration and becomes milky white.

Raynauds disease – Also called a phenomenon, this is a condition in which arteries in the fingers spasm, preventing blood flow and leading to a bluish discoloration of the fingertips. This is a problem for those with lupus and scleroderma, but is also related to rheumatoid arthritis as well. If left untreated, it can lead to ulcerations and further health problems.

Rheumatoid arthritis – Usually, the first signs of rheumatoid arthritis appear in the fingers and hands. Though this is a whole body condition that destroys the tendons, joints, and ligaments, it seems to always manifest strongly in the hands. It can cause tendon rupture and loss of mobility, and is a good indicator that arthritis is developing.

Clearly, there are many signs and symptoms that you can receive through your hands and fingers. Dont ignore any new problems with the hands, and if you notice something very unusual, do not hesitate to visit your hand specialist for an assessment of what is going on.

Source

Wikipedia. Systemic disease. 2015. http://en.wikipedia.org/wiki/Systemic_disease

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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.