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XIAFLEX for Non-Surgical Dupuytren’s Contracture Treatment

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Dupuytren’s contracture treatment

Dupuytren’s contracture is a disease that primarily affects men of North European descent. The primary symptom of the disease is a deformity of the hands that gets worse over the years. The condition damages the tissue that is right under the skin in the palm. The palm develops a knot of tissue that eventually becomes a thick cord. The thick cord eventually exerts pressure on a couple of fingers in the hand, leaving them in a permanently bent position.

Since the affected individual cannot straighten their hands, easy activities start to become a challenge to perform. For example, trying to put your hands in your pockets becomes impossible because you cannot straighten out all of your fingers. The same is true with wearing gloves or trying to shake another person’s hand.

While the disease can affect any of your fingers, it is more commonly seen in the ring finger and the pinky. While there is no cure for the disease, there are some treatments that are designed to slow down how quickly the disease progresses or relax some of the contractions in the hand. At Arora Hand Surgery, we may use XIAFLEX, an injectable enzyme, as part of a non-surgical Dupuytren’s contracture treatment regimen.

Causes and Symptoms of Dupuytren’s Contracture

Scientists are still mystified as to the exact cause of Dupuytren’s contracture. They have seen a link between individuals who have certain forms of diabetes, epilepsy, alcoholism and seizure disorders.

Dupuytren’s contracture is a hereditary disease. It is most often seen in men who are over the age of 50. The disease may affect both hands at the same time or just affect one hand. It is very rare that an individual suffering from this disease experiences pain. Most patients only report pain if they attempt to forcibly hyperextend their fingers.

While this disease primarily affects a person’s hands, researchers have seen it affect the soles of the feet as well. Doctors are able to diagnose the disease during a visual examination of the affected hand. Usually, other tests such as X-rays are not needed. At times, injuries to the hands, such as burns or other injuries that cause scar formation, might mimic Dupuytren’s contracture.

XIAFLEX: An Exciting Dupuytren’s Contracture Treatment Option

XIAFLEX is a relatively new treatment option for Dupuytren’s contracture. It works by breaking up the collagen-based scar tissue that forms in the hands, causing them to bend in an awkward position. As collagen formations break up, they become loose and the contracted tissue is able to return to normal mobility.

XIAFLEX is delivered via injection. Most patients are able to grasp objects, flex their fingers and have improved dexterity in their hands after a series of these injections.

This enzyme injection has been a lifesaver for many patients. This is because there is nothing that can be done to prevent Dupuytren’s contracture from developing. Since the disease develops slowly, treatment, especially treatment that begins early, generally works well.

With the proper Dupuytren’s contracture treatment, most patients are able to improve their quality of life drastically. During a consultation at Arora Hand Surgery in Macomb, Warren, Howell, or West Bloomfield, you can learn more about your treatment options for your condition. Contact us today to schedule an appointment!

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Conditions General

Gout vs. Pseudogout: What is the Difference?

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There are a number of differenes in gout vs. pseudogout.

Both gout and pseudogout are types of arthritis characterized by inflammation of a joint. Both are caused by an abnormal accumulation of crystals in a joint. Despite the similarities, there are important differences in gout vs. pseudogout.

Different Chemicals and Crystals

Gout is caused by an abnormal buildup of urate or uric acid. A certain amount of urate within the body is normal, and the excretory system expels any excess naturally. In a person with gout, the excretory system doesn’t expel enough urate, and it accumulates within the patient’s blood stream. As it accumulates, the urate forms crystals that typically gather in a joint and irritate and inflame it.

In pseudogout, the crystals are made of calcium pyrophosphate (CPP). The crystals form in the cartilage and eventually leak into the joint fluid. At this point, they cause a painful attack of arthritis. Researchers have not yet determined the cause of the abnormal buildup of CPP crystals, but they have noted that it tends to happen after an illness or injury involving the affected joint.

Gout vs. Pseudogout: Different Risk Factors

Various conditions can increase the risk of developing gout. As per the stereotype, obesity is one such risk factor, especially if the patient is also male and at least middle-aged. Gout is more common in men. Younger people can develop the condition, especially if it runs in their family. African Americans are more likely to develop it than are Caucasians. Health problems linked to gout include diabetes, high blood pressure, bone marrow disorders, some blood disorders and severe psoriasis. Diuretics and other medications that increase uric acid levels can also cause gout.

Gout has also been linked to certain habits. For example, drinking a lot of alcohol increases the chances of developing the condition. People who don’t get enough Vitamin C in their diet or drink too many sugary drinks are also more likely to develop it.

A susceptibility to pseudogout may run in families. Like gout, it is much more common in older people; most patients are at least 60 years old. Pseudogout is commonly seen in people who also have osteoarthritis, thyroid trouble and various disorders affecting the metabolism of iron, calcium or phosphate. Kidney problems increase the risk of developing both conditions. Unlike gout, neither gender nor ethnicity seems to affect susceptibility to pseudogout.

Different Joints are Usually Affected

On paper, gout can affect any joint, but about half of all cases involve the big toe. In many of the other cases, the wrist, fingers or heel are affected. Pseudogout most commonly involves the knee. Other common sites are the wrist, shoulder, hip or ankle.

What About Prevention?

So far, researchers have not found any links between pseudogout and a patient’s habits. For example, while there is a link between gout and obesity, no such link has been found for pseudogout and obesity.

A patient with gout might be able to prevent further attacks by cultivating healthy habits. If they drink, they should at least reduce their alcohol intake. If they are overweight, they should follow an exercise and diet regimen to lose weight.

Get All the Facts

If you are experiencing symptoms of either of these two conditions, make an appointment at Arora Hand Surgery to see how your situation can be addressed. You don’t have to live with your painful condition. Contact us today to schedule a consultation at our office in Macomb Township, West Bloomfield, Howell, or Warren.

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Conditions General Hands

What is Kienbock’s Disease?

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What is Kienbock's disease, and how is it treated? A basic overview is provided in our hand surgery blog.

What is Kienbock’s disease, and how is it treated? Those are the first questions patients may ask upon hearing this phrase.

Following are some of the basic facts about this hand condition.

What is Kienbock’s Disease, and What Causes It?

Also known as avascular necrosis of the lunate, Kienbock’s disease is a condition in which the blood supply feeding the lunate is somehow blocked. The lunate, which is one of the eight bones in the wrist, eventually dies and collapses. The condition, which usually involves only one wrist, is most common in young men.

Kienbock’s disease has multiple causes. It can be caused by such congenital defects like an abnormally short ulna. The radius and ulna are both forearm bones, and they share the force transferred from the hand to the forearm when the person grips something. An abnormally short ulna puts all of the pressure on the radius. The lunate, which is between the radius and the capitate bone, ends up absorbing excess pressure.

The disease can also be caused by injuries to the wrist, be they a single acute injury or chronic repetitive injuries that damage the blood vessels. Diseases that affect the blood vessels like sickle cell anemia can also cause Kienbock’s disease.

What are the Symptoms?

The chief symptoms of Kienbock’s disease are wrist pain coupled with limited mobility. The patient may also have trouble gripping items. During the early stages, the patient may feel only pain during or after actually using their wrist. As the disease progresses, the pain becomes constant.

A patient with this disease may also develop swelling in the wrist. The area around the lunate, the lower palm below the little and ring fingers, may become tender. The patient may also develop arthritis, but that symptom is associated with late-stage Kienbock’s disease, which takes years to develop.

How is the Disease Diagnosed?

During the early stages, the disease can be difficult to diagnose. Dr. Arora will likely begin by taking a medical history and examining the wrist. He will also order X-rays and MRIs. The X-rays can be used to determine how badly the lunate has deteriorated, while the MRI can be used to determine the damage to the blood vessels feeding the lunate. If necessary, the doctor may also order a CT scan of the bones.

What are the Treatments for Kienbock’s Disease?

There are several treatments for Kienbock’s disease. As the disease has several stages, the treatments vary accordingly. If our team catches the condition early, the wrist can be immobilized. This treatment is intended to let the damaged blood vessels and lunate heal on their own.

If the immobilization proves unsuccessful, or the patient has late-stage Kienbock’s disease, our doctor will recommend surgery. He may also recommend surgery if the Kienbock’s is caused by a birth defect, like an abnormally short ulna. In that situation, Dr. Arora can lengthen the ulna, shorten the radius or fuse certain bones so that the two bones meet the wrist bones above them properly.

The types of surgical procedures used will depend on how advanced the disease is. Wrist fusion, for example, is a procedure typically used for very late-stage Kienbock’s characterized by a wholly arthritic wrist.

Schedule a consultation at Arora Hand Surgery in West Bloomfield, Howell, Warren, or Macomb to have your condition evaluated and to learn more about what Kienbock’s disease is. Contact us today to book your appointment and get started with a treatment plan that can bring you relief.

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Conditions General

What Causes Carpal Tunnel Syndrome?

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carpal tunnel syndrome

Surrounded by bones and ligaments, the carpel tunnel is the narrow space located on the palm side of your wrist. The main nerve and tendons that control the movement of your hand and fingers run through this tunnel. Affecting one or both hands, carpal tunnel syndrome causes pain and burning sensations that travel up your arm from the wrist. The symptoms typically affect the thumb, index finger and middle finger.

Women are more likely to be diagnosed with this condition, which is often more troublesome at night. The symptoms typically present themselves between the ages of 30 and 60. A number of factors can cause a pinched median nerve in your wrist.

Running from your forearm, the median nerve provides the sense of touch for your thumb and first three fingers. The numbness and tingling symptoms of carpel tunnel syndrome occur when the nerve is compressed. Chronic inflammation associated with an underlying medical condition is the most common reason for the swelling and compression.

Ailments typically related to the condition include diabetes, thyroid dysfunction and autoimmune diseases like rheumatoid arthritis. High blood pressure and fluid retention associated with pregnancy or menopause can also cause inflammation in your wrist. Fractures or other trauma can cause carpal tunnel syndrome as well. Detrimental lifestyle choices like smoking, an increased body mass index and a high salt intake may increase the risk for developing carpal tunnel syndrome.

Repeated motions of your wrist can contribute to inflammation and swelling. Regularly overextending your wrist can make the symptoms worse. This type of physical stress occurs in occupations like assembly line work, construction and professions requiring constant keyboarding.

If you are experiencing the symptoms of carpal tunnel syndrome, schedule an appointment at Arora Hand Surgery so that a comprehensive assessment can be conducted. Treatment options will depend on the severity of your condition. Typically, the earlier the syndrome is diagnosed and treated, the more favorable the outcome.

During a consultation at our office in West Bloomfield, Howell, Warren, or Macomb, our team may also provide information on helpful lifestyle changes. These measures can reduce the risk of developing carpal tunnel syndrome in the future or provide significant long-term improvement or elimination of symptoms if you are already afflicted with the disorder.

You do not have to live with the debilitating effects of carpal tunnel syndrome. With the right treatment options and lifestyle changes, you can experience a significant improvement in your quality of life with help from Avery Arora, MD and his team at Arora Hand Surgery. Contact us today to book your appointment.

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Conditions General

What is Dupuytren’s Contracture?

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What is Dupuytren’s Contracture?

Dupuytren’s Contracture is a rare type of hand disorder that tends to take a number of years to develop. It causes the layers of tissues that lay beneath the skin on the palm of the hand to begin to form knots. These knots thicken and can actually cause one or more of the fingers to bend. Once they are bent into this position, it will no longer be possible to straighten them. Since it is impossible to bend the fingers, it will make it difficult to do many normal activities and actions. You would not even be capable of putting on a pair of gloves. Eventually, it will become difficult to grasp large objects.

In most cases, only the ring finger and the pinky will be affected. In very rare cases, it can also affect the thumb and the index finger. The contracture tends to affect older men who have a Northern European heritage.

What Are the Causes?

Currently, the cause of Dupuytren’s Contracture is unknown. Researchers have not been able to find any evidence that it is related to hand injuries or any occupations that could cause repetitive stress issues or injuries due to vibration. However, they have found a number of factors that can increase the risk of developing the condition.

Men, as mentioned are the most likely to develop the contracture, and it typically affects those who are 50 and over. The condition also tends to run in families. Those who have diabetes are also at an elevated risk. In addition, smoking can increase the risk of developing Dupuytren’s Contracture, as can alcohol.

What Are the Treatments?

Doctors can help to treat the condition in a number of different ways. They may use a needle technique, in which the doctor will insert a needle into the affected area to break up the hardened tissues that is causing the finger to contract. They may also utilize enzyme injections. Those who have advanced stages of the disease can also have surgery to help remove the hardened tissue.

If you suffer from Dupuytren’s Contracture, speak with a doctor about your condition to find the best treatment options.

Talking With a Doctor

Chances are good that you will want to speak with a specialist about this condition. Your primary care physician can refer you to a specialist, who will want to know more about your medical history and how you have been dealing with the condition. For example, they want to know whether there is a history of Dupuytren’s Contracture in your family, if you’ve tried any treatments, and what medications you are taking.

The doctor will also want to know when the symptoms first started. Since this condition comes on slowly, it can be difficult to pinpoint when it began. Let them know if you are in pain, if the condition has been getting worse, and how it currently affects your daily life.

Most of the time, your doctor will be able to diagnose you based on examining your hands. The signs of Dupuytren’s Contracture are very obvious.

If you have any specific questions, contact us at our hand and wrist surgery offices in West Bloomfield, Howell, Warren, or Macomb or click here to request an appointment with Dr. Arora.

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Conditions General

Syndactyly Causes and Treatment

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Everyone has a little web of flesh between their thumb and their forefinger. If there are fleshy webs between your fingers as well, though, you may have a condition known as syndactyly.

What Is Syndactyly?

Simply stated, syndactyly is a condition in which adjacent fingers have grown together and appear webbed. If the fingers are completely joined, the condition is known as “complete syndactyly.” If only part of the fingers are involved, this is “incomplete syndactyly.” If both the flesh and the skin are involved, the condition is referred to as “simple syndactyly,” although sufferers would probably argue that there is nothing simple about it. Complete syndactyly is a joining of the bones. Fingers may also be joined at the tips, but have separate bones. This is complete simple syndactyly.

Causes

Syndactyly is a birth defect. The condition is sometimes genetic, passed down from one generation to the next. Other times, it occurs for no apparent reason. What is known, though, is that syndactyly has nothing to do with anything the mother may have done or neglected to do throughout her pregnancy. There is no need for a mother to feel guilty if her child is born with syndactyly.

Treatment

If it appears that syndactyly may interfere with function, it can be surgically corrected. Otherwise, parents can make the decision based on aesthetics. Most cases of syndactyly actually will not impair function. If surgery is done, though, therapy will be required post-surgery. Usually this involves wearing spacers between the fingers while the child is sleeping, in order to prevent the fingers from growing together again. The hand will also need to be bandaged for some time – perhaps even months. There may also be a need for follow-up surgery in years to come.

Success of Treatment

The goal of the surgery for syndactyly is to improve appearance, and also prevent the deformity from progressing. Usually, this is successful, although the appearance of the hand may not be completely what we would consider to be “normal.” It is important to remember that unless the appearance of the hand is extremely abnormal, what most people notice about the hand is not how it looks, but how it works. As long as a person is using their hand in a natural manner, deformities will usually be overlooked by the casual observer.

Refusing Treatment

If you have a child who has syndactyly, treatment is generally optional. Syndactyly does not usually present a health risk unless the fingers are joined toward the tips – in that case, they will bend in undesirable directions over the course of time. In such situations, surgery should be performed in the early years so the child can adapt to the changes in his or her hand. If delayed beyond the early childhood years, the results of syndactyly surgery are usually less than satisfactory.

If the condition is likely to result only in aesthetic issues, then surgery can be foregone without fear of complications down the road.

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Conditions General

A Look at Gamer’s Thumb – Arora Hand Surgery

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Video games are designed for human beings, but human beings are not designed to play video games. Our hands are simply not constructed to manipulate game controllers for hours on end. Most video game controllers require the thumbs to take the brunt of the activity, and that often leads to a condition known, appropriately enough, as Gamers Thumb. This is a type of repetitive stress injury affecting not only the thumb, but the wrist as well.

Symptoms

People afflicted with Gamers thumb will often notice that they dont have the strength in their hands that they once did, or the range of motion. They may also notice a popping sound, or a feeling of snapping, on the outer part of the thumb where it joins the wrist.

The Mechanics

The thumb is designed to move inward toward the wrist, and its overall anatomy makes this possible. This action, the movement of opposable thumbs, is what distinguishes us from animals, enabling us to pick up objects and use tools. The thumb is made to grip, but not to complete complex motions that can put stress on the joint as wells as the tendons and muscles that are attached to it. When non-gripping movements are performed over and over, inflammation in the tendons and in the tenosynovium (a membrane that helps the tendons to slide through the wrist) can occur. The ability to grip is then reduced, and swelling can occur in the thumb, the wrist, and even the forearm. This, at its essence, is Gamers Thumb.

The Pain

Usually, Gamers Thumb pain occurs when the wrist is flexed, or when the sufferer grabs something or makes a fist. It occurs in gamers who play for long periods of time, usually every day. If left untreated, the inflammation can worsen, and the synovial sheaths that protect the tendons can thicken and even deteriorate. In the long term, this can lead to a loss of range of motion, loss of strength, and even permanent damage accompanied by constant pain. Not only will you have trouble performing ordinary activities, your gaming career is going to be over.

Treatment

If Gamers Thumb has not progressed significantly, it can be treated. Treatment is much the same as for other injuries to the hand and wrist. Most importantly, you need to rest, so whether your passion is Minecraft, Call of Duty, vintage games like Super Mario and Tetris, or maybe just Facebook games like Candy Crush or Bejeweled Blitz, you need to take a bit of time out. Watch a movie, read a book, go for a walk – whatever gets you away from your games.

You can get relief from the pain by applying cold packs to your hand and wrist, and taking over-the-counter pain remedies. Keeping your hand elevated can also ease the discomfort.

Keep in mind that if you have noticeable symptoms, you cant “scale back.” You have to stop for a while. But if you do, youll be back at your gaming console soon, none the worse for the wear.

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Conditions General Treatments

Signs, Symptoms, and Treatment for Arthritis Sufferers

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One of the most common afflictions among people in the United States is arthritis. There are more than 100 different types of arthritis, and while many of them have the same types of signs and symptoms, there are some differences that are important to note.

Osteoarthritis

Symptoms can include pain in the joints. Sufferers can feel pain in the joint during movement as well as after movement. The affected area may also be tender to the touch, even if there is only a minimal amount of pressure applied to the joint. Many sufferers also complain that they feel stiff when they wake up in the morning. They also lose a substantial amount of flexibility in their hands (and other joints). The joint could also develop bone spurs. This occurs due to the wearing away of the cartilage at the end of the joints.

This type of arthritis can affect many people, and there are a variety of different risk factors that come into play. Those who are older are at risk, as the cartilage in the joints tends to wear down with age. Women are more likely to develop osteoarthritis than men. Those who have suffered from joint injuries in the past could be at a higher risk as well. In addition, workplace factors (jobs that have repetitive motions), genetics, and other diseases can increase the risk of developing osteoarthritis.

Rheumatoid Arthritis

RA is another common type of arthritis, and this can be more dangerous than other forms of arthritis as it can affect the organs in the body. It can be difficult to detect RA, but there are some symptoms to consider. Those who have RA tend to have injuries that will be difficult to heal. They may also feel a tingling or numb sensation in their hands. This can sound similar to carpal tunnel. RA can also cause eye problems, foot problems, and aching joints. If you go to the doctor, make sure you tell him or her about all of your symptoms so you receive a proper diagnosis.

What Treatments Are Available?

Fortunately, there are a number of ways to treat arthritis today. Doctors may recommend some lifestyle changes for a start. They may want you to stop smoking and to get more exercise, which can promote feeling better in general. They may also offer pain medications, or suggest over the counter medications to help with the pain. Physical therapy can help as well. However, you want to make sure that you receive your exercises from an actual physical therapist so you can be sure you arent doing anything that could aggravate your arthritis further.

In some cases, the doctor may feel that surgery is the best option for you. You can discuss the surgical choices available. They may want to fuse the joints, which can help to relieve pain, clear out some of the inflamed areas, or even replace the joints.

Whenever you are suffering from any type of injury to the hand, whether it is arthritis or something else entirely, please call or visit our hand doctor’s office in Howell, Warren, West Bloomfield, or Macomb to get in touch with a medical professional. You need to have a proper diagnosis if you are expected to heal.

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Conditions General

When Should I Contact My Doctor About Arthritis Pain?

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If you have pain and stiffness in your joints, it could be a sign that you are developing arthritis. Waiting too long to get any type of treatment could mean that the joint damage is permanent, and it could be very difficult to correct, even with surgery. While you may not feel you need to see a doctor yet, there are certain “telltale signs” that it is time to get help from a professional. Lets look at some of the reasons that you should get in touch with a doctor.

What Should You Watch For?

If you only have some pain and stiffness in one of your joints, and you havent had issues with your joints in the past, it might not be arthritis. You may simply need to rest and take it easy for a while. However, when you notice that the pain, stiffness, and the swelling are affecting more than one joint, it could be a sign that you are developing arthritis. Its a good idea to get in touch with the doctor at this point, as catching and treating the problem early is the best option.

If you notice that the joints are red and warm when you touch them, it is another potential sign of arthritis. Those who start to notice that it is more difficult to do all of their normal daily activities because they are having issues with their joints will want to contact their doctor.

When the symptoms last for three days or longer without dissipating, and when you have more than one or two arthritic episodes over the course of a month, you need to talk with a doctor as soon as you can.

Ultimately, you dont have to wait to see a doctor, even if the symptoms seem mild. Its better to talk with the doctor and learn more about whats happening to your body as early as possible. Whenever you have any doubt or concern, make an appointment.

Understand Your Type of Arthritis

More than 100 different types of arthritis exist. While they may share some similarities in their signs and symptoms, they are different and may require different approaches to treatment. A specialist will let you know whether you are suffering from rheumatoid arthritis, osteoarthritis, or any other type of arthritis. The will also be able to discuss your different treatment options so you can start to find ways to relieve your pain and stiffness.

In the beginning, they will likely want to try different types of nonsurgical treatments to see whether they help. If the pain is infrequent and mild, for example, some lifestyle changes and pain medication might be all you need. However, surgery is an option for some patients.

When it comes to arthritis, you might start out going to your primary physician, but you will eventually want to work with a specialist who can provide you with more detailed information about your condition and what you need to do to limit or eliminate the pain and stiffness.

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Stories

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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.