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Conditions General Hands

Dupuytren’s Contracture: What You Should Know

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Dupuytrens 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 Dupuytrens 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 Dupuytrens Contracture, as can alcohol.

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 Dupuytrens Contracture in your family, if youve 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, the doctors will be able to diagnose you based on examining your hands. The signs of Dupuytrens Contracture are very obvious.

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 Dupuytrens Contracture, speak with a doctor about your condition to find the best treatment options.

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Conditions General

Understanding Dupuytren’s Contracture

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If you feel a tightening in your hands, or if from time to time your hands cramp up for no apparent reason, the cause could be Dupuytren contracture. This is a tightening in the fascia of your hands. Fascia are fibrous tissues that are located inside the palms of your hands, and progressive tightening can eventually result in difficulty using the hand along with an unsightly, claw-like appearance as your fingers begin to curl inward.

Diagnosing Dupuytren Contracture

As you might expect, diagnosis of Dupuytren contracture is done by examining the hand. During the examination, the doctor will usually find a tender nodule in the neighborhood of the third or fourth finger, in the palm. Initially, this nodule may cause pain, but eventually it will go away as the fingers begin to curl inward.

In order to effectively confirm or rule out Dupuytren contracture, your doctor will also take a complete history to determine if there is anything in your medical background that could be connected with the condition. If you consume excessive amounts of alcohol, or if you have diabetes or epilepsy, you are at a higher risk for Dupuytren contracture, although these are simply factors that seem to go hand in hand with Dupuytren contracture – the actual causes of the condition are not known.

What is known is that the condition appears to be hereditary, is more common in men than in women, and usually appears after the age of 45. There also appears to be a genetic component, but having the genetic makeup that is present in Dupuytren contracture sufferers does not necessarily mean that you will develop the condition. Approximately 5% of Americans have Dupuytren contracture. In about half of cases, both hands are affected. Interestingly, when the disorder affects only one hand, it is twice as likely to be the right hand.

Treating Dupuytren Contracture

If the condition is identified before the fingers start to curl inward, injection of a corticosteroid can relieve the symptoms. It is important to note, though, that this will simply ease the symptoms – it will not halt the progression of the condition.

Occasionally, Dupuytren contracture will go away without treatment, but usually at some point surgery will be required. Even after surgery, hand function may be limited. This is because removing the diseased fascia is not an easy procedure – the fascia protects a multitude of blood vessels, nerves and tendons, so the hand surgeon has to err on the side of caution.

The Final Word

If you are experiencing any of the symptoms of Dupuytren contracture, it is important that you see a competent hand surgeon in order to determine if the cause is actually Dupuytren disorder or due to some other condition. Then you can work together to agree on a course of treatment, which could include corticosteroid injections, and which may or may not include surgery. Although Dupuytren contracture does sometimes simply go away without treatment, that is the exception, not the rule.

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Conditions General

What Is a Ganglion Cyst and Does It Require Surgery?

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A ganglion cyst is a lump that people will develop on their hands and wrists. They are noncancerous, but they are full of fluid, which can cause pain if they are pressing on a nerve. The size of the cysts can vary greatly. Some are actually quite small, while others can be an inch or slightly larger in size. In some instances, the location of the cyst can make it difficult to move the joint.

The exact cause of ganglion cysts is unknown, and they will often disappear on their own. However, that is not always the case. Sometimes, you will need to have surgical treatment, which we will discuss further below.

What Are the Symptoms?

Most of the time, the cysts are painless. As mentioned though, if they are located close to a nerve, and they press on the nerve, this can cause a substantial amount of pain. Even a small cyst can cause problems, such as numbness and weakness in the muscle. The size of the cyst can change as well, depending on how often you use that joint. When you use the joint more often, the cyst could increase in size.

Whether you experience pain or loss of motion or not, you will want to make sure to head to a doctor so they can provide you with a proper diagnosis. You want to make sure it is a ganglion cyst and not anything more serious. The doctor will also be able to recommend treatment. As mentioned, many times, the cyst will go away without any type of treatment. Many doctors will want to see what happens with the cyst before providing treatment, as it might be unneeded.

Types of Treatment

When the doctor does decide that they need to treat the cyst, they have several options. First, they will likely want the patient to immobilize their wrist. This can help the cyst to shrink. For those cysts that do not go away, the doctor could aspirate the cyst. This involves using a needle, inserting it into the cyst, and then draining the fluid. Some doctors will then inject the area with steroids, which should help to keep the cyst from coming back. However, there is still the possibility of the cyst recurring.

Of course, there is a chance that the other treatments will not work. In those cases, the doctor will determine whether surgery is a good and viable option. The ganglion cyst surgery will remove not only the cyst, but also the connecting stalk that is attached to the tendon or the joint. While this is a good option for many, there is always the chance that the cyst could still return.

If you have a ganglion cyst, or a lump that you believe may be a cyst, you will want to get in touch with a medical professional who can examine you. You can talk to a specialist who performs hand surgery to determine whether removal is your best option to help get rid of the cyst.

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Conditions General Hands

How to Deal With Skin Cancer of the Hand – Arora Hand Surgery

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Cancer is a condition that ranges widely and which can appear in almost any part of the body. It does occur on the extremities, including the hands and arms, and it is best treated quickly and by a qualified hand surgeon or expert.

Naturally, it may be difficult to recognize when skin cancer of the hand is present. Interestingly enough, it is the skin that is the organ most commonly affected by cancer, and on the hands the most common types of cancer to appear are:

  • Squamous cell carcinoma
  • Basal cell carcinoma
  • Melanoma

There are other rare forms of skin cancer of the hand, as well, and it takes a medical professional to perform any diagnosis. However, you can know if you are at greater risk for developing it. The following list of factors tend to apply:

  • Chronic sun exposure
  • Immune suppression
  • Fair or light complexion
  • Exposure to chemicals and/or radiation
  • If you have pre-malignant lesions in the past
  • Family tendency to melanoma
  • Genetic conditions relating to skin cancer

And while there are many online resources with photographs of various forms of skin cancer of the hand or upper extremity, the best way to get diagnosed is through a visit to a hand expert. Though there are some very clear indicators that can be used to visually identify potential carcinomas and melanomas (such as discolored nodules appearing on the skin, cutaneous horns forming in odd locations, and areas that wont heal), the expert opinion is the best.

Diagnosis and Treatment

You hand doctor will do a visual inspection and take a biopsy or sample of the tissue in question. This is sent to a lab that assesses it and determines if the tissue is indeed cancerous or pre-cancerous. In some cases a larger sample may be required to make a definitive diagnosis.

If cancer is present, the next step is often to examine the lymph nodes to be sure that the cancer has not metastasized (or expanded to another area of the body). This is done through biopsy or through a range of different scans, such as a CT scan.

When a full diagnosis and assessment is done, the most common treatment is removal of the tissue by a qualified hand surgeon. The traditional approach is to remove all of the tissue infected with cancer cells along with tissue at the edges of the cancerous region. A surgeon will also perform all essential repairs at the same time, such as grafting healthy skin over the excised area.

In certain types of cancer, removal is followed by radiation or chemotherapy to be sure that all cancerous tissue has been eradicated. And in extreme cases there can be a need for amputation, but this is, as indicated, an extreme.

If you suspect that you are at risk for developing skin cancer of the hand or upper extremity, or have noticed a long-lasting change in the skin of one part of the hand, do not hesitate to visit a surgeon. As the experts say, the best treatment for skin cancer of any kind is prevention (SkinCancer.org, 2015). If you suspect something wrong, your next best treatment is early detection and rapid action in the care of a hand surgeon.

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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, including rheumatoid arthritis. Generally, arthritis 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.

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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
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
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

Understanding Reflex Sympathetic Dystrophy and Your Hands

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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

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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.