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Conditions General

Understanding Dupuytren’s Disease – Arora Hand Surgery

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

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

The Symptoms

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

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

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

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

How Is It Treated

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

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

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

Resources:

http://www.mayoclinic.org/diseases-conditions/dupuytrens-contracture/basics/definition/con-20024378

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Conditions General

What to Know about Cubital Tunnel Syndrome

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

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

Causes of Cubital Tunnel Syndrome

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

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

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

The Symptoms of Cubital Tunnel Syndrome

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

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

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

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

Resources:

http://orthoinfo.aaos.org/topic.cfm?topic=a00069

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Conditions General

What is DeQuervain’s Syndrome?

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

The Causes of the Syndrome

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

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

Available Treatments

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

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

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

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

How Do I Know if I Have de Quervain Syndrome?

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

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

Resources:

http://www.mayoclinic.org/diseases-conditions/de-quervains-tenosynovitis/basics/definition/con-20027238

Categories
Conditions General Wrists

Understanding Carpal Tunnel Syndrome

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

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

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

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

The Symptoms

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

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

Treatment of Carpal Tunnel Syndrome

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

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

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

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

Resources:

http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm

Categories
Conditions General

Understanding Complex Regional Pain Syndrome – Arora Hand Surgery

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

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

Symptoms of CRPS

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

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

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

Treatment for CRPS

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

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

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

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

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

Resources:

http://www.ninds.nih.gov/disorders/reflex_sympathetic_dystrophy/detail_reflex_sympathetic_dystrophy.htm

Categories
Conditions General Hands

Treating Vascular Disorders of the Hands and Upper Extremities – Arora Hand Surgery

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If you look at the anatomy of the human hand, you will notice right away that there are two main supply arteries that run into the hand to supply blood to the bones and tissues they contain. These are the ulnar and radial arteries, and the blood they transport is then delivered to the arteries and returned to the heart via the veins. Right away, this tells us that with two delivery routes, it is not likely that a lot of problems will occur with blood flow into the hands, unless there is injury or disease.

This is why hand experts know that, “Vascular disorders of the upper-extremity are uncommon, but…Variations in anatomy are common…which may affect the way blood flow ultimately reaches each finger.” (Handcare.org, 2015).

In other words, there are more causes for vascular problems that relate to systemic diseases than to technical problems with the hands themselves. This is not to say that certain issues dont occur. Consider that you may have trauma, compression, vasospastic, occlusive, or malformation issues that can impact how blood flows through a hand.

But, the more common reason you may experience vascular disorders in your hands would be that a certain disease has led to the problem (think hypertension, diabetes, kidney issues, and so on), or that your occupation forces you to expose your hands to patterns that impair healthy circulation. Additionally, it is known that smokers often experience problems with vascular disorders in the hands, as well.

Signs and Symptoms

It is usually fairly easy to detect a vascular problem in your hands. You will notice many obvious signs, such as discoloration of the fingertips, discomfort or pain, numbness or tingling, an intolerance to cold, swelling, and ulcerations that fail to heal. If any of these symptoms occur, it is time to visit your hand doctor for an examination.

They will be able to determine what the source of the problem is by doing a full medical history, exploring any swelling or discoloration, and performing a range of diagnostic procedures that will determine the quality of the blood flow (pulse) at all of the relevant points on the body.

Diagnosing and Treating

With a full range of tests, a hand doctor can then determine the cause and the appropriate treatment. For example, there are some fairly common, as well as several unusual issues that can lead to vascular disorders in the hands. Raynauds, as an example, is an unusual vascular condition (NYP.org, 2015) that forces the arteries in the fingers to spasm, interrupting blood flow and leading to discoloration of the fingertips. There are other fairly common causes, such as trauma (crushing, cutting, etc.), a blockage known as an aneurysm that may impeded blood flow, and even malformations of the vascular vessels that impeded flow.

It is important to give any vascular disorders of the hand adequate attention and treatment. A hand doctor is the most appropriate medical professional to consult as soon as possible in order to get the best outcome over the long term.

Source

NYP.org. Unusual Vascular Conditions. 2015. http://nyp.org/services/unusual-vascular-conditions.html

Categories
Conditions General

Explaining Metacarpophalangeal Joint Arthritis

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As you already know, you have numerous different joints in your hands. When it comes to your fingers, the largest of these joints are the metacarpophalangeal joints, which are located where your knuckles are. They provide gripping power and give you the ability to make a pinching motion.

In a normal joint, the two bones are connected with cartilage and a slick substance ensures that it moves smoothly. If cartilage is damaged or wears away, then the joint may stop working properly and it may become painful. Other problems could include the finger becoming displaced, which will lead to more problems. Arthritis of the MP joints is a common condition in which wear and tear destroys the cartilage in the joint.

Causes of MP Arthritis

The type of arthritis that can develop in this joint is due to a few different things. Everyday wear and tear can be the culprit. Additionally, injuries or medical conditions can lead to the arthritis development.

Rheumatoid arthritis is the most common medical condition to lead to the development of metacarpophalangeal arthritis. Thats because it damages the inner joint and destroys the cartilage eventually. There are other medical conditions that can have the same results, including gout, infections, and psoriatic arthritis.

Symptoms and Diagnosis

The most common symptoms of MP arthritis include pain, swelling, and loss of motion in the joint. The pain and stiffness may come and go, and it may worsen when you have to grip something or grasp at something. Additionally, people who have MP arthritis may experience weakness in their grip.

If you go to a doctor for an evaluation, a diagnosis will be made by x-raying your hands. Should you have a narrowing of the space between the bones, then this would indicate that cartilage is destroyed or severely damaged.

Treatment of Arthritis

If you have been diagnosed with MP joint arthritis, then there are different treatments your doctor could recommend. There are medications that can be prescribed to ease the inflammation and swelling while helping with pain as well. Some of the medications can even help to avoid further destruction to the cartilage. Most people find relief from this medication and will be able to manage a pain free life without any further treatment.

However, if the MP arthritis cannot be managed in this way, then there are surgical methods of correcting the damaged joint. The destroyed tissue will be removed to allow the joint to work again properly. If there is no way to correct the joint itself, then you may need a full joint replacement surgery or fusion of the joint in question. Generally, with joint replacement surgery, full use of the finger will be restored.

There are numerous different joints that can be affected by arthritis, and the hands are included. The MP joints, located at your knuckles are very prone to this problem. If you have been diagnosed with this type of arthritis, then talk with your doctor about treatments. You dont have to continue suffering.

Resources:

http://www.massgeneral.org/ortho/assets/pdfs/hand_conditions/MPJoint.pdf

Categories
Conditions General

Gout and Pseudogout in the Hands

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You may have heard of gout before, but you may not know what it is or what it does. There are actually two different forms that we need to discuss: gout and pseudogout (calcium pyrophosphate deposition disease). Essentially, when one of these diseases sets in, salt crystals will settle and form around joints in the hands or feet. As the crystals build up, they begin to cause irritation in the joints themselves as well as in tendons and other tissues in the area. Both forms of the disease will cause these buildups in the joints, but the actual material is different.

  • With gout, the buildup around the joints will be monosodium urate.
  • With pseudogout, the buildup around the joints will be calcium pyrophosphate.

This most commonly effects the joints in the hand as well as the big toe, the knee, and the wrist. Often, when people have one gout attack, they will have recurring attacks in the months and years to come.

What Causes Gout and Pseudogout?

Gout is caused when your body is producing too much uric acid, or alternatively, it is not excreting enough uric acid. This can happen due to medical conditions like hypothyroidism, heart disease, and kidney disease. Additionally, medications used for transplant patients, blood pressure medicines, blood thinners, and other can cause this change in the body.

Additionally, some people have developed gout after they have had surgery on a joint, there was an injury to the area, or there was an infection. Drinking alcohol has shown to cause flare ups.

Pseudogout or CPPD is usually caused when a patient has more than one injury to the same joint. It isnt connected with diet, medication, or other health problems. However, there does seem to be some correlation between people who have pneumonia, heart disease or stroke. Patients who have thyroid problems and develop an iron overload have developed CPPD as well.

The Symptoms

Symptoms of gout and pseudogout include:

  • Severe pain in the joint that will become extremely painful between four and 12 hours after it starts.
  • Discomfort that continues weeks after the pain subsides.
  • Redness, swelling, and inflammation in the affected joint.
  • Inability to use the joint properly, decreasing mobility.

A doctor will use examinations, x-rays and lab work to determine if you have gout or pseudogout.

The Treatment

Treatment for these diseases isnt designed to cure gout, but instead to decrease the inflammation in the joint and ease pain. Certain NSAID pain relievers have shown to be very effective in taking away pain. If the inflammation is bad enough, then the doctor may prefer a steroid injection. If the flare-ups cause enough problems, then surgery may be needed to remove the crystals from the joint.

If gout is left untreated, then it can permanently damage joints as the crystals can erode away at the bones and tissues. It is very important that you get treatment, so if you believe that you have gout in your hand, wrist, fingers, or any joint, be sure to schedule an appointment as soon as possible.

Resources:

http://www.mayoclinic.org/diseases-conditions/gout/basics/symptoms/con-20019400

Categories
Conditions General Hands

Understanding Hand Tumors

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People hear the word tumor and immediately think that this refers to cancer. However, thats not the case. In fact, a tumor is the name for any mass, lump, or bump hat may appear on or in the body. Most tumors are nonmalignant, which means they are not cancerous. On one hand, most tumors grow close to the surface. They may grow on the skin or directly under it. Of course, since you have all types of tissue in your hands, like tendons, muscles, skin, nerves, etc, then there are many different types of tumors that may occur. Instead of going over every type of hand tumor that is possible, lets discuss the most commonly seen.

Ganglion Cysts

Ganglion cysts are completely benign and they occur near or on a joint, especially on the fingers and the wrist. They are filled with a clear liquid and can grow or shrink from day to day. Sometimes, thy completely disappear all on their own. Usually, they do not cause any problems, but if they become painful or they get in the way of normal use of the hand, then surgical removal is possible. Ganglion cysts are the most common of all hand tumors.

Giant Cell Tumor on Tendon

This is the second most common and it occurs when a solid mass develops on the sheath protecting a tendon in the hand. They can occur anywhere a tendon is present, so anywhere in the hand. They grow very slowly and they are benign. It is unclear what may cause them, but some doctors feel there is a link between tumors and trauma or injury that affects the growth of the tendon sheath.

Epidermal Inclusion Cyst

Epidermal inclusion cysts are also very common and they are benign too, Essentially, they grow on the underside of your skin in the hand. Often, they form where the hand has been cut or otherwise wounded and they are made of keratin. As skin cells get trapped under the skin, keratin grows and continues reproducing.

Other, not so common types of hand tumors, include fibromas, glomus tumors, and bone spurs. In almost every situation, they are benign. If a foreign body, like a splinter gets stuck deep in the hand, then the skin may form a tumor around it as well.

Hand Cancer

As mentioned, most types of tumors are benign, but any lump or bump should be evaluated by a physician. Most of the time, hand cancer comes in the form of squamous cell carcinoma, melanoma, or basal cell carcinoma – all of which are skin cancers. It is important to get cancer in the hand diagnosed because it can spread to other parts of the body, especially the bones, breast, and lungs.

If you have a bump or lump on your hand, then be sure to visit a doctor. A diagnosis will be made and if the bump is causing you problems, then it can be removed surgically. This resolves the problems in most cases. Some people choose to leave the tumor alone if it is benign and it is not causing pain or discomfort.

Resources:

http://www.massgeneral.org/ortho/assets/pdfs/hand_conditions/HandTumors.pdf

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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.