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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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General

How Can a Hand Specialist Help Me?

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hand specialist

If you are having problems with your hands, a hand specialist is your best bet to find relief from the pain and restore the use of the hands. The anatomy of the hands is very complicated. It takes a lot of coordination to get the finger bones, joints, muscles, tendons and ligaments to work together in ways that make things like gripping or writing possible. The hands require a certain amount of strength to grip, lift and carry items. Fine motor skills are also critical for the hands to carry out activities that require precision. It is obvious that when the hands are not working right, a person’s lifestyle is negatively impacted in a major way.

A hand injury that seems like no big deal at the time of occurrence can actually turn out to be quite serious as far as the use of the hand is concerned. Our hand specialist will be able to diagnose this problem quicker and more accurately. He will also make sure the procedure or treatment is done promptly and correctly. Even if the injury or condition is not severe enough to require surgery, our hand specialist will know which treatments are best for the situation.

Our hand specialist can help with cumulative trauma disorders such as carpal tunnel syndrome also. This condition develops when the nerves that travel through the tunnel in the wrist become irritated because the tunnel through which the nerve passes begins to close off. This puts pressure on the nerve and can cause tingling, numbness or pain. It can also reach the point where it interferes with the use of the hand and fingers. Our doctor can develop a treatment plan that can help to alleviate these symptoms through a combination of medications, exercises and therapy. If these things do not bring relief, surgery may become necessary. Our hand specialist will understand when a case reaches that point so surgery is not scheduled unnecessarily.

You might also want to see our hand specialist if you are suffering from arthritis in the hands and fingers. Trigger finger is another condition that can be better handled with the help of a specialist. If you are having trouble using your hands or are suffering from discomfort, you should make an appointment at Arora Hand Surgery. It is important to note that the hands are the most valuable tools we will ever have. It is, therefore, crucial to take care of them. Contact us today to schedule a consultation at our office in West Bloomfield, Howell, Warren, or Macomb.

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Fingers General

What is Nail Bed Repair?

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nail bed repair

Nails are made of a tough protein called keratin that is also found in hair and skin. The phrase “nail plate” is the technical term for what most people call the nail. The nail bed is the skin immediately under the nail plate, and it is comprised of two tissue types: an epidermis and a dermis. The matrix is the part of the nail bed that produces more nail plate cells. The lunula or crescent, which can sometimes be seen at the base of the nail, is the visible part of the matrix. When injuries occur in or near the nail bed, nail bed repair is typically used to correct the situation.

What Causes an Injury to the Nail Bed?

Injuries to the nail bed are usually caused by injuries to the finger or toe. For example, a broken toe or finger may be accompanied by damage to the nail bed. The nail bed can also be damaged by cuts or lacerations. Pinching or crushing injuries, like that caused by getting a finger caught in a door, can cause injury to the nail bed.

What Does Nail Bed Repair Involve?

Our doctor will first want a description of how the injury occurred. He will also probably X-ray the patient in order to check for broken bones. The treatment will depend on the type of injury and its severity. The patient will probably be given a local anesthetic before nail bed repair is performed.

What is a Subungual Hematoma?

A subungual hematoma is bleeding under the nail. It is usually caused by a crushing injury like hitting one’s thumb with a hammer or dropping a heavy object on one’s toe. The patient’s blood collects under the nail and causes intense, throbbing pain and discoloration of the nail.

During a consultation, our doctor will check for broken bones and other serious injuries. If he doesn’t find any, he will likely decompress the hematoma to relieve the pressure caused by the accumulation of blood. After numbing the treatment site, either a needle, heated wire (electrocautery device) or carbon laser may be used to perforate the nail and let the blood drain.

In a complicated subungual hematoma, the blood has accumulated under the whole nail and caused it to separate from the nail bed. In these cases, our doctor may have to remove the nail. However, it all depends on the unique situation.

What is a Nail Bed Laceration?

A nail bed laceration is a cut involving both the nail and the nail bed beneath it. Our doctor may remove the damaged part of the nail and then stitch the wound to the nail bed. He may replace the damaged nail to have it serve as a splint. Over time, a healthy, new nail will grow in to replace it.

Learn More About Nail Bed Repair

Injuries to the nail bed can be painful. Fortunately, nail bed repair can be used to fix the problem, leading to a better quality of life for the patient. You can learn more about the details of nail bed repair during a consultation at Arora Hand Surgery in Macomb Township, Warren, Howell, or West Bloomfield.

Contact us today to schedule an appointment.

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General Wrists

Common Causes of a Sprained Wrist

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sprained wrist

If you have ever had pain and swelling in your wrist after an event such as a fall, which may have caused you to bend the wrist farther than it was designed to bend, you may have a sprained wrist. These injuries occur because of damage to a ligament, the connective tissue in the body that connects muscle and bone.

What Causes a Sprained Wrist

When you fall, the natural tendency is to reach out with the hand in order to break the fall. As a result, the impact of the hand hitting the ground and the momentum created by your body travelling toward the ground at a rapid speed causes the wrist to bend further than it is capable of bending naturally. When this happens, something has to give. Since the tendons are there to connect the tissue together, they are what get stretched to the point of injury. The injury could be that of a tear or it could be something less traumatic. At any rate, an injury occurs that is accompanied by pain, swelling and difficulty in using the wrist.

Diagnosis & Treatment of a Sprain

If you have a fall that results in an injury to your wrist, you should seek medical care. You will, first of all, want to make sure there are no broken bones. The only way to rule this out is to get an X-ray. If there are no broken bones, you will still need to be treated for the sprained wrist.

The method that is used to treat a sprained wrist will depend on the extent of the injury. It may be that wearing a splint for a few days will be all that is needed. In extreme cases, surgery may be required. If there is a ligament tear, it will need to be reconnected.

If you have a sprained wrist, you should understand that there are a number of bones, ligaments and cartilage that must connect and interact correctly for the wrist to function as it should. For this reason, letting an injury go without having it evaluated by a qualified hand doctor like Dr. Arora can lead to long-term discomfort and failure to regain full use of the wrist. Therefore, you should always seek treatment in these situations.

In addition to falls, other conditions can result in wrist injuries as well. For example, operating a piece of equipment that is held by the hand can result in an injury if that equipment makes a sudden move and takes your wrist with it. In these cases, the injury incurred could be similar to those incurred with a fall.

There are other wrist conditions that can happen over time, such as carpal tunnel syndrome. These cumulative trauma disorders can reach the point where they cause a lot of discomfort.

If you have a sprained wrist or a similar type of condition, schedule an appointment with our doctor at Arora Hand Surgery. We have offices in West Bloomfield, Howell, Warren, and Macomb. Call us today to request a consultation to learn more about your treatment options.

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General

Benefits of Having a Board-Certified Hand Surgeon

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board-certified hand surgeon

If you are facing the possibility of hand surgery, you obviously want the procedure done by a surgeon with the necessary skills to do it right while using the most effective methods. The question then becomes one of how to know whether or not your surgeon is among those who have the highest qualifications. Seeing a board-certified hand surgeon can eliminate the need to be concerned over whether or not you are getting a qualified doctor.

Not only is it important to have a board-certified doctor regardless of the field of specialty, but you especially want the best available if you are facing surgical procedures for your hand(s). Think for a moment about how we use our hands. If you have a job, you likely use your hands to make a living. Whether you use them for manual labor or something like pressing keys on a keyboard, you need your hands.

After work, you return home and use your hands to hug the kids or go out into the backyard for a game of catch. You come in afterwards and use your hands to eat dinner. The list can go on and on. The fact is we need our hands. Therefore, it stands to reason that you want a hand surgeon who is capable of doing the job in a way that maximizes your chances of getting the full use of your hands back.

Board-certified physicians must demonstrate that they are on top of their game when it comes to education, skill and experience. Doctors must be licensed in the state in which they plan to practice. Licensure does not mean the doctor is qualified as a specialist. That’s when you want to see if he or she is board-certified.

Depending on the area of specialty, doctors can become board-certified through one of 24 member boards that are part of the American Board of Medical Specialties. For doctors to become certified, they must not only have been trained at a qualified medical school followed by three to five years of residency, but they must also pass exams and be committed to a lifetime of learning in order to stay current with the latest medical developments. Board certification does not stop there. Certified doctors must demonstrate that they are following best practices when it comes to the safety of the patients, in addition to communication and ethics.

Seeking certification is voluntary on the part of the doctor. However, it should not be taken lightly. On the other hand, because it is voluntary, the act of going through the procedures to become certified in itself demonstrates a high level of commitment on the part of the doctor.

If you are looking for a doctor that you can be assured is well-qualified, look no further than our board-certified surgeon at Arora Hand Surgery. Dr. Arora can be your guide to a better quality of life when it comes to your hands. Visit his office in West Bloomfield, Howell, Warren, or Macomb so that he can assess your condition and come up with a personalized treatment plan for you. Contact us today to schedule a consultation with our board-certified hand surgeon.

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General Treatments

Alleviate Chronic Pain with Hand Surgery

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hand surgery

No one likes to think about having hand surgery, or most any other type of surgery for that matter. Doctors do not take the situation lightly when they recommend surgery either. Nevertheless, it is sometimes necessary, especially for individuals who have been suffering from chronic pain and nothing else they have tried has brought any relief. If you are in a situation like this, it may very well be that hand surgery is a more attractive option than continuing to live in pain. Any discomfort from the process of recovering from surgery is short-lived. The chronic pain has already proven to be long-lasting, which is why you are considering hand surgery in the first place.

Carpal tunnel syndrome is a common reason for which many people undergo wrist and hand surgery. It happens when the median nerve that passes through the carpal tunnel becomes irritated. This can happen if the space through which the nerve passes becomes too narrow and pinches or otherwise puts pressure on the nerve. People who have jobs that involve a lot of repetitive motion of the hands and wrist are at a higher risk for developing carpal tunnel syndrome than the general public.

Carpal tunnel syndrome symptoms include pain in the wrist, forearm, palm and fingers. If the problem persists and does not improve with other treatment methods, it may be necessary to perform wrist and/or hand surgery to open up the tunnel in a way that takes the pressure off the nerve.

De Quervain tendonitis is another condition that can cause chronic pain around one or both hands. It is caused when the tendons at the base of the thumb that connect to the wrist become irritated or inflamed. Like carpal tunnel syndrome, repetitive motion is often what leads to its development. People who have the condition often have trouble making a fist or turning the wrist. It can also be difficult to hold objects in the hand. Whenever treatments like cortisone injections and anti-inflammatory medications have not brought improvement, hand surgery may be the only other option.

Another source of chronic pain can be a condition known as trigger finger. It gets its name because it causes the fingers or thumb to lock in a bent position. Trying to straighten them can be extremely painful at times. It happens when the tendons that control the movement of the fingers and thumb become irritated. Over time, the irritation causes them to thicken within the sheath that surrounds them. While it is unknown exactly what causes it, people with diabetes, rheumatoid arthritis or gout have a higher risk of developing it. If treatments like corticosteroid injections do not help, hand surgery may be necessary.

If you have any of these or other conditions that are causing you a significant amount of hand pain or are making it difficult to use your hands, you might want to consult our team at Arora Hand Surgery to find out if surgery is a viable option. As much as you may want to avoid going through surgery, it may be your best answer to avoiding a life of pain.

Arora Hand Surgery has offices in West Bloomfield, Howell, Warren, and Macomb. Contact us today to schedule a consultation to learn more.

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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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General Wrists

Treating a Wrist Sprain with a Splint

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splint

Wrist sprains are common injuries that can happen to people of all ages from a variety of causes. They can happen as sports injuries or from simple falls during normal daily activities. Whenever you fall, the natural reaction is to reach the hand out in an attempt to break the fall. This is what causes a tremendous amount of wrist sprains as the impact of the fall and the weight of the body are absorbed by the wrist, overextending it.

An injury to a ligament is known as a sprain. Ligaments are the connectors in the body that connect bone to bone as opposed to tendons, which connect muscle to bone. Sprains can vary in their severity to those that have only minor ligament damage and accompanying pain and swelling to the most severe, which is a complete tear of the ligament. When this happens, there is a loss of function in the affected joint.

A splint is commonly used as part of a treatment program for a sprain. Splints help to immobilize the joint in order to limit further irritation and to promote healing. Sometimes, people will use splints as a way of treating themselves when they suffer a sprain. However, splints used by individuals should only be used as a way to keep the injured joint immobile until professional medical help can be obtained.

Only through a professional evaluation can a sprain-type injury be properly diagnosed. One should seek medical care after an injury of this nature to rule out other injury types, such as fractures. If no fracture is involved, the sprain should be evaluated for severity. While most sprains will heal on their own, some of the most severe ones could require surgery.

When a splint is used as part of treatment, our doctor’s recommendations should be followed regarding when and for how long to wear it. If you wear the splint for too long, you could be putting yourself at risk for additional joint stiffness and muscle weakness. Depending on your particular injury, our doctor may recommend some strengthening and stretching exercises.

If you have suffered a fall or some type of joint injury and you are experiencing symptoms like pain, swelling and tenderness, you should seek an evaluation from our team at Arora Hand Surgery. Our medical professionals can conduct whatever tests are necessary for an accurate diagnosis and develop a treatment plan accordingly. We have offices in West Bloomfield, Howell, Warren, and Macomb. Contact us today to schedule a consultation.

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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.