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When Will a Doctor Report a Broken Bone?

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One of the most heartbreaking decisions a doctor has to make is whether or not to report a suspected case of domestic violence. Often, injuries to the wrist, forearm or elbow, especially if they are recurring, are a tip-off that something is very wrong in the home.

So, what are the signs of domestic abuse, and when will a doctor report suspected abuse?

The Research

US government research shows that every ten seconds, a report of child abuse is filed, and that five children die each and every day from abuse. Most are abused by their parents, or by someone who is known to the family, and most children who die from abuse are under the age of 3. Child abuse transcends all races, religions, and economic levels. Sadly, many instances of child abuse go unreported. This is because often the child loves the abuser and is reluctant to report the abuse. The child may even feel that he or she deserves the abuse. That is where the doctor comes in, and has to use his or her diagnostic skills to determine whether abuse has occurred.

Identifying Abuse

Sometimes, identifying abuse is easy, and doesnt even require determining the cause of an injury. It is easier with children than it is with adults. For instance, if a child presents with an injury that appears not to have occurred as a result of normal activity, and the child is also withdrawn, uncommunicative fearful of adults, and offers explanations that do not make sense (“a bad man came into my room”), abuse is easy to identify. Additionally, breaks and sprains do not usually occur in children who have not progressed beyond crawling. Wrist, arm and elbow injuries to infants are almost invariably due to abuse.

With adults (women, usually), it may be a little more difficult. It is generally a given that no one gets a black eye because “I walked into a door,” but in the absence of other evidence, it is hard to prove abuse. Often, even the most skilled, compassionate doctor cannot draw out the true cause of an injury from an abused adult.

Signs of Abuse

The signs of physical abuse can include:

  • Black eyes
  • Unexplained broken bones
  • Bruises that have a certain shape (“grab” marks, welts that appear to have been caused by a belt, etc.)
  • Ligature marks
  • Burn marks
  • Bite marks

Often, strange explanations may also be given for the injuries to the injured child or adult – “He was falling off the swing, so I grabbed his arm,” or “She was having a bad dream and fell out of bed.” Stairs also seem to play a significant role in domestic injuries.

Getting Help

There are counseling and support groups for abusers and victims. There are also government agencies that are mandated to protect children under the age of 18. Systems vary from state to state, but usually involve family court. When children are involved, usually there is every effort made to reunite families. Abused adults also have access to safe environments and counseling. Doctors are required to report broken bones when abuse is suspected.

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General Wrists

Is My Wrist Broken or Sprained? – Arora Hand Surgery

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How can you tell if your wrist is sprained or broken? Essentially, it goes without saying that if you suspect either a sprain or a break, you should see your doctor or visit the emergency room in order to obtain an effective diagnosis. Sprains and breaks are both painful, and both can cause damage to the structure of the wrist. Interestingly, though, patients who have experienced both often report that a sprain is the more painful of the two injuries. It is also interesting to note that breaks are often more easily treated, whereas sprains can sometimes be more devastating, and if not treated promptly an effectively, can lead to complications like arthritis later on.

If you are determined to self-diagnose, and wait for treatment, or if you are providing first aid to an injured person, you need to know how to determine the difference between a sprain and a fracture. You also need to remember that a sprain is not a minor injury. It can involve serious tears to the ligaments that hold the wrist bones together.

How Did the Injury Happen?

This is the first thing that you need to consider when attempting to answer the questions, “Is it a break or a sprain?” If someone uses their hand to break a short fall, it could be a break, but the smart money is on a sprain. On the other hand, if someone falls off a roof and lands on their hand, a break is more likely.

What Can You See?

If a bone is protruding through the skin, the diagnosis is obvious – it is a break. Additionally, if there appears to be a great deal of swelling or bruising, a break is likely. If the swelling and pain doesnt go away in a day or two, suspect a break, but if it goes away relatively quickly, suspect a sprain.

What Can You Hear?

If moving the wrist results in a grinding or crunching sound, accompanied by excruciating pain, it is almost certainly a break.

What Should You Do?

Immediately following the injury, you or the person you are treating should immediately stop moving the wrist. Elevate it and apply cold packs. If stopping movement seems to be problematic, apply a wrist splint.

Exceptions

Although a break will usually hurt for a long time, and a sprain will stop hurting in a few days, there are exceptions. One is a scaphoid bone fracture. The scaphoid is a small wrist bone that, if broken, could feel painful for a day or two and then stop hurting. In this way, it imitates a sprain, and can be easily misdiagnosed. If untreated, it can lead to arthritis. Additionally, if certain wrist ligaments are sprained, that can also lead to arthritis, because the bones that those ligaments were intended to hold together move abnormally. This can also cause arthritis.

The Final Word

Any wrist pain that has not gone away within 3-5 days after an injury should be checked out. You may need surgery.

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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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General Treatments

Tips for Recovering From a Broken Wrist or Hand

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You have 27 bones in your hand and wrist. The most common fractures for these bones include broken knuckles, fingertips, and thumbs from blunt force to the hand or falling on it. Whether youve broken your hand or wrist in a work related accident or while playing ball with your kids, its important to seek the proper medical attention from a qualified hand surgeon and then to follow your hand doctors orders as closely as possible to ensure you are recovering from a broken wrist, or hand in the most efficient way possible.

If you are unsure whether youve broken your wrist or not, dont diagnose yourself. Its better to go to the hand doctor, get an X-ray, and find out that youve only suffered a sprain or strain than to let the injury go untreated. If you have even the slightest suspicion that youve broken a bone, call the hand doctor immediately.

Take Your Medication On Time

Whether you are prescribed over-the-counter NSAIDs (non-steroid anti-inflammatory drugs like aspirin) or a stronger pain reliever and anti-inflammatory drug, you need to take your medication. You may think that this is not important if the pain has subsided and youre feeling better, but your anti-inflammatory medication will keep the injury from swelling, which will help it heal faster and more completely.

If you want to avoid being in pain any longer than is absolutely necessary, take your prescription and take it on time as prescribed. This is especially true if your doctor prescribes antibiotics. If the skin was broken in the injury or if you had to have surgery, you may be at risk for infection, and taking an incomplete dose of antibiotics or skipping them entirely could result in a serious infection.

Do Not Remove Your Splint or Cast

If your hand surgeon had to do an invasive procedure to set the bones in your hand or wrist, you may be curious about your stitches. Your splint or cast might itch and feel hot. In other words, you might be tempted to take it off, at least for a little while. Dont do this.

If your hand doctor splinted or put a cast on your hand or wrist, that means the bones need to be immobilized to heal properly. Taking it off could result in problems with your recovery.

Follow the RICE Method

You’ve probably heard it before, but it bears repeating: Rest, Ice, Compression, Elevation. The compression part of the RICE method is already taken care of by the splint or cast your hand surgeon put on your hand. The rest is up to you. Dont go doing any strenuous exercises or activities while youre recovering from a broken wrist, or hand. Keep ice on the injury whenever possible, and keep it elevated above your heart to reduce swelling. If you do these things and follow your doctors prescriptions and recommendations, youll be recovered and ready to take on the world again in just a few weeks. And if you have any questions or concerns about the recovery process, never hesitate to call your hand surgeon and ask their advice on recovering from a broken wrist or hand.

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General Treatments

Why Your Hand Surgeon Prescribed Steroid Injections

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

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

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

What Are Steroids?

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

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

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

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

How Will Steroids Help My Hand Condition?

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

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

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

Categories
Fingers General

How To Treat Fingernail Injuries

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

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

Some common examples of injuries to the fingertips include:

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

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

Treatment of Fingertip Injuries

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

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

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

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

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

Resources:

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

Categories
Conditions General

Understanding Ganglion Cysts

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

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

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

The Causes of the Cysts

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

The Symptoms

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

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

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

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

Resources:

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

Categories
General Hands

Injuries to the Extensor Tendon

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

Types of Extensor Tendon Injuries

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

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

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

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

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

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

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

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

Resources:

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

Categories
Conditions General

A Deeper Look at Rheumatoid Arthritis

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Most are familiar with the term “arthritis,” but many of us do not know that there is more than one form of this condition, 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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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.