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General Wrists

What to Expect With a Wrist Sprain

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Treatment for a wrist sprain, as represented here, is important for proper healing.

We are often told that a sprain is a minor issue, but when we know just what a sprain is, we understand that it deserves good care and adequate time to heal. This is particularly true when it is a wrist sprain.

A sprain, according to the technical definition, is, “A stretching or tearing of muscle or tendon.” That alone sounds pretty serious, but when you realize that it is those torn or stretched tendons that hold the muscle to the bone, you understand that this is no laughing matter.

Essentially, a wrist sprain is when the tendons that hold the wrist together have been over extended or damaged, making it very hard for you to use your hand properly. The most frequent way that a wrist sprain occurs is in a fall or during active sports. The hand is usually bent backward or forward at a extreme angle, and this tears or overextends the tendons.

The immediate response is pain, and this is rapidly followed by swelling. The hand becomes painful and difficult to move. Generally, it is not all of the tendons in the wrist that are harmed. There are two ligaments that seem to take the brunt of falls and injuries of this kind, and they are the scapho-lunate ligaments, which are tucked between the scaphoid and lunate bones in the hand/wrist area.

Though other sprains can occur, it is most common to experience this particular type of sprain, but it can also range from mild to severe, with some instances of ligament rupture occurring.

Dealing With a Wrist Sprain

Should you fall or sustain any sort of injury that leads you to believe you have injured or sprained the wrist, do not hesitate to get to a hand doctor. They are going to be able to determine what has happened by taking x-rays, doing a thorough exam, and discovering if there are any fractures in addition to the sprain.

The most conservative treatment is immobilization in a splint or a cast. If there has been more extensive injury, it may be necessary to perform surgery in order to repair damaged ligaments or bones. The scaphoid bone is the most frequently broken bone in the hand, and it can be difficult to heal, meaning even a minor sprain that includes a broken scaphoid bone may need surgery.

As with many types of hand injury, a wrist sprain is best dealt with immediately. If the injury is ignored, it becomes a chronic concern. After several months or years, the ligament may still need repair, but in many instances the chronic condition worsens and can allow arthritis to set in or for the joint to become very stiff. Treatment can range from surgery to steroid injections and therapy. As the American Society for Surgery of the Hand indicates, “Despite optimal treatment, wrist sprains occasionally result in residual long term pain, stiffness, and swelling.”

The complexity of the wrist makes it difficult to rebalance the many bones and tissues after injury. Instead of waiting to see how the wrist heals after an injury or fall, head to your hand doctor and get the best possible treatment and results.

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General Wrists

Dealing With a Wrist Fracture – Arora Hand Surgery

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Did you know that your wrist contains a large number of bones as well as the soft tissue and tendons that make the hand work fully? In fact, there are, “Eight small bones and the two forearm bones,” (AAHS.org, 2015) that form the wrist. Because of this, the wrist can be fractured, and in many different ways. Any wrist fracture will impede movement of the hand simply because it is the wrist that allows the hand to move and swivel freely.

Wrist fractures can be sustained during a fall, an accident of some kind, or during sports. Though there are many bones in the wrist, the most commonly fractured of them are the radius, which is one of the two arm bones leading into the wrist area, and the scaphoid (a small bone that links two rows of smaller bones in the hand).

Regardless of the severity of the break, it will often cause pain and swelling and prevent the individual from using the wrist and hand as normal. That means that it is imperative to seek medical care from a hand professional as soon as any injury occurs. Broken bones may be shattered, blood flow could be impaired, nerves or tendons could be damaged, and there could even be the need for a surgical repair.

Diagnosing and Treating a Wrist Fracture

Usually, your doctor has to order an X-ray to see which bones have been broken and to do a full evaluation of the situation. In the least serious cases, when the bone or bones are not displaced (out of their usual location) and the fracture is stable, you will probably need a splint or cast to keep the bone in alignment and allow it to set and grow.

If the situation is not as simple, there can be the need for surgery in order to use pins or screws to stabilize the bones or reconstruct them. There are also instances of external fixation devices used to force the bones into their proper alignment for full healing.

Regardless of the approach used to set the bones, there is always the need to maintain function and flexibility of the digits and hand. This is usually done with the help of a therapist working in cooperation with the physician. Even when splints, casts, or external frames are removed, the need for therapy continues in order to rebuild strength and ensure that full function remains.

It usually requires a period of several months for a wrist fracture to heal, and for the discomfort, stiffness, or pain to completely fade. There are so many ways that a wrist fracture can occur, and so many secondary injuries possible, that there is no universal answer to, “How is a wrist fracture treated?” However the first step is to head to the hand doctor or surgeon and get a complete diagnosis. Following the treatment and therapy plan is the only way to retain functional use of the wrist and hand, and the outcomes are usually very positive and successful.

Source

AAHS.org. Wrist Fracture. 2015. http://handcare.assh.org/SearchResults/tabid/145/SearchModuleID/1720/sites/1/Default.aspx?SearchTerm=wrist+fracture

Categories
Fingers General

How Arthritis in the Thumb is Treated

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Treating arthritis of the hand can be helpful.

You know how much you depend on your thumbs, and so it becomes important to deal quickly with any mobility issues that impair movement of this vital limb. However, many people do not notice the slow progress of arthritis in their thumbs, and so it becomes necessary to work with a hand doctor, should it develop to the point where movement, flexibility, and function are impaired.

To begin with, arthritis in the base of the thumb is a bit more complicated because it often strikes the CMC joint or the thumb basal joint. This is a joint that lets your thumb enjoy that amazing range of motion that tends to make it such an essential digit. Without it, you cannot form “pincers”, make a fist, and/or grip tightly.

Diagnosing and Treating Arthritis of the Thumb

How can you know that it is arthritis developing at the base of the thumb and not something else? First of all, more women develop this type of arthritis than men, and it is more common in people over the age of 40. It can present after injury to the joint – including a dislocation as well as a fracture.

One of the first signs is not, as many suspect, stiffness but is instead pain at the base of the thumb. Generally, pain is encountered after use of the thumb in everyday movements such as turning doorknobs, writing, or opening a jar. The pain tends to progressively increase, even when the hand is at rest.

If allowed to develop, it can often move the metacarpal bone out of joint, leading to a bump developing at the base of the thumb. This is immediately followed by a weakening of the grip and a loss of range of motion. Hyperextension of the joint above the thumb joint also commonly occurs as arthritis worsens.

At the first signs of this condition it is important to get in touch with a hand doctor. They will take your medical history and perform a basic examination that often identifies the condition. Confirmation may be done through an x-ray of the hand, as well, though this may only provide confirmation of the worst cases.

Treatment is then chosen based on the extent of the condition. Less serious cases are often treated with some splinting and therapeutic exercises meant to help retain the strength in the hand. Medications or steroid injections can also help with inflammation, and day or evening splinting is not unusual.

Those whose arthritis of the thumb cannot be addressed with non-surgical remedies will often need to be considered for surgical treatments. The main focus of any procedure is to eliminate pain while also reconstructing the joint for functionality. There are several ways this can be done, and it is important to speak with your hand surgeon about your lifestyle and needs before choosing the most appropriate surgical remedy.

The good news is that the faster you act when you suspect arthritis in the thumb, the better your outcome. Consult your hand doctor immediately and get this condition treated quickly for the best results.

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General

4 Labor Day Safety Tips for Your Holiday

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Practice the following Labor Day safety tips for an enjoyable weekend. This image features a family grilling at a park.

Labor Day is typically thought of as marking the end of summer (it hurts me to even type that). Hopefully, your long holiday weekend will be packed with celebratory events like backyard barbecues, final excursions to the lake, picnics at the park, and fireworks. But even festive events like these present hazards you should be aware of.

Whether you’re planning a final summer outing or staying home to wrap up summer chores, I want you and your family to enjoy a safe holiday. Of course, I am a hand surgeon, so keeping that in mind, here are some simple and quick Labor Day safety tips that you can use to enjoy your weekend.

1. Be Careful with Fireworks

I love fireworks, but obviously there is an inherent danger in handling them. It is NOT a good idea to hold fireworks while you light them. Sounds simple and common sense, right? Then why do people continue to do this? Do not modify or tamper with fireworks, you could set them off. Children, in particular, are at risk. The National Safety Council reports that children 10 to 14 years of age are at three times the risk of being injured by fireworks than the population as a whole. Even sparklers can inflict serious injury. So please be mindful in handling and lighting these potentially dangerous items.

2. Protect Your Hands while Conquering Outdoor Chores

I will probably be out in the garden this weekend picking weeds – its a never-ending battle. I have a lot of weeds that have spines and can cause a lot of irritation if I don’t use proper protection. In fact, I have found that I have to double-glove. I wear a latex-coated work glove as the first layer and a leather garden glove as the outer layer. I used to just wear regular garden gloves, but I would still get poked all the time!! Not only can garden related injuries result in scratches and cuts, infection is also a real risk.

I have a hedge trimmer. Frankly, I am a little scared of it. I have had more than a handful of patients who have suffered injuries as a result of using hedge trimmers. I am not saying that you should not use them, I am asking you to please be careful. Keep BOTH your hands on the machine at all time so as to avoid any possible contact with the moving blades. Concentrate on the location of the blade – be aware of where it is at all times while it is on and moving. Use a tool to clear the blades if they jam – not your hands.

3. Prevent Foodborne Illnesses

Lets face it. Our hands are dirty. You may be out in the garden, or dealing with raw meats while grilling this weekend, so be mindful of germs and dirty. Wash contaminated surfaces and your hands frequently to avoid infection and/or getting sick.

4. Practice Safety Tips when Firing up the Grill for Labor Day

What’s a Labor Day holiday without lots of food? Hopefully, I’ll be firing up the grill myself.

Are you using charcoal? I do and wow, can it get hot. I bought special thick gloves to protect my hands when dumping hot coals from my chimney starter. I also use them when things get really hot and I am trying to handle the food on the grill. Gas grills get mighty hot too, so you might consider using them for that too. At the very least, think about using some general oven mitts to protect those hands when dealing with the fire and the heat. Burns can happen in an instant so best to be preventative and use the appropriate protection.

Of course, keep kids away also. Those hands move fast and will get burned quicker than you have a chance to say, “I have told you a million times to keep your hands away from there!”

Have a good holiday everyone!
Categories
General Hands

Understanding Stiffness In Your Hand – Arora Hand Surgery

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We dont often realize just how flexible and fluid the movement in the hand is until we experience stiffness in a digit or joints of the hand and wrist. Trouble with just one small area of the hand can limit mobility and function, and so it is important to never ignore any stiffness in the hands or fingers, and to visit a hand doctor at the first signs of trouble.

What Stiffness May Mean

You probably are aware of the fact that your hands and wrists are made up of many different bones, tendons, muscles, nerves, and other tissue. These are all designed to move smoothly and in many different ways. Most of the joints and tendons are strong and flexible, allowing you to do an almost limitless number of tasks with your hands.

Naturally, because they are used so much, they can be at risk for injury and wear and tear. They can also show signs of various diseases, such as systemic issues like Diabetes, and so you should be aware of any loss of movement or the beginning of stiffness in any part of the hand.

The hands are made of many joints, and this is where you notice stiffness. The joints are very complex structures made up of cartilage, ligaments, bones, muscles, and tendons. Anything that can impair any individual component of a joint is going to cause the entire joint to experience trouble.

So, something like arthritis may cause the rheumatoid cartilage between two bones to begin to degrade (WebMD.com, 2015), and this can cause a problem with movement. This can lead to the joint moving in a way that it had never moved before, and the misalignment can then negatively impact the tendons or the muscles.

Of course, stiffness may not be due to a slow moving disease or problem and can be the result of an injury or trauma. Fractures to the bones of the hand, scarring during healing of tissue, sprains or dislocations, and harm to tendons and muscles can all result in stiffness in the hand.

Clearly, this means that any loss of fluid movement is a sign that it is time to head to the hand doctor.

Evaluation and Treatment

Your hand doctor is your first line of defense when you experience stiffness in any part of the hand, wrist or arm. Your doctor will be able to accurately gauge the range of motion in the digit or limb and determine the underlying cause of the problem. They will test your active range of motion and then do tests using passive motion (this is when they flex or bend the joints to test them). They will look for any signs of swelling and determine if there is tenderness or damage. They may require x-rays as well to gauge whether the problem is due to an undiagnosed issue or something as common as arthritis.

Once they know the cause, they will begin treatment. Most will use conservative methods such as therapeutic modalities (heat, splinting, exercise, etc.) to attempt to adjust any problems. If this is not going to provide relief, they may use medications or surgical treatments appropriate to the condition.

You use your hands far more than you may realize, and when they are not functioning properly due to stiffness it is not only frustrating, it can be dangerous. Dont hesitate to contact your hand doctor if you have even mild stiffness, the sooner you address the issue the better the outcome. Whether it is rheumatoid arthritis or a minor sprain, it shouldnt wait.

Source

WebMD. Joint Stiffness and Rheumatoid Arthritis. 2015. http://www.webmd.com/rheumatoid-arthritis/guide/joint-stiffness-and-rheumatoid-arthritis

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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
General Treatments Wrists

Why You May Need Wrist Arthroscopy – Arora Hand Surgery

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Though it is a totally modern medical technique, the process known as arthroscopy is actually named from two Greek words. Arthro, which means “joint” and skopein, which means “to look”. This tells us right away that any arthroscopy is looking at a joint in the body. However, it is a bit more technical than that because it is actually a process that allows us to look at the inside of a joint.

Why would that be needed? Think of it as a far more efficient and much less invasive way of examining and diagnosing problems in the hand and wrist. Rather than making large incisions, disrupting and harming soft tissue, and causing the subsequent swelling and pain that surgery demands, the use of arthroscopy is a much more preferable way to visualize and even repair problems.

Why the wrist? Remember that it can be a diagnostic tool as well as a surgical tool. It is something that lets a hand surgeon diagnose and treat something, and so it is a very popular way of exploring problems with the wrist. In fact, the wrist is the third most commonly treated area (after shoulders and knees) with arthroscopy.

What Arthroscopy Provides

The patient who has injured their wrist or who is encountering a wrist problem that is difficult to diagnose with traditional exams can have the bone, ligaments, and cartilage safely and easily assessed in a comprehensive way with arthroscopy. It is a tiny device that features a thread-like fiber optic tube equipped with a small camera at the end. Tiny incisions are made in the wrist area, and the device is then inserted safely into the appropriate region. The camera then sends images back to a monitor for the surgeon to assess.

The arthroscopic equipment also allows medical tools to be fixed to the camera end of the device, and this can allow on the spot treatment of suspected problems using forceps, knives, shavers, and probes (AAOS.org, 2015).

Generally, hand surgeons turn to the arthroscopy to deal with bone fractures that require reduction due to scarring or problematic bone growth, to explore the integrity of certain areas of cartilage in the wrist (known as TFCC), and even to remove less problematic issues such as ganglion cysts. The arthroscopy can also help with certain fractures and even to assess the progress of arthritis in the wrist area.

It can be combined with “open” procedures, meaning surgical procedures more invasive, if this allows better visualization of the patients condition. However, it is often far less invasive, and allows recovery to be faster and less difficult. Patients often wear a splint or bandage, depending on their condition, and will have to manage swelling and pain according to their doctors advice.

The good news about wrist arthroscopy is that it is a good alternative to several major wrist problems. When your hand doctor has the experience and skill required, it can provide a very precise and reliable treatment that is often superior to surgery in its outcome and its invasiveness.

Source

AAOS.org. Wrist Arthroscopy. 2015. http://orthoinfo.aaos.org/topic.cfm?topic=a00001

Categories
General Treatments

Anesthesia Used in Hand Surgery – Arora Hand Surgery

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If you have to go through hand surgery, dont worry. There are different types of anesthesia to ensure you dont feel pain or discomfort during the procedure. Lets talk about the different options that may be used depending on your surgeons preference, your preference, and the type of problem that needs surgical correction. These include local, regional and general anesthesia.

Local

Local anesthetics means only a very small area of the body will be numbed. The medication will be injected directly in the site where the surgery will take place. A local anesthesia means you will be awake, which can be very stressful for some people. For that reason, you will likely also be given medications to help you relax, either beforehand or intravenously during the procedure. This way, you will remain relaxed while the surgery is done and you shouldnt feel any pain. This is used for minor procedures on the hand

Regional

Regional anesthesia is often also called a nerve or arm block. With this type, your whole arm, forearm, wrist, or hand will be completely numbed. There are different ways the block can be used depending on how much of your arm needs to be numbed. These include:

  • Supraclavicular Block, which is placed above the collarbone. It is often used because it provides anesthesia to the whole arm, wrist, and hand.
  • Axillary Block, which is injected in the armpit and works to provide anesthesia for elbow, forearm, wrist, and hand surgeries.
  • Interscalene Block, which is injected near the base of the neck and will even numb the shoulder so that surgery can be done on any part of the arm.
  • Infraclavicular Block, which is injected below the collarbone and provides numbing for forearm, wrist, and hand.
  • Bier Block, which is injected in the arm also uses a tourniquet to keep the numbing agent in the arm itself. It is used often for very short procedures in the hand and wrist.
  • Wrist Block, which is injected in the wrist nerves, will numb the fingers and hand.
  • Rescue Block, which is used after surgery to control pain and is often used in conjunction with one of the other blocks.

The block will be placed after a small area of your skin has been numbed so that you wont feel as much discomfort. A nerve stimulator may be used, which causes the nerves to jump so that they can be found.

General

The final type of anesthesia is general, and will completely put you to sleep during the surgical procedure. Sometimes, this is used with a nerve block to ensure the least amount of discomfort or stress possible.

Your surgeon will explain what type of anesthesia you should have during your own procedure. However, you can let your preferences be known and if possible, the surgeon will accommodate them. Sometimes, depending on the type of injury or problem and the required surgery, there will be no choice but to use a certain type of anesthesia during the procedure.

Resources:

http://www.handwristcenter.com/anesthesia.cfm

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

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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.