Blog Category

Category: General

Blog // General
Categories
General Hands

Fractures in the Hands

Read Blog

You have numerous different small bones in your hand and wrist. They work together in an intricate process to allow you to use your hands. Your bones allow muscles to attach and connect with tendons so that you can move your fingers too. Any bone can be broken if enough pressure is applied to them, but the hand bones are especially prone because they are smaller. There are different types of fractures that occur in the hand, including:

  • Compound fractures are those where the bone shows through the skin.
  • Closed fractures stay underneath the skin.
  • Comminuted fractures are those where the bone is actually broken into numerous different pieces.
  • Hairline fractures occur when the bone is not displaced and the break may not even go all the way through the bone either.

Compound fractures come with a risk of infection since the skin is broken.

Symptoms of a Hand Fracture

If you have a hand fracture, you will most likely feel pain as soon as the injury occurs. The pain can be severe and you may lose movement in your hand. If the fracture is in your finger, you may notice that the digit is no longer straight and looks deformed.

After the hand has healed, you may experience weakness and some pain. Additionally, if the fracture involved a joint, then there is a greater likelihood you will develop arthritis in the area in the years to come.

How Are Hand Fractures Treated?

If you believe you have a fracture, you will need to see a doctor. Depending on the type of break and the severity of it, different treatments will be used.

If the fracture is not displaced, then a cast may be used simply to keep the bones steady while they heal. If the fracture was displaced, but can be set, then the doctor will set it and then place a cast on it.

Many times, hand fractures require surgery due to the delicacy of the bones. Surgery will involve repairing the bones, putting everything back in the proper place and then using pins to hold them still. Sometimes, pins can even be put in place without surgery itself.

Sometimes, hand surgeons will use something called external fixator. This is a metal contraption that extends into the bone to hold it in place.

Healing

Once the hand is healed, you will need to go through physical therapy to restore proper use. If everything was put back together properly, then you shouldnt have any more problems aside from some stiffness in the hand. However, complicated fractures sometimes mean a shift in the bone and that may mean you never fully get use of your hand in the same manner as before. As a side note, smoking will slow fracture healing times.

The hand is a delicate series of bones, muscles, and tendons. An injury, trauma, or pressure can break those bones, resulting in a fracture. If you have suffered an injury and you feel pain in your hand, then you need to visit a hand surgeon to diagnose the issue.

Resources:

http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000552.htm

Categories
Conditions General

Gout and Pseudogout in the Hands

Read Blog

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
General Hands

Infections in the Hand – Arora Hand Surgery

Read Blog

It is very important that you get treatment for infections in the hand as soon as possible. Because, if they are left untreated, then they can cause serious problems, including loss of use in the hand, stiffness, loss of tissue, loss of nerves, and even loss of fingers. If infections are caught early enough, then soaking, rest, and antibiotics will resolve the issue very quickly. However, it only takes a day or two for an infection to become a serious issue. Often, when not treated in time, a hand infection will require drainage, removal of tissues, and other surgical procedures. Lets discuss the types of hand infections so that you will know what they are and how they appear.

Paronychia

This is a type of infection that appears around the fingernail in the cuticle. It is often caused when bacteria gets under the skin and becomes trapped. Symptoms include redness, swelling, pain, and pus. If caught early, then the infection will be treated with antibiotics. Sometimes, the infected area needs to be lanced to remove pus. This type of infection occurs often in people who must keep their hands wet for an extended period of time because exposure to moisture can weaken the tissue and introduce fungus to the area.

Felon

This very painful infection occurs in fatty tissues, such as in the fingertip. It can be so painful that it throbs and will require drainage of the pus along with antibiotics. If it is diagnosed and treated early enough, it can cause damage to the bone and muscle.

Herpetic Whitlow

If a person has the herpes virus, then it can show up as an infection in the hand. It often also occurs in healthcare workers who are exposed to saliva from herpetic patients. Symptoms include small blisters that are swollen and angry red. It usually takes a few weeks to fully resolve.

Septic Arthritis

Arthritic joints can lead to infections near the area, especially if bacteria is introduced. Usually, the only way to resolve his infection is through surgical drainage. If the infection is not treated in a timely manner, then the infection can spread to the bone.

Deep Space Infection

Throughout your hand, there is space between different types of tissue. A puncture wound can cause an infection in these spaces. They often occur on the thumb, in the palm of the hand, and at the base of the fingers. They can spread to the rest of your body, so it is important that they get treated.

Tendon Sheath Infection

This infection occurs in the sheath that protects the tendons in your hand. They can cause destruction to the tendon if they are not treated properly. The only treatment is surgical removal of infection.

Bite Wound Infections

If a patient is bitten by another human or animal, they are at serious risk of infection because mouths contain a plethora of bacteria. If you are ever bitten, it is vital that you visit a doctor as soon as possible so that infection can be avoided.

Atypical Mycobacterial Infection

This is another infection of the tendon sheath that will develop slowly and causes swelling, stiffness, and pain. It will have to be treated with antibiotics over the course of several months and sometimes, the tendon lining must be removed to control the infection. It usually develops from puncture wounds or abrasions that are exposed to stagnant water.

Infections of the hand should not be ignored, and if you have signs of an infection, contact your doctor as soon as possible.

Resources:

http://www.aafp.org/afp/2003/1201/p2167.html

Categories
General Hands Treatments

Understanding Hand Joint Replacement Surgery

Read Blog

Sometimes, due to injury, regular wear and tear, or other problems, the joints throughout your body can simply stop working properly. Normally, in a healthy joint, the two bones will glide across each other due to articular cartilage, which is smooth and slick. There is also a layer of fluid called synovial, which allows the joint to work smoothly as well. Different problems can affect the joint, creating a situation in which it becomes stiff, swollen, or unable to work. The cartilage can wear out or become damaged. The joint fluid may become abnormal. If the joint is damaged enough, then joint replacement surgery may be needed.

Essentially, a new joint will be inserted so that you have a metal or plastic implant that works in the place of our damaged joint. Usually, once surgery is completed, you will be able to use the joint as normal with no pain.

In the hand, joints that can be replaced include:

  • Finger joints
  • Knuckle joints
  • Wrist joints

Joint replacement surgery can be done in most cases, but not always.

Problems That Prevent Surgery

An artificial joint cannot be placed in certain circumstances, some of which can be resolved, others cannot. These include:

  • Infection in the joint
  • Damaged muscles and tendons that interact with the joint
  • Other joint replacements that get in the way
  • Poor bone quality
  • Problems with the skin

If joint replacement surgery is not available for any of these reasons, then the problem can be treated in other manners, including steroid injections, oral anti-inflammatories, hand therapy, splinting, bone fusion surgery, arthritis surgery, and surgery to repair tendons.

Why Get Joint Replacement Surgery?

Obviously, when a joint has become damaged beyond repair, it can cause pain, loss of motion in the hand, deformity, and other problems. The problems can be bad enough that you will not be able to use your hand properly or you may be in pain every time you need to bend a finger. Joint replacement surgery can improve hand function and remove the source of pain.

Ensuring the Surgery Provides Good Results

Of course, you need to choose a good hand surgeon, but there are things you will need to do after hand replacement surgery to ensure you get the best results without complications.

  • Always follow the directions of your surgeon and hand therapist. If they say not to do something, dont do it.
  • Do not overdo anything or try to use your hand too soon. You could damage the joint replacement and put yourself in new pain.
  • If something looks wrong with your hand, such as it is hot to the touch, red, very painful, or crooked, then contact your doctor immediately.

If you get a joint replacement, you should notice a marked difference as soon as the surgical incisions heal. However, you do need to take proper care of your hand to ensure the surgery has the best results, and you will need to discuss with your surgeon whether or not you should consider joint replacement surgery in the first place.

Resources:

http://www.medicinenet.com/joint_replacement_surgery_of_the_hand/article.htm

Categories
General

Hand Therapy and Rehabilitation – Arora Hand Surgery

Read Blog

If you have had an injury to your hand, some type of disorder, or you required surgery, then you may also need occupational or physical therapy on your hand to ensure that you are able to use it properly in the years to come. Hand therapy can actually even be used for preventative measures and to help control chronic pain. Hand therapy will be provided by someone who is licensed and educated to provide the best service in order to get your hand back to full usefulness as soon as possible.

When Is Hand Therapy Used?

As mentioned, there are numerous different times when hand therapy can be used to deal with problems and situations:

  • Therapy can be used for management of chronic pain.
  • It can be used to desensitize the hands and nerves after there has been a nerve injury.
  • It can also be used to reintroduce senses to the hand after a nerve injury.
  • It can teach patients how to use exercises at home after an injury or surgery.
  • Therapy can be used to help retrain the patient to use their hand for normal, everyday activities.
  • It can be used to recondition the hand before a patient needs to return to work.

In the case of hand surgery, therapy has a number of other uses as well, such as assisting in the healing open wounds, controlling swollen or sensitive scars, reducing swelling during the healing process, and providing patients with at-home exercises for the hand.

People need hand therapy in a variety of situations, including injury directly to the hand, surgery, trauma, severe burns, scars, amputations, carpal tunnel syndrome, tennis elbow, arthritis, and much more. In addition, patients who have problems after a stroke may need hand therapy to use their extremities properly.

Splinting and Protection

Often, after a hand injury or surgery, the hand will need to be immobilized in a certain position. This is another job of the therapist. Often, they will create or choose a certain splint or brace to ensure the hand stays in one position while it is still healing.

When you go to a hand therapist, you can rest assured that this is a professional who specializes in the hand or arm only. They will not be general therapists who may have to get information on how to offer therapies for your hand specifically. You can even find out more about hand therapists by visiting the American Society of Hand Therapists at www.asht.org. You can even search for therapists in your area by looking up your city and state. This will tell you more information and get you on the right track to choosing the best therapist for your needs.

Hand therapy is a very important part of the healing process, and it should not be ignored. Instead, if you have to have surgery or you have an injury to your hand, be sure to follow your doctors orders and get the therapy you will need in the wake of your situation.

Resources:

http://www.asht.org/

Categories
Conditions General Hands

Understanding Hand Tumors

Read Blog

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

Categories
Conditions General

What Is Kienbock’s Disease?

Read Blog

There are numerous different diseases and problems that can affect the hand specifically. In the case of Kienbocks disease, one of the small bones in the wrist is effected specifically. This bone is called the lunate and it is closer to the fingers than the forearm.

Kienbocks disease occurs when the lunate bone goes without the blood supply it needs.

There is no specific cause to the disease, and there are a number of different factors that can lead to it, including: the arteries, the bones themselves, and the veins that take blood away. If any one of these things is not quite right, it can cause this disease to develop. Many times, people with certain conditions are more prone to the disease. These conditions associated with Kienbocks disease include sickle cell anemia, cerebral palsy, and gout.

Sometimes, certain types of trauma and injury can also lead to a lack of blood supply to the bone. Certain occupations put it at risk especially.

Diagnosing the Disease

The most common symptom of Kienbocks disease is pain in the wrist that continues over an extended period of time. Additionally, you will feel tenderness when touched right where the lunate bone is situated. Generally, the disease is diagnosed through a combination of a physical exam and x0rays. Sometimes MRIs, CT scans, and bones scans are used to pinpoint the disease.

It is impossible to determine how the disease will progress. Some people may experience the same level of discomfort for a very long time. However, x-rays will be used to track progression. Over time, if the disease is not treated, then fractures will occur throughout the lunate bone. Eventually, it will completely collapse and change the way the wrist works altogether. If not treated, then Kienbocks disease can be debilitating.

Treatment

Treatment of the disease will be determined based on the severity of the condition. Sometimes, the disease will simply be tracked and observed. Other times, the hand may be immobilized with a splint. Some more serious treatments include:

  • Surgery to fuse the bones
  • Hand therapy to ease pain and restore hand functionality
  • Hand surgery to lengthen or strengthen the bone

There is no one specific treatment for this condition and your doctor will decide what to do strictly based on your condition and how the disease will progress. Since there is no sure way to determine progression either, then the condition will need to be closely observed. Otherwise, it may progress quicker than expected and cause serious problems much sooner. If Kienbocks has progressed to severity, then surgery will have to be considered in order to save the bone.

If you have wrist pain, then you should visit a doctor as soon as possible to determine whether or not you have Kienbocks disease. There are other conditions that could result in wrist pain as well. So, make sure you get diagnosed. If you have the disease, then you will need to discuss your options with your doctor and determine how it will be handled going forward.

Resources:

http://orthoinfo.aaos.org/topic.cfm?topic=a00017

Categories
Fingers General

Understanding Mallet Finger and Treatment Options

Read Blog

There are tendons located in your hand and fingers that are designed to straighten those digits. These tendons, called extensors, connect to muscles on each end so that you can have full control of your hands. If the extensor tendon becomes damaged, then it cannot properly do its job and may even be torn away from the bone and muscle. If this happens, you could develop mallet finger, which is often also referred to as baseball finger.

The common manner in which this injury occurs is if the finger is straightening and then forcibly hit by an object such as a ball, a hammer, or something similar.

The main symptom of mallet finger is a dropping fingertip that cannot straighten out. There could be other symptoms associated with the injury, including pain, swelling, and bruising. If the finger bone was fractured at the same time, more swelling and pain will be evident.

Diagnosing the Condition

Generally, the doctor will look at the finger first and then order x-rays. When the tendon was damaged, it may have forced a fracture and pulled a piece of the finger bone loose. It will be important to diagnose this properly so that the bone can be repaired.

Treatment of Mallet Finger

There are essentially two paths for treatment of this condition: surgical and nonsurgical. If the damage was only partial and no bones were broken, then the tendon may heal on its own. To help this happen, you will need to wear a splint for at least eight weeks. This will allow the tendon time to heal without experiencing any stress.

In many cases, the finger will go back to normal after it has been given healing time. However, some patients find that they are never able to fully extend their finger after such an injury. To help avoid this, your doctor or surgeon will go over therapy exercises you can do to regain full use of your finger and fingertip.

If the tendon is completely torn, or if bone is broken, then surgery will be needed in order to repair the injury. Pins and wires may be used to repair the bone fragments and get everything aligned back in place. Surgery on the tendon may be used to stitch it together. Additionally, the tissues may need to be fused in order to regain use of the finger. Your surgeon will go over the options you have when you are diagnosed with mallet finger.

Mallet finger is often called baseball finger simply because it is a common injury associated with this sport. If a player attempts to catch a ball and the ball hits the back of outstretched fingers, then this could cause the injury. However, it is not limited to the diamond. There are numerous different ways someone could injure the extensor tendons in their hand. If you suffered an injury and you have trouble extending your finger or it droops, then it is important that you visit a doctor as soon as possible. In fact, to avoid further complications, it is best to see a doctor within a week of the injury.

Resources:

http://orthoinfo.aaos.org/topic.cfm?topic=a00018

Categories
Elbows General

Cubital Tunnel Syndrome

Read Blog

cubital-tunnel-syndrome-figWhat many people call the “funny bone” really is a nerve. This ulnar nerve runs behind a bone in the elbow through a space called the “cubital tunnel” (Figure 1). Although “banging the funny bone” usually causes temporary symptoms, chronic pressure on or stretching of the nerve can affect the blood supply to the ulnar nerve, causing numbness or tingling in the ring and small fingers, pain in the forearm, and/or weakness in the hand. This is called “cubital tunnel syndrome.”

Causes

There are a few causes of this ulnar nerve problem. These include:

Pressure. Because the nerve runs through that “funny bone” groove and has little padding over it, direct pressure (like leaning your arm on an arm rest) can compress the nerve, causing your arm and hand—especially the ring and small fingers—to “fall asleep.”

Stretch. Keeping the elbow bent for a long time can stretch the nerve behind the elbow. This usually happens during sleep.

Anatomy. Sometimes, the ulnar nerve does not stay in its place and snaps back and forth over a bony bump as the elbow is moved. Repetitive snapping can irritate the nerve. Sometimes, the soft tissues over the nerve become thicker or there is an “extra” muscle over the nerve that can keep the nerve from working correctly.

Signs and Symptoms

Cubital tunnel syndrome can cause pain, loss of sensation, and/or tingling. “Pins and needles” usually are felt in the ring and small fingers. These symptoms are often felt when the elbow is kept bent for a long time, such as while holding a phone or while sleeping. Some people feel weak or clumsy. Loss of sensation and loss of strength or muscle in the hand is serious.

Diagnosis

Your doctor will be able to tell a lot by asking you about your symptoms and examining you. S/he might test you for other medical problems like diabetes or thyroid disease. A test called electromyography (EMG) and/or nerve conduction study (NCS) might be needed to see how much the nerve and muscle are being affected. This test also checks for other problems like a pinched nerve in the neck, which can cause similar symptoms.

Treatment

The first treatment is to avoid actions that cause symptoms. Wrapping a pillow or towel around the elbow or wearing a splint at night to keep the elbow from bending during sleep can help. Avoiding leaning on the “funny bone” part of the elbow can help also. A hand therapist can help you learn ways to avoid pressure on the nerve. When symptoms are severe or not getting better, surgery may be needed to relieve the pressure on the nerve.

This can involve releasing the nerve, moving the nerve to the front of the elbow, and/or removing a part of the bone. Your surgeon will talk to you about what is the right option for you and guide your care. Therapy sometimes is needed after surgery, and the time it takes to recover varies. Numbness and tingling may improve quickly or slowly, and it may take many months for the strength in your hand to improve. Cubital tunnel symptoms may not totally go away after surgery, especially if symptoms are severe.

View our Cubital Tunnel Syndrome PDF 

Bill Payment Made Easy

Pay on the Go!

Get on the List

Subscribe

Patient

Stories

Read All

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.