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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!
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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

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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

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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

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Conditions General

Explaining Metacarpophalangeal Joint Arthritis

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

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

Causes of MP Arthritis

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

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

Symptoms and Diagnosis

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

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

Treatment of Arthritis

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

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

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

Resources:

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

Categories
General Hands

Fractures in the Hands

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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

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

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

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

What Causes Gout and Pseudogout?

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

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

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

The Symptoms

Symptoms of gout and pseudogout include:

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

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

The Treatment

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

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

Resources:

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

Categories
General Hands

Infections in the Hand – Arora Hand Surgery

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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

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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.
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