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General Hands

Nerve Injuries of the Hands

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If there were some sort of illustration that showed us how much of our brains functions went to operating the hands, it might astonish you. A huge amount of communication and activity between the hands and the brains occurs each day of your life, and when there are nerve injuries it can be tremendously disruptive to your ability to function completely.

As the American Society for the Surgery of the Hand indicates, the nerves are like a “telephone wiring” system in the body which sends and transports messages from the brain and out to every possible location. Just as in a real world setting, if those lines are damaged or downed in some way, communication ceases and messages cannot head back and forth as usual.

Nerves are also, physically, a lot like phone lines with their outer protection and their many inner lines and fibers. Additionally, the various inner lines have different tasks, too, and there are motor nerves for making your body move, sensory nerves that indicate everything from pain to temperature. Any nerve fiber can carry only one message – either sensory or motor, but all nerve tissue is made up of both types of nerves.

Should a nerve be harmed due to injury, pressure, crushing, or stretching, all of the messages stop, too. This can leave you unable to move a limb or experience sensation or feeling in the area where the nerve once communicated. Interestingly enough, the part of the damaged nerve that is closest to the brain does not die when injured. It remains alive and can continue to function and even grow. Though this can develop into a painful condition known as neuroma, it also means that a nerve that has been damaged does have a chance at being restored.

Can Damaged Nerves Come Back to Life?

If a nerve is severed, the various lines and connections can be reconnected through a surgical procedure. However, it is not as simple as it sounds, particularly when speaking about the nerves of the hand, which are thin strands no bigger than threads of yarn.

The good news is that it can be done, but it does have a lengthy recovery process. The initial goal is to get that outer sheath back together in order to encourage the inner nerves to reconnect and restore themselves. This is why any surgeries for nerve injuries demand at least three weeks of “downtime” after the procedure. Even then, the pace of regrowth is very slow, and to prevent any further damage, the patient is discouraged from using the digit or hand during the initial recovery period.

After that, however, there will be the need to use therapy to help the hand or fingers regain flexibility and function.

Your hand surgeon can review the options for nerve repair, and let you know your expected prognosis. With time and work, though, even severed nerves can be recovered or restored to at least partial function and health.

Source

ASSH.org. Nerve Injury. 2015. http://handcare.assh.org/SearchResults/tabid/145/SearchModuleID/1720/sites/1/Default.aspx?SearchTerm=damaged+nerves

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General Hands

Dealing with Animal Bites and the Hand

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Animal bites are very common in humans, and they often occur on the hands. Thats because people may be reaching toward the animal or holding out their hands in defense. These bites are painful and they often lead to infection because of bacteria found in the animals mouth. Complications from this type of infection can be very minor, resulting in just discomfort, but they can also be very serious, to the point that they are life threatening.

Every year, millions of people in the United States are bitten by dogs, cats, rodents, rabbits, monkeys, and ferrets. Of course, the vast majority of these are dog bites, specifically.

The Problem with Animal Bites

When animal bites occur in the hand or fingers, the wound itself is usually not that bad. However, there is a high risk of infection. In fact, the infection can be so bad that it could lead to hospitalization and does in about 1% of people who have been bitten by dogs and 6% of people who have been bitten by cats.

When it comes to animal bites, there could be a risk for rabies infection, but this is fairly rare. However, no matter what, if you have been bitten by an animal other than your own pet, you will need to report this bit to the health department. The animal will need to be tracked down.

The Problem of Human Bites

Human bites are, in essence, more dangerous than animal bites. Thats because humans have more bacteria in their mouth and this puts the bitten individual at high risk. Human bites can occur in different ways, including children biting people or broken skin that occurs during a fistfight.

Signs That a Bite Is Infected

Redness and swelling from a bite to the hand or fingers should only last about 24 hours. Symptoms of an infection include:

  • Swelling
  • Red Streaks Extending from the Bite
  • Swollen Lymph Nodes in the Arm
  • Pus in the Bite Wound
  • Loss of Sensation in the Hand or Fingers
  • Fever

Treatment of the Bite

If you have been bitten by an animal or human, it is a good idea to seek help from a physician. If it is showing signs of infection, then you definitely need to make an appointment. The hand will be examined and then cleansed carefully. The doctor may need to remove any dead skin from the wound. You will be given antibiotics, either in oral or intravenous form, to stop any infection. You will need to continue with follow up appointments to ensure the infection is being managed and is diminishing.

Animal and human bites can be very dangerous, leading to infection that can spread quickly. If not controlled, this could lead to permanent damage or even loss of part of the hand. If the infection spreads, then this could even lead to other medical problems throughout the body. So, if you have been bitten by an animal or a human, you will need to visit a physician as soon as possible.

Resources:

http://www.webmd.com/first-aid/tc/animal-and-human-bites-topic-overview

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General Hands

Congenital Hand Problems in Children

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Congenital differences refer to problems that a baby is born with. In the hands, this can result in a couple of different fairly common problems, which can range from very minor to major, requiring surgical correction. When a baby is being formed in the mothers womb, thousands upon thousands of different things happen to form each part of its body. In the case of the arms, when the woman is about four to eight weeks pregnant, the fetus will develop an arm bud, or the beginnings of the arm itself. Over time, signals will be sent to the cells to form the arm. If any step is missed or confused, then a congenital hand problem could develop. Sometimes these are genetic, but often there is no diagnosable cause for the issue.

Types of Congenital Hand Problems

There are a few different types of congenital hand problems that could develop and appear in a newborn. These can include:

  • Webbed Fingers
  • Fused Fingers
  • Missing Parts of the Hand or Arm
  • Extra Fingers or Other Parts
  • Fetal Band Syndrome

We will go over most of those momentarily. Fetal band syndrome occurs when a band of tissue stretches from the placenta and wraps around a part of the baby. In some cases, this will mean wrapping around the hand, wrist or arm, cutting off circulation. This often results in amputation of all or part of the hand or arm.

Common Congenital Hand Problems

About one out of every 20 children will have a difference of some type. Some of them are so minor that very little has to be done. However, in many cases, correction will be needed to ensure the hand looks and functions normally. Common problems include:

  • Webbed or fused fingers (called syndactyly). The fingers can be separated through surgical procedures.
  • An extra pinky finger (called post axial polydactyly). Again, this can be corrected with surgery.
  • An extra thumb (called thumb polydactyly)

If the congenital problem is an issue, then it will likely need to be treated through surgical means.

Surgery to Correct Problems

When a congenital hand problem has been identified, then a surgeon will discuss options with you. In most cases, any problem can be corrected with surgery. Webbed or fused fingers can be separated. Extra fingers can be removed and the other finger, which may have been effected, can be surgically reconstructed.

The only time when surgery would not be considered is if it would severely compromise use of the childs hand. This is something that will be evaluated by a hand surgeon and discussed with you.

You can find out more about these surgeries by visiting the American Society for Surgery of the Hand at www.assh.org. Congenital hand problems do not have to be a lifelong issue. Instead, through corrective surgery, the hand can be restored to normal, often providing better functionality. If you have any reason to believe that your child has a congenital hand problem, then it is best to make an appointment with a hand specialist.

Resources:

www.assh.org

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General Hands

Hand Fractures in Children

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Children have a different bone structure than adults. Their bones are softer and are growing. An adult will have harder bones that are completely grown. Because there is such a difference, when a child has a broken bone, it needs to be treated differently than it would be in an adult.

Fractures of the hand and fingers are common in children for a variety of reasons, including:

  • Curious children may put their hands in something dangerous
  • Hands and fingers can be crushed in closing doors
  • Sports injuries can break bones
  • Falling and twisting while playing can cause fractures as well

Essentially, you must remember that children are active and curious. They are more prone to injury simply because they dont know how to keep themselves out of harms way.

Types of Fractures in Children

Most people assume that they will see a deformity that indicates the hand, finger, or arm has been fractured. A vast majority of fractures in children will be non-displaced. This means the bones did not move out of place. Another name for this is hairline fracture. The bone may not even be fully broken into two pieces, but the fracture could still be present.

Fractures in children have to be handled in the proper manner. Thats because growing kids have something called growth plates at the ends of the bones. These cart ledge plates allow the bone to continue growing and lengthening, and the whole area is weaker, making it especially prone to breaking. If the bone doesnt heal properly at the growth plate area, then this could actually limit the growth of the bone in the future.

Treating a Hand Fracture in Children

As long as the break is clean, there is no need for surgery and the physician may be able to “set” the bone and then place a cast or splint on the hand or arm. In most of these cases, the break will be healed in a month. Thats because children heal quickly. However, if the fracture is severe, then surgery may be needed. Pins may be placed to keep the broken areas in the proper alignment until the bone is able to heal properly. It is important that fractures in the joints or those that are twisted are realigned exactly to ensure proper healing. That means the child will need surgery to ensure the fracture is aligned in the right manner.

While you may be able to prevent certain fractures in your children, many of them will not be preventable. Its important that you teach your child not to reach out and touch machines or other types of equipment. Additionally, you can have your child wear wrist guards whenever they are engaging in sports. While this will lower the risk of a fracture in the hand or fingers, it will not take away all of the risk. Children are naturally curious and full of energy. They will likely put themselves in more than a few dangerous situations no matter how careful you are as a parent.

Resources:

http://kidshealth.org/parent/general/aches/b_bone.html

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General Hands

Injuries to Flexor Tendons

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Whenever you use your fingers and they bend different ways, then your flexor muscles are at work. These are muscles in your hand that are connected together by tendons. The muscles themselves are located in the hand and go all the way up to the forearm right near your elbow. Where the muscle ends in the hand, flexor tendons take up the job, run the length of your fingers and then connect to smaller muscles in your fingertips. They are located on the palm side of your hand, running up through your wrist, and since there isnt much tissue covering them, they can be injured fairly easily.

What Causes Damage to Flexor Tendons?

The tendon could become severed if a deep cut occurs to the palm or wrist. The tendon will pull away from itself as soon as it has been cut or torn, and that means your finger will not be able to bend. If the tendon has not been completely cut or torn, then the finger may still bend, but the bending may be very painful and the tendon will eventually tear all the way.

You can also develop tendonitis in the flexor tendons, which means they have become inflamed and painful. Tendonitis will heal over time and not cause any permanent damage.

Repair

Tendons, like other tissues in your body, can heal themselves if the two cut ends are brought together through surgery. There is no way a completely cut or torn tendon will heal on its own. Your doctor will need to determine the nature of the cut or tear and then choose the right surgical method for repairing it. Often, when the tendon has been damaged, tissues in the area will be damaged as well, and they may need repair during surgery also.

After you have had surgery to repair the tendon, then you will need to keep the finger immobilized and that is why you will need to wear a splint. After several weeks, you will be able to move your finger, but only when you are going through hand therapy. Generally, you will need to wait up to six weeks to move your finger much at all and three months before you can use your finger as normal.

Therapy

However, you will likely never gain proper use of your finger if you do not go through therapy. This therapy is required to help build up strength in the hand, prevent scars from stiffening, etc. So, if you have a torn tendon repaired, be sure to follow up with therapy as advised. This therapy could last anywhere from a few weeks to a few months depending on your injury.

Your hand is an intricate thing, and each tendon within it plays a very important role. If the flexor tendons have been damaged, then you will not be able to bend your fingers as needed. It will be important that you seek the help of a physician so that the damage can be properly repaired and so that you can use your hand properly again.

Resources:

http://orthoinfo.aaos.org/topic.cfm?topic=a00015

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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

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
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.