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General Treatments

How Does a Fractured Arm Heal? – Arora Hand Surgery

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Fractures are very common injuries, and the healing process is essentially the same for all fractures – it happens in stages, as new bone begins to form and fill in the area that was fractured. With severe fractures, healing may happen more slowly. A fractured arm heals in five stages:

  1. Inflammation

This is the stage where swelling occurs. It begins when you incur the fracture, and it is caused by bleeding from the bone and tissue. This stage typically lasts anywhere from 2-3 weeks.

  1. Soft Callus

Around the third or fourth week, the swelling will ease and the injury will become less painful. Stiffness will occur as the new bone begins to develop. This stage typically lasts between 4-8 weeks.

  1. Hard Callus

In 1-2 months, the fracture is bridged by the growth of new bone. Within 3 months, new bone should have filled in the fracture.

  1. Bone Remodeling

At the 3-4 month point, the site of the fracture begins to remodel itself. This is when deformities that may have occurred as a result of the injury begin to correct themselves. In adults, this will probably take the full 4 months. Children typically heal more quickly.

Complications

Most of the time, fractures will heal without complications. That said, though, most of the time fractures are also due to a severe injury, and sometimes that injury can result in swelling that is so bad that pressure is placed on the blood vessels, preventing blood from getting to the muscles surrounding the fracture. When this happens a condition known as “compartment syndrome” can result – the muscles begin to die, and long-term disability can result. In extreme cases, amputation of the affected limb may be necessary.

Other complications can include:

  • Infection – In cases of an open fracture, the bone ends are exposed to air and contaminants, and infection can result. In severe cases, infections due to arm fractures can lead to the need for intravenous antibiotics, and possibly several days in hospital.
  • Neurovascular Injury – This is a type of complication that can occur when the injury is so severe that the nerves and blood vessels around the injury are also harmed. Usually surgery is needed to repair the damage.
  • Growth Abnormality – This is a type of complication that occurs when a childs bone is fractured. One side of the arm bone, or even the entire bone, stops growing normally, and develops an abnormal angle. This can result in one arm ending up shorter than the other.
  • Post-Traumatic Arthritis – When a fracture extends into the joint, the bones can meet abnormally, and premature arthritis can result.

Most of the time, complications will not occur. Broken arms happen with great regularity, and generally speaking, they heal as they should. When the injury is severe, though, and complications result, medical professionals have a number of ways of dealing with them. Assuming that you follow your doctors directions, you can usually expect a full recovery, free of complications, from a broken arm.

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General Hands Treatments

Is Hand Surgery Right for You? – Arora Hand Surgery

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Do you have issues with your hands? Are they painful and swollen much of the time, and does it cause you pain to do many of the things that youve always done and taken for granted, such as driving, holding a grandchild, or just typing? Have you had an injury to your hand, or have you developed a cyst or tumor on the hand? Many different things can go wrong with the hands, which are easily one of the most important, and often underappreciated, parts of the human body.

Determining the Right Course of Action

While some types of hand injuries can be remedied with medicine and rest, there are other injuries that could require surgical treatment. However, surgery is not the right option for all patients. Most of the time, doctors will want to avoid surgery unless it is the only or best option, and if other types of treatment have no effect.

You will need to speak with your hand specialist about whether surgery would work for your type of issue or not. In addition, you need to make sure that you are actually a good candidate for surgery.

You and the doctor will need to sit down and discuss the problems you are having with your hands (as they can vary so widely) and then come up with the best course of treatment. In some cases, they may want to move forward and consider surgery, but they need to make sure it you are actually a viable candidate. They will consider the type of condition and the severity, as well as whether you have exhausted other means of treatment. The doctor also wants to make sure you are healthy enough to have surgery, so they will ask a number of questions about your medical history and run tests.

In some cases, the patient may not be a good candidate. If they are smokers, are overweight or have other issues that could cause problems with the surgery, the doctors may request that they make some lifestyle changes first, to help make the surgery go more smoothly. Of course, this really depends on each individual case, and is something you can discuss with your hand specialist.

When you are speaking with the hand surgeon about the possibility of getting surgery, you should ask about the specific type of procedure being performed, the length of the procedure, how long it will take to heal, and what types of hand therapy might be necessary after the surgery. Getting answers to all of these questions in advance can help you determine whether it is the right option for you.

Emergency Surgeries

Of course, some types of surgery simply cant wait. A compound fracture, a crushing injury and the like will require immediate hand surgery in an attempt to repair damage and set the bones so the hand can heal. Emergencies are handled differently.

Find a Great Surgeon

When you are considering hand surgery, whether it is cosmetic surgery, surgery for arthritis, or any other issue, make sure you take the time to research and locate a respected hand surgeon in your area.

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General Treatments

Tips for Recovering From a Broken Wrist or Hand

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

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

Take Your Medication On Time

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

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

Do Not Remove Your Splint or Cast

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

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

Follow the RICE Method

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

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General Treatments

Why Your Hand Surgeon Prescribed Steroid Injections

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

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

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

What Are Steroids?

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

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

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

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

How Will Steroids Help My Hand Condition?

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

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

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

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General Treatments

A Look at Tendon Transfer Surgery

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In a report on hand tendon transfers, a group of physicians explained how this amazing treatment can be used to, “Create major improvement in the function of the extremity”, and that it was able to restore function in a new location. (Baumeister, et al, 2015).

Obviously, this makes tendon transfer surgery sound somewhat miraculous, and to those who need it and receive it, it truly can be. It is a surgical procedure in which a functional section of tendon is moved from its normal, natural position and attached to a new location in order to help restore function to that particular area.

It is as complex as it sounds and yet hand surgeons rely upon it for a long list of patients:

  • Babies born without specific muscle functions can benefit from tendon transfer surgeries.
  • Patients with nerve injury may benefit from the ability to use muscles disabled by the damaged nerves.
  • Muscles that have been lacerated or ruptured (and which are beyond repair) can benefit from the procedure.
  • Tendons damaged beyond repair can be replaced with a transfer.
  • Patients with nervous system disorders may lose muscle function, and yet tendon transfers may help them to regain some use of certain hand functions. This includes patients with traumatic brain injuries and stroke.

Clearly, this is a very useful procedure that can be a far more amenable option than many alternatives. For instance, the tendon transfer surgery can easily be used instead of surgery attempting to repair a nerve or muscle.

How a Tendon Transfer Surgery Works

It is difficult to summarize such a complex procedure, but to keep it a simple as possible: when a hand surgeon is going to use a tendon transfer, they begin by altering the point of contact between the tendon and the bone on which it originally resided. In its natural place, the tendon would always connect to a group of muscles that are, in turn, connected to their point of origin. In tendon transfer, the muscles are left alone, and it is the end point or terminus of the tendon that is altered.

The new connection point is chosen in order to create a very specific outcome. This is because the tendon can be attached to a different bone or tendon. This will allow the muscles to “fire” as normal, but their functions will now produce a different action or outcome.

This is why some stroke patients who have limited movement in the hands can have the most important functions, the pinching function, restored through a tendon transfer. This allows whatever muscle and nerve function remains to provide the pincer fingers with the ability to grip and move at will.

Your hand doctor will be able to determine if a tendon transfer is the best surgical solution for your needs. You will need to heal for a period of two months or more, get therapy to ensure the hand functions properly, and follow a rigid course of rehabilitation to get the best outcomes. However, the prognosis for most patients is usually good, and this procedure can provide you with a return of function that may have been lost.

Source

Baumeister, Steffen, et al. Hand Tendon Transfers. 2015. http://emedicine.medscape.com/article/1286712-overview

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General Treatments

When Replantation is an Option

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Most of us have read news stories or headlines about replantation, or may even know someone who has had this procedure done. What is it? In the world of hand surgery, it is the surgical reattachment of a finger, hand, or even an arm after it has been severed from the body.

Unfortunately, replantation is often an emergency surgery and this can make the decision-making process around it a bit complicated. Generally, a limb or digit can be reattached if:

  • It will work better than a prosthetic, or just as well.
  • It is in good enough condition to safely attach.
  • The patient feels that the lengthy recovery and rehabilitative process warrants the procedure.

It may seem obvious that a somewhat functional hand or arm is better than none at all, but there are many instances when a prosthetic will actually work far better and not cause the individual any further pain or discomfort. These are all things that must be taken into consideration before replantation surgery is done.

Of course, when it is the arms or hands in question, the need for these limbs is extreme, and so it can be very challenging to make the right decisions. This is why an experienced and knowledgeable surgeon must be consulted if possible.

How is it Done?

There are many things that have to be done before the procedure can be accomplished. First and foremost is an examination of the finger, hand, or arm that has been severed from the body. The damaged tissue has to be taken away; bone must be assessed and even trimmed if needed. All of the nerves, tendons, muscles, veins, and arteries have to be reconnected and new tissue may need to be grafted over the areas where it was lost or destroyed. (AAOS.org, 2015)

There are no guarantees to replantation success, and it is a very long period of recovery. However, it should be noted that the further down along the arm the replantation occurred, the more likely it is to be restored to its former use and condition. Additionally, joint injuries are less likely to heal quickly than non-joint injuries. And no replanted digit or organ can ever be “100%” due to the likely nerve and tissue damage.

It is up to the patient to do the hard work of recovery and use therapy and rehabilitation to get the best results. The first phases of recovery involve nerve healing and tissue growth. Once this has stabilized, the use of physical or occupational therapy can ensure that the limb is slowly and carefully restored to the fullest use possible.

There are also some complications that can arise, including emotional struggles with the loss of the limb if the replantation process does not succeed. Working with a qualified surgical team is the only way appropriate path. They can help a patient and their family through every part of the process and will explore every option for the fullest recovery possible.

Source

AAOS.org. Replantation. 2015. http://orthoinfo.aaos.org/topic.cfm?topic=A00314

Categories
General Treatments

Amputation and Your Hand

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Traumatic injury and disease are common reasons for amputation, which is the removal of a body part. For example, amputations of the hand or fingers could be a method of keeping infection from spreading into the body. Occasionally, unplanned amputation occurs, as in an accident that leads to the loss of fingers or a hand. In some cases, fingers that were accidentally amputated can actually be reattached, but this is not always feasible for the comfort of the patient.

The Amputation Procedure

Before any procedure is completed, the surgeon will take the time to examine the body part that is expected to be removed. They will use tests, such as x-rays, to determine the damage and its extent so that they can better prepare for the procedure ensuring that they remove the right amount of hand or fingers.

Depending on the extent of the surgery needed, the physician will use one of two methods to close the wound:

  • The existing skin and tissues will be used to close the wound at the amputation site.
  • Skin, tendons, or muscles will be taken from another part of the body and then used to close the wound at the amputation site.

Generally, the surgeon will do their best to leave the remaining tissue shaped in a way that a prosthetic will easily be fitted for the patient.

Recovery from Surgery

In the few weeks after surgery, you will feel some discomfort at the amputation site. Pain medications will be used to control the discomfort while you go through the healing process. You will need to keep your hand properly bandaged and cleaned until the doctor states bandages can be removed.

During recovery, you will need to perform certain exercises and processes so that you can strengthen your hand and ensure you keep the muscles and tissues flexible.

Anytime someone loses a body part, they may go through some emotional difficulties and they may find it hard to adapt to the new changes. You may even wish to consider counseling to get you through the difficult time. Its a good idea to seek help if you are feeling emotionally distressed or stressed in the wake of your amputation. You may be able to get that help from resources like the Amputee Coalition of America, found at www.Amputee-Coalition.org.

In many cases, you will be able to get a prosthesis to replace your amputated body part. The exact type of prosthetic will depend on what part is missing, what remains of the hand or finger, and what you prefer yourself. Prosthesis for amputated or partially amputated fingers usually are for looks and to provide opposition so that you can still use your thumb and fingers normally. Prosthetic hands can be used with bendable fingers. Finally, prosthetics for the full arm can include electric and mechanical parts to create a usable hand.

If you have to go through the amputation process, keep in mind that you will have options during healing. While this is a stressful and emotional procedure, you dont have to live with the consequences, thanks to prosthetics.

Resources:

https://amputee-coalition.org/limb-loss-resource-center/resources-by-amputation-level/partial-hand-fingers/index.html

Categories
General Treatments Wrists

Why You May Need Wrist Arthroscopy – Arora Hand Surgery

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

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

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

What Arthroscopy Provides

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

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

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

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

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

Source

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

Categories
General Treatments

Anesthesia Used in Hand Surgery – Arora Hand Surgery

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

Local

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

Regional

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

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

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

General

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

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

Resources:

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

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Stories

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Dr. Aroras office from my first call to schedule my appointment was friendly. Walking in the first day, I felt like I was in a nice atmosphere. Dr. Arora was EXCELLENT in taking great care of my hand injury. He was gentle and very understanding to the concerns I had about my hand. His expertise was admirable and I would recommend anyone with an injury to their hand to his office to be under his care. Because of him, I have healed faster than expected and will make an 100% recovery! Thank you Dr.

Jackie S.

I first thought I was going to have to have painful injections or surgery, but Dr. Arora suggested physical therapy may do the trick. I was doubtful, but I agreed to do it. Now, my pain is gone, and with the help of an ergonomic keyboard at work to keep my hands in the correct position, I am virtually pain free. The therapy strengthened my wrists and shoulders, and built more flexibility into my wrists.

Jerry T.

My experience with this doctor was positive from the outset. Dr. Arora was kind and spent a great deal of time with me. Staff was friendly. The office was nice and bright.

Ariel G.

Very friendly and helpful Great staff!!! Doctor Arora was very professional and did great work. I was very happy with everything!

L B.