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General Wrists

You Have a Scaphoid Fracture…What Does That Mean?

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We all know that there are a surprising number of bones in our bodies, and when you start to look at the hand, it is even more astonishing to discover the amazing number of bones there as well. Just the area we know as the wrist contains a few groups of bones, including the carpal bones. They are composed of two rows of tiny bones, and these are linked by the “scaphoid” bone.

Because the scaphoid holds such a prominent position it ends up being the most commonly fractured carpal bone.

The Hidden Injury

The wrist is put under a lot of stress and strain in general, but one of the most common is intense pressure from a fall or a sharp blow with the hand. These types of incidents are what lead to a scaphoid fracture. For instance, someone is falling towards the ground and the natural instinct is to reach out with the hands to stop the impact. The pressure of the hands striking the ground can easily fracture the scaphoid.

The problem is that a fracture of this bone is not always obvious, and though there may be pain or bruising and tenderness at first, it may subside so quickly that the individual does not seek medical care. This is why many scaphoid fractures go undiagnosed for days, weeks, months or even years.

How is it diagnosed? Generally, it requires an x-ray to determine if the small bone has been broken, and even then it can be hard to detect. There is one key indicator, however, and that occurs in the area of the wrist known as the “snuffbox”, which is the noticeable hollow that appears at the outer base of the thumb at the wrist area. (AAFP.org, 2014) Should this area have tenderness, it is generally diagnosed as scaphoid fracture and the patient is then treated accordingly.

How Scaphoid Fractures Are Treated

There are two ways that the fractures of this bone occur – displaced and non-displaced. The non-displaced are the tricky fractures because they are not so obvious or even visible on an x-ray. The displaced are just as they sound – the bones are clearly displaced due to the fracture.

If diagnosis is not certain, the wrist is put into a splint and kept immobile until further x-rays or scans can detect the break. Treatment is ongoing immobilization using a cast over the entire forearm, hand, and thumb area. Generally requiring up to ten weeks (in some cases more) to heal, the treatment can be complicated by bone death.

Because a fracture to the scaphoid can interrupt the blood flow to the bone, healing may be a challenge. Surgery can be required to pin the bone together with a screw or bone graft, and even then healing is not guaranteed. The most common problems arising during or after treatment are non-union of the bones, death of the bone, and arthritis.

Though a tiny bone like the scaphoid may not seem all that vital or critical, it can cause many problems if broken and left untreated. Visiting a hand surgeon or expert immediately after any injury to the area is key to the best outcome.

Source

AAFP.org. Diagnosis and Management of Scaphoid Fractures. 2004. http://www.aafp.org/afp/2004/0901/p879.html

Categories
Conditions General Wrists

Understanding Carpal Tunnel Syndrome

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You have nerves in your wrist that play very important roles in your hands. One of these nerves, called the median, runs through the wrist and can become compressed or pinched. As a result, carpal tunnel syndrome may occur. When this happens, you might experience pain, swelling, numbness, and tingling. Eventually, as the swelling gets worse, you could lose partial use of your hand.

Because carpal tunnel syndrome can be caused by a variety of different issues, your doctor may not be able to pinpoint your specific problem. Causes can include:

  • Swelling to tendons and their lining in the arm and wrist
  • Dislocation of the joints in the wrist or hands
  • Arthritis
  • Holding the wrist in a bent position for extended periods of time
  • Fluid retention during pregnancy
  • Thyroid problems

Again, though, your physician may not know the exact cause, but can still diagnose carpal tunnel syndrome.

The Symptoms

As mentioned, as the median nerve is put under more and more pressure, you will experience pain, tingling, and numbness in the hand. You will notice that it effects the thumb, ring, index and middle fingers specifically. Generally, these symptoms will be more noticeable at night.

Other symptoms of carpal tunnel syndrome includes weakness in grip, hand clumsiness, and loss of sensation in the thumb.

Treatment of Carpal Tunnel Syndrome

Depending on the severity of the condition, different treatments can be used. For example, a doctor may recommend that you change how you use your hand and hold your wrist. You may also need to splint your wrist so that it remains straight. This will relieve pressure on the median nerve and allow the inflammation to subside.

Sometimes, your doctor may recommend that you have a steroid injection directly in the wrist. This will reduce swelling and inflammation, easing the discomfort. If your doctor has gone through all of these things or your carpal tunnel syndrome is very severe, then surgery may be needed to rectify the issue. When surgery is chosen, the procedure is simple. The surgeon will need to make an incision on the palm side of your hand and then cut through some of the ligaments around the nerve. This will relieve pressure.

Recovery from surgery will mean a few weeks of discomfort at the incision site. Numbness and tingling that you experienced from the carpal tunnel syndrome may disappear almost immediately, or it may slowly get less and less until you do not notice it anymore. You can expect several months of recovery before you regain full use of your hand. In some, isolated cases, surgery may not fully relieve all symptom of carpal tunnel syndrome.

Many people develop carpal tunnel syndrome because they have to bend their wrists for extended periods of time. For example, people who type on a computer regularly are at high risk. However, no matter what you may do, you could develop the condition. Depending on symptoms, there are different ways your problem can be treated so that any pain or discomfort can be relieved.

Resources:

http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm

Categories
General Wrists

What to Expect With a Wrist Sprain

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

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

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

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

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

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

Dealing With a Wrist Sprain

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

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

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

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

Categories
General Wrists

Dealing With a Wrist Fracture – Arora Hand Surgery

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

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

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

Diagnosing and Treating a Wrist Fracture

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

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

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

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

Source

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

Categories
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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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.