Wrist injuries are very common. Treatment of wrist injuries is a specialized task because of the complexity of the area. There are 8 carpal bones including the radius and ulna bones of the forearm. There are multiple important ligaments which connect and stabilize the bones in the wrist and tendons which cross the wrist in order to move the fingers. Important nerves travel across the wrist to supply sensation to the thumb and fingers. Critical blood vessels supply nutrition and blood flow to the digits.
Some wrist injuries are minor sprains and heal with a brace within a few weeks. Others are more severe and require casting, hand therapy, and sometimes surgery. Surgical cases include fixation of displaced wrist fractures, repair of ruptured carpal ligaments, repair of torn TFCC ligaments, decompression of the median nerve, repair of lacerated tendons, among others. Specialized evaluation is often important to make a proper diagnosis and involves a careful physical exam, history, radiographs, and possibly an MRI. For subspecialty evaluation in the greater Raleigh area please call our office for an appointment. Please watch this video from the American Society for Surgery of the Hand for additional information about broken wrists.
Avocado related hand injuries are on the rise. Chefs and celebrities recently have been injured while attempting to cut the fruit, bringing increased attention to the risks involved. Most people accidentally cut their non-dominant hand which is holding the avocado. The knife can slip quickly through the soft flesh and into the hand which is holding the fruit. Nerve and tendon damage are common with this type of injury. This can result in several weeks or months of recovery after surgical repair of the lacerated structures.
In order to avoid a hand injury, cut the avocado only on a stable, flat surface. Do not cut towards your hand.
If you have a hand laceration, clean the wound in running water, place a clean bandage on the wound and hold pressure to stop bleeding. If the bleeding does not stop after 5-10 minutes of firm pressure on the wound, or if you have numbness in your hand or finger, or limited finger range of motion, seek medical attention promptly.
Drs. Edwards Jr, Erickson, and Messer were at hand conferences last week and have now returned to Raleigh. Dr. Edwards Jr and Dr. Messer attended the annual Southeastern Hand Society Meeting in Florida. Dr. Erickson attended the annual Vanderbilt Hand and Upper Extremity Conference in Nashville, TN.
Dr. John Erickson of Raleigh Hand Center presented at UNC Orthopedic Hand Conference on Monday, 4/23/2018. His talk was titled “Preventing Complications in Distal Radius Fracture Surgery.” Local area hand surgeons, therapists, radiology staff, and ortho residents were in attendance.
Raleigh Hand Center doctors are experts in the diagnosis and treatment of carpal tunnel syndrome as well as many other conditions of the hand and arm. Carpal tunnel syndrome is the most common nerve problem in the hand. It results from increased pressure on the median nerve at the wrist, within the carpal tunnel. Symptoms such as hand numbness, tingling, weakness, and pain can result if the nerve is compressed or “pinched.” Patients often wake up at night with the hand numb and shake out the hand for relief.
The carpal tunnel is a passageway in the wrist through which the median nerve and tendons of the hand travel. The carpal tunnel is a narrow, confined space: the floor of the tunnel is made up by the carpal bones of the wrist, and the roof is created by the transverse carpal ligament. The median nerve is at risk for compression within this tunnel. If there is abnormal swelling, altered wrist anatomy, or injury to this area, the function of the median nerve may be affected.
Patients with CTS commonly report “numbness” or “tingling” in the fingers. Some patients feel that the fingertips are “asleep” or report “poor circulation” in the hands. Symptoms often wake patients up at night. Some patients report increased symptoms while gripping a steering wheel. Dropping objects, clumsiness with the hands, or a weak grip are also common complaints. Some people also report pain in the forearm, wrist or fingers. In severe cases, the muscles at the base of the thumb (thenar muscles) can become weak and atrophy, sometimes permanently. See image below.
Often the diagnosis can be made on the basis of your symptoms, medical history, and physical examination. A nerve test can be ordered to confirm the diagnosis. Please call (919) 872-3171 to schedule a consultation with a hand specialist at Raleigh Hand Center. Surgical and non-surgical treatments are available.
Dupuytren’s Contracture is a common condition affecting the hands. Patients with this condition develop nodules in the palms followed by fibrous cords extending into the fingers. In many patients, the cords gradually contract and cause the fingers to bend or flex. If left untreated, the fingers may remain permanently bent and impair hand function. Activities such as shaking hands, wearing gloves, and reaching into a pocket can be difficult. Fortunately, if treated in the early stages of contracture, the results are usually good to excellent and the results frequently last many years.
In mild forms of the disease, intervention is not always required. Once a finger contracts to the extent where the palm cannot be placed flat on a table top, it is usually time for treatment.
There is no cure for Dupuytren’s disease. The goal of treatment is to remove or break up the contracted palmar cords to allow for improved finger range of motion and better hand function. Recurrence of the contracture is possible with any of the available treatments. There are 3 main techniques used by hand doctors today:
Surgical excision (Dupuytren’s fasciectomy): this surgery is performed by the hand doctor in the operating room under the care of an anesthesiologist. During surgery the diseased, contracted Dupuytren’s tissue is removed through incisions in the palm. Patients are treated with splinting, wound care, and hand therapy for a few weeks during the recovery process. Results from surgery can last a lifetime and typically the results last many years.
Needle aponeurotomy (percutaneous fasciotomy): this less-invasive procedure is performed by the hand doctor in the office using the tip of a needle to perforate the Dupuytren’s cord using local anesthesia. Once the Dupuytren’s cords are weakened, the finger can be manipulated and straightened. Recurrence is common with this technique, but it is the least expensive option and has minimal downtime. The technique can be repeated for recurrent contractures in the future. Not all patients are good candidates for this procedure.
Collagenase enzyme (Xiaflex): this medication is used to treat Dupuytren’s contracture and was FDA approved in the United States in 2010. Xiaflex is an enzyme which dissolves the collagen fibers in Dupuytren’s cords. The Xiaflex injection is performed by the hand doctor in the office, and later that week the patient returns for a manipulation procedure under local anesthesia. The surgeon then manually pops the cord once it has been weakened by the Xiaflex medication. Patients are instructed in home exercises and splinting by therapy, and there is minimal downtime required after the procedure. Recurrence is common with this technique, but it can be repeated for recurrent contractures. Not all patients are good candidates for this procedure.
As with any medical procedure, there are possible complications from these treatments. Complications from Dupuytren’s surgery include infection, poor wound healing, bleeding, swelling, hand stiffness, and nerve/artery injury. Complications from needle aponeurotomy include skin tears, nerve injury, and infection. Complications from Xiaflex include flexor tendon rupture, allergic reactions, hand swelling, bruising, lymph node swelling, and skin tears.
Dupuytren’s surgery, Xiaflex injection, and needle aponeurotomy are available at Raleigh Hand Center. Call 919-872-3171 to schedule a consultation with a hand doctor.
Dr. George Edwards, III recently published an article in the journal “Advances in Plastic and Reconstructive Surgery”. His study involved children with thumb abnormalities from birth, and evaluated surgery which could improve the child’s hand function. Dr. Edwards and colleagues at the University of Southern California performed bilateral pollicization surgeries for children with thumb hypoplasia or thumb absence. Here is a link to the article, click here
Dr. George Edwards III and Dr. John Erickson returned from their Nicaraguan mission trip. The physicians traveled with the not-for-profit organization COAN (Cooperacion Ortopedica Americano Nicaraguense) to deliver orthopedic care to patients in Leon, Nicaragua. They also provided lectures to orthopedic residents and medical students in several teaching conferences and taught surgical techniques to residents in the operating room. The surgical cases included a wide variety of problems including chronic contractures of the fingers and wrist, nonunion of a radius fracture, chronic nerve laceration in the forearm, acute fractures of the hand, wrist and forearm, trigger fingers, and tumors of the hand and wrist. For more information about COAN, please visit their website here: http://www.coanhealth.org