Sports injuries and on-the-job injuries are unpredictable and sometimes unavoidable. Volleyball, football, baseball, basketball, gymnastics; most sports involve some degree of risk. A sharp blow to the finger, whether from a pop fly, a hurtling volleyball, a hammer, or landing on the hand incorrectly can cause a fracture.
The hand is comprised of many bones, and each finger in the hand is made up of three small bones called phalanges. Damage can occur to any one of these bones. Typical symptoms of a broken finger are immediate pain with swelling and bruising. It will be difficult to move the finger, and the finger may appear deformed if the joint is dislocated or the bone is displaced. Numbness and tingling may be present if nerve damage has occurred. Needless to say, if the injury is severe and the bone is visible through the skin, a trip to the Emergency Room is required immediately. Serious problems with infections or bones that heal out of alignment can occur with any finger break.
Especially in children, these types of injuries can be difficult for the lay person to differentiate from a serious sprain or strain. An X-Ray is the definitive diagnostic tool to determine whether a break has occurred, and your doctor or a special hand surgeon will perform this procedure. Once diagnosed, treatment usually consists of realigning the bones and splinting or casting to immobilize the area for several weeks for the bones to knit back together. Initially the doctor may also recommend keeping the hand elevated above the heart to reduce swelling and pooling of blood, and to ice the affected area for 20 minutes 3 to 4 times a day until the pain is gone. Depending on the age of the individual, over the counter or prescription anti-inflammatory medications may also be prescribed to reduce swelling and pain.
Once the cast or splint is removed and the phalange has healed, stiffness and immobility may be present. Specially-trained Occupational Therapists, known as Hand Therapists, will create a treatment program including exercises, stretching and other modalities to assist in regaining full range of motion and strength in the hand. Faithful performance of the exercises, using the proper alignment, will result in the most favorable outcome.
We rely on our hands for everything we do! Injuries to the hand that aren’t treated properly can have long-term effects, including disfigurement and immobility. Most broken fingers heal well with the above-described measures, but if the break is in multiple locations, or very severe, surgery may be required. In this case you especially need a hand specialist, who understands the complexities involved in repairing damage to the hand. Reach out to Dr. Rehman and her team of professionals today if you are experiencing hand, arm, wrist or shoulder pain. Click here to contact her office, or call 586-532-0803 for more information.
Olympian long-distance cyclists are at risk for this condition, as are professional baseball pitchers, but you could be too. Do you notice numbness, tingling or pain radiating into your arm and hand on the side of the little finger? “Handlebar Palsy” or Ulnar Neuropathy can be caused by the repeated jarring of the wrists and hands when cycling. The result is an inflammation of the ulnar nerve, a major nerve in your arm that runs down your hand. Inflammation of the ulnar nerve can occur in several areas as it travels from your neck to your hand. Resting your elbows on hard surfaces for a long period may cause a slight inflammation, but intense physical activity such as long-distance biking or repeatedly pitching a baseball are more likely to cause the serious cases of this condition.
Watch for numbness, tingling or pain in the forearm or hand on the side of the little finger. Pain and numbness in the elbow may also be present, with decreased hand grip and the inability to pinch together the thumb and the little finger. The ulnar nerve often becomes trapped in the elbow, as the space it has to travel through in this area is limited. This is called “Cubital Tunnel Syndrome.”
Although ice, rest and anti-inflammatory medications may help initially, if the pain and tingling persist, seek the advice of a specialist trained to evaluate and rehabilitate the hands and upper body. This doctor will review your symptoms and ask about your lifestyle and activities. He or she will examine your neck, shoulder, arm and wrist. The doctor may order tests such as a nerve conduction study (NCS) or an electromyogram (EMG). EMG is a procedure where electrodes are placed into the muscles and on the skin to measure the health of muscles and the nerves that control them, to help identify the area of nerve damage and determine the severity of the condition.
The exact cause of the condition must be determined, and behavioral changes must be made to reduce the pressure on the nerve. Wrist splints may be prescribed to reduce discomfort. If the cause is from bicycling, it may help to wear padded gloves and to change your hand position on the handlebars frequently. Oral anti-inflammatory medications and B vitamins may also be prescribed. Typically these minimally invasive measures will alleviate the condition, but if not, surgery may be required. The vast majority of patients respond favorably to some type of surgery to correct this condition.
If the nerve is trapped in the elbow, Cubital Tunnel Release surgery can be effective. This is typically done on an outpatient basis, and individuals can go home the same day. The area known as the cubital tunnel is cut to allow more room for the nerve to pass through. As healing occurs, new tissue is formed and fills in this area. The recovery period for this type of surgery includes wearing a splint for a few weeks and physical rehabilitation therapy to return full range of motion and strength to the arm and hand.
Repetitious motions or constant jarring of the arm cause the inflammation of the ulnar nerve. Try to reduce activities that repeatedly stress this area, and take frequent breaks with arm stretching when you can. If you are a bicyclist, wear padded gloves and move your hand position on the handlebars frequently.
If you are experiencing pain, stiffness or tingling in your hands, arms or shoulder, contact Dr. Rehman for a comprehensive evaluation and treatment plan. Her team of hand therapists will help you return to your activity with full use of your arm or hand. Call 586-532-0803 for more information.
Bumps on the hand or wrist are most often ganglion cysts: a fluid-filled sac that bulges up. They can appear quickly, and disappear just as quickly. But sometimes the cysts remain, and are unsightly or cause impaired function or pain in the hand or wrists. Why these cysts develop is still unknown, but they are more common in younger people from ages 15 to 40, and they are more common in women than in men. One theory posits that they are caused by repetitive motion of the hand or wrist. Gymnasts have been noted to experience the problem more frequently, due to the extra stress and pressure on their hands and wrists.
Treatment for ganglion cysts is often non-invasive, and may involve the use of wrist splints to immobilize the hand, thus allowing the overworked area to rest. Sometimes this can reduce the cyst. If the cyst is quite bothersome or painful, an aspiration procedure may be performed. In this procedure, the affected area is numbed and a needle is inserted into the fluid-filled cyst, withdrawing the fluid. This can relieve the pressure that may have been placed on nerves or tendons, causing the tingling or pain in the hand or wrist. If the cyst grows back, sometimes this procedure can be repeated with success.
Failing that, and if the cyst is quite bothersome or creating pain, a surgical procedure may be required. In this case a special orthopedic surgeon such as Dr. Rehman will perform a procedure to remove the ganglion and its root. This is typically an outpatient procedure, and the patient can go home later in the day. Splints and dressings are required, and often Occupation Therapy is prescribed to return full strength and range of motion to the hand and wrist. Because the structure of the hands and wrists is so delicate, it is best to have a specially trained doctor, such as a hand surgeon, perform this procedure.
If you are experiencing pain, stiffness or tenderness in your hands, arms, should or elbow, contact Dr. Rehman today at 586-532-0803. Her team of orthopedic experts will implement a comprehensive treatment plan to help you attain a full recovery.
We’ve all heard of splinting, and have a general idea of what it is. But today’s advanced, custom-designed orthopedic splints are so much more than the basic splints of years ago.
Particularly for hand and wrist involvement, a specially-designed splint that is custom made for the individual’s particular situation can make a world of difference in the healing process and the return to full use of the affected area. Custom splints are often used to treat conditions like muscle strain, neuritis, tendonitis, and sometimes are used following hand or wrist surgery. The splint acts to provide rest for the injured or inflamed areas, as well as holding the affected appendage in the correct position.
Especially after surgery, custom splints can help the patient with the early motion protocols that are needed to help facilitate a full recovery. Custom splints also help following surgery by providing a barrier against common post-operative injuries.
With today’s technology and the advanced skill set of the hand therapists at Dr. Rehman’s office, custom splints can be made for many applications. The therapist designs and fabricates the custom splint, which is manufactured from low-temperature thermoplastic material; it can be designed specifically for the injury, as well as the size of the patient.
Injuries and conditions of the hand and wrist that are not healing properly deserve the attention of an experienced, knowledgeable, Board Certified orthopedic doctor who specializes in this area of the body. If you are having pain in the hand, wrist or shoulder, seek a consultation from Dr. Rehman today.
Middle school and high school football and cheerleading are back in full swing, and the potential for sprains is increased. Twisting, falling, a blow to the body, or slipping can all result in soft tissue damage.
Ligaments are the strong bands of tissue that connect the bones of the body together. They stabilize and support the body’s joints. A stretch or a tear to a ligament is called a sprain. These types of injuries can occur slowly over time, or they can be of sudden onset—due to an accident, a fall, twisting or landing wrong. Football players and cheerleaders alike are susceptible to strains; the most common areas injured are the knees, ankles or wrist. Sudden twisting can damage the ligaments that stabilize the ankle or the knee, and falling on the outstretched hand can injure the ligaments in the wrist.
Sprains are classified into three categories:
Grade 1 – Mild- Involves slight stretching and some damage to the ligaments.
Grade 2 – Moderate – Is indicated when the ligament is partially torn; looseness in the joint may be noticeable.
Grade 3 – Severe – This diagnosis is indicated when there is a complete tear of the ligament. The joint involved will be basically non-functional.
Considerable pain may be involved, the severity of which will be related to the amount of damage incurred. Bruising, swelling and inflammation will also be present.
The best protocol to follow is to rest and ice the affected area for 20 minutes at a time, several times a day, using cold packs. An elastic compression bandage may be of help to reduce additional swelling. Along those same lines, elevating the injured area can help reduce swelling. If the injury is especially severe, surgery may be required for the recovery of full range of motion in the joint.
Even with proper treatment, strains may take a prolonged time to heal. With the delicate bones and ligaments of the wrist, especially, if an injury does not seem to be resolving, contact a Board Certified Orthopedic specialist such as Dr. Rehman for a full evaluation and comprehensive treatment plan. She is best equipped to determine whether surgery is needed. Plus, her team of therapists can augment your treatment with specialized exercise programs or physical therapy, so a full and complete recovery is assured.
Ganglion cysts show themselves as lumps or bumps on the hands or wrist. The most common locations are the top of the wrist, the palm side of the hand, the base of a finger on the palm side and the top of the end joint of a finger. These cysts can be painful, but often they occur and don’t display any symptoms.
The cause of ganglion cysts is for the most part unknown, although cysts that occur at the far joint of a finger may have an arthritic bone spur associated with them.
Cysts occur on top of a joint or tendon, and are basically a sac filled with a thick, clear, colorless jelly-like substance. Sometimes they will go away on their own, but if discomfort is associated with them, it is best to seek professional treatment.
Problematic symptoms you should watch for are:
Pain
Numbness
Weakness in the hands or fingers
If these symptoms are present, the cyst may be pressing on a nerve or tendon in the hand or the wrist.
If the cyst is not causing pain or other complications, it can often be treated with aspiration. A sterile needle is inserted into the sac, and the fluid is removed in a simple in-office procedure. Following this, a steroidal compound is often injected to reduce inflammation; the patient will then wear a splint to stabilize the area until healing is complete.
If pain or numbness are present, sometimes surgery is required to remove the cyst. The areas of the wrists and hand are exceedingly delicate, and it is best to choose a surgeon with extensive experience who specializes in hand surgery. Dr. Rehman is a Board Certified Doctor of Osteopathy, and employs a team of professionals who assist her patients with a full recovery after surgery.
If you are experiencing a cyst that does not go away on its own, contact Dr. Rehman today for a full evaluation and a comprehensive treatment plan.
Called “Carpal Tunnel Release”, the surgery for this painful condition is one of the most common surgeries in the US today. Since the hand and wrist are such delicate and complex mechanisms, with incredible sensitivity, you should seek out a hand surgeon who is highly trained and who employs the latest surgical technology.
Traditional Open Release surgery requires an incision about two inches long at the wrist. The surgeon then cuts the carpal tunnel ligament to make more room in the carpal tunnel and relieve the pressure on the median nerve. This surgery is usually done on an outpatient basis, unless there are other complicating medical conditions.
Newer surgery, called Endoscopic Surgery, requires only one or two incisions, about ½ inch each, in the wrist and the palm. A camera attached to a tube is inserted so the surgeon can see the tissue, and using small instruments the surgeon cuts the carpal ligament to release the pressure on the nerve. This surgery is usually performed under local anesthesia on an outpatient basis. Far less damage is done to the surrounding tissue, and recovery time is usually much less from this type of surgery than the traditional Open Release procedure.
Nontheless, this is still a surgical procedure and recovery time must be expected. Full recovery could take two or more months, and patients should undergo physical therapy after surgery to re-build wrist strength and flexibility. A well-planned rehabilitation plan is essential, and Dr. Rehman employs specialized therapists to help each patient gain a full recovery. Always consult with a Board Certified specialist like Dr. Rehman when you have issues involving your hand or your arm.
Carpal Tunnel syndrome occurs when the median nerve leading from the forearm into the palm of the hand becomes compressed. This nerve is carried through the carpal tunnel, which is a narrow, rigid passageway made up of bones and ligaments and located at the base of the hand. In some individuals, there may be a genetic pre-disposition to a smaller carpal tunnel. In other instances, the tunnel may become narrowed by injury or a thickening of tendons or other swelling. Carpal Tunnels syndrome can also be associated with underlying diabetes and arthritis.
Symptoms usually start gradually and build over a period of time. There may be tingling and/or numbness in the hand, wrist or fingers. As the symptoms worsen, shooting pain can be felt in the hand or even up the affected arm. The problem may be noticed initially in the morning upon wakening; many people sleep with their wrists flexed, and this may exacerbate the condition.
As with other conditions, early intervention will allow for the best use of minimally-invasive techniques to ameliorate the condition. Consult early with a Board Certified doctor who specializes in treating the hand and arm. Initially, the doctor will conduct tests to rule out the underlying conditions of diabetes or arthritis. Non-steroidal anti-inflammatory drugs may be prescribed, to lessen the swelling and pain. A period of rest may be required, and a splint may be used to immobilize the wrist and allow it to heal. Later in treatment, exercises may be employed to foster range of motion, build strength and reduce pain and swelling.
If these techniques and time do not control the condition, surgery may be required. A special hand surgeon, such as Dr. Rehman, performs this surgery using minimally invasive techniques and specialized endoscopic instruments. The special scope allows the surgeon to see the tissue and the ligaments inside the hand, and make the necessary adjustments using tiny instruments. This type of minimally-invasive Carpal Tunnel surgery usually results in minimal scarring and tenderness, and a quicker recovery time than traditional Open Release surgery.
If you are experiencing symptoms of carpal tunnel syndrome, consult with Dr. Rehman early for the greatest chance of success using the least invasive procedures.
With the advent of winter and the recent snowfalls, avid sports fans are ready to get out and have some fun! Sledding, ice skating and skiing are all attractive activities for a Michigan winter, but common injuries can occur.
What is the biggest problem when skiing? Falling down! And sometimes when you fall down, you forget to release your poles. When this happens, an injury to the thumb can occur. It is sometimes called Skier’s Thumb, and also called Gamekeeper’s Thumb. When a fall occurs and you fail to release your poles, or you try to use them as leverage, injury to the ulnar collateral ligament (UCL) can occur. This ligament is located in the joint where the thumb meets the hand; the UCL’s job is to assist your thumb and fingers to pinch objects. This type of injury is not only painful, but frustrating as well.
If you notice the following symptoms after an injury on the slopes, seek immediate attention from a qualified doctor who is certified by the American Osteopathic Board of Orthopedic Surgery:
Pain or swelling at the base of the thumb
Difficulty picking up objects
Tingling or numbness of the thumb and/or hand
Instability of the thumb at its base
Bruising at the base of the thumb
It is best to seek treatment as soon as possible after such an injury. Skier’s Thumb can turn into a chronic condition if damage is done that is left untreated. Most often, treatment by your doctor will consist of the application of ice packs, 4-6 weeks of immobilization, and the continued use of anti-inflammatory medications to help reduce swelling during the healing process. If quite severe, surgery may be required. Typically an outpatient procedure, the surgeon enters at the base of the thumb through small incisions, removes the damaged tissue and will re-attach the ligament to the bone.
Dr. Rehman is an experienced, Board-certified Orthopedic doctor who specializes in hand injuries. Contact her today for a thorough evaluation and treatment plan for your injury, so you can get back on the slopes before winter is gone!
A tissue loss amputation is a procedure that is performed by a hand surgeon to manage an injury to a digit or the hand. Amputations may be immediate or post-trauma depending on the particular condition. Every case is unique but we identified some common factors in determining if amputation is required. When it comes to digital amputations, there are four types of injuries.
Type I include distal tip amputations – these involve only a small portion of the nail bed. When these injuries are free of exposed bone or tendon, they can be treated with irrigation and dressings. These injuries typically heal well with positive cosmetic and fully functional results.
Type II involve any injury that encompasses <50% of the nail bed and a significant portion of the finger tip. Often these injuries are treated with a shortening and closure of the wound. If such a large portion of the nail bed is compromised, it is unlikely that maintaining the nail will produce positive results. Removing the nail bed will avoid conditions like hook nail – which can be painful and result in significant complications down the road.
Type III injuries are amputations through the distal interphalangeal joint, aka your second knuckle. In clean injuries replantation can be considered but there are many factors in predicting the success of such an endeavor. Recovery from this type of amputation is significantly greater than Type II as more nerves are involved as well as a compromised grip.
Type IV injuries spare a significant amount of dorsal tissue – if the tissue area lost is less than 1x1cm and the bone and tendon are not exposed, these injuries can heal with flushing and wrapping. In instances where the loss is greater, local flaps may be applied to cover up the exposed areas. Unlike other areas, grafts do not take well in Type IV injuries and are typically not used.
Should you have the unfortunate circumstance of requiring this type of treatment make sure that you are seeing a board certified surgeon who specializes in hand surgery. The digits and hands are such a sensitive area that seeking appropriate treatment as soon as possible is critical. Questions? Contact us today!
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