Systemic Disease and Your Hands

Systemic disease affects a number of tissues that work together to perform a common function. Since your hands contain a multitude of different types of tissues, including muscles, tendons, ligaments, blood vessels, bones, nerves, etc., they are sometimes the first to show signs of disease in other parts of your body. You may notice changes in your hands before the systemic disease is even detected.

What Symptoms Present Themselves in the Hands?

There are several conditions that affect the hands which could indicate a larger problem. It is highly important to call The South Florida Hand and Orthopaedic Center and make an appointment with one of our doctors if you experience any of the following conditions:

• Raynaud’s Phenomenon – The fingers will turn a blueish-purple discoloration and display a coolness. This is due to a temporary spasm of the arteries in the fingers. This could indicate rheumatoid arthritis, systemic lupus, scleroderma, and other diseases. If it becomes severe, ulcers may become present on the fingertips.
• Clubbed Nails – The fingers may take on a club-like appearance, indicative of some heart and lung diseases.
• Buerger’s Disease – A disease of the blood vessels affecting the small arteries and blood supply to the extremities. Ulcerations or even gangrene can appear.
• Rheumatoid Arthritis – This generally causes destruction of the joints, ligaments, and tendons. The inability to straighten the fingers may be one of the first signs of rheumatoid arthritis.
• Gout – Gout is a disease of the uric acid metabolism and can cause severe bone changes beneath the skin, leading to finger deformity. A yellowish-white nodule may form, as well as extremely thin skin on the fingers. If drainage occurs, some tend to mistake it for an infection.
• Diabetes – Diabetes may cause changes to the tendons and ligament tissue as well as affect circulation to the area. This disease of the endocrine system (your hormones) is a known cause of “trigger finger,” where the finger may be temporarily locked in the trigger position.
• Liver and Kidney Disease – These diseases can cause changes to the skin and nails, such as Terry’s disease, which causes the fingernail bed to turn white and is indicative of liver disease.

Please do not hesitate to call South Florida Hand and Orthopaedic Center if you think your hands could be showing symptoms of a systemic disease. Our doctors can make a diagnosis and, if necessary, refer you to a specialist. Call (561) 241-4758 today to make your appointment.

What is Replantation?

Replantation is the surgical reattachment of a finger, hand, or arm that has been completely cut from a person’s body. The goal is to restore as much function as possible to the injured area. Replantation is not always possible because a part may be too damaged. If this is the case, a patient may decide to use a prosthesis.

Replantation is recommended when the replanted part will work at least as well as a prosthesis. If a missing finger or hand would not work, be painful, or get in the way of everyday life, it won’t be reattached.

The doctor will carefully evaluate your injury and discuss your options during your visit.

How is Replantation Performed?

The doctor will start by carefully removing the damaged tissue. He then shortens the bone ends and rejoins them with pins or plates. This holds the part in place, allowing for the rest of the tissue to be restored to a normal position. He will then proceed to repair muscles, tendons, arteries, nerves, and veins.

What Kind of Recovery Can You Expect?

As the patient, you have the most important role in the recovery process. Smoking causes poor circulation and may contribute to loss of blood flow in the replanted area. Allowing the replanted area to hang below the heart level may also contribute to poor circulation.

Younger patients have a better chance of their nerves growing back, and may regain more feeling and function in the replanted area.

Generally, the further down the arm the injury occurred, the better the return of use. If you have not injured a joint, you will also get more movement back. A cleanly cut part normally works better after replantation than one that has been crushed or pulled off.

Recovery of use depends on re-growth of the sensory nerves (which let you feel) and motor nerves (which tell your muscles to move). Nerves grow about an inch per month, so the number of inches from the finger to the tip of the finger will give you the minimum number of months after which you will be able to feel something with that fingertip.

The replanted part will never regain 100% of its original use. Most doctors consider 60% to 80% of use to be an excellent result.

Rehabilitation and Therapy

From the beginning, braces are used to protect the newly repaired tendons but allow you to move the replanted part. Therapy with limited motion will help keep the joints from getting stiff, keep the muscles mobile, and minimize scarring tissue.

Even after recovery, you may not be able to do everything you wish to do. Tailor-made devices may assist with special activities or hobbies. Talk to one of our doctors or your therapist to learn more about such devices.

Emotional Problems Following Replantation

Replantation sometimes affects patients emotionally. Once your bandages are removed and you see the replanted part for the first time, you may feel shock, grief, anger, disbelief, or disappointment because the replanted part doesn’t look like it did before. Worries about the appearance of a replanted part and how it will work are common.

Talking about these feelings with our doctors can help you come to terms with the outcome. The doctor may also ask a counselor to assist with this process.

Is Additional Surgery Necessary?

Some patients require additional surgery to improve the function of the part. The most common procedures are:

• Tenolysis: which frees tendons from scar tissue.
• Capsulotomy: which releases stiff, locked joints.
• Tendon or muscle transfer: which moves the tendons or muscles to another spot so that they can work in an area that needs the tendon or muscle more.
• Nerve grafting: which replaces a scarred nerve or gap in the nerve to improve function.
• Late amputation: which involves removing the part because it does not work well, interferes with function, or has become painful.

Find out if replantation is right for you. Call (561) 241-4758 to schedule your appointment with South Florida Hand and Orthopaedic Center today.

Power Saw Injury Overview

Any structure that comes into contact with a saw blade can be injured. Scrapes and cuts can damage the skin. Deeper injuries can damage tendons and muscles of the fingers, thumb, or wrist and affect the way they move. A nerve may be cut, resulting in the loss of feeling or the loss of ability to control certain muscles. If an artery is injured, circulation may be lost. Fractures can also occur in the shaft of the bone or in the joint, sometimes with loss of bone substance. Amputations can also occur.

Factors Affecting the Severity of Power Saw Injuries

The severity of a power saw injury can vary depending on several factors:

• The level at which the injury occurs (fingertip vs. hand vs. forearm).
• The depth of the injury (skin only vs. tendons, nerves, arteries, and bone).
• Characteristics of the saw such as thickness, tooth pattern, and type and force of the saw. For example, jigsaws tend to have a finer, sharper cut, whereas a chainsaw is much more powerful with an aggressive blade that can tear out more tissue.

No matter the injury, always seek medical attention as soon as possible. The damage done to a finger, hand, or any site often exceeds what is visible due to the force. A delay in treatment increases your risk of infection and tissue loss.

Treating Power Saw Injuries

A simple cut may be treated with stitches or bandages, while a larger area of skin loss may require a skin graft for coverage. Tendon and nerve injuries may require repair, but if too much shredding has occurred or there is an excessive loss of the tendon and/or nerve tissue, a repair may not be possible. Fractures can be repaired with pins, wires, or plates and screws. A severely damaged joint may need to be fused permanently. In some cases, an amputation can be replanted. Amputation of a single finger may be best treated by leaving it off, as the reattached finger may affect function of the hand.

In any case, the goal of treatment is to optimize the overall function of the hand. Yet, residual impairment such as weakness, stiffness, numbness, or loss of parts is possible with many of these types of injuries.

Lawnmower Injury Basics

As Spring rolls into high gear and the rain brings quickly growing grass, lawnmowers all over the city find their way out of winter hibernation in garages and into full use. If an operator of the lawnmower is not careful, it can cause serious injury to the hands. Lawnmowers are made to cut, and if a hand gets in the way trying to dislodge something that is “stuck” or the like, the blades of the lawnmower can cut through the skin and bones of the hand.

Safety Tips to Avoid Lawnmower Injuries

There are several things a person can do to protect their hands from lawnmower injuries:

• Keep your hands and fingers away from any moving parts and blades of the lawnmower at all times when it is running. This includes both the input and output areas of the lawnmower. Never go near a blade unless the machine is turned off and the power cord is disconnected.
• If an object is lodged in the lawnmower, use a tool to remove it. Do not use your hands or fingers.
• Anytime you pick up a push mower or move it, make sure that the power is turned off and it is disconnected from the power source.
• Never lift a machine from the bottom, even if it is turned off. The blades are sharp and could cause injury even if they are not moving.
• When operating the lawnmower, make sure to wear protective clothing such as non-slip, closed-toe shoes. Gloves can protect the hand to an extent; however, blades are sharp enough to cut through them.
• Never let children operate or play near the machine while it is in use.

Treatments for Lawnmower Injuries

Even if you are extremely careful, accidents can happen. Injuries from lawnmowers often result in multiple finger amputations, and infections are common. Infections can be treated with antibiotics, while multiple surgeries could be needed for patients with severe injuries. Most patients with severe injuries will not recover full, normal use of the hand.

If you obtain a serious injury from a lawnmower to the fingers or hands, it is highly important to head to the emergency department right away. If you need reconstructive surgery, our doctors at South Florida Hand and Orthopaedic Center are highly trained, certified hand surgeons. Our doctors can work with you to help you regain as much function in your hand as possible.

The Importance of Knife Safety in the Kitchen

Every chef knows the secret to a successful dish is the knife behind the cooking. While having a sharp blade is important for culinary success, it can also lead to very severe injuries. Whether or not you are an expert in the kitchen, knife injuries can leave cooks with debilitating conditions like severed nerves or large lacerations.

The experienced doctors at South Florida Hand and Orthopaedic Center have decades of experience treating hand and finger injuries caused by kitchen knives. Our specialists understand the severity of knife injuries and are dedicated to getting you back in the kitchen!

Preventing Knife Injuries

As stated above, a sharp knife is better for kitchen use than a dull one, but it can also lead to quick, effortless injuries. Sharp knives are designed to grab the surface of whatever it is cutting. Preventing injuries through safety precautions is the best way to avoid harming yourself.

To prevent knife injuries, follow these tips from South Florida Hand and Orthopaedic Center:

• Cut rounded items in half to provide a flat surface to cut on.
• Hold your item with the finger pointed down and tucked in, using the knuckles to guide the knife.
• Use a proper cutting surface. Plates, stove tops, and tile can cause food items to slip; use a wooden or plastic cutting board instead.
• Choose the proper blade for the job.
• Never reach for a blade that is falling. Your hand-eye coordination cannot keep up with the handle.

Treating a Knife Injury

If you have been injured by a knife, stay calm. Most knife cuts are easily treated. Here’s what you should do:

• Clean your cut with soap and water to prevent infection.
• Ensure the bleeding is only oozing, not gushing or squirting out. Apply pressure with a clean cloth to stop the bleeding.
• Once the bleeding has slowed or stopped, cover the wound with a bandage or sealant made for injuries.

If the wound is bleeding heavily and fast, call 911 immediately. If a piece of your digits has been removed, save it in a large bag of ice before paramedics arrive and keep pressure on the open end.

Expert Care for Knife Injuries

Contact the offices of South Florida Hand and Orthopaedic Center to receive expert care for serious injuries. Our doctors are specialists in treating damaged fingers and hands. Don’t let one accident leave you with a debilitating condition.

What Is Amputation?

The first question you may ask yourself is, what is amputation? Either due to traumatic injury or surgical operation, amputation is the removal of a hurt or deformed body part. An amputation of the finger or hand will result in the complete loss of the appendage.

Amputated fingers can sometimes be reattached depending on the severity of the injury and how quickly the patient can receive surgical care. In many cases, however, this is not an option. Often, amputation is the answer to a more threatening condition. For example, a patient with a tumor on their finger may undergo amputation if the tumor is malignant.

How Is an Amputation Performed?

During surgery, the doctor must safely remove the injured body part while prepping the amputation site for future prosthetics. The skin, muscles, bones, and nerves must be treated very carefully to ensure the patient will be comfortable when the time comes for prosthetics. The doctor will determine the length of the remaining body part based on medical and prosthetic factors.

What Can You Expect After Surgery?

In the first couple of weeks following surgery, patients will experience some pain and discomfort. Pain can be managed with medications prescribed by the physician. The doctor also teaches patients how to care for and bandage the surgical site.

After surgery, most patients are prescribed rehabilitation exercises to build strength and increase the range of motion. Touching and moving the skin will help to mobilize and desensitize the area.

Finger and Hand Prosthetics

In today’s times, patients are fortunate enough to be eligible for prosthetics. Prosthetics increase functionality by restoring length to a partially amputated finger or hand. Increasing the length of the finger allows patients to hold objects between the thumb and affected finger again. An electric or mechanical hand prosthetic might be given to a patient who has experienced a hand amputation above the wrist.

What Type of Prosthesis Will You Get?

The type of hand or finger prosthesis you will use depends on the location and length of your residual finger or hand. The doctor will also take your lifestyle needs into consideration. It’s important to communicate with your doctor and prosthetist to let them know which activities are most important. You may also choose not to use a prosthetic.

What Is Dupuytren’s Disease?

Dupuytren’s disease, also called Viking’s disease, is an abnormal thickening of the fascia (the tissue just beneath the skin of the palm).

It often starts with firm lumps in the palm, with some patients developing firm cords beneath the skin that stretch from the palm into the fingers. Gradually, these cords may cause the fingers to bend into the palm.

Although the skin may become involved in the process, deeper structures such as the tendons are not. Occasionally, the disease will cause thickening on top of the finger knuckles (knuckle pads) or nodules or cords within the soles of the feet (plantar fibromatosis).

What Causes Dupuytren’s Disease?

The cause is unknown but may be associated with certain biochemical factors within the involved fascia. Dupuytren’s disease is more common in men over age 40 and in people of northern European descent. There is no evidence that hand injuries or specific occupational exposures lead to a higher risk of developing Dupuytren’s disease.

Signs and Symptoms

Symptoms usually include a small lump or series of lumps and pits within the palm. The lumps are generally firm and adherent to the skin.

A cord may develop gradually, which will extend from the palm into one or more fingers (the ring and little fingers are most commonly affected). Although the cords may be mistaken for tendons, they actually lie between the skin and tendons. In many cases, both hands are affected, although the degree of involvement may vary.

While the initial nodules may produce discomfort, Dupuytren’s disease is not typically painful.

You may first notice it due to difficulty placing your hand flat on an even surface. As your fingers are drawn into the palm, you may notice increasing difficulty with activities such as washing, wearing gloves, shaking hands, and putting hands into pockets.

The progression of the disease is unpredictable. Some individuals will have only small lumps or cords, while others will develop severely bent fingers. More severe disease often occurs with an earlier age of onset.

Treatment for Dupuytren’s Disease

In some cases, our doctors may simply observe the nodules and cords that contracted.

If you have more advanced contractures, you may require surgery to improve function. There are various surgical techniques that can correct finger position. The doctor will discuss which method is most appropriate for you based on the stage of the disease and joints involved.

Surgery should help improve finger position, and thereby hand function. Even after surgery, the disease may reoccur, and the fingers may begin to bend into the palm once again.

Schedule an Appointment

Call South Florida Hand and Orthopaedic Center at (561) 241-4758 to make an appointment with one of our doctors.
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Bites Can Be Dangerous

Whether they are by animal or human, bites are extremely painful and can be quite dangerous. If not properly treated and cared for, animal and human bites can lead to infection. It is important to recognize signs and symptoms of infection and seek treatment right away.

Factors That Contribute to Infection

• Type and location of the wound
• Pre-existing health conditions that impair immunity (diabetes, HIV, etc.)
• Extent of delay before treatment
• Presence of a foreign body in the wound
• Animal causing the bite

Animal Bites

Infection is a major concern with animal bites. In the U.S. alone, about 1% of dog bites and 6% of cat bites end in hospitalization. Because cat bites often result in deep puncture wounds that quickly heal over, drainage can become blocked resulting in infection. With proper care and treatment, most animal bite patients completely recover.

Although rabies in domesticated pets is very rare these days, it is an extremely fatal infection that spreads amongst animals in the wild. Your risk of coming in contact with a wild animal infected with rabies is fairly low in the United States. However, if you are bitten by a wild animal, report it immediately to your public health department. The department of public health often needs your assistance locating the animal so they can confine it and test for rabies.

Seek Emergency Treatment if You Experience Any of the Following Symptoms

• Swelling, redness, warmth, or continued pain beyond 24 hours
• Pus draining from the bite wound
• Red streaks extending up the arm or forearm
• Swollen lymph nodes (“glands”) around the elbow or in the armpit
• Loss of mobility
• Loss of sensation in the hand or fingertip
• Fever, malaise, night sweats, or rigors

Animal Bite Examination

The doctor will examine the wound and ask you about the injury. He will need a complete history of the bite, which includes:

• Type of animal and its status (general health, rabies vaccine, behavior, etc.)
• Time and location of the event
• Circumstances of the bite
• Whereabouts of the animal
• Pre-hospital treatment

If you have not had a booster tetanus shot within the past 10 years, it’s crucial to update your status.

Because tooth fragments can break off in the skin and bone, the doctor may take an X-ray of the site and check for further damage to the bones and joints. Patients who leave infection untreated for too long may experience osteomyelitis. Osteomyelitis is the spread of the infection to the bone and can also be observed through X-ray.

Red streaks on the forearm can predict lymphangitis or inflammation of the lymphatic channels. The doctor will look for signs of these red streaks and also look for enlarged lymph nodes on the inner side of the elbow.

If the wound proves to be infected, the next step will be to identify the type of bacteria that is causing the infection. It is necessary to know what is causing the infection in order to properly prescribe the most effective antibiotic and treatment.

Animal Bite Treatment

A common bite site for animals is the hands. These bites require careful cleansing and treatment. The doctor will wash the wound and possibly trim away any dead tissue or damaged skin that could be a source of infection.

The antibiotic you are prescribed depends on:

• Circumstances of the injury
• Your health
• Your sensitivity to medications
• Appearance of the wound

While some animal bites can be treated with oral medications, others might require the patient to receive antibiotics via IV.

It is vital patients follow up on a regular basis with the physician until they are cleared of infection in order to fully recover.

Human Bites

Human mouths contain high amounts of bacteria, making infection very probable if your human bite is not treated properly. Early treatment is essential in order to avoid complications and prevent the infection from quickly spreading.

Sometimes human bites are not an obvious bite. For example, during a fistfight, a person’s fist might be driven into another person’s mouth. If the skin is broken, bacteria can settle into the soft tissue. If left untreated, the infection can essentially destroy the knuckle joint. Complications such as this are easily avoidable with early diagnosis, antibiotics, and if needed, additional treatment such as surgery.

Schedule an Appointment

If you recently sustained a bite, don’t wait to make an appointment with South Florida Hand and Orthopaedic Center. Call (561) 241-4758 today.