Carpal Tunnel Syndrome

Carpal Tunnel Syndrome
Carpal Tunnel Syndrome (CTS)

Carpal tunnel syndrome (CTS) is a condition caused by increased pressure on the median nerve at the wrist. Simply put, it is a pinched nerve at the wrist.

The carpal tunnel is a space in the wrist where the median nerve and nine tendons pass from the forearm to the hand. When pressure builds from the swelling in the tunnel, it puts pressure on the nerve. When the pressure becomes great enough, you may experience one or all of the following symptoms:

  • Numbness
  • Tingling
  • Pain in the arm, hand, and fingers
What Causes Carpal Tunnel Syndrome?

The cause is often unknown, but pressure on the nerve can occur in several ways:

  • Swelling of the lining of the flexor tendons (tenosynovitis)
  • Joint dislocations, fractures, or arthritis narrowing the tunnel
  • Keeping the wrist bent for long periods of time
  • Fluid retention during pregnancy (this often goes away after delivery)
  • Thyroid conditions, rheumatoid arthritis, and diabetes
  • Carpal tunnel is sometimes due to a combination of causes
Signs and Symptoms

Symptoms usually include pain, numbness, tingling, or a combination of the three, with tingling and numbness most often in the thumb, index, middle, and ring fingers.

You will most likely experience symptoms at night, but some notice them during daily activities. Some patients also notice a weaker grip, occasional clumsiness, or a tendency to drop things.

In severe cases, it’s possible to lose sensation permanently while the muscles at the base of the thumb slowly shrink (thenar atrophy).

Carpal Tunnel Diagnosis

In order to diagnose carpal tunnel, one of our doctors will complete a detailed history, which will include any previous medical condition, how you’ve used your hands, and whether there were any prior injuries. He will also take an X-ray to check for other causes of your symptoms, such as arthritis or a fracture.

In some cases, a laboratory test may be needed if your doctor suspects a medical condition associated with CTS. Your doctor may also perform a nerve conduction study (NCV) and/or electromyogram (EMG) to confirm your diagnosis, as well as to check for other possible nerve problems.

Carpal Tunnel Treatment

It is often possible to relieve carpal tunnel symptoms without surgery. By identifying and treating the underlying medical condition, changing the patterns of hand use, or keeping the wrist splinted in a straight position, you may be able to reduce pressure on the nerve.

Other treatment options include:

  • Wearing wrist splints at night to relieve symptoms that interfere with sleep
  • Adjusting your workstation to alleviate a possible cause
  • Carpal tunnel surgery

If your symptoms are severe or do not improve, a hand surgeon may recommend surgery to make more room for the nerve. By cutting the ligament that forms the top of the tunnel on the palm side of the hand, it is possible to decrease the pressure on the nerve. The incision allows the doctor to enlarge the tunnel and decrease pressure on the nerve.

Swan-Neck Deformity

Swan Neck Deformity
Swan-Neck Deformity

Swan-neck deformity is a condition explaining the deformed position of your finger. This condition is a complex ailment where the proximal IP (PIP) joint over straightens because of a lax ligament on the palmar side of the joint. The ligament on the palmar side of the joint is called the volar plate, which is designed to prevent over straightening. When a patient is experiencing a swan-neck deformity, the finger will have a hyperextended PIP joint and a bent distal IP (DIP) joint, making the finger appear in a position that resembles a swan’s neck.

What Causes Swan-Neck Deformity?

The most common cause of swan-neck deformity is rheumatoid arthritis. The chronic inflammation on the PIP joint stretches the volar plate. As the volar plate becomes stretched and weakened, the PIP joint begins to hyperextend. This causes the extensor tendon to get out of balance, which makes the DIP joint get pulled down toward the flexion.

Swan-neck deformity commonly results from an overlooked injury in childhood, adolescence, or young adulthood. The finger can begin bending downward on its own and stay in a fixed over-straightening position. If this happens, this condition can be extremely debilitating. Other causes of swan-neck deformity include:

  • Untreated mallet finger
  • Looseness of the fibrous plate
  • Looseness of the finger ligaments
  • Chronic muscle spasms caused by nerve damage
  • Other types of arthritis
  • Ruptured finger tendon
  • Misalignment
Diagnosis and Treatment of Swan-Neck Deformity

In most instances, swan-neck deformity can be diagnosed from a physical examination. However, an X-ray may be ordered to allow the physician to examine joint alignment, check the condition of joint surfaces, and determine if a fracture is present. After diagnosis is complete, physicians can use either non-surgical or surgical treatment options.

Non-surgical Treatments

Non-surgical treatments are based on restoring balance in the fingers and hand. The goal of non-surgical treatment is to realign the PIP joint and prevent hyperextension, which should restore DIP extension. Stints are commonly used to protect the joint from hyperextending and line PIP joints up.

Physicians may also prescribe physical and occupational therapy in order to restore function and alignment.

Surgical Treatments

If non-surgical techniques are unable to treat the swan-neck case, surgery may be used to reconstruct the hand around the PIP joint. Your physician may use soft tissue repair, PIP joint arthroplasty, and/or finger joint fusion to remedy your swan-neck deformity.

Schedule an Appointment with South Florida Hand and Orthopaedic Center

Swan-neck deformity is a debilitating condition that can affect every area of your life. The experts at South Florida Hand and Orthopaedic Center offer several years of experience treating this condition and other conditions of the hands and fingers. We treat patients of all ages.

Boutonniere Deformity

Boutonniere,Deformity,On,Pinky,Finger
Boutonniere Deformity: Causes, Symptoms, and Treatment

There are several tendons running along the top and side of your fingers that work simultaneously to help it straighten and bend. The central slip of tendon on the top of your finger is connected to the middle bone in your finger. If this integral tendon is injured, you may be unable to straighten your finger fully, which explains boutonniere deformity. If boutonniere deformity is left untreated, the condition may worsen and result in impaired function and deformity.

What Causes Boutonniere Deformity?

In most instances, boutonniere deformity is caused by a “jammed finger” or an impactful blow to the top side of the middle joint in a bent finger. This ailment can also be the result of a cut on the top of your finger. If the cut is deep enough, it can actually sever the tendon from its connection to your bone. When this happens, the tear looks similar to a French “boutonniere” or buttonhole. In rare instances, the bone could start protruding through the opening. A third cause of the boutonniere deformity is arthritis.

Symptoms of Boutonniere Deformity

Patients can begin developing signs of boutonniere deformity immediately after an injury to the finger. In some cases, symptoms can develop anywhere from one to three weeks later. Some of the most common symptoms of boutonniere deformity include:

  • The middle joint of the finger swells and starts to hurt
  • You have problems straightening your finger at the middle joint
  • The fingertip cannot be bent
Diagnosing and Treating Boutonniere Deformity

Boutonniere deformity is one of many injuries that can be caused by jamming your finger. Because of this, it’s imperative to consult the hand experts at South Florida Hand for a proper diagnosis. During the diagnosis, your hand specialist will examine your hand and fingers. You may be asked to straighten and bend the fingertip of the affected finger. Your physician may also request x-rays to determine if there are any broken bones.

If you want to keep the full range of motion in your finger, it’s important to seek treatment immediately. There are two different treatment options for boutonniere deformity:

Non-surgical Treatment

Non-surgical options are the preferred solution for boutonniere deformities. A few of the most common treatment options are:

  • Exercises designed to bolster the flexibility and strength in your fingers.
  • Splints can be applied on your finger at the middle joint to keep it straight. Splints allow the end joint of your finger to bend, while preventing the tendon from separating as the finger heals.
  • Protection or taping can be used after the splint has been removed, especially if you play sports.
Surgical Treatment

Although non-surgical methods are preferred, certain instances require surgery, such as:

  • If your tendon has been severed.
  • If your condition doesn’t heal with the splint.
  • A bone fragment is displaced from its normal position.
  • If your deformity is the result of rheumatoid arthritis.
Contact South Florida Hand and Orthopaedic Center

If you suffer from boutonniere deformity, the hand experts at South Florida Hand and Orthopaedic Center offer treatments for relief. The staff and physicians at South Florida Hand and Orthopaedic Center treat patients of all ages for conditions affecting hands, arms, fingers, and thumbs.

Schedule your appointment today to see a hand expert at South Florida Hand and Orthopaedic Center.

Vascular Disorders

Vascular Disorders Hands
Vascular Disorders in the Upper Extremities

Generally, vascular disorders in the upper-extremities are rare, but they do occur and can cause havoc to the body. The human body is supplied with oxygen through an intricate system of blood vessels called the vascular system, or the circulatory system. Arteries carry oxygenated blood to the tissues, and veins carry deoxygenated blood back to the heart.

There are two major arteries of the arm that carry oxygenated blood from the heart to the wrist and hand. These arteries are the radial and ulnar arteries. Any time you restrict blood flow to a certain area of the body, the tissues will suffer from a lack of oxygen, which is vital for the tissues to carry out their functions.

Vascular problems may occur more frequently in high-risk patients with pre-existing conditions such as diabetes, hypertension, or kidney failure. However, environmental factors such as smoking and exposure to cold can also be a factor. Causes of vascular disorders can be classified into five groups: traumatic, occlusive, compressive, tumors/malformations, and vasospastic. Vasospastic is a spasm of the artery that reduces blood flow.

Common Conditions that Cause Vascular Disorders
  • Trauma – Any kind of trauma from a sharp object or blunt injury can damage blood vessels, causing blood flow to the area to become weak.
  • Aneurysms – This is a localized weakness in the blood vessel wall. It can cause a blockage and clot(s), leading to gangrene of the fingertips.
  • Vascular Malformations – Abnormal connections between veins and arteries can cause blood to be re-directed.
  • Raynaud’s Disease – Arteries in the fingers can spasm, depriving the fingers of blood flow.
Symptoms and Treatment of Vascular Disorders

There are several symptoms that are indicative of a vascular disorder. These symptoms may include:

  • Pain in the area
  • Changes in the color of the fingertips
  • Ulcers that won’t heal
  • Intolerance to cold
  • Numbness or tingling in the fingertips
  • Localized inflammation around the blood vessels

When you see the doctor at South Florida Hand and Orthopaedic Center to diagnose a vascular disorder, he will give you a thorough examination to determine the diagnosis. The doctor will look at the quality and presence of your pulse, check for any swelling or inflammation, look for any discoloration associated with the site of concern, and check for masses. He may use a variety of diagnostic tests to evaluate the condition as well. These tests may include a Doppler or ultrasound of the blood flow, pulse volume recordings, MRI, arteriography, or a cold stress test.

Our doctors can discuss any conditions that may put you at high risk for a vascular disorder and go over treatment options. If you believe that you are suffering from a vascular disorder, it is important to seek treatment with South Florida Hand and Orthopaedic Center as soon as possible to alleviate any further pain or injury.

Systemic Disease

Systemic Disease 2
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.

Rheumatoid Arthritis in the Hands

Rheumatoid arthritis
Rheumatoid Arthritis Overview

Rheumatoid arthritis affects the cells that lubricate and line joints, causing the tissue (synovium) to become inflamed and swollen. The swollen tissue stretches the ligaments and tendons, causing the joints to deform and become unstable. Joint cartilage and bone also erode. Your knuckle may feel hot and look red. Rheumatoid arthritis in the hands most often occurs in the wrist and knuckles. The disease is symmetric, meaning what occurs in one hand usually occurs in the other.

Signs and Symptoms of Hand Rheumatoid Arthritis

While common arthritis symptoms such as stiffness, swelling, and pain may occur, the classic features of rheumatoid arthritis include:

  • Firm nodules along fingers or the elbow.
  • Soft lump on the back of the hand that moves as the fingers straighten.
  • Angulation or collapse of fingers.
  • Sudden inability to straighten or bend a finger because of tendon rupture.
  • Deformity in which the middle finger joint becomes bent (Boutonniere deformity).
  • Deformity where the end of the finger is bent and the middle joint over-extends (Swan-neck deformity).
  • Prominent bones in the wrist.

You may also experience numbness and tingling in your hands (carpal tunnel syndrome) because the swelling of the tendons causes pressure on the adjacent nerve. They may make a squeaky sound as they move joints (crepitus), and sometimes the joints snap or lock because of the swelling.

How is Hand Rheumatoid Arthritis Diagnosed?

The doctor will perform a clinical examination, x-rays, and lab tests. He will also ask you questions about your symptoms and how the disease has affected your activities. Because rheumatoid arthritis may have a hereditary component, he may ask if any family members suffer from similar symptoms.

The doctor will also complete a detailed examination of your hands. The appearance of your hands will help him diagnose the specific type of arthritis.

An x-ray may reveal characteristics of rheumatoid arthritis including:

  • Swelling of the non-bony structures
  • Joint space narrowing
  • Decreased bone density
  • Erosions near joints

There are also several blood tests that can confirm the clinical diagnosis.

Hand Rheumatoid Arthritis Treatment

Treatment is designed to decrease inflammation, relieve pain, and maintain function. While there is no cure for rheumatoid arthritis, there are medications that slow the progression of the disease.

Hand therapy may help relieve pain and protect the joints. Exercises, splints, and adaptive devices can also help you cope with activities of daily living.

Rheumatoid arthritis can be a progressive disease. Surgical intervention may be necessary to maximize function and minimize deformity. In certain cases, the doctor may recommend preventative surgery which could include:

  • Removing nodules
  • Decreasing pressure on the joints and tendons by removing inflamed tissue.
  • Removing bone spurs that may rub on tendons or ligaments.

Several types of procedures treat joints affected by rheumatoid arthritis including:

  • Removal of inflamed joint lining
  • Joint replacements
  • Joint fusions

The procedure the doctor recommends will depend on many factors including which joint is involved, the degree of damage present, and the condition of surrounding joints.

Replantation

Replantation
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 Injuries

Power Saw Injuries
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

Lawnmower Injury
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.

Kitchen Knife Injuries

Kitchen Knife Injuries
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.