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.