In this series of articles, I’ll . . . → Read More: Joints of the Thumb – Language of Hand and Arm Surgery Series]]>

My thumb hurts in the joint! Many patients want to use the right technical terms when talking with their physician, and this can certainly improve the efficiency of your office visit. In this article, I’ll quickly show you how to identify the joints in your thumb.

In this series of articles, I’ll go through some of these terms along with some helpful diagrams and shed some light on the common language of hand and arm surgery.

Three Joints of the Thumb

The three joints are as follows:

• Carpometacarpal (CMC) Joint
• Metacarpophalangeal (MP) Joint
• Interphalangeal (IP) Joint

CMC Joint

The CMC joint of the thumb is located at the junction point of the thumb and the wrist. Break down the words in the name, carpometacarpal, and you get carpo- (wrist) and metacarpal (hand bone). This joint is commonly affected by arthritis.

The CMC joint’s main function is to allow the thumb to open and grasp wide objects, like a basketball or (for us mortals) a large glass of your favorite beverage.

MP Joint

The MP joint of the thumb is the middle joint of the thumb, located between the CMC joint and the tip of the thumb. Break down the words in the name, metacarpophalangeal, and you get metacarpo- (hand bone) and phalangeal (finger bone). This joint moves a lot in some people and just a little in other people. Compare MP thumb joints around your family and you may find some big differences.

Sometimes this joint is injured when you jam it in a skiing or sports injury. This causes the joint to pop out of place and tear a ligament. This is sometimes called skiier’s thumb. The ligament can heal without surgery if it’s not moved out of place.

IP Joint

The IP joint of the thumb is at the tip of the thumb. The word interphalangeal means “between the phalanges”. Important tendons attach on the bottom and top of this joint and move the tip of your thumb back and forth.

If you jam your thumb and the tip of the thumb doesn’t move normally, this could be a sign of a ruptured or torn tendon. Tendons move joints – when a tendon is ripped off the bone, the joint no longer moves normally.

Familiarity with the language of the joints of the thumb will help streamline your visit with a hand specialist or other health care provider.

My patients often ask, “Is my fracture healing?”. How does your doctor decide whether your fracture is healed or not? This article will help you learn how fracture healing takes place and how to tell if your fractured bone is healed.

When a bone breaks, it bleeds. . . . → Read More: How Do I Know If My Broken Bone is Healed?]]>

a healing metacarpal fracture

My patients often ask, “Is my fracture healing?”. How does your doctor decide whether your fracture is healed or not? This article will help you learn how fracture healing takes place and how to tell if your fractured bone is healed.

When a bone breaks, it bleeds. Your bones contain thousands of blood vessels that supply the cells inside. Clotted blood pools into a glob (how’s that for a medical term?) that surrounds the broken ends of the bone.

That clotted blood is good and normal – the cells and proteins inside it provide a type of scaffold that allows bone cells to know where to grow.

The bone cells form strands of new bone that interlink and grow into a solid mass of bone across and around the fracture site. This process of going from clotted blood to solid bone takes about six weeks in most situations.

As the bone heals, the pain from the fracture will decrease and become less painful. When you touch the fractured area, the pain will lessen as the fracture gets more solid.

So, one way to tell if the broken bone is healed is for the doctor to examine you – if the bone doesn’t hurt when he touches it, and it’s been about six weeks since you broke it, the bone is most likely healed.

Most doctors check x-rays to see if bones are healing. The calcified blood clot around the fractured ends of the bones will show up on x-rays and is called “callus”. Callus is just new bone that has formed and grown across the fracture site. It’s another sign that the broken bone is healed.

For example, when a bone breaks, there is usually a space between the bones on the x-ray. This space gradually fills in with new bone as the bone heals – you can see this space get filled up with bone on x-rays taken after the fracture happens. Sometimes this new bone (callus) doesn’t show up on x-rays until right at the end, around four or five weeks.

So, a broken bone is healed after the bone stops hurting and there is some evidence of new bone formation on x-rays taken in the doctor’s office.

And the next time you wonder if your broken bone is healing, the answer is that it’s been healing since the instant you broke it!

Not every hand surgeon uses . . . → Read More: Hand Surface Anatomy – Language of Hand and Arm Surgery Series]]>

Is it called the pinkie finger or the little finger? Many patients want to use the right technical terms when talking with their doctor, and this can improve the efficiency of your office visit. Here I’ll show you how to accurately discuss where your hand problem is.

Not every hand surgeon uses the same words to describe hand anatomy and upper extremity (hand and arm) problems. Many surgeons have their own particular and preferential ways of describing normal anatomy and disease processes. However, there are some pretty consistent terms, labels, and concepts that you should know when discussing your problem with a hand specialist.

In this series of articles, I’ll go through some of these terms along with some helpful diagrams and shed some light on the common language of hand and arm surgery.

www.assh.org

Surface Anatomy

The names of the fingers are as follows:

• Thumb
• Index
• Middle (sometimes called Long)
• Ring
• Small

Each finger has three main segments:

• Distal phalanx
• Middle phalanx
• Proximal phalanx

The two terms distal and proximal mean “towards the tip” and “towards the body”, respectively. You can apply this terminology to other parts of the body, like the foot (the toes are distal to the ankle, or the knee is proximal to the toenail).

The thumb has only two segments:

• Distal phalanx
• Proximal phalanx

Between each of the segments of the thumb and fingers is a joint. As we develop, the bending of our joints creates skin creases on the palm side. These creases have names you can see in the image.

The crease between the distal phalanx and middle phalanx segments is called the distal interphalangeal (DIP) crease because it’s the most distal of the finger creases (out towards the tip).

The next crease in line as you move away from the fingernail and towards the wrist is the proximal interphalangeal (PIP) crease, between the middle and proximal phalanx segments.

The palm creases are named as follows, starting distally and working proximally (toward the wrist):

• Palmar digital crease
• Distal palmar crease
• Proximal palmar crease

The major crease at the wrist on the palm side is simply called the wrist flexion crease. It’s formed as the wrist joint bends into a flexed position.

Another critical pair of terms used when describing sides of the hand (or even wrist and forearm) is radial and ulnar. These terms are named after the radius and ulna bones in the forearm; the two long bones of the forearm, between the elbow and the wrist.

Hand surgeons often describe an injury or problem as being on the ulnar side or radial side of the hand. If you have symptoms isolated on one side or the other, this can be valuable information that leads to a correct diagnosis.

Thenar and hypothenar are two terms that describe the fleshy mass of skin, fat, and muscle on the thumb side (radial) and the small finger side (ulnar) of the hand.

Utility and Application

The best way to picture the usefulness of these names and labeling conventions is to imagine yourself describing a cut on your hand to a hand specialist on the phone. An accurate description could mean the difference between urgent surgery and treatment with a couple of butterfly tapes or Band-Aids.

Here’s an example:

If the red line in the image is a laceration, using your new knowledge of hand terminology, you should describe the cut in the following way:

I cut myself with a knife! It’s kind of an angled cut about an inch long on the palm side of my left hand. The cut is between the DIP and PIP creases on my index finger.

If I heard that description over the phone, I’d know almost everything necessary to recommend treatment with the exception of a few clarifying questions.

Do you think your familiarity with hand surface anatomy and terminology would help streamline your visit with a hand specialist? Of course!

See how powerful “knowing the language” can be?

The term or job description “hand surgeon” means much more than just “a doctor who does surgery on hands”.

In fact, this field of surgery has changed . . . → Read More: What is a Hand Surgeon?]]>

Many patients tell me, “Doc, I need my hands!” I’m glad they feel this way, because hands are my specialty and my passion.

The term or job description “hand surgeon” means much more than just “a doctor who does surgery on hands”.

In fact, this field of surgery has changed a lot over the past 60 years or so since it has evolved into a subspecialty practice area. Many of the first hand surgeons were general surgeons (performing all kinds of surgery) and orthopaedic surgeons. Hand surgery was first recognized as a separate specialty area of surgery after thousands of patients were treated in World War II for hand injuries sustained in combat.

Today, a surgeon calling himself a “hand surgeon” may be an orthopaedic, plastic, or general surgeon. These three areas of surgery have their own organizations, their own certifying specialty boards, and surgeons may practice differently even within their own specialties.

For example, some general surgeons who treat hands may also operate on gall bladders. Some plastic surgeons who treat hands may have a large cosmetic surgery practice. Today, most surgeons trained in hand surgery fellowships (an extra year of training in hand surgery) treat conditions affecting the fingertips to the shoulder.

The professional organization for hand surgeons, the American Society for Surgery of the Hand (ASSH) also administers a test, called the Certificate of Added Qualification. Passing this exam is required for full membership in the ASSH. However, there are other levels of membership that do not require passing the exam.

A patient with a stiff finger once told me about her injury to that finger, which happened many years ago. She said her family doctor told her, “well, you just have to let it heal – there’s nothing they can do for a finger”. Fortunately, that statement hasn’t been true for 60 years. Hand surgeons treat fingers and much more.

Picking a hand surgeon is like picking any other doctor. Experience, passion, and a good reputation are all factors in the decision. No one wants to deal with a complex hand, wrist, or elbow problem, but if you have a hand surgeon in your area, take advantage of their expertise!

Find out if there is a hand surgeon practicing near you by doing a Google search for hand surgeon city state, where you plug in your own city and state in Google’s search box.

In my practice at Ozark Orthopaedics, we have three full-time, fellowship-trained hand surgeons on staff, ready to provide you with expert care.

In the video below, you can learn about Olympian gymnast Paul Hamm’s hand injury and how a hand surgeon’s expertise helped him recover.

Putting patients in splints after surgery for hand and arm problems is common – I recommend splinting for almost all my patients after surgery – but not after carpal tunnel release!

Splinting is not necessary or recommended after carpal tunnel release.

Many people with hand and wrist arthritis also have carpal tunnel syndrome. You may wonder if surgery for carpal tunnel syndrome relieves the pain of arthritis.

The answer is no.

Carpal tunnel release surgery relieves pressure on the median nerve, which allows the . . . → Read More: Carpal Tunnel Syndrome and Arthritis]]>

Does carpal tunnel surgery cure arthritis?

Many people with hand and wrist arthritis also have carpal tunnel syndrome. You may wonder if surgery for carpal tunnel syndrome relieves the pain of arthritis.

The answer is no.

Carpal tunnel release surgery relieves pressure on the median nerve, which allows the nerve to recover its blood flow. Any pain relieved by carpal tunnel release surgery was coming from the nerve being pinched, or compressed in the carpal tunnel. Any pain coming from arthritis (in a joint, by definition) will not be relieved by carpal tunnel release surgery.

Sometimes patients with arthritis can have bone spurs that may crowd the contents of the carpal tunnel (median nerve and finger flexor tendons). If the bone spurs are removed in an arthritis-treating surgery, the symptoms of carpal tunnel syndrome may be improved, but it doesn’t work the other way around.

Pain relief from arthritis comes from an operation on an arthritic joint. Carpal tunnel release is a surgery on an anatomic compartment containing a nerve and nine tendons, not a joint.

Health care providers like doctors and nurses use many different types of injectable cortisone (or steroid) medication to treat tendonitis, carpal tunnel syndrome, and joint inflammation. Skin dimpling is an uncommmon side effect to these shots.

There are several unlikely risks to having a steroid shot, which you can read . . . → Read More: Skin Dimpling From Steroid Injection]]>

Health care providers like doctors and nurses use many different types of injectable cortisone (or steroid) medication to treat tendonitis, carpal tunnel syndrome, and joint inflammation. Skin dimpling is an uncommmon side effect to these shots.

There are several unlikely risks to having a steroid shot, which you can read about here.

What is the Problem?

One of these risks is skin dimpling from steroid injections. This happens when the steroid solution collects at the site of injection, either in the muscle or in the fatty layer beneath the skin. The steroid changes the contour or consistency of the tissue and results in a dent or dimple in the skin.

The frequency of this side effect depends to some degree on the dose and specific type of steroid injected. Some steroids are more soluble (dissolve better) than others.

The less soluble steroids tend to last longer and have a better therapeutic effect where they’re injected (generally a good thing). However, these less soluble steroids may cause more skin dimpling than the ones that dissolve better – it’s sort of a rock and hard place problem!

Skin dimpling is more likely in areas where there’s not much padding, like on the bony thumb side of the wrist, a common place for tendonitis.

How Long Does the Side Effect Last?

The effects of dimpling will appear within one to four months and may last for six months to over a year.

Some types of steroid are more commonly linked to skin dimpling (also known as fat atrophy or subcutaneous atrophy) than others. Triamcinalones (try-am-sin-alones) are the most widely known offenders, but other steroid types can potentially create this side effect.

What Can be Done to Prevent This?

Make sure you understand which steroid your doctor is using and whether he has seen this side effect in the past or not.

Deeply massage the site of the injection during the one or two hours after the shot. This will keep the steroid from accumulating under the skin and will disperse any steroid that is outside of the desired treatment area.