In the following drawing of two . . . → Read More: Finger Joint Arthritis]]> Arthritis can appear anywhere in your finger. Osteoarthritis is the most common type of arthritis that affects the middle joint of the finger, also called the proximal interphalangeal joint. I’ll show you where this joint is in your finger and what can be done to treat it.

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In the following drawing of two finger bones, you can see the normal finger joint in the top picture. It’s wide; there’s a nice, healthy space between the two bones.

Drawing of a normal PIP joint

This is the PIP (proximal interphalangeal) joint. When I’m referring to it, I say, “P-I-P” (pronounced pee-eye-pee). It just means the joint between the two finger bones closest to the wrist.

What does finger arthritis feel like?

Patients with arthritis feel a deep aching, sometimes a sharp pain in this joint with gripping or heavy use activities.

Some patients feel pain most of the time or even with light activities, like getting ready in the morning or with writing.

How is finger arthritis diagnosed?

Hand surgeons diagnose finger arthritis by examining your hand and taking regular x-rays.

In the following drawing (compare this with the drawing above), I’ve pointed out the complete destruction and narrowing of the joint space between the two bones.

Drawing of PIP joint arthritis and joint destruction

 

You can also see the big bone spurs sticking out around the joint – they look like tiny spikes.

What can you do to relieve finger joint arthritis pain?

I recommend a combination of avoiding strenuous activity, anti-inflammatory medications, and heat.

Unfortunately, the more we move our fingers, the more stress and strain we put on them, the faster they wear out, especially once arthritis sets in. Learn what activities make your finger pain worse, and avoid or limit those activities.

Anti-inflammatory medicines (oral or topical) can help decrease swelling, pain, and redness that can go along with arthritis.

Heat (bath, shower, paraffin wax bath, warm washcloth, etc.) will open up capillary blood flow and decrease pain. It also loosens up stiff joints and tendons, helping you move your joints better.

How can a hand specialist help?

Once you’ve tried over the counter medicine and non-invasive treatments without success, it may be appropriate to think about the next step.

Prescription-strength anti-inflammatories may work better than over the counter medication. Your regular doctor or hand specialist can prescribe these. Topical pain creams work better in small finger joints close to the skin better than deeper joints (like the hip).

Steroid (cortisone) injections also help dramatically reduce inflammation and pain in small finger joints. These are usually done in the office. I use local anesthetic to numb up the skin before injecting the steroid.

All these conservative treatments are simply band-aids for the arthritis. They help with symptoms (sometimes for months or years), but never cure it.

Replacing the joint is the only way to preserve motion of the joint and stop finger arthritis pain permanently.

Joint replacements are made from either silicone or metal. The arthritic portion of the joint is cut out, leaving a space. The surgeon then fills this space with the joint replacement implant, usually a piece of soft, flexible silicone.

Silicone artificial joint in a PIP joint for finger arthritis

Recovery from this surgery is usually about 2 months; you can start gripping and lifting more aggressively at that time. Some therapy is necessary.

Am I taking out a tumor?

Releasing the carpal tunnel?

Fixing a broken bone?

Obviously the location on the arm is . . . → Read More: Incisions In Surgery – How Does A Surgeon Decide Where To Put The Incision?]]> How do surgeons decide how to make an incision? Many factors go into choosing the right incision for surgery. I’ll share three I use to make my decision.

Purpose of the surgery

Am I taking out a tumor?

Releasing the carpal tunnel?

Fixing a broken bone?

Obviously the location on the arm is an important factor in choosing where to put the incision. However, the incision may need to be longer than you think if I need to see and protect a nerve or artery.

For instance, the incision to take out a small, pea-sized cyst on the palm side of the finger is bigger than the cyst for this reason. I have to see the nerves to protect them while I take out the cyst.

Getting access to the target

Incisions may be directly over the bone or joint, or may be over to one side of the same area.

For instance, on the back of the elbow, it’s better to put an incision to the side of the midline so when you rest the elbow on a hard table, it’s not putting pressure on the scar.

Sometimes an indirect approach is better, to avoid pressure on the body part or to hide a scar.

Minimizing scarring during surgery

In the picture below you can see how the wrinkles or creases in the wrist are lined up. They run across the wrist.

Incision for a wrist ganglion surgery

The incision runs parallel to these skin lines, called Langer’s lines. This tends to minimize scar width and thickness.

Sometimes the orientation (which direction I make the cut) of the incision is designed to minimize the scar.

The incision above has completely healed. There is still some dried blood left over from the surgery. You can see the lighter area where some little butterfly tapes were taken off.

The sutures are running under the skin, and sticking out either end. They’re ready to be taken out.

Incision for a wrist ganglion surgery

Credit: John Rhodes

The Dallas Morning News reports that Dallas Cowboys wide receiver Dez Bryant admits he needs surgery for his broken finger but wants to delay surgery until the off season. Apparently the surgery will require bone grafting. What does this involve? Is it a good idea for Dez to wait . . . → Read More: Dez Bryant – Finger Fracture Surgery Using Bone Graft]]>  

Credit: John Rhodes

The Dallas Morning News reports that Dallas Cowboys wide receiver Dez Bryant admits he needs surgery for his broken finger but wants to delay surgery until the off season. Apparently the surgery will require bone grafting. What does this involve? Is it a good idea for Dez to wait to have surgery?

Types of finger fractures

Each finger has three bones in it. I don’t know which one Dez broke, but if he needs bone graft surgery, it’s probably around a joint. This means that it’s most likely around the middle of the finger, at the PIP joint.

Remember that fractures are the same as breaks. If a bone is just cracked all the way through, a bone graft is rarely necessary. This means that the injury is probably a severe one, involving a piece of his joint.

Not good.

Doctors who treat finger fractures

Sometimes a sports medicine doctor will treat both legs and arms. More commonly, players will go see a hand specialist, a hand surgeon. I’m guessing Dez saw one or two hand surgeons to get opinions about a plan to fix his finger.

Hand surgeons certainly can treat things differently – one may fix a finger fracture in a slightly different way than the next guy.

However, the bottom line is that the broken pieces of a finger joint must be lined up and stabilized with metal if the player wants to use that finger in a game. They may even recommend that he not play at all if the fracture is fragile after surgery and the risk of re-breaking it is too high.

Here’s an x-ray of a finger, fractured, completely broken and deformed through the joint.

What if Dez refuses to have surgery until after the season ends?

Delaying surgery on a broken finger joint will create several problems.

Pain, stiffness, and deformity may be the consequences.

Some players are tough enough to play through almost any discomfort. But if a finger joint is left to heal in a crooked position, the jagged edges of the joint will start to wear away like two sandpaper-covered surfaces over a period of months. This will cause arthritis, and potentially a very stiff and painful joint.

On the other hand, Dez may have a joint that’s not lined up well, but functions at 90% of normal after the bone heals. The point is that it’s unpredictable.

What is predictable is that if you line up crooked pieces of bone, they’re going to function better.

Here are two pictures from surgery I performed on a broken finger joint – showing before and after pictures. In the first one, the bone is opened up, exploded like Pac-Man. Putting the fracture together requires closing those two pieces down and pinning them together – you can see that in the second picture.

Does a bone graft have to come from the hip?

No.

Dez says that “No one’s touching my hip.” I’d tend to agree with him. Usually the pain from the hip bone graft hurts more after surgery than the finger itself.

Bone graft is necessary when a bone is so crushed that putting it back where it should be creates an open place that needs to be filled in between the pieces.

Bone graft for a finger fracture can come from many other places in the body besides the hip bone.

Possibilities include:

• radius bone – by the wrist
• tibia bone (shin bone) by the knee
• olecranon (ulna bone) by the elbow

As mentioned in the Dallas Morning News article, we can get bone graft from cadaver bone, from the bone bank. This is generally a very safe thing to do.

Usually a small amount of bone is necessary to fix a finger fracture – even a bad one.

Therefore, I don’t think the fact that the bone graft part of the operation will slow Dez down anymore than fixing the fracture would.

If you play golf long enough, you’ll have wrist pain – it’s not a question of if, it’s a question of when.

In this article I’ll cover some basics of wrist pain in golfers and point you to some great resources on golf injuries in the hand and arm.

A scaphoid fracture is a break or crack through . . . → Read More: Scaphoid Fracture Surgery – What Happens If A Scaphoid Fracture Never Heals?]]> An important part of deciding to have surgery for a scaphoid fracture is figuring out what can happen if you don’t have surgery. This article shows you a good example of what happens if a scaphoid fracture never heals.

What is a scaphoid fracture?

A scaphoid fracture is a break or crack through the scaphoid bone of the wrist. It’s on the thumb side of the wrist.

Scaphoid bones usually break when an athlete or young person falls on their hand and wrist, trying to break their fall. The impact hyperextends the wrist, snapping the scaphoid bone in half.

Why are scaphoid fractures bad?

The scaphoid bone has poor blood supply. The arteries that feed it blood enter the bone at strange locations. If the break is in a bad location (usually proximal, or further back away from the fingers), the bone can be very difficult to heal, even if surgery is done.

Most breaks happen in the middle of the bone. If the bone is held in a stable, solid position, it can heal, and does just fine most of the time.

However, sometimes when a scaphoid fracture isn’t recognized – it can be hard to tell the difference between a sprain and a wrist fracture – the wrist stops hurting as bad and the patient keeps using the wrist after a couple of weeks.

This keeps the broken pieces moving together, and the bone never heals.

What happens if the scaphoid never heals?

If the pieces aren’t lined up and held still with a cast or a screw in surgery, the pieces will keep grinding on each other and on the rest of the wrist joint, wearing it out over time.

This type of wear and tear after trauma (or fracture) is a form of arthritis called post-traumatic arthritis.

Here’s an example of an x-ray of a painful left wrist. This man injured his wrist about 40 years earlier and it was never treated surgically or with a cast.

X-ray of a painful arthritic wrist after scaphoid fracture years earlier.

The white areas between the bone edges are areas of bone-on-bone arthritis where the joint is wearing out.

This type of arthritis can only be treated with removal of the bones or fusion of bones together. This stops the pain of arthritis but limits the normal motion of the wrist.

How can this type of wrist arthritis be prevented?

Wrist arthritis after scaphoid non-union (failure to heal) can be prevented by an appropriate cast or surgery to line up the fragments and keep them still so they can heal together.  Most scaphoid waist fractures (in the middle of the bone) will heal in a cast if the pieces aren’t out of place.

Kendall Marshall, UNC’s star point guard, needed surgery for his scaphoid fracture.

Bruising is caused by bleeding underneath the skin.

It’s usually a sign of severe trauma in a young person, whose bones are harder and ligaments . . . → Read More: David Ash’s Wrist Injury – What Causes Bruising In An Injured Wrist?]]>

image credit: ABC

Texas QB David Ash goes to the locker room for x-rays of an injured, bruised wrist

What causes bruising in a wrist injury like David’s?

Bruising is caused by bleeding underneath the skin.

It’s usually a sign of severe trauma in a young person, whose bones are harder and ligaments thicker than an older person.

In a young person, several layers of anatomy have to be damaged to see bleeding underneath the skin after a wrist injury.

For example, bleeding from a broken bone has to pass from the broken bone edge, up through the muscles or tendons, through the tendon covering (called fascia), and spread underneath the skin and fat layer.

That’s why bruising after a wrist injury is often a sign of a broken wrist.

What is a wrist contusion?

A contusion just means an injury caused by a direct blow, or direct impact.

The blow can be from landing directly on the wrist on the ground or from another player’s pads or helmet striking the wrist.

Contusions are usually minor injuries, don’t require surgery, and heal quicker than sprains, though they can hurt a lot.

An example of what a smashed, broken, fractured wrist looks like

In the picture below, you can see the dark purple bruising in the wrist and hand (compare to the normal color in the fingertips) one day after this patient broke her wrist. X-rays of this wrist show a smashed radius fracture in several pieces. This is a fracture that needs surgery.

Keep in mind that she is older and her skin, bones, and ligaments are weaker, so bruising and swelling will be worse than in a young person.

Parents of a Massachusetts fourth grader, Ally Deon, are furious after officials at her school failed to call an ambulance when she broke her arm . . . → Read More: School Fails To Call An Ambulance For Child’s Broken Arm – What Should Parents Do?]]> School officials in Massachusetts failed to call 911 for a child’s broken arm. What type of break was this? What should parents do? How to protect your child…

Parents of a Massachusetts fourth grader, Ally Deon, are furious after officials at her school failed to call an ambulance when she broke her arm on the playground.

Here’s a link to the video of the news story from WCVB.com:

Apparently Ally’s mom took her to a local ER, where Ally was evaluated and transferred to Boston Children’s Hospital for treatment about 15 miles away.

Ally’s fractured arm

All I’ve seen is the videos of Ally’s cast and some of the x-rays.

This looks like a radius and ulna fracture with angulation (bending deformity).

These fractures may or may not need surgery, depending on if the bone came through the skin or if the arm can be straightened out in the emergency room with some sedation. This procedure might be done by an ER doctor or an orthopedic surgeon.

After the bones are straightened, the doctors usually put the arm in a temporary splint, take x-rays to see if the bones are in a better position, and send the child to the orthopedic surgeon for repeat x-rays the next week.

Sometimes a colored cast is put on in the ER, but more commonly a plaster or fiberglass splint is used.

I can tell you from the videos of Ally’s arm that the curve of the cast means her bones are likely in a good position.

Boston Children’s Hospital is known as one of the best places for children’s orthopaedic surgery in the country, if not the world.

What should parents do?

I see a lot of kids in the ER and straighten lots of broken bones like Ally’s. Most parents in my experience do not call 911; they drive their child to the ER themselves.

However, this obviously can’t happen when the child falls at school, and those minutes between the injury and getting treatment for the child are hair-raising for parents.

Any organization with a playground should have a clear policy on what to do in the face of a deformed child’s broken arm.

Parents also have an obligation to know what the policies are and the consequences of those policies, for example:

• parents may have to pay for the ambulance ride
• parents may be angry that the school called them first if that’s the policy
• parents may be irritated that their child was taken to the ER with some random school staff member and they weren’t notified first

Make sure you know what the policy is at your child’s school. Review it and meet with school officials if necessary for clarification.

Another tip is to find out from your local ER (where your child would likely be transferred) if an orthopedic surgeon is on call there, and whether children’s fractures are routinely transferred to other more specialized hospitals, as happened in this case.

In defense of the parents

Regardless of the school policy, a deformed, broken child’s arm can be very simple or very complex and needs to be seen by a physician as soon as possible.

Other injuries are also possible to neck, head, or leg. If there’s any doubt, the child shouldn’t be moved and an ambulance called immediately.

Imagine the liability of making the wrong choice here.

I don’t know what the majority of school policies are on this, but I’d be surprised if most schools don’t call 911 at the same time they’re calling parents.

Hopefully this case will be a wake-up call for parents to stay involved and alert to these school policy issues.

More information on broken arms in children

For more detailed information on children’s broken arms, visit BrokenArmAnswers.com.

Post any questions, comments or other good links for parents in the comments below!

Thumb arthritis is the number two most common location for arthritis in the hand.

In a recent edition of Health Matters, I wrote an article about this . . . → Read More: Arthritis In The Thumb]]> Where is the most common location for arthritis in the thumb? Find out in my recent article in Health Matters, a publication of Northwest Health Systems.

Thumb arthritis is the number two most common location for arthritis in the hand.

In a recent edition of Health Matters, I wrote an article about this common condition and the treatments available.

In the article I reveal where the arthritis is located in the thumb.

If you or someone you care about has thumb pain, it may be arthritis, especially in someone older than 50.

You can download the article on thumb arthritis here.

Don’t forget to get access to my arthritis presentation at the top of this page, or contact me for more information.

You can read about the four most common causes of thumb pain here.

Flexion (bending) of the elbow while on the phone can make cubital tunnel syndrome worse

The cubital tunnel is a tight passageway on the inner, or medial side of your elbow. The ulnar nerve, possibly the most important nerve in the arm, travels . . . → Read More: What Is Cubital Tunnel?]]>

Flexion (bending) of the elbow while on the phone can make cubital tunnel syndrome worse

The cubital tunnel is a tight passageway on the inner, or medial side of your elbow. The ulnar nerve, possibly the most important nerve in the arm, travels through this tunnel.

Most people discover this spot accidentally when they hit their funny bone.

Cubital tunnel syndrome is a collection of symptoms you feel when this nerve is pinched. symptoms involve numbness, tingling, and pain, mostly on the pinky side of your hand.

Since the ulnar nerve supplies the pinky and half the ring finger with sensation, most patients with cubital tunnel have symptoms here.

Cubital tunnel syndrome also causes numbness on the back side of the hand, just up from the base of the pinky finger.

Avoiding hand pain when cooking with tomatoes can be easier, thanks to a simple trick.

My patients with hand arthritis, tendonitis, and other tendon problems of the hand and thumb have trouble in the kitchen. Repetitive motion, strong gripping with one hand, and . . . → Read More: Avoid Hand Pain And Injury When Cooking With Tomatoes And Peaches]]>

tomatoes – peel these easily and avoid hand pain

Avoiding hand pain when cooking with tomatoes can be easier, thanks to a simple trick.

My patients with hand arthritis, tendonitis, and other tendon problems of the hand and thumb have trouble in the kitchen. Repetitive motion, strong gripping with one hand, and tight pinching can all aggravate and even start hand, wrist and elbow problems.

If you don’t plan ahead, repetitive activities during food preparation can leave you with painful, sore hands. Peeling foods like tomatoes and peaches with a sharp knife can also put you at risk for devastating nerve, tendon or blood vessel injuries.

In a recent article on lifehacker, Alan Henry reveals a technique for quickly peeling peaches and tomatoes that reduces pain and injury risk.

The technique

Here’s the secret:

1. Boil some water
2. Prepare a deep bowl of ice water and set it aside
3. Make an X in the skin of the fruit with a knife
4. Drop the tomato or peach into the boiling water for about one minute
5. Fish out the fruit with a spoon and transfer it immediately to the ice water. When cool enough to touch, remove the skin easily with your fingers.

Try this technique for quickly peeling peaches and tomatoes the next time you’re in the kitchen.