Avocado related hand injuries are on the rise. Chefs and celebrities recently have been injured while attempting to cut the fruit, bringing increased attention to the risks involved. Most people accidentally cut their non-dominant hand which is holding the avocado. The knife can slip quickly through the soft flesh and into the hand which is holding the fruit. Nerve and tendon damage are common with this type of injury. This can result in several weeks or months of recovery after surgical repair of the lacerated structures.
In order to avoid a hand injury, cut the avocado only on a stable, flat surface. Do not cut towards your hand.
If you have a hand laceration, clean the wound in running water, place a clean bandage on the wound and hold pressure to stop bleeding. If the bleeding does not stop after 5-10 minutes of firm pressure on the wound, or if you have numbness in your hand or finger, or limited finger range of motion, seek medical attention promptly.
Dr. John Erickson of Raleigh Hand Center presented at UNC Orthopedic Hand Conference on Monday, 4/23/2018. His talk was titled “Preventing Complications in Distal Radius Fracture Surgery.” Local area hand surgeons, therapists, radiology staff, and ortho residents were in attendance.
Raleigh Hand to Shoulder Center Doctors are experts in the diagnosis and treatment of carpal tunnel syndrome. The also treat many other conditions of the hand and arm. Carpal tunnel syndrome is the most common nerve problem in the hand. It is caused from increased pressure on the median nerve at the wrist within the carpal tunnel. Symptoms such as hand numbness, tingling, weakness, and pain can result if the nerve is pinched. Patients often wake up at night with the hand numb and tingling. Carpal tunnel symptoms should be evaluated by a doctor, and not ignored.
The carpal tunnel is a passageway in the wrist through which the
median nerve and tendons of the hand travel. This tunnel is a narrow and tight
space. The bottom of the tunnel is made up by the carpal bones of the wrist and
the roof is created by the transverse carpal ligament. The median nerve is at
risk for compression within this tunnel. If there is abnormal swelling, altered
wrist anatomy, or injury to this area, the function of the median nerve may be
affected.
Patients with CTS commonly report “numbness” or “tingling” in the
fingers. Some patients feel that the fingertips are “asleep” or report “poor
circulation” in the hands. Symptoms often wake patients up at night. Some
patients report increased symptoms while gripping a steering wheel. Dropping objects,
clumsiness with the hands, or a weak grip are also common complaints. Some
people also report pain in the forearm, wrist or fingers. In severe cases, the
muscles at the base of the thumb (thenar muscles) can become weak and atrophy,
sometimes permanently.
Often the diagnosis can be made on the basis of your symptoms, medical history, and physical examination. A nerve test can be ordered to confirm the diagnosis. Please call (919) 872-3171 to schedule a consultation with a hand specialist at Raleigh Hand to Shoulder Center in Raleigh, NC.
Surgical and non-surgical treatments are available.
Options include hand therapy, night splints, stretching exercises, cortisone injections, and carpal tunnel surgery.
Dupuytren’s Contracture is a common condition affecting the hands. Patients with this condition develop nodules in the palms followed by fibrous cords extending into the fingers. In many patients, the cords gradually contract and cause the fingers to bend or flex. If left untreated, the fingers may remain permanently bent and impair hand function. Activities such as shaking hands, wearing gloves, and reaching into a pocket can be difficult. Fortunately, if treated in the early stages of contracture, the results are usually good to excellent and the results frequently last many years.
In mild forms of the disease, intervention is not always required. Once a finger contracts to the extent where the palm cannot be placed flat on a table top, it is usually time for treatment.
There is no cure for Dupuytren’s disease. The goal of treatment is to remove or break up the contracted palmar cords to allow for improved finger range of motion and better hand function. Recurrence of the contracture is possible with any of the available treatments. There are 3 main techniques used by hand doctors today:
Surgical excision (Dupuytren’s fasciectomy): this surgery is performed by the hand doctor in the operating room under the care of an anesthesiologist. During surgery the diseased, contracted Dupuytren’s tissue is removed through incisions in the palm. Patients are treated with splinting, wound care, and hand therapy for a few weeks during the recovery process. Results from surgery can last a lifetime and typically the results last many years.
Needle aponeurotomy (percutaneous fasciotomy): this less-invasive procedure is performed by the hand doctor in the office using the tip of a needle to perforate the Dupuytren’s cord using local anesthesia. Once the Dupuytren’s cords are weakened, the finger can be manipulated and straightened. Recurrence is common with this technique, but it is the least expensive option and has minimal downtime. The technique can be repeated for recurrent contractures in the future. Not all patients are good candidates for this procedure.
Collagenase enzyme (Xiaflex): this medication is used to treat Dupuytren’s contracture and was FDA approved in the United States in 2010. Xiaflex is an enzyme which dissolves the collagen fibers in Dupuytren’s cords. The Xiaflex injection is performed by the hand doctor in the office, and later that week the patient returns for a manipulation procedure under local anesthesia. The surgeon then manually pops the cord once it has been weakened by the Xiaflex medication. Patients are instructed in home exercises and splinting by therapy, and there is minimal downtime required after the procedure. Recurrence is common with this technique, but it can be repeated for recurrent contractures. Not all patients are good candidates for this procedure
As with any medical procedure, there are possible complications from these treatments. Complications from Dupuytren’s surgery include infection, poor wound healing, bleeding, swelling, hand stiffness, and nerve/artery injury. Complications from needle aponeurotomy include skin tears, nerve injury, and infection. Complications from Xiaflex include flexor tendon rupture, allergic reactions, hand swelling, bruising, lymph node swelling, and skin tears.
Dupuytren’s surgery, Xiaflex injection, and needle aponeurotomy are available at Raleigh Hand Center. Call 919-872-3171 to schedule a consultation with a hand doctor.
Dr. George Edwards, III recently published an article in the journal “Advances in Plastic and Reconstructive Surgery”. His study involved children with thumb abnormalities from birth, and evaluated surgery which could improve the child’s hand function. Dr. Edwards and colleagues at the University of Southern California performed bilateral pollicization surgeries for children with thumb hypoplasia or thumb absence. Here is a link to the article, click here
Dr. George Edwards III and Dr. John Erickson returned from their Nicaraguan mission trip. The physicians traveled with the not-for-profit organization COAN (Cooperacion Ortopedica Americano Nicaraguense) to deliver orthopedic care to patients in Leon, Nicaragua. They also provided lectures to orthopedic residents and medical students in several teaching conferences and taught surgical techniques to residents in the operating room. The surgical cases included a wide variety of problems including chronic contractures of the fingers and wrist, nonunion of a radius fracture, chronic nerve laceration in the forearm, acute fractures of the hand, wrist and forearm, trigger fingers, and tumors of the hand and wrist. For more information about COAN, please visit their website here: https://www.coanhealth.org
Dr. Terry Messer returns from a week-long medical mission trip to Leon, Nicaragua.
“I recently traveled to Nicaragua with a group of doctors and nurses. We are part of a group called COAN, a Triangle based group founded nearly 20 years ago, whose mission is to improve the quality of orthopeadic care in Nicaragua. On our first day there, we saw more than 80 patients in the clinic with a variety of orthopedic problems, ranging from simple problems like carpal tunnel syndrome and trigger finger, to more complex problems like distal radius malunions, recurrent shoulder dislocations, severe ankle arthritis, and scoliosis. Throughout the remainder of the week, we performed more than 30 surgeries, and we helped teach the orthopedic surgery residents and attendings at HEODRA Hospital in Leon. In the end, our team left feeling like we received much more than we gave. I look forward to returning to Nicaragua next year!” — Dr. Messer, Raleigh Hand Center
Dr Messer and COAN in Nicaragua
For more information about COAN, please visit our website at coanhealth.org
Metacarpal fractures are common hand injuries. They can occur from a variety of injuries such as a fall, a motor vehicle collision, or striking the fist against a hard surface. There are five metacarpals, one for each finger and the thumb. The metacarpals contribute to the bony architecture of the hand. Satisfactory healing of this fracture is important to restoring hand function. A fracture of the 5th metacarpal neck (the small finger) is sometimes called a “boxer’s fracture,” as they can be seen in punching injuries.
The treatment plan will depend on the severity of the fracture and the patient’s medical condition and activity level. Most people have fractures which are well-aligned, and, therefore, do not require surgery and are treated in a splint or cast. Follow-up x-rays are obtained to evaluate how the fracture is healing. Hand therapy is sometimes necessary to improve strength and range of motion of the hand.
Some patients with displaced fractures can be treated with manual realignment of the fracture. This is performed in the office or emergency room with local anesthesia such as lidocaine (numbing medicine). Once the bones are “set,” a splint is placed to maintain the alignment for a few weeks.
Surgery may be recommended to patients with more severe fractures, such as those fractures with poor alignment or when the bone breaks through the skin (open fracture).
WHAT IS INVOLVED WITH SURGERY?
The surgery is performed as an outpatient often using regional anesthesia or a nerve block. During surgery, the bones are realigned and stabilized. In some cases, a low-profile plate and screws are used to fix the bones internally. This is called “open reduction and internal fixation” and requires an incision on the back of the hand. In other cases, temporary pins are placed through the skin to stabilize the bones while they heal. This is called “closed reduction and percutaneous pinning.” The pins can be removed in clinic after a few weeks. Other options include intramedullary nail fixation and external fixation. Which technique is used depends on the fracture pattern and is often determined in the operating room. The bone healing process takes about 6 weeks, but full recovery for maximizing hand function can take a few months.
Call Raleigh Hand Center for a consultation on treatment of your metacarpal fracture
4th and 5th metacarpal fractures
Open reduction and internal fixation of 4th and 5th metacarpals
Carpal tunnel syndrome is the most common nerve problem in the hand. It results from increased pressure on the median nerve at the wrist, within the carpal tunnel. Symptoms such as numbness, tingling, weakness, and hand pain can result if the nerve is compressed or “pinched.”
The word “carpus” means “wrist.” The carpal tunnel is a passageway in the wrist through which the median nerve and tendons of the hand travel. The carpal tunnel is a narrow space: the floor of the tunnel is made up by the carpal bones of the wrist, and the roof is created by the transverse carpal ligament. The median nerve is at risk for being pinched within this tunnel. If there is abnormal swelling, altered wrist anatomy, or injury to this area, the function of the median nerve may be affected.
WHAT CAUSES CARPAL TUNNEL SYNDROME (CTS)?
In most cases, the cause of CTS is unknown. Thyroid disorders, rheumatoid arthritis, pregnancy, vitamin deficiencies, diabetes, fluid retention, and trauma can be associated with CTS. Women are more commonly affected than men. Repetitive, forceful gripping and heavy use of vibratory tools may increase the risk of CTS.
HOW DO I KNOW IF I HAVE CARPAL TUNNEL SYNDROME?
Patients with CTS commonly feel numbness and tingling in the fingers. Some patients feel that the fingertips are asleep or report poor circulation in the hands. Symptoms are often worse at night and people tend to shake their hands for relief. Some patients report increased symptoms while gripping a steering wheel. Dropping objects, clumsiness with the hands, or a weak grip are also common complaints. Some people also report pain in the forearm, wrist or fingers. In severe cases, the muscles at the base of the thumb (thenar muscles) can become weak and atrophy. See image below.
Often the diagnosis can be made based on your symptoms and physical examination. A nerve study can be ordered to confirm the diagnosis in some cases.
WHAT ARE THE TREATMENT OPTIONS?
Not everyone with carpal tunnel syndrome needs surgery. Many people with CTS improve with non-operative treatment. Wearing a wrist brace at night supports the wrist in good alignment and takes pressure off the nerve. Corticosteroid injections provide an anti-inflammatory effect and can be effective in many patients.
If nerve compression is severe, or if conservative treatment does not help, carpal tunnel surgery may be recommended. A carpal tunnel release (CTR) is performed to decrease pressure on the median nerve. During this procedure, the “roof” of the carpal tunnel (the transverse carpal ligament) is divided. Cutting the transverse carpal ligament increases the size of the carpal tunnel and provides more room for the median nerve.
The type of surgical incision varies among surgeons; however, the common goal is to reduce pressure on the median nerve. Open CTR and endoscopic CTR are two surgical options. The recommended procedure will be discussed with you with your doctor. Raleigh Hand Center physicians are experts in carpal tunnel syndrome treatment.
Phalanx fractures are common hand injuries. These fractures are also called a “broken finger,” and they can occur from a variety of injuries such as a fall, a motor vehicle collision, or sports injury. There are fourteen phalanges in each hand — three in each finger and two in the thumb. The phalanges make up the bony architecture of the fingers and they are very important for normal hand function.
broken fingers
If you recently injured your finger and are wondering if it is broken, the best thing to do is get an x-ray to find out.
In many cases, Raleigh Hand Center physicians can see patients the same day of an injury or the next day.
Call 919-872-3171 to contact Raleigh Hand Center. After regular office hours, if you call this phone number you will be connected to our hand surgeon on-call to discuss your injury to help guide your treatment.
Many breaks or fractures in the fingers can be misdiagnosed as “just a sprain” or a “jammed finger.” If a finger fracture is not treated appropriately, the long-term results may not be good. Many patients say: “I could still move it, so I didn’t think it was broken.” While in many cases, a fracture causes the finger to be stiff and difficult to move, however, this is not true in all cases. When in doubt, get it checked out.
