Oct 2015


October 7, 2015

Hands and injuries have been much in the news of late, from hand transplants to robotic hands to injuries.

Football fans, for example, know about Jason Pierre Paul (JPP), the defensive end for the NY Giants who blew off parts of his hand with fireworks. Well, we’re way past July 4, but every season brings its hazards.
Coming up soon:
The Goal: carve the pumpkin, not your hand!

Some tips, especially for those of you with kids/grandkids:

    And the Pope?

    Well, I didn’t notice Pope Francis doing this on his recent visit, but maybe I missed it. Often when a Popes blesses the flock, he has his last two fingers bent.

    This is known as Benediction Hand and may have its origin back in the Middle Ages or earlier. One of the early Popes may have had an injury to the Median or Ulnar nerve or possibly an untreated case of Dupuytren’s contracture.

    The good news: these conditions are all treatable in the 21st century if you catch them early enough.

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    Carpal tunnel syndrome is a problem that affects the median nerve of the hands. Sometimes one, sometimes both.Typically it starts with numbness of the fingers and especially the thumb, index, and middle fingers. Usually the pinkie is not involved. 
    *Numbness and tingling of the fingers and hand
    *Discomfort or aching of the hands
    *Weakness of the hands
    Often, people describe waking at night with discomfort. Many people have symptoms when they drive. If the conditon progresses there is loss of strength and people may drop cups or have trouble carrying packages or even with dressing or undressing.
    Though it is commonly tied to computer/keyboard use, many people develop carpal tunnel in other ways. There can be an underlying genetic predisposition that is made worse with repetitive movement of the wrist and especially holding the wrist bent for prolonged periods of time. 
    Often a good history and exam will tell the story. If needed nerve testing (so-called EMG/NCV) can be done to confirm the diagnosis or the severity of the condition. This testing can also help in sorting out other conditions and especially neck involvement.
    Many people with Carpal Tunnel Syndrome also have other problems with the hand and especially arthritis and various forms of tendonitis. The Carpal Tunnel can be part of a more generalized Repetitive Stress problem that can end up affecting the whole arm to the neck.
    Also, because the nerves that travel into the hand start way up in the neck it is important to make sure there are no associated problems there (so-called Cervical Radiculopathy) Other medical conditions such as diabetes and underactive thyroid can also influence the symptoms.
    Luckily the vast majority of cases can be treated quite simply and without surgery. One of the main components of treatment is using the hand and wrist in a smart way and so limiting added pressure on the nerve. A simple wrist splint will usually do the trick. There are other forms of non-surgical treatment such as Vitamin B6, massage and therapy, and cortisone injection that may be indicated depending on the specifics of the case.
    Surgery is a last resort but happily it is usually a very straightforward out-patient procedure under local anesthesia with a high rate of success and a small,if any, scar. Many patients get almost immediate relief and are able to return to work sometimes within a few days, depending of course on the job. 
    Hope that this is helpful to you.


    Arthritis in its simplest description is a damaged joint. This can involve damage to the cartilage cushion within the joint and/or damage to the support structures of the joint, namely the capsule and ligaments and surrounding tendons.

    There are many types of arthritis and many causes for arthritis so it is misleading to lump them all together in terms of diagnosis and treatment. While it is a long list, some examples of arthritis include rheumatoid arthritis, scleroderma, psoriatic arthritis, gout, and lupus. I am leaving many examples out so as to focus on one of the more common types and specifically OSTEOARTHRITIS.

    These two types account for the vast majority of arthritis that is seen by hand surgeons and therapists and rheumatologists.

    The main problems that result from these conditions are joint pain and joint swelling and stiffness. This can involve joints all over the body from the neck and back, the hips and knees. Each form of arthritis has its own typical distribution.

    With OSTEOARTHRITIS, it can just happen for no apparent reason or it can be caused by or provoked by trauma. In other words, a particular injury can lead to a mechanical problem with the joint or there can be an underlying problem that is set of by the injury.

    With RHEUMATOID ARTHRITIS, there is a autoimmune component wherein the body actually attacks itself and in this case especially the joints (though other organs can be involved) Why that happens in some people and not other that is still being researched.

    THE ENEMY OF GOOD- a guide to hand rehabilitation

    I don’t know who was it that said, “don’t let perfect be the enemy of good” but whoever it was it’s worth keeping in mind. Including when it comes to hand issues.

    Whether it’s in dealing with recovery from an injury or from surgery or arthritis or some other chronic conditions, the prime goal should be reasonably painless functional use. Sure it would be nice to get rid of all the swelling, and sure it would be great to have pretty joints, and wonderful to have absolutely complete motion and unlimited strength. And do everything we would like to do like we always did it. But...don’t let perfect be the enemy of good.

    In real estate, the saying is “location, location, location.” That’s the priority. That’s the value added. But with hands it’s “function, function, function.” That’s what we want to achieve. And as quickly and effortlessly as possible.

    So if we have inflammation and irritation we try to reduce it with simple steps, without medicine if possible and with surgery only as a last resort. If some body part needs to heal, whether a bone or tendon or muscle or ligament, we try to promote healing as naturally as possible. Simple steps if possible.

    Our job, as a team of patient and physician, is to support the body’s own natural processes as well as we can. And remember, there is usually a process that has to play out. And processes play out at their own pace. We can support it but not rush it. It’s like turning up the heat on a pie in the oven; you’ll just burn it.

    So simple therapies, support the process, and work towards a realistic functional goal. One step at a time. If the results are unacceptable there’s usually a plan B and C, but try to keep the big picture in mind.

    So you may not be able to open every jar... maybe you’ll eat something else. And you may not be able to play a full 18 holes without a break or knit a sweater as quickly as you could or....
    But remember even if you’re not perfect, you’re damn good!