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Hand Fractures

What is a Fracture?

Simply put, a fracture is a broken bone. It may be simple, with bone pieces aligned and stable, or unstable, with the bones shifting or displaced. Some fractures occur in the shaft (main body) of the bone, while others occur along the joint surface. When the bone is fracture into many pieces, this is known as a comminuted fracture. An open, or compound, fracture occurs when a bone fragment breaks through the skin. There is some risk of infection in these cases.

Hand Fractures

Because your hand is made of many bones, hand fractures are common. Common signs of a fracture include:

Some fractures result in an obvious deformity, such as a crooked finger, but many do not.
Due to the close relationship of bones to ligaments and tendons, your hand may be stiff and weak after the fracture heals. Fractures that involve surface joints can lead to early arthritis in the joint involved.

How Are Hand Fractures Treated?

Your hand doctor will perform a medical evaluation and take an X-ray to determine if your hand is fractured. Depending on the type of fracture, he will recommend one of several treatment methods.

If the fracture is not displaced, your hand doctor may use a splint or cast. This also protects a fracture that has been set. In some cases, a displaced fracture needs to be set and then held in place with wires or pins without making an incision (closed reduction and internal fixation).

Other fractures may need surgery to set the bone (open reduction). Once the bone fragments are set, they are held together with pins, plates, or screws. If the fracture disrupts the joint surface (articular fracture), it usually needs to be set more precisely to restore the joint surface as smooth as possible.

If a bone is missing or so severely crushed that it cannot be repaired, it may require a bone graft. This procedure involves taking bone from another part of the body to provide more stability. Once the fracture has enough stability, motion exercises may be started to try to avoid stiffness. Your surgeon will determine when the fracture is sufficiently stable.

What Results Can You Expect?

Perfect alignment of the bone on x-ray is not always necessary. You may develop a bony lump at the fracture site as the bone heals. This is known as a “fracture callus,” which functions as a “spot weld.” This is a normal healing process, and the lump should get smaller over time.

Problems with fracture healing include:

You can ease the chances of complications by carefully following your surgeon’s advice during the healing process and before returning to work or sports activities. Your doctor may recommend a hand therapy program with splints and exercises to speed and improve the recovery process.

Call (770) 333-7888 to make an appointment with Atlanta Hand Specialist. We have multiple offices throughout the metro Atlanta area.

Ganglion Cyst

Ganglion cysts are common lumps within the hand and wrist that develop adjacent to joints or tendons. The most common locations are:

The cyst often resembles a water balloon on a stalk, and is filled with clear fluid or gel. The cause is unknown, although they may form in the presence of joint or tendon irritation or mechanical changes. They can occur in patients of all ages.

Ganglion cysts may change in size or even disappear completely. They may or may not be painful. These cysts are not cancerous and will not spread to other areas.

How Are Ganglion Cysts Diagnosed?

Dr. Patel can usually diagnose a ganglion cyst based on the appearance and location of the bump. Ganglion cysts are usually oval or round and may be soft or very firm. Dr. Patel may also request x-rays in order to investigate problems in the adjacent joints. Cysts at the end joint of the finger frequently have an arthritic bone spur associated with them.

Ganglion Cysts Treatment Options

Treatment is often non-surgical. In many cases, cysts are simply observed, as they frequently disappear on their own.

If the cyst becomes painful, limits activity or is otherwise unacceptable, there are several treatment options including:

Surgery involves removing the cyst along with the portion of the joint capsule or tendon sheath. With wrist ganglion cysts, traditional and arthroscopic techniques may yield good results. Dr. Patel will discuss which treatment options are right for you during your appointment.

Call (770) 333-7888 to schedule your appointment at Atlanta Hand Specialist. We have offices in Smyrna, Douglasville, and Marietta.

Flexor Tendon Injuries

What Are Flexor Tendons?

Flexor tendons are cord-like extensions that connect the flexor muscles to the bone, and allow these muscles to bend or flex the finger.

The flexor muscles start from the elbow and forearm regions, turn into the tendons just past the middle of the forearm, and attach into the bones of the fingers. In the finger, the tendon passes through fibrous rings (pulleys), which guide the tendons and keep them near the bone. This enables the tendons to move the joint much more effectively.

Flexor Tendon Injuries

Deep cuts on the palm side of the wrist, hand or fingers may injure the flexor tendons and the nearby nerves and blood vessels. The injury may appear minor, but is more complex on the inside. If a tendon is cut, it acts like a rubber band, with its cut ends pulling away from each other. A tendon that has not been cut completely through may allow the finger to bend, but will cause pain or catching and might eventually tear all the way through. When a tendon is completely cut through, the finger joint can’t bend on its own.

Treating Flexor Tendon Injuries

Since the cut ends of a tendon usually separate after an injury, it will likely not heal without surgery.

Your doctor will advise you on how soon surgery is needed after the tendon is cut. There are many ways to repair the cut tendon, and certain types of cuts need a specific type of repair. It’s important to preserve certain pulleys in the finger, and there is little space between the tendon and the pulley in which to perform a repair.

After surgery, the injured area can either be protected from movement or started on a very specific limited-movement program for several weeks, depending on the type of cut. Your surgeon may also prescribe hand therapy after surgery. After four to six weeks, you should be allowed to move your finger slowly and without resistance.

If you believe you’ve suffered a flexor tendon injury, call Atlanta Hand Specialist at (770) 333-7888 to make an appointment with a dedicated hand doctor at Atlanta Hand Specialist in metro Atlanta.

Fingertip Injuries

Fingertip Injuries

Fingertip injuries include any injury to the skin, bone, nail, nail bed, tendon, or the pulp of the padded area of the fingertip.

The skin of the palm side of the fingertip has many more nerve endings than most other parts of the body. These nerve endings enable fine sensation, but can be damaged. When this specialized skin is injured, exact replacement is difficult.

Evaluating an Injury

How the injury occurred as well as any medical problems are important factors in determining treatment. Your hand doctor will examine the extent of the tissue injury and its size. He or she will also assess sensation and circulation of the finger tip.

Your doctor may check the mobility of the tip, as injuries can occur to the tendons that bend or straighten the fingertip. An X-ray may be necessary to see if the bone has been injured.

Fingertip Injury Treatment

Severe crush or avulsion injuries may completely remove some or all of the tissue at the fingertip. If just skin is removed and the defect is less than a centimeter in diameter, you may simply treat these injuries with dressing changes.

If there is a little bit of bone exposed at the tip, your doctor may trim it back slightly and treat it with a dressing, too.

For larger skin defects, skin grafting may be recommended. Your doctor can obtain smaller grafts from the little finger side of the hand. Larger grafts may be harvested from the forearm or groin.

Call (770) 333-7888 to schedule an appointment with a dedicated hand doctor at Atlanta Hand Specialist. We have multiple locations throughout metro Atlanta.

Extensor Tendon Injuries

What Are Extensor Tendons?

Located on the back of the hand and fingers, the Extensor tendons allow you to straighten your fingers and thumb. These tendons are attached to muscles in your forearm. The tendons become flat and thin as they continue into your fingers, and are then joined by smaller tendons from the muscles in the hand. It is these small-muscle tendons that allow delicate finger motions and coordination.

Extensor Tendon Injuries

The extensor tendons lie just below the skin, directly on the bone, on the back of the hands and fingers. Due to their location, they are easily injured, even by a minor cut. Jamming a finger may tear these thin tendons away from the bone. After this type of injury, you may have trouble straightening one or more joints. Treatment is necessary to return use to the tendon.

Common Types of Extensor Tendon Injuries:

Extensor Tendon Injury Treatment

A cut that splits the tendon may require stitches, but tears caused by jamming injuries are usually treated with splints. The splint prevents the healing ends of the tendon from pulling apart, and should be worn at all times until the tendon has fully healed.

Dr. Patel will apply the splint in the correct place, and give you directions on how long you should wear it. He may also place a pin through the bone across the joint as an internal splint.

Call (770) 333-7888 to schedule an appointment with Dr. Patel. Atlanta Hand Specialist has offices in Smyrna, Douglasville, and Marietta.

Dupuytren’s Disease (Viking’s Disease)

Dupuytren’s disease, also called Viking’s disease, is an abnormal thickening of the fascia (the tissue just beneath the skin of the palm).

It often starts with firm lumps in the palm, with some patients developing firm cords beneath the skin that stretch from the palm into the fingers. Gradually, these cords may cause the fingers to bend into the palm.

Although skin may become involved in the process, deeper structures such as the tendons are not. Occasionally, the disease will cause thickening on top of the finger knuckles (knuckle pads), or nodules or cords within the soles of the feet (plantar fibromatosis).

What Causes Dupuytren’s Disease?

The cause is unknown but may be associated with certain biochemical factors within the involved fascia. Dupuytren’s disease is more common in men over age 40 and in people of northern European descent. There is also no evidence that hand injuries or specific occupational exposures lead to a higher risk of developing Dupuytren’s disease.

Signs and Symptoms

Symptoms usually include a small lump or series of lumps and pits within the palm. The lumps are generally firm and adherent to the skin.

A cord may develop gradually, which will extend from the palm into one or more fingers (the ring and little fingers are most commonly affected. Although the cords may be mistaken for tendons, they actually lie between the skin and tendons. In many cases, both hands are affected, although the degree of involvement may vary.

While the initial nodules may produce discomfort, Dupuytren’s disease is not typically painful.

You may first notice it due to difficulty placing your hand flat on an even surface. As your fingers are drawn into the palm, you may notice increasing difficulty with activities such as washing, wearing gloves, shaking hands, and putting hands into pockets.

The progression of the disease is unpredictable. Some individuals will have only small lumps or cords while others will develop severely bent fingers. More severe disease often occurs with an earlier age of onset.

Treatment for Dupuytren’s Disease

In some cases, Dr. Patel may simply observe the nodules and cords that contracted.

If you have more advanced contractures, you may require surgery to improve function. There are various surgical techniques that can correct finger position. Dr. Patel will discuss which method is most appropriate for you based on the stage of the disease and joints involved.

Surgery should help improve finger position, and thereby hand function. Even after surgery, the disease may reoccur, and the fingers may begin to bend into the palm once again.

Call Atlanta Hand Specialist at (770) 333-7888 to make an appointment with Dr. Patel. We have offices in Smyrna, Douglasville, and Marietta.

de Quervain’s Tendonitis or Wrist Tendonitis

de Quervain’s tendonitis (first dorsal compartment tendonitis) is brought on by irritation or inflammation of the wrist tendons at the base of the thumb. This inflammation causes the compartment (a tunnel or a sheath) around the tendon to swell and enlarge, making thumb and wrist movement painful. Making a fist, grasping, or holding objects often causes pain.

What Causes de Quervain’s Tendonitis?

This condition is usually caused by taking up new, repetitive activity.

New mothers are especially prone to this type of tendonitis because caring for an infant often creates awkward hand positioning. Hormonal fluctuations associated with pregnancy and nursing further contribute to its occurrence.

A wrist fracture may also predispose you to de Quervain’s tendonitis because of increased stresses across the tendons.

Signs and Symptoms of Wrist Tendonitis

The main symptom is pain over the thumb-side of the wrist. It may appear gradually or suddenly, and is located at the first dorsal compartment at the wrist. The pain may radiate down the thumb or up the forearm, with hand and thumb motion increasing pain (especially with forceful grasping or twisting).

You may experience swelling over the base of the thumb which can include a fluid-filled cyst in this region. There may be an occasional “catching” or “snapping” when you move your thumb.

Because of the pain and swelling, motion such as pinching may be difficult. Irritation of the nerve lying on top of the tendon sheath may cause numbness on the back of the thumb and index finger.

Diagnosis of Wrist Tendonitis

You will be asked to make a fist with your fingers clasped over your thumb. This involves bending your wrist in the direction of your little finger, making the maneuver quite painful if you have de Quervain’s tendonitis.

Wrist Tendonitis Treatment

The goal of wrist tendonitis treatment is to relieve the pain caused by the irritation and swelling. Options may include:

Each of these non-operative treatments helps reduce the swelling, which typically relieves pain over time. In some cases, simply stopping the aggravating activities may allow the symptoms to go away on their own.

If symptoms are severe or do not improve, surgery may be recommended to open the compartment to make more room for the inflamed tendons, which breaks the vicious cycle of the tight space causing more inflammation. You can resume normal use of your hand once comfort and strength have returned.

Call Atlanta Hand Specialist at (770) 333-7888 to make an appointment for wrist tendonitis treatment at any one of our multiple metro Atlanta locations.

Cubital Tunnel Syndrome

Cubital tunnel syndrome is brought on by increased pressure on the ulnar nerve at the elbow. The ulnar nerve passes under a bump of bone on the inner portion of the elbow (medial epicondyle or “funny bone”). At this site, the ulnar nerve lies directly next to the bone and is susceptible to pressure. When the pressure on the nerve becomes great enough to affect the way the nerve works, then numbness, tingling, and pain may be felt in the elbow, forearm, hand, and/or fingers.

What Causes Cubital Tunnel Syndrome?

The ulnar nerve is positioned right next to a bone that has very little padding. Pressure on this bone can put pressure on this nerve. Below are a few examples:

If you learn your arm against a table on the inner part of your elbow, your arm may fall asleep and be painful from sustained pressure on the nerve. If this occurs repetitively, the numbness and pain may be more persistent.

Sometimes the ulnar nerve at the elbow clicks back and forth over the bony bump as the elbow is straightened. If this occurs repetitively, the nerve may be significantly irritated.

Pressure on the ulnar nerve can also occur from holding the elbow in a bent position for a long time, stretching the nerve across the medial epicondyle. Sustained bending of the elbow tends to occur during sleep.

Sometimes the connective tissue over the nerve grows thicker, or there may be variations of the muscle structure over the nerve at the elbow that causes pressure on the nerve.

Cubital tunnel syndrome occurs when the pressure on the nerve is significant enough, and sustained enough, to disturb the way the ulnar nerve works.

Symptoms of Cubital Tunnel Syndrome

Symptoms usually include pain, numbness and/or tingling. Numbness or tingling most often occurs in the ring and little fingers.

You’ll usually notice symptoms when there is pressure on the nerve, such as when you are sitting with your elbow on an arm rest or with repetitive elbow bending or straightening. You may also notice symptoms when you’ve held your elbow in a bent position for a period of time, such as when holding the phone or while sleeping.

You may notice weakness while pinching, occasional clumsiness, and/or the tendency to drop things. In severe cases, you may lose sensation and the muscles in the hand may lose bulk and strength.

Diagnosis

Dr. Patel will assess the pattern and distribution of your symptoms and examine for muscle weakness, irritability of the nerve to tapping and/or bending of the elbow, and changes in sensation. He may also need to evaluate other conditions such as thyroid disease or diabetes.

He may perform a test called electromyography (EMG) and/or a nerve conduction study (NCS) to confirm the diagnosis of cubital tunnel syndrome and stage its severity.  This test also checks for other possible nerve problems, such as a pinched nerve in the neck, which may cause similar symptoms.

Cubital Tunnel Treatment

Sometimes symptoms can be relieved without surgery, particularly if the EMG/NCS testing shows that the pressure on the nerve is minimal. Dr. Patel may suggest:

Dr. Patel may also recommend a session with a therapist to learn ways to avoid pressure on the nerve.

If symptoms are severe or do not improve, you may need surgery to relieve the pressure on the nerve. Dr. Patel often recommends shifting the nerve to the front of the elbow, which relieves pressure and tension on the nerve. He may place the nerve under a layer of fat, under the muscle, or within the muscle. He may also recommend trimming the bony bump (medial epicondyle).

Your recovery following surgery depends on the type of procedure performed. Dr. Patel will most likely recommend you avoid lifting and/or certain elbow movements for a period of time. Therapy may also be necessary.

If you’re suffering from cubital tunnel syndrome, call Atlanta Hand Specialist at (770) 333-7888 to make an appointment today. We have offices in Smyrna, Douglasville, and Marietta.

Carpal Tunnel Syndrome

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome (CTS) is a condition caused by increased in pressure on the median nerve at the wrist. Simply put, it is a pinched nerve at the wrist.

The carpal tunnel is a space in the wrist where the median nerve and nine tendons pass from the forearm to the hand. When pressure builds from the swelling in the tunnel, it puts pressure on the nerve. When the pressure becomes great enough, you may experience one or all of the following symptoms:

What Causes Carpal Tunnel Syndrome?

The cause is often unknown, but pressure on the nerve can occur in several ways:

Signs and Symptoms

Symptoms usually include pain, numbness, tingling or a combination of the three, with tingling and numbness most often in the thumb, index, middle and ring fingers.

You will most likely experience symptoms at night, but some notice them during daily activities. Some patients also notice a weaker grip, occasional clumsiness or a tendency to drop things.

In severe cases, it’s possible to lose sensation permanently while the muscles at the base of the thumb slowly shrink (thenaratrophy).

Carpal Tunnel Diagnosis

In order to diagnose carpal tunnel, one of our doctors will complete a detailed history, which will include any previous medical condition, how you’ve used your hands, and whether there were any prior injuries. He will also take an x-ray to check for other causes of your symptoms such as arthritis or a fracture.

In some cases, a laboratory test may be needed if your doctor suspects a medical condition associated with CTS. Your doctor may also perform a nerve conduction study (NCV) and/or electromyogram (EMG) to confirm your diagnosis, as well as to check for other possible nerve problems.

Carpal Tunnel Treatment

It is often possible to relieve carpal tunnel symptoms without surgery. By identifying and treating the underlying medical condition, changing the patterns of hand use, or keeping the wrist splinted in a straight position, you may be able to reduce pressure on the nerve.

Other Treatment Options Include:

If your symptoms are severe or do not improve, a hand surgeon may recommend surgery to make more room for the nerve. By cutting the ligament that forms the top of the tunnel on the palm side of the hand, it is possible to decrease the pressure on the nerve. The incision allows the doctor to enlarge the tunnel and decrease pressure on the nerve.

If you’re experiencing any carpal tunnel symptoms, don’t hesitate to make an appointment with one of the dedicated hand doctors at Atlanta Hand Specialist. We have multiple locations throughout the metro Atlanta area.

Hand Burns

In addition to many other conditions, Atlanta Hand Specialist treats hand burns.

Degrees of Burn Injuries

Burns are classified by the depth (degree) of injury to help determine the appropriate treatment.

1st Degree: Superficial—redness of skin without blisters
2nd Degree: Partial thickness skin damage –blisters present
3rd Degree: Full thickness skin damage –skin is white and leathery
4th Degree: Similar to 3rd degree, but with damage to deeper structures such as tendons, joints and bone

Burn Treatment

The depth and extent of your burn injury will determine your treatment needs. In most cases, Atlanta Hand Specialist can treat hand burns on an outpatient basis if the pain can be controlled.

Treatment will focus on preventing further problems with stiffness and infection.

1st Degree (Superficial Burns): These burns usually heal within a week and can be treated for pain with local analgesics and pain medications.

2nd Degree (Partial Thickness Burns): We may or may not trim blisters, but the hand and forearm should be splinted in a position of safety to prevent later stiffness. If there are open, raw surfaces, we recommend cleaning with frequent dressing changes and the application of local topical antibiotics until the wounds are healed. Wounds should begin healing within two to three weeks. Some 2nd degree burns may need excision of damaged skin followed by skin grafting.

3rd Degree (Full Thickness Burns): We will remove the dead skin and replace it with skin grafts. The timing of this procedure depends on the size and location of the burns. Dr. Patel usually removes dead skin as soon as it is evident that the burn is at full thickness, and grafts immediately. Your hand will probably be splinted until the grafts are healed, and then mobilization begins (ideally within two to three weeks after the injury).

Small full thickness burns may be treated like the partial thickness but will take longer to heal and will leave scarring. A burn that goes around the full circumference of the limb can sometimes constrict it like a tourniquet. If this is the case, Dr. Patel may release the construction with a procedure known as escharotomy.

Therapy and Rehabilitation

The need for therapy depends on the depth of the burn and any other factors that may lead to stiffness in the hand. Superficial burns generally do not require hand therapy. Deep burns or burns that occur in conjunction with other injuries may require extensive therapy and rehabilitation. Dr. Patel will coordinate therapy with a therapist if he feels you would benefit from rehabilitation.

Additional Surgery

Many patients with burn injuries will require more than one operation. Burned hands may develop contractures months or years after the original injury. Dr. Patel will plan your long-term follow up to evaluate the possibility of further surgery to improve hand function.

If you’ve suffered from a hand burn injury, call Atlanta Hand Specialist at (770) 333-7888 to make an appointment today. We have offices in Smyrna, Douglasville, and Marietta.

Carpal Tunnel Syndrome

Do you have pressure on your wrists? Many people have symptoms of Carpal Tunnel Syndrome without knowing it. Find out how the condition is caused and what treatment you’ll receive from Atlanta Hand Specialists for Carpal Tunnel Syndrome.

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Wrist & Hand Fracture

If you have shooting pain in your hand or wrist, you may have a wrist or hand fracture. Fracturing, or breaking, the bones in the wrist or hand is extremely easy because of their size and structure. Read on to learn how wrist and hand fractures are treated by Dr. Patel and the Atlanta Hand Specialists.

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Trigger Finger

Trigger finger is caused by stressing the tendons and getting your thumb or finger stuck in the bent position. Inflammation and localized pressure are common signs for trigger finger. Seek treatment from the Atlanta Hand Specialists about trigger finger and your treatment options available.

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Ganglion Cyst

Tender lumps found on the hand or wrist can be a cyst. Ganglion Cysts are commonly filled with fluid, and form because of tendon or joint irritation. Find out more about how Ganglion Cysts are treated by the specialists at Atlanta Hand Specialist.

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