Finger Deformity

An abnormal flexing of the end of the finger along with an abnormal extension of the middle finger joint is known as a Swan Neck deformity. The condition is normally caused by a tearing or weakness of one of the ligaments on the palmar side of the finger. Swan Neck deformities can occur following an injury or with rheumatoid arthritis.

Causes of a Swan Neck Deformity

In patients with a Swan Neck deformity, the tendons slide toward the back of the finger whenever the middle joint is extended. This causes the middle joint to become hyperextended, which makes it harder for the tendons controlling the end joint of the finger to straighten.

Symptoms of a Swan Neck Deformity

A Swan Neck deformity makes it difficult to bend the middle joint of the finger. Patients often complain of a snapping sensation when trying to bend the finger. Over time, the affected finger can become increasingly stiff.

Non-Invasive and Surgical Treatments

Treatment depends on the cause and severity of the deformity. Non-invasive treatments include placing a special ring over the affected joint to prevent the snapping and to hold the finger in the proper position. Surgical options include joint replacement or fusion or repositioning of the tendons. Patients with a Swan Neck deformity should consult with one of LA Hand Surgeon’s board-certified plastic hand surgeons to discuss their treatment options.

Signs of Trigger Finger

Stenosing tenosynovitis, commonly known as trigger thumb or trigger finger, occurs when the protective sheath that surrounds the tendons that allow the fingers and thumb to bend becomes inflamed or irritated. As a result, the tendon is no longer able to glide as the fingers and thumb open and close. Over time, the tendon can become scarred and thickened or develop nodules, which can make movement even more difficult. Click here to learn more about trigger finger, treatment and recovery.

Who is At Risk for Trigger Finger or Trigger Thumb?

Individuals who engage in work or hobbies that involve repeated or prolonged gripping or hand use are more likely to develop trigger finger or trigger thumb. The condition is also more common in women and individuals with inflammatory conditions, such as rheumatoid arthritis, or diabetes.

Symptoms of Stenosing Tenosynovitis

Stenosing tenosynovitis can affect any finger and often affects more than one finger at a time. Symptoms may progress from mild to severe as the inflammation and damage to the tendon worsen.

Symptoms typically include:

  • a nodule or tenderness at the base of the affected finger,
  • stiffness that is normally worse in the morning,
  • a finger pops or clicks with movement, and
  • a finger catches or locks when bent and then pops straight suddenly.

In severe cases, the bent finger may become locked to the point that it cannot be straightened.

Trigger Finger Treatment

Mild to moderate cases of trigger finger or trigger thumb may be treated with conservative measures, including:

  • splinting,
  • over-the-counter or prescription anti-inflammatories,
  • stretching exercises,
  • rest, or
  • steroid injections.

In severe cases, the doctor may need to perform a procedure to release the constriction so that the tendon can move freely. One method involves inserting a needle into the area around the tendon to break apart the constriction. Another method involves making a small incision to open up the constricted tendon sheath. The majority of patients are able to move the affected fingers normally immediately after the procedure. Depending on the severity of the condition, the doctor may recommend physical therapy following the surgery.

Contact us, Los Angeles’s best team of board-certified plastic hand surgeons, to schedule your consultation and learn how to best treat your symptoms of trigger finger. If you have not yet been diagnosed but feel you may have many if not most of the above symptoms, you should see a board-certified hand surgeon to obtain a proper diagnosis.

Warning Signs of Carpal Tunnel Syndrome

Carpal tunnel syndrome is a cumulative trauma condition that occurs when there is pressure on the median nerve in the wrist. This nerve, which passes through the length of the arm and an area of the wrist known as the carpal tunnel, connects to the hand and is responsible for finger movement and sensibility. When the carpal tunnel swells, excessive pressure is applied to the median nerve and leads to carpal tunnel syndrome.

Causes of Carpal Tunnel

Carpal tunnel syndrome is one of the most common overuse injuries and often occurs in people who use their hands a lot for work, sports or other activities. Diabetes, thyroid abnormalities and other medical problems can additionally lead to the development of carpal tunnel syndrome. Some pregnant women also experience this condition. Sometimes, however, the exact cause of carpal tunnel syndrome cannot be determined.

Symptoms of This Condition

Tingling, pain or weakness in the hand or wrist are some of the most common symptoms. Numbness may also be felt in the thumb, index, middle and ring fingers. Feelings of numbness may be especially prevalent when waking up in the morning or in the middle of the night. People who have carpal tunnel syndrome may also find themselves dropping things or performing clumsy motions with their hands.

Triggering Factors

In addition to the specific causes of carpal tunnel symptoms, certain factors can worsen its symptoms. Typing, driving and other activities that cause the wrist to bend often exacerbate this condition. Sleeping with a bent wrist position is another triggering factor. Some sufferers of carpal tunnel syndrome also say that their symptoms become more intense with high impact or vibration on the palm of the hand.

Non-Surgical Tips and Surgical Treatment of Carpal Tunnel Syndrome

Los Angeles board-certified plastic surgeon can recommend a treatment plan to resolve this medical condition. Anti-inflammatory medication may be prescribed to reduce swelling and alleviate symptoms. Patients may also be instructed to wear wrist splints at night to prevent the wrist from bending and thereby worsening symptoms. Stretching and other hand therapy exercises can sometimes be effective in treating this condition. Injections or surgery may be recommended if other treatments haven’t worked or in severe cases of carpal tunnel syndrome.

Elbow Fractures: How They Occur & How to Prevent Them

Elbow fractures occur when breaks form in any of the bones that make up the elbow joint. These fractures can result from low-energy and high-energy injuries and range in severity. A board-certified plastic hand surgeon can diagnose and treat elbow fractures so that patients can return to their normal lives with less pain and greater mobility.

Click here to learn about tennis elbow pain in comparison.

What Causes Elbow Fractures?

Many elbow fractures are caused by low-energy injuries such as falling while standing or bumping the elbow into a hard surface. Falls from high places, car accidents and hard collisions while playing sports are examples of high-energy injuries that require more intensive treatment to heal elbow fractures. Osteoporosis and other medical conditions that negatively affect the bones can also lead to elbow fractures developing.

Symptoms

Most elbow fractures result in at least some pain and swelling, but small breaks in the bone may only cause minor discomfort with no other symptoms. It  can result from acute or cumulative trauma or injury. Larger fractures can result in intense pain, instability of the joint and deformity. Dislocation of the elbow can occur as well with certain fractures. Bruising may also be visible around the area of the fracture.

Treatment

Treatment will depend on the severity and specific location of the elbow fracture. For smaller fractures with mild to moderate pain, minimal bruising and no visible deformities, the RICE (rest, ice, compression and elevation) treatment method can help the bone breakage heal quickly. Persistent pain, bruising and swelling with sensations of clinking, clunking or catching in the elbow should be evaluated by a doctor.

If medical treatment is required, the doctor will likely take x-rays of the elbow to identify the severity and exact location of the fracture. A splint, brace or cast may be used to stabilize the elbow so that the fracture can heal properly. Surgery may be required to treat fractures that are particularly large or deep.

Outlook

Most elbow fractures heal without complications and do not cause long-term effects in patients. If soft tissue was damaged in addition to the fracture, pain and instability could persist and require treatment with physical therapy. Some patients report experiencing stiffness and arthritis even after their elbow fractures have healed.

Prevention

Keeping the elbow bones and surrounding tissues strong and healthy by getting enough calcium can prevent these fractures. A doctor may recommend other preventative measures if the elbow bones are frail and susceptible to breaking. Using night lights and removing tripping hazards around the home can further prevent injuries that result in elbow fractures.

Contact LA Hand Surgeon today to see what treatment would most benefit you and your elbow condition.

The Anatomy of the Elbow and What Causes Cubital Tunnel Syndrome

Ulnar nerve compression also known as cubital tunnel syndrome is a condition in which the ulnar nerve running from the neck to the hand (through the elbow) becomes constricted. This condition is similar to carpal tunnel syndrome with some distinctions.

Cubital Tunnel Syndrome Symptoms

The ulnar nerve passes through the cubital tunnel, which is located under the bony prominence on the inner portion of the elbow. The ulnar nerve controls a number of the hand muscles that allow for fine movement, some of the forearm muscles necessary for gripping, and provides sensation to part of the ring finger and the little finger. When the ulnar nerve is compressed, you may feel tingling and numbness in the hand, pinky (little finger), and ring finger. Cubital tunnel syndrome can be differentiated from carpal tunnel syndrome by the fact that carpal tunnel syndrome affects the median nerve that provides feeling to the thumb, index, and middle finger but not the pinky or little finger.

Causes of Ulnar Nerve Compression

When the elbow is bent, the ulnar nerve is stretched around the medial epicondyle of the elbow. Over time, this repeated stretching can cause the nerve to become irritated and inflamed. Excess fluid in the joint, trauma, and leaning on the elbows for prolonged periods may cause swelling that can lead to nerve compression. Those most at risk for ulnar nerve entrapment include:

  • Individuals with prior dislocations or fractures involving the elbow;
  • Individuals engaged in activities that require repeated flexing and bending of the elbow; and
  • Individuals with arthritis, bone spurs, or cysts involving the elbow.

Possible Conservative Treatment

Rest, bracing, and other conservative treatments may be sufficient to reduce the inflammation and alleviate cubital tunnel symptoms. If symptoms persist or cause chronic muscle weakness in the hands, a cubital tunnel specialist may have to perform surgery to relieve the compression on that nerve.

Click here to learn about other cumulative traumas treated in our Beverly Hills’ office. For more information about treatments for ulnar nerve compression, schedule a consultation with one of our Beverly Hills plastic hand surgeons today.

411 on Carpal Tunnel Syndrome

Carpal tunnel syndrome is a common condition that occurs when the median nerve located in the wrist becomes pinched. The median nerve, which provides feeling to the thumb and fingers, passes through a narrow passageway called the carpal tunnel. Certain health conditions and activities can cause swelling within the carpal tunnel that impinges on the median nerve.

Common Symptoms of Carpal Tunnel Syndrome

In the early stages, symptoms typically include numbness, tingling, and burning sensations in the fingers and palm. The fingers may feel swollen even when there is no evidence of swelling. Initially, the symptoms may be worse at night since it is common to sleep with the wrists in a flexed position. Eventually, the symptoms may persist throughout the day to the point that it is difficult to grasp objects, make a fist, or perform other tasks requiring manual dexterity. When left untreated, the muscles located at the bottom of the thumb may atrophy and touch sensation may be lost.

How Does Carpal Tunnel Syndrome Develop?

Carpal tunnel can arise from a variety of factors and causes. In most instances, the condition is caused by a reduction in the amount of space within the tunnel itself rather than an issue with the median nerve. Trauma, thyroid problems, excess fluid retention, cysts, and rheumatoid arthritis can all cause inflammation within the carpal tunnel. The condition is also common in individuals who perform repetitive tasks with their hands and wrists or use vibrating tools, just as jackhammers.

What Does Diagnosis & Treatment Entail?

One of LA Hand Surgeon’s board-certified plastic hand surgeons and hand specialists can diagnose carpal tunnel syndrome by compiling a detailed medical and lifestyle history as well as using a variety of imaging, laboratory, and electrodiagnostic tests. In severe cases, surgery may be necessary to relieve the pressure on the median nerve.

Contact our office today to learn more about the surgical and non-surgical treatment options our plastic surgeons offer for carpal tunnel syndrome. Our team of board-certified plastic hand and reconstructive surgeons includes Dr. Arezou Yaghoubian, Dr. S. Daniel Golshani and Dr. James Coleman.

Ways to Prevent Carpal Tunnel Syndrome

Numbness and tingling in the thumb and fingers are often a sign of carpal tunnel syndrome. The condition is common in individuals who perform repetitive actions using their hands and wrists. The median nerve that provides feeling to the thumbs and all of the fingers with the exception of the pinky finger, passes through a small tunnel of ligament and bone called the carpal tunnel. Repetitive motions can cause inflammation within the carpal tunnel to the point that it impinges upon the median nerve causing numbness and tingling. Click here to learn about other medical services our LA plastic hand surgeons offer including for cumulative trauma, tumors and masses, hand infections and more.

How You Can Prevent Carpal Tunnel Syndrome

Although it may not be possible to avoid all activities that can lead to carpal tunnel syndrome, there are certain steps that can be taken to limit the stress on the wrists and hands that can exacerbate symptoms.

• Avoid using excessive pressure or force to perform activities. For example, use light keystrokes when typing instead of pounding the keyboard.

• Avoid tensing the hands or gripping objects too tightly.

• Take a break for 10 to 15 minutes each hour to rest and stretch the fingers and wrists.

• Try to keep the wrists in a neutral position instead of bent to reduce pressure on the median nerve.

• When possible, switch hands when performing tasks.

• Maintain good body posture since slouching can place strain on various muscles and nerves that can exacerbate wrist problems.

• Try to keep the wrists and hands warm to alleviate pain and stiffness.

Stretching Exercises for the Fingers and Wrists

The following stretching exercises can help release tension in the wrists and hands:

Start by making a fist and then fan the fingers out by stretching them as far as possible. Make a fist again and then slide the fingers up to point straight out. Repeat these exercises up to 10 times during each break.

For more information about carpal tunnel treatment options, contact our Beverly Hills practice to schedule a consultation with one of our board-certified plastic and hand surgeon and carpal tunnel specialists.

How to Prevent Tennis Elbow

Lateral epicondylitis, commonly referred to as tennis elbow is a repetitive stress injury involving the muscles and tendons of the forearm. Despite the name, only about 5 percent of individuals develop the condition from playing tennis.

Symptoms of Tennis Elbow

Tennis elbow is characterized by pain along the outer portion of the forearm that may extend from the elbow to the wrist. The pain is usually most noticeable when bending or lifting the arm, grasping small objects, when moving the forearm in a twisting fashion, or when extending the arm. With proper care and rest, most lateral epicondylitis cases resolve within six months to two years.

Coping With Tennis Elbow Pain

At the first sign of tennis elbow pain, it is important to refrain from any activities that may place stress on the tendons and muscles of the forearm. When possible, try to use the muscles of the forearm, upper arm, and shoulders evenly so that one muscle group does not become overused. When engaging in sports, such as racquetball, tennis, or squash, be sure to use proper form and technique to reduce the chances of strain and injury to muscles and tendons. Warming up before activities that require repetitive movements, using tools and equipment with wider grips, and wearing splints can also help prevent damage to the tendons.

Exercises for Tennis Elbow

The following exercises can help strengthen the forearm muscles so that they are less prone to injury:

  • Wrist Stretches
    Place the forearm on a table allowing the wrist to hang off of the edge with the palm up. Holding a light weight, lift and drop the wrist slowly.
  • Extensor Stretches
    With the wrist bent, grasp the fingers with the opposite hand and gently pull them backward to stretch the muscles and tendons of the forearm.
  • Tricep Stretches
    With the arm bent behind the back, use the opposite hand to place pressure on the affected elbow.
  • Hand Squeezes
    Holding a tennis or similar type ball in the affected hand, practice squeezing and relaxing the hand several seconds at a time.

For more information about available treatment options for tennis elbow, contact our office today to schedule a consultation with one of LA Hand Surgeon’s finest plastic hand surgeons. Our selection of Beverly Hills surgeons includes board-certified plastic and reconstructive surgeons Dr. Arezou Yaghoubian, Dr. S. Daniel Golshani, Dr. James Coleman.

Does Computer Use Create Carpal Tunnel Syndrome?

We live in a society where we are exposed to computers at least once a day, spending anywhere from an hour to several hours in front of one. Your hands are constantly typing or operating the mouse to navigate your computer or the Internet. So the question becomes… does repetitive computer usage increase your chances of developing carpal tunnel syndrome?

The most obvious answer you may be thinking is, “well of course it does!”. The good news is that research suggests otherwise. A study was done on people who heavily used the computer, specifically the keyboard, everyday for at least 6-7 hours a day. The study contained a sample of 250 people where only 9 of them actually had carpal tunnel. The studies concluded that heavy computer usage is not correlated with an increased risk of carpal tunnel syndrome.

Individuals who are Susceptible to Carpal Tunnel

You may not develop carpal tunnel syndrome specifically, but it’s certainly possible that repetitive mouse and keyboard usage will result in some strain to your hands. 30% of the 250 people who were studied reported that they felt numbness or pins-and-needles in their hands; however, these same people did not meet the criteria to be diagnosed with carpal tunnel syndrome.

How to Use the Computer in a Safe Way to Prevent Carpal Tunnel Syndrome

Of course there is! Simple changes go a long way. You can place a rolled up towel in front of your keyboard to rest your hands on while you type. This will allow your fingers to perform most of the work. You can even find comfortable keyboard wrist supports online in different variations.

It also helps to have strengthened wrists. This can be done using a wrist grip for only a couple minutes a day. If you do not have a wrist grip, then a low weight dumbbell works too. Simply hold the dumbbell in your hand, keep your hand flat and use only your fingers to move it up and down. All it takes is a few minutes a day.

It’s the repetition of movement that will catch up to you. Take frequent small breaks throughout the day to let your wrists relax. Get up, walk around, and stretch for a bit.

Look into different mice options. Some mice are not as rough on your wrists and require little to no finger movement. A great example is a trackball mouse, which essentially require only your fingers to move the cursor around.

Ultimately, the best defense to carpal tunnel syndrome and wrist pain is to avoid computers altogether.

Hand Injury Prevention Tips from a Plastic Surgeon

Whether you’re in front of a computer, drilling away at concrete with a jackhammer, or simply bowling with friends, it’s important to learn a few tips on preventing hand injuries that may save you from years of unknown sources of pain.

We use our hands everyday; they’re what make us able to perform work of any sort. Our hands are made up of many complexities involving tendons, small bones, tissues, and nerves, which is why injuries may never heal back to full potential. One mistake could cause you years of various pains in your hands.

Most hand injuries are a result of carelessness or disregard to safety protocol that is required to follow on certain jobs. The most common hand injury is carpal tunnel, which occurs over time due to hours of repetitious movement that many of our jobs may force us to endure.

Click here to learn more about sources of acute trauma injuries and types of cumulative trauma.

Here are the tips you should always keep in mind, especially if you have a job dealing with lots of hand movement:

Keep Your Wrists Straight – By keeping your wrists straight, you avoid unnecessary pressure to your wrists. When you slightly bend your wrists or twist them, you are applying extra pressure to your wrists that may result in long-term damage.

Take Breaks – Most of us are too busy tasked with so many activities that we don’t find time to simply get up and take a quick 1 or 2-minute break from our work. Small, frequent breaks throughout your workday has the possibility of preventing strain on your hands, especially your wrists if you’re in front a computer majority of the day.

Grip it or Rip It – If you have a job that involves lifting or using specific tools that require a grip of any sort, then you need to make sure you have proper form. You should always try and grip objects or tools with your whole hand and not just a few fingers or thumb. When you grip objects with your thumb and fingers only, you put a lot of extra strain on your wrists.

Switch Hands – If you are able to switch your hands to complete task, then you will be giving some rest time to the hand that has to bear all of the work throughout the day. It’s hard for people to switch hands when they’re ‘right-handed’ or ‘left-handed’, but being ambidextrous is something you can also brag to your friends about!

Build Hand Strength – By keeping your hand strength high, you can effectively decrease the chances of sustaining a hand injury. Simply making a fist for maybe 5 minutes worth of time could increase your hand’s strength. You could purchase a grip strengthener, which increases the strength of your wrists.

Talk To Your Supervisor – Don’t be afraid to talk to your supervisor about changing around a few activities on the job that you believe might be contributing to any type of hand injuries. Your workplace should always be accommodating of the physical conditions of their employees.

If you sustain a hand injury that does not seem to be getting better over time, then you should seek out a professional that specializes in hands. Your hands are very complex and delicate features of the body. Consult with a LA Hand Surgeon specialist to determine appropriate diagnosis and treatment for any acute trauma or hand pain you face.