Symptoms and Treatment of Dupuytren’s contracture

Dupuytren’s contracture occurs when knots or thick cords of tissue form just under the skin of the palm. The thickened tissue can eventually pull one or more fingers into a permanently bent position. This can make certain everyday activities difficult, such as opening the hand fully in order to grasp large objects or to put on gloves. The condition most often affects the ring and pinky fingers and normally affects one hand more than the other.

Symptoms

Dupuytren’s contractures typically develop over a number of years. The individual may first notice a thickening of the skin on the palm that develops into knots that may appear puckered or dimpled. The knots may be sensitive to the touch but are generally painless.

Causes and Risk Factors

The exact cause of Dupuytren’s contracture is unclear. It does not appear that vibrations, repetitive motions, or hand injuries have any bearing on the condition. Dupuytren’s contractures are most common in males over the age of 50. Individuals of Northern European descent or who have a family history of Dupuytren’s contractures are also at higher risk for the condition. Smoking, diabetes, and excessive alcohol intake are also associated with a higher risk of Dupuytren’s contracture.

Treatment for Dupuytren’s contracture

If the contractures interfere with daily activities or cause pain or neuropathy in the hand, a Los Angeles hand surgeon can use a variety of procedures to remove or separate the cords causing the contracture.

  • A needle may be inserted through the skin to break apart the cords. This technique is minimally invasive and does not require extensive physical therapy or downtime; however, it cannot be used in certain locations on the finger because of the possibility of nerve injury.
  • The U.S. Food and Drug Administration has approved an enzyme injection for the treatment of Dupuytren’s contractures that softens the cords so that they can be manipulated and broken apart.
  • In severe cases, surgery may be required to remove the affected tissue. This normally entails a longer recovery time and extensive physical therapy. Contact LA Hand Surgeon and meet with one of our board-certified plastic hand surgeons if surgery is necessary for your condition.

When Amputation and Prosthesis are Necessary

Certain parts of the body that have become seriously injured or diseased may need to be removed by amputation. In some cases, amputated fingers can be reattached via surgery, however, this is not always possible or advisable if reattaching the fingers will cause great discomfort, severely impaired functioning or other serious complications. Prosthetics are often recommended for replacing arms, legs and other body parts that have been amputated.

The Amputation Process

To determine if surgery is required to remove a severely injured or diseased body part, a doctor will take x-rays to assess the extent of the damage. If amputation is the only option, surgery will be performed only on the damaged area with an attempt to save as much of the healthy body part as possible. The surgical site can sometimes be closed by rearranging the skin and making the bone or tendon length shorter. Skin, muscle tissue or tendons from another part of the body are sometimes needed to close the surgical area. When hand surgery is performed, the surgery site can often be closed directly with fingertip injuries. Finger or hand shape sometimes needs to be altered in cases of acute trauma to be able to fit a prosthetic device in the future.

Following amputation surgery, some pain should be expected during the recovery phase. Pain medication may be prescribed to help control pain. Doctors can advise patients on how to properly bandage and care for the surgical sites and recommend exercises to build strength and increase flexibility in these areas.

Using Prosthesis to Restore Functioning

Prosthetic limbs have helped many amputees regain much of the quality of their lives. Most people can be fitted for prosthesis three months after surgery. When hand or finger amputation is performed, a Los Angeles hand surgeon can fit a patient for a prosthetic limb that is based on the length and location of the remaining hand or fingers. Prosthetic limbs can be customized to suit the activities and functional needs of each patient. A full-arm prosthesis that has an attached electrical or mechanical hand on the end often works well for people whose hands were amputated through or above the wrist. Prosthetic limbs for people who have undergone hand or finger amputations are designed to restore finger length and make it easier to hold objects. Manufacturers can make prosthetic limbs look natural with realistic skin tones and nails that can be polished. Most silicone prosthetic limbs have a lifespan of three to five years before they need to be replaced.

Our team of board-certified plastic surgeons at LA Hand Surgeon can offer support and recommend the best prosthesis options for people who have undergone amputations.

The Impact of Smoking on the Hands

The nicotine found in cigarettes, cigars and other tobacco products can have many adverse effects on the body. In addition to harming the lungs, smoking can damage the hands and other upper extremities.

Hand Problems Caused by Smoking

People who smoke regularly may experience reduced blood circulation in the hands that could affect the fingertips. Nerve damage in the hands can also occur from smoking. Some smokers notice that the skin on their hands has formed wrinkles or shown other premature signs of aging. The nicotine in tobacco products may cause the nails to turn yellow or develop fungal infections. Tobacco use has even been linked to a condition known as Dupuytren’s contracture which causes tissue knots under the skin of the hands to form and bend the fingers permanently. Some studies have also shown evidence that smoking increases the risk of developing conditions like reflex sympathetic dystrophy and hand-arm vibration syndrome.

Smoking Worsens Existing Hand Conditions

Tobacco use can also exacerbate existing conditions of the hands and lead to further complications. Breaks and fractures in arm, wrist and hand bones often heal slower and could be prevented from healing completely. Skin wounds on these upper extremities may also have trouble healing and are more susceptible to infection in smokers. Anyone who plans to undergo surgery is advised to quit smoking in order to speed up recovery time and reduce the chances of complications while healing.

Talking to a board-certified hand and plastic surgeon at LA Hand Surgeon or another trusted professional is advised for anyone who is having trouble quitting smoking and is about to undergo surgery.

Signs of Reflex Sympathetic Dystrophy

A nervous system disorder known as Reflex Sympathetic Dystrophy or RSD, also known as complex regional pain syndrome or CRPS, often causes chronic pain in individuals who fall victim to it. RSD occurs when nerves in the central or peripheral nervous system become overactive and transmit frequent pain signals to the brain. This condition often results from trauma that causes nerve injuries, but some people develop RSD with no clear explanation.

Symptoms of Reflex Sympathetic Dystrophy

Unusually sensitive skin accompanied by burning sensations is often one of the first signs of this condition. Throbbing pain in the legs and arms may be felt as a result of the neuropathy that is often associated with the condition. Certain parts of the body can feel warmer or cooler upon touch than other parts of the body. Some areas of the skin may look red, purple or pale or have a blotchy appearance. Skin texture may also change and become thin and shiny. Some people with RSD report sweating more than usual and experience swelling and stiffness in their affected joints. Mobility impairment can occur in the area of the body where it develops as well. Trembling, jerkiness and other unusual movements in the affected part of the body can also occur. Hair and nail growth may be affected as well.

What are the Treatment Options?

No cure currently exists for reflex sympathetic dystrophy, but certain treatments may help alleviate symptoms considerably. Sympathetic nerve blocks, steroid medications and intrathecal drug pumps that deliver pain medication into the spinal fluid have helped many people lead lives with less pain. Ibuprofen, aspirin and other over-the-counter medications can also minimize pain. Some people have also experienced relief through physical therapy, heat therapy and psychotherapy. Surgery to repair nerve damage may be required in some cases.

At La Hand Surgeon, our board-certified plastic and reconstructive hand surgeons in Beverly Hills and Los Angeles often treat individuals who have been diagnosed with RSD or CRPS. Our team of medical professionals are able to suggest treatments that are personalized to you and gives each patient the best outcome.

How to Prevent Tendonitis in New Mothers

Tendonitis that affects the tendons of the thumb, known as de Quervain’s tenosynovitis, can cause pain at the base of the thumb and wrist that worsens with wrist or thumb movement.

Risk Factors for De Quervain’s Tendonitis

De Quervain’s tendonitis is caused by overuse of the thumb and wrist, particularly in a side-to-side motion. The condition is often seen in new mothers and caregivers of children because of the repetitive motions involved in holding, feeding, bathing, and dressing the child. The increased swelling associated with pregnancy can also contribute to the symptoms.

Treatment for De Quervain’s Tendonitis

Avoiding repetitive activities involving the affected thumb will allow the inflammation to subside. Some patients find relief by wearing a prescription brace that immobilizes the affected joint. In extreme cases, cortisone injections or even surgery may be recommended.

How New Parents Can Prevent De Quervain’s Tendonitis

  • Lift the child in a scooping fashion instead of using the wrists.
  • Change positions frequently when carrying the baby or while feeding.
  • Avoid clothing with lots of buttons or other fasteners that require the use of the thumbs.
  • When possible, use slings and strollers to carry or transport the child to limit the strain on the arms and wrists.
  • Open baby food jars with a hand-held or electric opener.
  • Don’t be afraid to ask for help.

If the pain persists or worsens, be sure to consult one of LA Hand Surgeon’s qualified board-certified hand and plastic surgeons. Contact our office to schedule your consultation.

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.