August 2013

My goal is to provide the best possible care using the latest techniques without compromising safety.

 

March 31, 2014

Q:

My daughter is 1 year and 8 months old. She fell holding a glass, which cut the ring finger of her right hand and damaged her flexor tendon muscle. She can’t fold her finger now; it is always straight. It’s now five since it happened. Please advise.

A:

It is likely that your daughter has severed the tendon that bends the finger. An injury to the tendon requires repair. I would recommend that you take her to see a hand specialist as soon as possible. She needs a thorough hand examination before any advice can be given.

August 27, 2013

Q:

I had a skin graft on three of my fingers 35 years ago. Now I am noticing some burning sensations around the grafts with occasional redness. Should I be concerned?

A:

The edges of the skin graft are subject to shearing forces and can get irritated with use. As long as the skin graft does not break down you need not be worried. You should keep the grafted area well moisturized and use protective gloves when doing strenuous activities. If the skin graft breaks down and you develop a wound, you should see a specialist.

August 21, 2013

Q:

My daughter hurt her thumb a few months ago playing volleyball. We did not take her to the doctor. Now she says that she cannot lift her thumb completely (for example, to give a thumbs up). What is this and can it be treated?

A:

Without seeing her but from your description, I would guess she has sustained a ligament or tendon injury. She would need to see a hand surgery specialist for evaluation and X-rays. The surgeon will discuss the options of splinting/therapy or surgery to repair the injured structures.

August 21, 2013

Q:

Apparently my son has a “buckle fracture” on his left wrist. He is in a temporary cast. How soon should I get him in for a “real” cast?

A:

It would be ideal to get a cast placed within a week or so as the temporary casts or splints are less effective in immobilizing the wrist and usually work loose in a few days.

August 21, 2013

Q:

I broke my wrist and then had surgery and therapy, but it did not heal correctly. Now I have carpel tunnel syndrome and it’s extremely sensitive and painful. My tendon gets locked up from time to time also. What do you suggest I do?

A:

Unfortunately some folks can develop carpal tunnel syndrome after wrist injuries and fractures. I usually recommend trying anti-inflammatory medication and a wrist splint. If those fail, you should discuss the option of a steroid shot with your treating surgeon. If all measures fail, surgery can give you pain relief.

August 15, 2013

Q:

My brother’s hands swell even while riding his motorcycle. Will cortisone shots help him?

A:

Cortisone shots are effective at reducing swelling but are a temporary fix. I would suggest your brother should have his hands examined to find the cause for the swelling. Then he could be offered a better long-term solution to his problem.

August 14, 2013

Q:

I still have pain in my hands after I had surgery. I was diagnosed with a severe case of carpal tunnel syndrome and tendinitis. Would this qualify as a disability case for me?

A:

Pain cannot be quantified and in itself does not qualify for disability. An actual loss of function may limit you from being able to do certain types of jobs. You should discuss this with your primary care physician.

August 14, 2013

Q:

I’m experiencing numbness in my hand. What could be causing it?

A:

Numbness usually results from compression (pinching) of a nerve. The most common cause of numbness in the hand is carpal tunnel syndrome. The numbness comes and goes, is often brought on by driving, writing, gripping and typically wakes you up at night. It is caused by compression of the median nerve at the wrist and can be cured by surgery.

August 12, 2013

Q:

I have dislocated my pinky finger numerous times while playing basketball in college. Now I have to wear a brace while playing. Should I consider surgery?

A:

Recurrent dislocation of the finger is a tough problem, and the only way to remedy it is with surgery. The type of surgery depends on the condition of the joint and different procedures have different side effects, such as stiffness. I think you should discuss the problem with a hand surgeon and then weigh the pros and cons of surgery with the amount of trouble your finger is causing.

August 12, 2013

Q:

My hands and feet hurt when I lie down. I’m in my mid-50s and I work in construction.

A:

It is quite possible that you have osteoarthritis. I would recommend you see your GP as a starting point for further evaluation.

August 12, 2013

Q:

What causes erosions in the wrist?

A:

Erosions can be seen on X-ray and usually imply inflammation of the lining tissue (synovium). There are several causes, some common ones include: gout, infection and rheumatoid arthritis. Blood tests and further tests can help determine the underlying problem. Sometimes a keyhole surgery (arthroscopy) may be required to remove a sample of tissue for biopsy.

August 9, 2013

Q:

I hurt my wrist last year at a club after someone pushed me. I feel tension in my wrist when I text on my phone or use it a lot. I used a wrist guard for a while to help it keep straight. Is there anything I can do to make it strong again?

A:

The tension in the wrist could have many causes, ranging from ligament damage from the injury to carpal tunnel syndrome, a common condition that affects the hand. You should have it checked out to find out the underlying problem first before you can make it strong again.

August 9, 2013

Q:

I broke my bone near my nail bed in my pinky years ago. Now it’s permanently bent inwards. How do I fix it? I’m also a dental hygienist. Will it affect my tactile sensation if I have surgery to fix it?

A:

Surgery to correct the nail growth is possible in some cases and depends on the underlying problem. Finger sensation is not likely to be affected with surgery.

August 9, 2013

Q:

I waited too long to have carpal tunnel surgery. It did relieve most of the problems but as time goes the numbness seems to worsen. Is this something I will have to learn to live with?

A:

Residual numbness is common after delaying surgery or in severe cases of carpal tunnel syndrome. But worsening of numbness is not usual and may indicate a new problem. You should have it looked at.

August 8, 2013

Q:

I had a steroid injection this week. It has helped the trigger finger and some of the pain in my wrist and thumb. How long does it take for the steroid to work completely? I think that waitressing is the culprit. I have psoriatic arthritis in my collarbone that is treated successfully with nabumetone.

A:

A steroid injection starts to work after a week or so and it is about 6 weeks before you will experience the full benefit.

August 8, 2013

Q:

I punched an object, and according to X-rays nothing fractured. But the place where it had been bruised now feels like a bone. Plus it hurts to move it in certain angles. Can I do anything to fix my hand?

A:

You need to be evaluated again to ensure that you do not have a malalignment of the bones, which can be sometimes missed on X-rays. If the alignment is correct, you will benefit from a short course of therapy to reduce the swelling and pain and to regain mobility.

August 8, 2013

Q:

I have a ganglion cyst on my left wrist and it aches terribly. My doctor told me to hit it with the edge of a book. Ouch, that sure hurt but it did nothing. I also had it drained twice, they tell me that if it’s not causing major issues, then leave it. I hate it. It hurts a lot and everyone says its gross. Can it be removed?

A:

Yes, a ganglion cyst can be removed if the measures you stated above have not worked. You will, however, trade the bump for a scar.

August 8, 2013

Q:

I popped my pointer finger out of the socket (the part where it bends) just playing around one day. I popped it back in and it hurt to bend and was pretty swollen. Three weeks have passed and it does not really hurt as much anymore, and I can bend it will little to no pain. Should I still be worried about it?

A:

There are three joints where the finger can bend and it generally takes a significant injury for the joints to fall out of place – if the finger pops out of its socket easily you may have an underlying ligament weakness and it should be evaluated by a specialist.

August 8, 2013

Q:

I have had tendinitis in my right wrist for about 3 years now. What things can I do to help maintain it and prevent it from acting up? Also, why won’t tendinitis ever go away?

A:

Depending on the tendon or tendons involved there may be some stretching exercises or activity modification to prevent recurrence. A hand therapist would be able to help you with that. Surgery can provide long-lasting relief in some cases as well.

August 7, 2013

Q:

When I lift free weights (dumbbells) after a certain period of time my hands automatically lock onto the handle of the weight and it goes numb. To stop it, I just slowly move my hand off and it slowly unlocks back up. What can be the cause of this problem?

A:

Your symptoms suggest a nerve compression problem in the hand such as carpal tunnel syndrome.

August 7, 2013

Q:

I have what I’ll call broken blood vessels in my fingers. My fingers on both hands will for no reason suddenly get a tiny hard spot, half the size of a pea, and within 5 minutes that spot and surrounding area turn a deep blue-ish purple. This has gone on for years. What is it?

A:

The symptoms you describe may be Achenbach syndrome, a harmless condition. You should have a work-up to rule out other problems such as bleeding disorders. I would recommend you consult a skin specialist.

August 7, 2013

Q:

I crack my fingers multiple times during the day. Just an old habit. Is it really that bad for you? Does cracking your fingers give you arthritis?

A:

The long-term effects of “knuckle cracking” are not really known. Studies comparing people who have habitually cracked knuckles versus those who do not have not shown any bad effects of this habit.

August 7, 2013

Q:

I was wondering why my wrist had been in chronic pain ever since 2010 from a case involving a police department in Afghanistan. Could it be possible the scars represent an injury? I got it checked out a couple months ago and it’s definitely not broken!

A:

Pain in the wrist lasting for 3 years after an incident should be evaluated further. If you have some scars there may be an underlying injury to the soft tissues that would not be seen on X-rays.

August 7, 2013

Q:

I’ve been having a wrist problem with weight training. From time to time, I have major wrist pain when I lift weights, specifically, the region by my thumb from the snuff box and under. After a bit of warming up, the pain goes away. I’m assuming that’s because blood flows in my wrist and temporarily relieves the pain. What can I do to resolve this?

A:

I do not think your pain is related to blood flow but more likely is from a mechanical problem due to straining tendons in that area, or weakness in the ligaments within the wrist. You will need to be evaluated by a specialist for work-up to diagnose the problem.

August 6, 2013

Q:

Recently I noticed my hands sweat more than usual. Usually when I’m nervous they sweat, but recently even when I’m not nervous my hands are sweating. Is this serious? Should I get this checked out?

A:

Sweating of the palms when nervous is not unusual. Excessive sweating, or hyperhidrosis, can occur without cause in some folks or it may indicate an underlying endocrine gland problem. I would suggest talking to your general practitioner first and they can arrange some screening blood tests. You can find further information about this condition on www.sweathelp.org

August 6, 2013

Q:

I get pain in my left wrist from time to time. It leaves me unable to put any kind of pressure on it, or my hand, and it seems like my hand loses any kind of grip/strength. It lasts for a couple days, then subsides. What could this be and what actions should I take?

A:

Pain in the wrist can arise from any problem that afflicts the eight small bones within the wrist, the cartilage covering the bones or the ligaments connecting the bones. To determine the cause of the pain you will need to be evaluated by a doctor and likely need X-rays as well.

August 6, 2013

Q:

I have carpal tunnel syndrome in both hands, and arthritis in both hands. I broke my left wrist four or five times, and the right was broken twice. I have had both my hands lock up cramping for 1 to 5 minutes, and I also had one lock up for 12 hours. I couldn’t sleep, and I don’t take pills. I have needed surgery for over 2 years and I don’t have any insurance – I know it’s not getting any better. Any suggestions?

A:

The optimal treatment for long-lasting relief from carpal tunnel syndrome is surgery. You can gain temporary relief and better sleep at night using an over-the-counter wrist brace that keeps your wrist still.

August 6, 2013

Q:

I got surgery on my right thumb a few years ago, and haven’t gotten my flexibility back. I cannot bend my thumb at all. How can I gain this motion back?

A:

If your thumb has not been bending for a few years, it would be very difficult to get movement back by yourself. Regaining movement requires a healthy joint and gliding tendons. You would need to be seen by a specialist to determine the cause of stiffness and then decide if you need therapy or additional surgery.

August 6, 2013

Q:

Last year, I was having severe pain on the left hand toward the wrist. I consulted my doctor, an X-ray was done and the doctor told me that the muscles around this area are weak and this causes the pain. He prescribed some medication to apply on the area. I got no relief until later when I tried some traditional medicine. That helped for a few months and now the pain has started again. What is the problem?

A:

Were the X-rays normal? You could have a ligament problem in the wrist and this would need evaluation by a specialist, as ligament problems do not show up on X-rays

August 6, 2013

Q:

I am 63 years old and have osteopenia. I have broken several bones in the past 8 years from falls. I fell 4 days ago and injured my left arm and elbow. I had X-rays taken of my wrist and elbow, and they were negative. I have moderate pain to mid shaft of radius area that radiates to left elbow and to upper arm. The pain becomes severe when doing anything with resistance.

A:

There are two possibilities: There is a non-displaced fracture that is not seen on the initial X-rays, or the pain is from the associated soft tissue injury. I must be careful to make recommendations without seeing you, but I can suggest that you avoid doing resistance activities and use the arm within the limits of pain. If the pain persists past 2 weeks, I would recommend repeat evaluation and perhaps repeat X-rays.

August 5, 2013

Q:

I have pain in my thumb, ring finger and pinky finger that goes up to my elbow.

A:

The information is too limited for me to advise you further, other than you need to see your doctor to be evaluated.

August 5, 2013

Q:

I have pain generating from the base of my thumbs to the top of my wrist. What exercises can I do to help when this sharp pain occurs?

A:

Generally, rest in a splint is recommended for pain rather than exercise. You need to first get a diagnosis and be treated for the cause of the pain. Once the pain is resolved, you can get on an exercise program to get strength and mobility.

August 5, 2013

Q:

I have rheumatoid arthritis. I am right handed and, while my left hand remains straight, my right hand doesn’t open fully and all of my fingers are deviated toward the side. My little finger seems to be dislocated with the ring finger only slightly better. Are there any surgical options that could restore function to my hand?

A:

Yes. There are several options and they depend on the condition of the joints and tendons. Once your disease is controlled you can consult your rheumatologist or general practitioner for referral to a hand surgeon. Surgery varies from tendon balancing in mild cases to joint replacement of the knuckles in your fingers.

August 5, 2013

Q:

I play a lot of tennis and as a result of always holding a racket, it is hard to bend my pinky finger on my right hand. I believe that it is a “trigger finger.” Is there a way to fix this problem?

A:

Trigger finger usually presents with the finger getting locked in the fist and having difficulty opening. I am not sure that is what you have. If it is trigger finger, a steroid injection can help.

August 5, 2013

Q:

In February I broke a bone in my right wrist, which dislocated my two outer metacarpals. I had surgery with five pins, and everything healed fine. Recently it’s been bugging me though, and it hasn’t bugged me for months now. My hand gets a bit stiff at times. What do you suggest?

A:

A feeling of stiffness from time to time is to be expected after a dislocation and is often worse with damp/cold weather. This may last up to a year. If the pain is severe or constant, you should see your surgeon again.

August 5, 2013

Q:

My mom has been having frequent pain in her wrist area and sometimes her whole right hand gets swollen. What does this mean?

A:

It’s very difficult for me to give an opinion with the limited information. It seems to be an inflammatory problem, and I would suggest you see your general practitioner for an evaluation and workup.

August 5, 2013

Q:

My wrist feels normal but when I work out it tends to hurt. I sprained it once. What do you think, doc?

A:

I think there may be a problem in your wrist and you need to have it checked out. To begin with, you will probably need to get X-rays taken.

August 5, 2013

Q:

I cut my index finger with a knife the other day and got 12 stitches. It’s been roughly 32 hours. The right side of the tip is numb and tingly to the touch. The left side has feeling. The cut is horizontal across the width of the finger, between the first and second knuckle. The intern stitching me up said the numbness was due to the lidocaine used, and said it would wear off. It didn’t.

A:

The numbness could be from the lidocaine or an injury to the nerve itself when you sustained the cut. The lidocaine should have worn off by now, but sometimes can last two days or so. You may have to see a hand specialist if the sensation has not recovered after two days to discuss if surgery would be necessary.

August 2, 2013

Q:

The wrist of my right hand has been hurting for two years. I feel pain every time I move it around or when I play basketball.

A:

Pain in the wrist can occur from many causes and it is not possible to make a diagnosis on the basis of the symptoms you describe. I would suggest you start by seeing your doctor for examination and preliminary work-up with X-rays. Your doctor can then suggest referral to a specialist if needed.

August 2, 2013

Q:

I sometimes have pain in the pinky side of my hand, close to my wrist. I’ll also sometimes feel tingling or weakness in my ring finger and pinky. Do you know what that might be?

A:

Tingling and pain in the fingers can result from compression (pinching) of a nerve in the arm. Tingling in the ring and pinky usually indicates a problem with the ulnar nerve at the elbow or the wrist. You should see a hand specialist for a more thorough evaluation and to determine if nerve tests are needed. Mild cases can be treated with splints and modifying lifestyle such as sleeping with elbows straight, avoiding resting the elbow on hard surfaces and, as much as possible, avoiding keeping the arms bent.

August 1, 2013

Q:

As the years have gone by, I am experiencing pain at the base of my thumb when I squeeze, open a jar, turn a key. Do I have arthritis?

A:

The joint at the base of the thumb is one of the commonest joints to develop osteo, or age-related, arthritis. Pinching or grasping increases pressure within the joint and can be difficult.  It is important to see a hand specialist to get X-rays and other tests to confirm the diagnosis. An occupational therapist will help you adapt to your symptoms and suggest ways to perform your daily activities with minimal discomfort. Most patients get better with splinting, steroid injections and learn to work around the problem. There are several surgical options to treat arthritis in resistant cases, and the hand surgeon will individualize the procedure to your lifestyle and needs.

August 1, 2013

Q:

I have developed pain on the thumb side of my wrist and have trouble picking my baby.

A:

Young mothers often develop tendonitis or inflammation of the tendons on the thumb side of the wrist from repeated activities related to picking up the baby, changing diapers etc. We confirm the diagnosis by testing if pain gets worse by turning the wrist to the side of the small finger. Mild cases can be treated with a splint and ibuprofen or a similar anti-inflammatory drug.  An injection of steroids into the area usually resolves persistent cases. Surgery is reserved for severe cases and involves releasing a band that is squeezing on the tendons.

August 1, 2013

Q:

My finger sometimes gets stuck when I make a fist and I have to use my other hand to release it.

A:

You are describing a “trigger finger.” The tendon, or sinew, that bends the finger into the palm develops a small nodule, or knot, on it and tends to get caught under a pulley, or band, in the palm. Mild cases may get better without treatment, but if not then early cases can improve with a steroid injection into the area. More chronic cases may require a small outpatient procedure to release the pulley and resolve the problem.

August 1, 2013

Q:

I use a keyboard a lot. Will it put me at risk for Carpal Tunnel Syndrome?

A:

While repetitive movements can increase the symptoms of Carpal Tunnel Syndrome, not all patients with the condition even use a keyboard. Nor do all patients who use a keyboard develop the problem. Frequent breaks, maintaining good posture and appropriate positioning of your work station will help to prevent or minimize musculoskeletal problems.