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  1. Wrist sprain, Getting the diagnosis right

    January 10, 2016 by Greg Balourdas

    The wrist is a very complex joint… with motion nearly equal to the ball and socket joints of the shoulder and hip, it is made up of 10 separate bones held together by a complex lattice of ligaments.  Considering the demand we put on wrists, and the trauma they are subjected to, our wrists hold up pretty well.

    Wrist injuries are very common with most the result of falls and include distal radius fractures and scaphoid fractures.  If a ligament tears before a bone breaks, you suffer a wrist sprain.  A sprain is an injury of the structures connecting bone to bone (ligaments).  These injuries vary in severity, and in the case of the wrist, vary in pattern and consequence, by which of the many ligaments of the wrist are involved.

    Ligaments do not show up on X-ray, only the bones are seen directly.  An injury to the ligaments of wrist, can however, be inferred by a change in the relationships between the wrist bones.  A motion study with a fluoroscopy unit (motion X-ray), can help make the diagnosis.  Typically this type of study is done in a hospital radiology department but as a specialist limiting my practice to the hand and arm, I have a hand-specific fluoroscopy unit.  The Orthoscan Mobile DI unit is an invaluable adjunct to such wrist and hand examinations.  Cool, don’t you think!

    Once a definitive diagnosis is made, treatment can range from rest and immobilization to therapy, injection and surgery.

    Early and accurate diagnosis is very important for such injuries, if examination, X-ray and fluoroscopy doesn’t result in an answer, MRI is the definitive way to visualize the ligaments and other soft tissues (non-bone) of the wrist.

    If you do fall and symptoms are severe or last for more than a week or two, get in to a specialist, you won’t be sorry.

    Take care,
    Greg Balourdas, MD   TheHandDoctor.com


  2. Do I have Carpal Tunnel Sydrome?

    December 13, 2015 by Greg Balourdas

    People who use their hands repetitively can develop carpal tunnel syndrome (CTS).  Many tasks at work are repetitive and even hobbies like knitting, sewing, crafts, woodworking or playing computer games can result in CTS.

    As a hand specialist, I doubt a day has gone by without at least one person with this condition making up my clinic schedule.  This common condition can cause pain, numbness, burning and tingling and sometimes progresses to hand weakness and muscle atrophy.  CTS results from compression of the median nerve at the level of the wrist bones (carpal bones).  This nerve controls 80% of the sensation and 20% of the small hand muscles.  At first CTS symptoms of numbness and tingling might awaken one from sleep or occur with use.  Symptoms progress over time to more consistent episodes of pain and even hand weakness.

     

    CTS aaos CTS aaos2

    Images from AAOS fact sheet.

    Women are more likely to develop CTS, especially during pregnancy.  CTS is sometimes associated with certain medical conditions including diabetes, thyroid problems, arthritis and kidney insufficiency.  An evaluation by a specialist and blood work may be needed.  The nerves to the hand can also be pinched at other levels, including neck, shoulder and forearm, resulting in symptoms similar to CTS.

    Please don’t assume a “little numbness”, especially if present for more than a few weeks is normal.  Seek attention for your symptoms.  Seek a specialist for evaluation.  Further information is available on my website and if you are aware of persistent symptoms contact Dr. Balorudas.

    Take care,

    Greg Balourdas, MD – TheHandDoctor.com


  3. Thumb Basal Joint Arthritis

    September 17, 2015 by Greg Balourdas

    Our ability to pinch and grasp is easy to take for granted.  I came accross this great quote in science fiction writer, Isaac Asimov’s Foundation series recently and have to share it.  Who would have thought someone other than a hand specialist would understand the hand so well?!

    “Why not the hands?

    The eyes were no more than sense organs, the brain was no more than a central switchboard, incased in bone and removed from the working surface of the body.  It was the hands that were the working surface, the hands that felt and manipulated the universe.  Human beings thought with their hands.  It was the hands that were the answer of curiosity that felt and pinched and turned, lifted and hefted.  There are animals that had brains of respectable size but it was the hands that made all the difference.”

    Isaac Asimov, Foundation’s Edge c1982

    And what is the most crucial part of the hand and the most devastating if lost?  You guessed it: the thumb.  Loss of use of the thumb due to pain, weakness or loss of motion from injury or arthritis has a profound affect on daily life.

    Arthritis of the base of the thumb goes by other names: Thumb basal joint arthritis and CMC (carpometacarpal) arthritis.  Arthritis is progressive and can cause pain, weakness and stiffness and impact daily activities including opening jars, turning doorknobs or keys, using a computer mouse, and writing.

    CMC OAArthritis of the Basal Joint of the thumb.

    Other conditions and injuries can cause similar symptoms and difficulties.  There are many important structures that can be affected that affect the area.  Tendons (DeQuervain’s tendinitis), nerves (radial and median), as well as other ligaments and bones which are in the vicinity of the thumb basal joint.

    An accurate diagnosis of Thumb Basal Joint Arthritis is made by examination by a specialist, x-ray and sometimes other studies to be certain other diagnoses are not at play.

    Treatment options for thumb arthritis begin with assisting in the managment of pain and improving motion and function with ice, heat, anti-inflammatory medicines, splinting and adaptive aids.  Treatment is commonly provided by a skilled hand therapist.  Further treatment by your hand specialist includes injections and surgery.

    splint cmc oa

     

    Splint created by a Hand Therapist

    Joint replacement surgery, (similar to joint replacement of the knee or hip), is the most common procedure for arthritis of the hand or arm.  This procedure has a 30 plus year history for effectively stopping arthritis, providing pain relief and improved pinch.

    pop cmc lrtiX-ray after joint replacement surgery

    Some informative links to more information on the subject:  My office website,  American Academy of Orthopedic Surgery, American Association of Hand Surgery, and Dr. Eaton’s website.

    Greg Balourdas, MD

    TheHandDoctor.com

     


  4. Hand rejuvenation for hand selfies!?

    August 16, 2014 by Greg Balourdas

    With all the money spent on injection procedures and plastic surgery, your hands can still give it away!  Now there is an option, at least in New York City.  May not make you a hand model…. or will it?  A temporary fix, but beats skin tucks!!  You be the judge.   Take care, Greg Balourdas, MD – TheHandDoctor
    Excerpted from an article in the NY Daily News:  “Hand rejuvenation”

  5. Climber’s Finger

    June 22, 2014 by Greg Balourdas

    Climber’s finger, like many injuries that can affect the hand and arm can occur from trauma but frequently develops from repetitive overuse.  Because of the cause and nature of the injury it is difficult for the individual to stop the activity to allow the needed time to heal.  With climber’s finger the problem develops from the forceful and repetitive use of one or more fingers, commonly the long finger for a fingertip hold.  The injury can range from inflammation to a significant injury to the small but crucial pulleys and sheath that support the flexor tendons in the finger.

    Pulley Rupture seen in Climber's finger

    Example of possible injuries seen in climbers.

    To slow the damage and inflammation, standard initial measures can help (ice, rest and activity restriction).  Taping encircling the middle section (middle phalynx) of the involved fingers can support the most commonly injured pulley.  If there is some relief in symptoms with these measures, then there is good reason to expect that with time the area will heal.  Hand therapy can help to control symptoms and encourage healing.  Such efforts are aimed at decreasing the inflammation while encouraging healing of any damaged structures.  If symptoms respond then the injury is partial and most likely at the inflammatory end of the spectrum of such injuries.

    With persistent pain and swelling, or if there is any sense that the tendon on the under surface of the finger is “loose” (pulls away from the finger like the line on a fishing rod when you’ve caught a big one!) more significant injury has likely occurred.  An expert evaluation is needed.  After examination by your hand specialist, an MRI scan or Ultrasound evaluation may be recommended in order to clarify the extent of injury.  The physical exam and imaging studies can determine what is inflamed and what might be torn.  If the injury to the pulley that supports the tendon is complete or near-complete then it cannot heal fully on its own and surgical reconstruction will be recommended.

    This information is provided on the basis of a presumed conditions: “climber’s finger”.  Many conditions can mimic the inflammation and swelling seen with climbing and my have different treatments and outcomes.

    Take care,

    Greg Balourdas, MD

    TheHandDoctor.com

     


  6. Texting Thumb and Repetitive Trauma

    August 14, 2012 by Greg Balourdas

    The conditions that we treat may not change much but the way that we injure ourselves changes with the technology.

    Take care that you don’t develop Texting Thumb.

    Recognized for a number of years and very treatable.

    Please don’t ignore your symptoms. And once in a while call!

     

     

    Such injuries from overuse include various tendonitis conditions and nerve entrapments (carpal tunnel syndrome etc.)  Many were recognized 100 years and more ago.

    Very interesting excerpt from a 1914 text on Occupational Disorders.  It goes on to describe conservative treatment similar to measures we employ today!  The more things change, the more they stay the same.

    From a textbook on Occupational Diseases published in 1914

    Check out the occupations associated with these conditions in 1914.  No texting to be found!

    And please don’t text and drive!

    Take Care,

    Greg Balourdas, MD

    TheHandDoctor.com


  7. Hand Surgery for the Stars

    August 7, 2012 by Greg Balourdas

    I remember many nasty lacerations from people trying to separate frozen hamburger patties with a knife dating back to my Orthopedic training at Case Western Reserve University in Cleveland.  More recently for me, here in Southern California and now for Meryl Streep, the avocado is a very dangerous fruit.  Please be careful and use the right tool for the job at your home.  Check out this link!

    http://www.showbiz411.com/2012/08/05/meryl-streep-is-not-actually-julia-child-cuts-through-her-hand-with-a-kitchen-knife

    Greg Balourdas, MD

    TheHandDoctor.com

    Facebook-TheHandDoctor


  8. Wrist sprain or Scaphoid fracture?

    July 25, 2012 by Greg Balourdas

    I indicated that I’d be covering the many injuries that can occur when you fall forward, sacrificing the health of your hand and wrist to protect your face!  I introduced you to FOOSH injuries which are common and usually heal in days to weeks.  However the occurrence of fractures and dislocations of the wrist are very common.

    The most common wrist fracture is a fracture to the scaphoid bone (peanut shaped bone at the base of thumb and also called the carpal navicular).  These fractures are common and notorious for problems in healing.  There a number of reasons wrist injuries are missed:

    • Contrary to popular wisdom you can still move the wrist even if it fractured

    • Scaphoid fractures occur without visible signs, sometimes even swelling is absent

    • Even when x-rays are taken in the first few days a fracture can be missed

    And why fractures of the scaphoid are slow to heal:

    • The bone is nearly completely covered by cartilage and therefor the blood supply is limited

    • Even stable scaphoid fractures, unlike finger and hand fractures must be immobilized for an extended time

    • The cast must include the thumb and many times requiring the elbow, making compliance difficult

    Certain fractures do not heal and require surgery with an embedded, headless screw.

     

     

     

     

     

     

    Here is an awesome video by Dr. Nabil Ebraheim in Toronto.

    For more information or assistance please contact our office and the educational page on this subject.  TheHandDoctor.com

     

    Take care,

    Greg Balourdas, MD

     

     


  9. Animated hand anatomy overview

    May 2, 2012 by Greg Balourdas

    Notice at 41 seconds how the carpal tunnel is filled with the tendons and tendon sheath… now put the median nerve in there.. not much room!
    Greg Balourdas, MD


  10. AAOS Orthopedic Annual Meeting

    February 12, 2012 by Greg Balourdas

    I spent a great 5 days in San Francisco at the annual international meeting of the American Academy of Orthopedic Surgeons.  Getting an update on the latest Technology and Techniques.  Saw a lot, learned a few things too!  Pictures are also posted on FB. https://www.facebook.com/TheHandDoctor.  Stay tuned for more information on the latest on the non-surgical treatment for Dupuytren’s Contracture…

     

    Trying some new surgical instruments