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‘Injury’ Category

  1. Boxer’s fracture. Madison Bumgarner _”punches”_ baseball

    March 29, 2018 by Greg Balourdas

    The most common fracture of the hand is referred to as a “Boxer’s Fracture”.  As the name implies, this fracture is most commonly the result of a striking a solid object with knuckle of the small finger.  Usually from angrily punching a wall, other immobile object or from hitting someone else.

    San Francisco Giant’s ace pitcher finished his spring training with a new twist on this common fracture.  He found out that putting his hand in the way of a hard hit ball (off of his 101 mph pitch) is a good way to start the regular season late.  Although I haven’t seen the x-rays, it looks like he suffered an impact to the small finger side of the hand.   In this video excerpt from MLB baseball, concentrate on the ball and you can see Madison Bumgarner, in effect “punching” the ball, reportedly causing a fracture of his small finger metacarpal (bone in the hand from the knuckle to wrist bones). Find out more about fracture and sports injuries at and American Academy of Orthopaedic Surgeons.

    Depending on the fracture pattern, these fractures can be set and held in a cast. If out of position, or if the break is toward the base of the metacarpal, (closer to the wrist) pins, or even a plate and screws are needed to correct and hold the fracture in position.  In the case of a professional athlete, surgically fixing the fracture to leave nothing to chance, is the way to go.  These fractures typically heal in 3 weeks. A professional pitcher will likely miss 6 weeks to rehab his throwing hand.  Tough start for Bumgarner and the Giants.

    BTW… Opening day today!  Let’s play ball!!

    Greg Balourdas, MD

  2. Microdermal Engagement Ring Piercings

    March 17, 2018 by Greg Balourdas

    Finger-PiercingEngagement ring piercings?  Not the best way to show your love or good judgement!

    While body piercings routinely heal and do well in clean, protected areas of healthy skin with good circulation, the implantation of a metal-backed,  Microdermal ring finger piercing, is ill-advised.  Since the circulation and healing potential of the hand is good it might be tempting to conclude that this is a safe idea.  Not in this Hand Surgeon’s opinion.  I do too much surgery already treating hand infections without  introducing an implant.  Even traditional rings can get caught and cause severe degloving injuries (just ask Jimmy Fallon).  These piercings introduce a whole different level of concern.

    The lack of padding in the area of the extensor surface of the finger, and the motion of the extensor tendon immediately below the skin is a formula for tendon injury.  The tendon is at risk of damage from the procedure itself or erosion over time from constant motion of metal against extensor tendon.  The backing (anchor) can become detached and migrate either after catching the ring during activity on or wear and tear failure.  Finally, and most devastating, is the risk infection.  Our hands are not the cleanest area of our bodies and the ring piercing is unlikely to wall off (epithelialize) around the implant in the same way piercings do in other parts of the body.  Infection might be treated effectively with ring removal and a course of antibiotics, but it could also result in deep space infection requiring extensive surgery and require long term antibiotics.  Such finger infections can be hard to eradicate and result in permanent loss of motion, or even finger loss.

    I’d rather we not meet in the Emergency Department, headed to the Operating Room because you wanted to show your love with a finger ring piercing.  Show you love in another way and protect your hands!

    Greg Balourdas, MD –


  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


  4. 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.


    Take care,

    Greg Balourdas, MD



  5. FOOSH!!

    January 25, 2012 by Greg Balourdas

    You’ve FOOSHed before and probably didn’t even realize you were doing it!  In my world this stands for one of the most common events which result in injuries to the hand, wrist and arm. It’s a natural reflex to protect your head and face!

    • Fall
    • On an
    • Out-
    • Stretched
    • Hand


    We have all done it and thankfully we are usually able to protect ourselves without significant injury. Occasionally the FOOSHer ends up sacrificing certain body parts to protect other parts.  Such falls can result in sprains, breaks and dislocations… A significant portion of upper extremity Orthopedic trauma and reconstruction can be traced to such injuries! Thought I’d introduce the subject and branch out to talk about specific fractures and dislocations of the wrist. I think we’ll start with Scaphoid fractures (one of the bones of the wrist, also known as the carpal navicular)…. easy to break and sometimes slow to heal!  …then perhaps move on to even more complicated injuries of the wrist such as this extreme FOOSH!. – Greg Balourdas, MD

    Also find me on Facebook: The Hand Doctor – Greg M. Balourdas, MD and my office site.

  6. I just jammed my finger Doc

    January 6, 2012 by Greg Balourdas

    Ok now that professional basketball season in underway.. I seem to be seeing an increase in “jammed” fingers. Probably just coincidence but when my son jammed his finger playing goalie it prompted me to start thinking about these injuries which do occur when flying spherical objects contact extended fingers as in “ball” sports (basketball, volleyball and soccer). I never fail to cringe when I see a patient who says there finger was jammed and crooked so they (or a teammate) pulled on it to straighten it! While this frequently works (there are a lot of jammed fingers out there that thankfully don’t make it to a surgeon’s office) when it doesn’t it can become a major problem. The joints of the fingers are actually quite complex and in delicate balance. One of the giants of Hand Surgery, J. Littler, called the extensor tendon function a “fugue of motion”, denoting a very complicated interaction of forces each dependent on the other to maintain balance and precise function.

    Suffice to say that some these structure and certain injury patterns are very benign and heal without problem but others do not.
    So look out the following “Red flags” that suggest problems may be lurking:
    1. Obvious, even slight, persistent angulation or lack of finger extension (doesn’t stay straight)
    2. Significant restriction in joint motion that does not improve over a few days.
    3. Grating or clicking sensation with motion.
    4. Pain that persists and if simple (“popsicle stick” splint) immobilization doesn’t give you relief.
    5. Numbness or tingling in the fingertip.

    By the way, Happy New Year and be careful out there!
    – Greg Balourdas, MD

    A little anatomy review:

    Anatomy of the Tendons and Joints of the Finger