Engagement 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.
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.
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.
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
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!
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
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