Hayes Hand Center Blog

Chattanooga, Tennessee

Wednesday, August 21, 2013

Dupuytren’s Contracture

Dupuytren’s contracture is a hand disorder that can slowly progress over time. Nodules develop in the palm and straightening of the fingers becomes difficult or impossible. Most patients do not have significant pain or numbness but as the disease advances a debilitating posture to the fingers can occur. This most commonly involves the palm, ring and small fingers. Patients with this disorder have thick, firm nodules beneath the palmar skin, pits or crevasses in the skin, and a tight contracture or cord that pulls the fingers into the palm. Scientists believe this condition is due to a change in the body’s natural collagen in the hand that allows it to build up excessively and shorten or contract. Dupuytren’s disease is fairly common in the United States, seen in about 4% of the population. While anyone can be affected, patients are generally male, over 50 years old, and Caucasian. The condition has been referred to as the “Viking disease” due to the high incidence in people of Northern European descent. There is also evidence of a genetic link. Patients often can remember their dad or uncles had deformities to their ring and small fingers that may never had been treated. Doctors can usually make the diagnosis with a history and physical exam of the hand and additional tests are rarely needed. There are a few other diagnoses such as trigger fingers and arthritis that can present with similar findings and complaints. Because the treatment of these conditions is quite different, an exam by a physician with experience in hand surgery is important. Fortunately, treatments to improve the debilitating effect of Dupuytren’s contracture are available. These treatments are usually reserved for people with painful nodules or contractures of the MP joint (the joint between finger and hand) or PIP joint (the middle joint of finger) that may prevent them from straightening the fingers out on a flat surface. Once a patient is felt to be an appropriate candidate for treatment, a few options may be discussed. Traditionally, during an operation, an incision is made in the skin over the thickened tissue from the palm out onto the finger. The diseased tissue is then carefully separated from the nerves, blood vessels and tendons so that that it can be removed. More recently, the FDA has approved a nonsurgical treatment that is useful in many patients. A medicine called Xiaflex can be injected through a syringe into the diseased tissue while in the office. This medication contains enzymes or proteins that break down and weaken the collagen that builds up and tightens the finger joints. A day later, the physician can manipulate the fingers and break the softened tissue so that the fingers straighten. There are risks and benefits specific to each type of treatment and differences in the finger contracture may make one treatment more advisable than another. An experienced hand surgeon can evaluate your finger contracture and discuss the treatment that is most appropriate for you. Most people treated for Dupuytren’s contracture experience a significant improvement in the functional use of the hand and resume an active lifestyle. A visit with an experienced hand surgery specialist will determine if you have Dupuytren’s disease and provide a helpful treatment plan.

posted by The Plastic Surgery Group at 6:23 AM

Tuesday, August 28, 2012

Testimonial

 We love sharing our patients testimonials with you.

This is the second time I have seen Dr. Jemison. He operated on my left hand and it was very successful and I had no problems, then he did my right and I had no problems whatsoever. What makes me like and feel so good about Dr. Jemison is that he has time for his patient's. If you have questions he explains the procedure and tells you what he expects. He is a very patient and friendly doctor. I would recommend him to anyone who is having problems with their hands or needing surgery.  Inez Hixson

posted by The Plastic Surgery Group at 1:08 PM

Monday, August 22, 2011

Video Games and Children (Young & Old)

VIDEO GAME CRAZE CAN LEAD TO HAND AND WRIST AILMENTS IN CHILDREN

Professional Hand Therapists Issue National Education Alert and
Offer Health Tips to Prevent Future Injuries

Video games encompass 80 percent of entertainment in American homes, and children will spend hours in front of the television and computer monitor this year playing video games. While the dominance of video games may diminish backyard bruises, scrapes and broken bones, the hours children spend engaging in gaming activities can lead to over use injuries of the hand and upper extremities. The American Society of Hand Therapists (ASHT) has issued a national education alert for parents and offering injury prevention tips to help the millions of children/young adults playing video games avoid hand and upper extremity problems later in life.

“It is as important for children to take the proper precautions in playing video games as it is for them to warm-up and safeguard against injury before a soccer game. Video games are immensely popular and hand therapists are working to keep young hands healthy as they enjoy this activity,” said ASHT Past President William W. Walsh, MBA, MHA, OTR/L, CHT. “The repetitive movements associated with playing video games can lead to future ailments given excessive hours of play time. Professional hand therapists are working to educate parents and children on how to avoid potential injury risks and keep young hands healthy.”

According to Walsh, video games involve intense grips, repetitive punching motions on small buttons and sharp wrist movements while guiding joysticks. Extensive video game playing may lead to musculoskeletal disorders or repetitive stress injuries such as “Nintendo Thumb,” a repetitive stress injury that causes swelling at the base of the thumb due to overuse of video games. Continued stress on tendons, nerves and ligaments in children’s hand and arms could potentially lead to long-term ailments such as lateral epicondylitis, also known as “tennis elbow,” tendonitis, bursitis and carpal tunnel syndrome.

ASHT recommends parents teach their children the following hand and wrist exercises to reduce the risk of future injuries:Note: These exercises should never be painful when completing them. You should only feel a gentle stretch. Should you experience pain, please consult a hand therapist or physician.



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Fold your hands together and turn your palms away from your body as you extend your arms forward. You should feel a stretch all the way from your shoulders to your fingers. Hold for 10 seconds and repeat eight times.
Fold your hands together and turn your palms away from your body, but this time extend your arms overhead. You should feel the stretch in your upper torso and shoulders to hand. Hold for 10 seconds and repeat eight times.
Place your hand just above the back of the elbow and gently push your elbow across your chest toward the opposite shoulder. This is a stretch for the upper back and shoulder. Stretch both the right and left arms. Hold for 10 seconds and repeat eight times.
Raise one arm overhead. Bend the elbow. Place the opposite hand on the bent elbow and gently push the elbow back further. This is a stretch for the triceps. Stretch both the right and left arms. Hold for 10 seconds and repeat eight times.
Extend an arm in front of you, making sure the elbow is completely straight. With your palm down, take the opposite hand and bend the hand down toward the floor. Then turn the palm up, and stretch the hand up toward your body. This stretches the forearm and wrist muscles. Hold for 10 seconds and repeat eight times.
Open up hands and spread the fingers are far as possible. Hold for 10 seconds and repeat eight times.


“Parents should not only encourage their children to practice these exercises before playing video games, but also help them to develop overall healthy video game habits. This will keep children from developing injuries while at the same time allowing them to enjoy their favorite games,” said Walsh.

ASHT also provided some overall tips and health guidelines for kids and video gamers of all ages:

Tell your child to use a neutral grip when holding the controller. Try to keep the wrist in a neutral (i.e. unbent) position, and make sure you’re not hunching forward towards the screen. Keep good posture. Holding the game pad near your chest may be a natural reaction when the game play gets going, but keep it closer to your to your lap means less work against gravity and less stress to the muscles.
Take breaks or switch to another activity. Probably the single most important concept, taking frequent breaks allows muscles to rest and recover. Kids often fall into the “video game trance” not realizing how much time is actually spent hours in front of the monitor or computer.
Make sure the monitor is at the correct height. While looking at the horizon, your child’s eyes should be looking at the top of the monitor (this may vary if child wears glasses).
If your child is typing, the keyboard should be at a height so that with his/her wrist/hands are straight, his/her forearms are parallel to the keyboard surface.



When he/she is using a hand held device, encourage your child to put pillows in their laps and rest arms on pillows. This will allow them to keep their head in a more upright position and therefore decrease neck strain. The pillows will help support the arms so they do not have to be held up in the air.
Whenever, possible your child should be sitting in an appropriate chair. This would be a chair that allows your child to comfortably put their feet on the floor and also provides good back support.
When he/she is using a single control device (like a mouse), encourage your child to switch hands frequently. This will allow the one hand to rest and reduce fatigue. A mouse should be located on a desk near the body, rather than out and away.
Hold the game pad or joystick lightly and try to hit the keys with lighter pressure. As the game gets more exciting the tendency is to grip the game pad too hard, this can result in discomfort in the wrist and fingers or thumbs.
Utilize any “programmable” features of the game pad- since repetitive actions can lead to repetitive stress injuries check to see if the game pad can be programmed to group common functions of key sequences.
Have your child frequently focus on a distant object (away from the monitor) to help reduce eye fatigue.




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ASHT stresses the importance of developing good habits early on in children to prevent hand and wrist injuries in adulthood. Healthy techniques learned at a young age can carry over into other aspects of life where there is a similar injury risk such as sitting in front of a computer or playing musical instruments. For more information about prevention technique and professional hand therapy, visit http://www.asht.org/.
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The American Society of Hand Therapists is a not-for-profit organization seeking to advance the specialty of hand therapy through communication, education, research and the establishment of clinical standards. ASHT’s 3,000 members in the United States, Canada and around the world strive to be recognized leaders in the hand therapy profession. For more information about hand therapy or to find a hand therapist in your area, visit http://www.asht.org/.

posted by The Plastic Surgery Group at 3:26 PM

Friday, June 10, 2011

Tips to Prevent Injuries this Gardening Season

It's gardening season and gardeners everywhere are working in their yards and gardens. By following these tips, you can lessen your chances of having an injury and really enjoy the growing season.

1. Stretch and warm up before starting. Raking, weeding, digging and pruning can put a log stress on the hands and wrists. It's important to warm up with gentle stretching to the upper extremities just like you would for a vigorous workout.

2. Wear gloves. Protect your hands from bacteria and fungus in the soil. A small cut on your hand exposed to bacteria has the potential to become a major infection.

3. Keep hands and arms covered. This is particularly important in an area known for snakes, spiders, or rodents.

4. Take a break every hour or switch activities to give your muscles a break.

5. Store your tools to prevent accidents. Keep sharp tools out of the reach of children.

6. Do regular/periodic tool maintenance. This will reduce the physical effort required.

7. Use well designed tools. Tools with non-slip rubber or padded handles protect smaller joints.

So, now you know how to take care of yourself, get out in the yard/garden and enjoy yourself! But, remember, if you do have an injury, we are here to take care of you at Hayes Hand Center.

posted by The Plastic Surgery Group at 7:50 AM

Tuesday, May 24, 2011

Can I get my hand wet after surgery?

After surgery, you are usually in a bulky post op dressing that is designed to reduce swelling, bleeding and movement in the surgical area. Generally, you will remain in the dressing until your next visit with your surgeon. At that visit, the bulky dressing will be removed. Depending on the time table, the sutures are removed 10-14 days post operatively. While the sutures are in, you are not to soak your hand in water and avoid a direct stream of water while showering. It is important not to allow the hand/arm to remain in a moist dressing, so if the dressing does get wet it will be important to get it changed to a dry dressing. You may call our office at 423-756-1300 to arrange for a dressing change if it becomes necessary.

posted by The Plastic Surgery Group at 2:07 PM

Tuesday, May 10, 2011

Splint vs Cast

QUESTION: Why are splints used more often than casts at Hayes Hand Center?

ANSWER: Splints are made of a lighter material. They can be removed to wash your hand and do wound care as ordered by your MD. When there is a great deal of swelling, they can be remolded to fit you as your swelling goes down. This allows for a good fit all of the time.

We are always happy to answer any questions you may have. Contact us at 423-756-7134 or email us.

posted by The Plastic Surgery Group at 8:06 AM

Friday, May 6, 2011

Lateral Epicondylitis ("Tennis Elbow")

“Tennis elbow” is a term sometimes associated with elbow pain. The official name for the ailment is Lateral Epicondylitis. This generally occurs after using the arm in a repetitive manner or after lifting with the palm side of the hand facing down. It is actually an irritation of the fibers that attach the muscles extending from the outside of the elbow to the wrist and fingers. Pain is generally felt where those fibers attach to the bone on the outside of the elbow. The pain is usually more noticeable during or after stressful and/or repetitive use of the arm. You don’t have to play tennis to get tennis elbow.

Immediately after you feel the onset of pain it is important to stop the activity and allow the arm to rest. In some cases, ice may ease the pain. A counterforce band placed on the forearm may also help ease the pain. If symptoms don’t subside with rest and restriction of activity, it may be necessary to speak to your doctor about treatment options. Along with anti-inflammatory medications or injections, your doctor may recommend therapy. Therapy for tennis elbow is designed to eliminate or at least reduce the pain so that you can resume your normal activities. However, it may be necessary to modify HOW you do those activities to avoid overstressing the elbow. Knowing what NOT to do is just as important as what TO DO!

A type of soft tissue mobilization that Hayes Hand Center does to treat tennis elbow is ASTYM (Augmented Soft Tissue Mobilization). We have had good results with this treatment for many of our patients, allowing them to more quickly resume normal activities. It is a non-invasive technique using specially designed tools to encourage the body to heal itself.

If you, or someone you know is suffering from elbow pain, don’t just ignore it. Let us help you get past your pain and start the healing process so that you can return to your life.

posted by The Plastic Surgery Group at 8:58 AM

Wednesday, September 8, 2010

Dupuytren's Disease

You may have seen someone with a “crooked finger” or may have one yourself. There was no injury to cause the problem. It just seemed to gradually get more pronounced. Usually, the ring or small finger is the one affected. Most people do not consult with their doctor until it begins interfering with function-- when you reach in your pocket, you can’t get the finger in easily or you pull out objects you didn’t mean to pull out.

Your doctor will examine your hand and take a careful history. Eliminating the possibility of an injury to the digit, the doctor may diagnose you as having Dupuytren’s disease. This is a thickening of the dense tissue in the palm that is called fascia. It usually begins as a sore knot in the palm. As it progresses, a distinctive cord can develop that actually begins to bend the finger into the palm, making it difficult or even painful to straighten out the finger. Left untreated, the finger will continue to bend and be a nuisance. In some cases, it can flex so much that it can become a hygiene problem.

Your next step is to consult with a hand surgeon to review your options. The most common approach is to have surgery to remove the diseased palmar fascia. Following the surgery, you are placed in a splint for night time to keep the finger straight. Sutures come out at 2weeks post op and you are allowed to gradually return to using the hand with daily activities. On occasion it is necessary to have therapy to help you get your fingers moving well. Therapy will involve active exercise, modalities to soften the tissues in the palm, and gradual strengthening to help you return to your daily activities.

A new approach to treating Dupuytren’s disease is the use of an injectable called XIAFLEX. It is a prescription medicine that is injected directly into a Dupuytren’s cord, where it helps break down the collagen, which can help straighten the finger. If you are determined to be a good candidate for the procedure, the doctor will inject the cord and wrap your hand in gauze dressing to keep you from using it until you return the next day. When you return to the doctor the following day he will evaluate the finger. If necessary, he will attempt to extend, or straighten, your finger by applying moderate pressure. After this visit your doctor will have you wear a splint to wear at night for up to 4 months to help keep the treated finger straight. As with the surgical approach, it will be necessary for you to do finger exercises several times a day for several months to get your mobility in the fingers.

So, if you, or someone you know has a “crooked finger” that is getting in the way of daily activities, consult with you doctor. You don’t have to “live with it”.

posted by The Plastic Surgery Group at 3:04 PM

Monday, May 3, 2010

It’s Just A Jammed Finger, Isn’t It?

Spring is the time of the year that injuries can occur that involve the fingertips. A ball hits an outstretched finger, causing the fingertip to droop. Despite your best effort, you are unable to make the finger straighten out! This is not an uncommon injury. Most often we think it is just jammed and will straighten out on its own with a little time. Only if it begins to hurt or a few weeks (or months) pass by without improvement do we become concerned enough to seek out medical treatment. When evaluated, the doctor may tell you that you have what is called a Mallet finger. This occurs when the tendon in the end of the finger becomes disrupted or torn from the bone. A portion of bone can even be broken off with the tendon in some cases. Mechanism of injury can be trauma such as a ball hitting a finger tip or something as simple as scrubbing a counter top and having the fingertip be forecefully bent. Non-sports injuries are actually more common in women with a history of osteoporosis.
In most instances, immobilization of the joint for 6-8 weeks continuously will allow the tendon to re-attach itself. (Continuous means 24-7!) After 6 to 8 weeks the splint is worn only at night for an additional few weeks. If the finger begins to droop again after weaning from the splint, splinting will have to be resumed immediately. If the splinting regimen is not successful, internal splinting is done where percutaneous K-wire is inserted to maintain the extension of the fingertip. In the event that x-ray shows a bone fragment of significant size, it may be necessary to have surgery to place a screw in the bone to hold the fracture more securely. Even if you do not seek out medical attention immediately, it is possible that the finger will heal once immobilized. However, the longer out from injury, the higher the risk of not being successful with just splinting. Formal therapy after being splinted is usually limited to a home program of active exercise.
Don't want to bothered with it? Be warned! Left untreated, the mallet finger deformity can progress to an even greater deformity that involves the next joint (PIP joint). So be careful with your hands as you play sports or even clean house. For more information contact the Hayes Hand Center.

posted by The Plastic Surgery Group at 1:33 PM

Wednesday, April 14, 2010

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