Dr. Burgess Speaks to Fellow Hand Surgeons!

Dr. Burgess Speaks to Fellow Hand Surgeons! 

Dr. Kraig Burgess, one of the hand and upper extremity specialists here at TOCA recently delivered a talk to area hand surgeons, physician assistants and orthopedic residents on an exciting new form of treatment for scaphoid nonunions. “A scaphoid nonunion is a difficult to treat broken bone in the wrist that fails to heal and has continued to challenge hand surgeons for decades,” said Dr. Burgess. Current treatment has been placement of bone graft and a central screw. “This new treatment involves placement of a highly specialized plate and the early results have been very encouraging,” said Dr. Burgess. Dr. Burgess is coordinating efforts with two other valley hand surgeons to investigate the biomechanical properties of the device and they also intend to publish there results upon completion of the data collection. “This is something that could revolutionize the care of these injuries and create a complete paradigm shift for the future,” commented Dr. Burgess. Dr. Burgess is one of three hand surgeons here at TOCA specializing in the surgical and nonsurgical treatment of disorders affecting the hand, wrist and elbow. Visit our webpage at www.tocamd.com to learn more about the hand surgeons at TOCA serving your community.

#RESULTS.RECOVERY.RELIEF.

TOCA
602-277-6211
www.tocamd.com

Hand Surgeon Provides Simple Tips to Avoid Spoiling Your Family’s Halloween - Dr. Burgess

Hand Surgeon Provides Simple Tips to Avoid Spoiling Your Family’s Halloween

Excitement looms around the corner for many families as we begin to pick and choose our favorite Halloween costumes, dig up the ghoulish decorations, and of course, carve our pumpkins. As a Board Certified Fellowship Trained Hand Surgeon at TOCA, I can tell you this holiday brings with it some degree of trepidation.  I have seen year after year devastating injuries as a result of improper safety precautions when it comes to carving pumpkins.  A hand slipping down the blade of a knife too many times results in more than just a cut in the skin. 

These injuries are even more common in kids and adolescents.  As much as a family affair as this may be, the carving should be left up to the adults or at most, adolescents under supervision.  Pumpkin carving parties can have a number of distractions and someone should always be designated to oversee the safety of these young adults to make sure safe and proper technique is being utilized.  For young children, I would recommend you engage them more in cleaning out the pumpkin seeds and the actual design work for your unique pumpkin ideas.  Drawing your ideas onto the pumpkin or tracing them from paper drawings still allows them to be a part of the process.

Many of these accidents can be avoidable by taking simple precautions and using the right tools.  There are many commercially available pumpkin carving kits with specific tools which lessen the risk of injury and if injury does occur, it is often less severe.  The use of typical kitchen knives for pumpkin carving typically leads to the most common and most devastating injuries.  Here is a list of probably the most common causes of injury I see as a hand surgeon:

1.       Sharp knives get easily lodged into the tough pulp of the pumpkin.  When someone tries to push or pull the knife further, the hand can slide down the very slippery blade resulting in injury. 

2.       While trying to pull the knife out, I see injuries to the non-dominant hand which is used for counter force to dislodge the knife.

3.       The non-dominant hand is also frequently injured along the web space of the hand between the thumb and pointer finger when the knife is being used to make a cross cut through the pumpkin.

4.       Stabbing injuries are also encountered when one hand is used to support the back of the pumpkin and the knife penetrates through the back side or the pumpkin slips and rolls from being poorly stabilized. 

The more severe injuries most commonly result in damage to the tendons of the hand, the small sensation or movement (motor) nerves and also the arteries that supply the critical blood supply to the fingers.  Injury to the nerves will always result in some degree of lost, altered sensation, or even increased painful sensitivity.  Repair of these complex injuries can require months of healing and rehabilitation.

Although it is impossible to completely avoid injury, following these simple tips can help avoid or lessen the severity of these injuries.  Here is a list of recommendations you can follow to keep this holiday safe and fun for everyone in your family. 

1.       Get the right equipment.  Sharp ordinary kitchen knives are dangerous.  There are many commercially available pumpkin carving kits on the market.  Make them an investment in your family’s safety.  The Journal of Preventative Medicine has shown these kits to be effective in lowering the number and severity of carving related injuries. 

2.       Make smaller and more controlled cuts with the right instrument.  Avoid using a tool which has the capability of passing through the entire pumpkin which can injure the hand in back providing support.

3.       Prepare your workstation.  The work surface you choose to use can decrease your risk of injury.  Choose a surface which will decrease the risk of the pumpkin sliding around as you apply pressure with carving tools.  This also lessens the risk to your non-dominant hand by allowing the work station to steady the pumpkin while keeping your hand out of the path of the blade.  Commercially available bases are also available.

4.       Dry your hands, your tools and your pumpkin thoroughly and frequently.  The pulp of a pumpkin is extremely slippery so anytime you handle sharp instruments with a compromised grip, you are asking for injury.

5.       Control your distractions.  This is especially true for those pumpkin carving parties with multiple people, multiple age ranges and levels of experience.  Use the chaperone method where one person watches for sharp tools lying dangerously around, corrects dangerous technique, and assists in drying the carver’s hands and tools frequently.

6.       Avoid alcohol.  This may seem obvious but I can’t tell you how many times I see avoidable injuries caused by poor judgment, diminished coordination, and a lack of focus.  Leave the libations for afterwards when everyone can enjoy each other’s creations without someone sitting in the Emergency Department.

Should you or your family happen to be injured from a cut or stabbing wound, apply direct pressure to the injury.  This is usually the most affective and quickest way to control bleeding.  Wash the wound thoroughly with soap and water or other equivalent disinfectant.  Apply a topical antibiotic and appropriate sized bandage.  More severe injuries will require medical attention.  If 15 minutes of pressure to the injury does not stop the bleeding, if you notice discoloration to the hand, if you notice an immediate or later change in the sensation to your hand or finger, or if you find you cannot move any of the joints of your hand normally, you should seek medical attention immediately.  Urgent Care facilities and Emergency Departments are a good place to start.  They can often evaluate the wound for more significant injuries and provide stich closure to wounds.  I can’t emphasize enough; however, how important it is to make sure you receive appropriate follow up with one of the board certified hand surgeons here at TOCA if there is any question at all regarding the possibility of further injury.  Although these injuries almost never require hospital admission and emergency surgery, timely follow up as an outpatient in our office can make a world of difference if surgery is found to be necessary.

I do hope you find this information helpful in avoiding potential injury to you and your family during this and future Halloween seasons.  

 - Dr. Burgess

TOCA

602-277-6211

www.tocamd.com

ARTHRITIS AT BASE OF THUMB: Dr. JOSH VELLA

WHAT IS ARTHRITIS?

Any condition that irritates or destroys a joint is referred to as arthritis.  The most common form is osteoarthritis, or as it is sometimes known, degenerative joint disease.   In a normal joint, cartilage covers the ends of the bones and permits their smooth, painless movement against one another.  In osteoarthritis, the cartilage layer wears out, allowing bone to make contact against bone.  As the process worsens, the signs and symptoms of arthritis develop.

The basilar joint, or the first carpometacarpal joint of the thumb, is formed by a small wrist bone called the trapezium and the thumb metacarpal bone.   The unique shapes of these bones permit the thumb to move in and out of the plane of the palm, as well as bend across the palm to oppose the other fingers.  Arthritis involving the base of the thumb is far more common in women than in men, and typically occurs after the age of 40.  A prior history of fracture or other injury to the joint may increase the likelihood of developing arthritis.

WHAT ARE THE SIGNS AND SYMPTOMS?

The earliest symptom of basilar joint arthritis is pain with activities that involve pinching.  These include opening jars, doorknobs, car door and turning keys.  Prolonged or heavy use of the thumb may produce an aching discomfort at the base of the thumb.  Changes in the weather may produce similar symptoms.  As the disease progresses, less stress is required to produce pain.  Pinch strength diminishes.  Activity-related swelling may develop.  Later, any motion of the thumb, even without stress, may become painful.  Eventually the joint begins to appear larger and out of place.  This is usually accompanied by decreased thumb motion.  Often the most difficult maneuver is grasping objects.

HOW IS THE DIAGNOSIS MADE?

A careful history by the physician will give a high index of suspicion of basilar arthritis.  Inspection of the thumb will sometimes reveal a tender prominence at the base of the thumb.  As a diagnostic test your physician may press the thumb metacarpal against the trapezium and move the joint.  This grind test will usually reproduce the symptoms of pain, and may produce a gritty sensation called crepitation.  This represents bone on bone contact, which also may show up on x-ray.

HOW IS TREATED?

Initially, the symptoms of basilar joint arthritis will respond to limited activities and rest.  If this fails, use of an anti-inflammatory medications and a protective splint may be of benefit.  Additional relief of symptoms can sometimes be achieved by a cortisone injection into the joint.  When conservative methods of treatment no longer provide benefit, surgery may be warranted.

The goal of surgery is to decrease pain and preserve motion in the thumb. This is accomplished by removing the destroyed joint and creating a substitute joint called an arthroplasty.  Unrestricted use of the thumb is usually allowed at 12 weeks from surgery.

TOCA