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Thomas D. Kaplan has one of the 5 most highly cited papers published in Journal of Hand Surgery

Kaplan Journal Certificate

 

The editors of Journal of Hand Surgery recently informed Dr. Kaplan that his paper, “Dupuytren contracture recurrence following treatment with collagenase clostridium histolyticum (CORDLESS Study): 3-year data,” published in 2013, is one of the most highly cited papers during 2014 and 2015. Congratulations Dr Kaplan.

The Journal of Hand Surgery publishes original, peer-reviewed articles related to the diagnosis, treatment, and pathophysiology of diseases and conditions of the upper extremity; these include both clinical and basic science studies, along with case reports. Special features include Clinical Perspective and History of Hand Surgery articles, Comprehensive Review manuscripts, and Surgical Technique articles that provide an overview of hand surgery, technical aspects of surgery, and current controversial topics.

For more information on the Journal of Hand surgery please visit http://www.jhandsurg.org

To find out more about Dr. Kaplan visit his profile.

 

Preventing and Treating Wrist Tendonitis

Any time you see the suffix itis, it indicates the inflammation of a particular part of the body (think appendicitis, which is inflammation of the appendix, or arthritis, which combines the Greek word for joint–arthro–and itis). And inflammation usually means pain. So in the case of wrist tendonitis, there is pain associated with the inflammation of the tendon or tendons of the wrist, typically due to trauma of some kind or repetitive stress.

In order to treat wrist tendonitis, you must first identify its cause. Once you do, you can then either stop this activity altogether or modify your body mechanics to prevent it from reoccurring. One common example would be switching to an “ergonomic keyboard” to improve your typing posture. This may reduce stress to your wrist tendons and eliminate the inflammation and its associated pain.

Home treatment for wrist tendonitis may include icing the affected area to reduce inflammation, the use of over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, acetaminophen or naproxen, or exercise to strengthen the affected area to prevent recurrence.

If home treatment doesn’t achieve the desired effect, professional treatment may be required. This may include the use of splints to immobilize the joint, cortisone injections to reduce inflammation, or surgery to permanently repair the joint.

Radial Longitudinal Deficiency

By: Kathryn M. Peck, M.D.

Radial longitudinal deficiency (RLD) is a condition in which the radius bone of the forearm is underdeveloped or absent, resulting in the hand and wrist that angles toward the thumb-side of the forearm. It is a congenital condition (present at birth) in which the radius (the inner bone that connects the elbow to the forearm) did not form correctly in the womb. The radius may be malformed or missing.

radial longitudinal deficiencyIN RADIAL LONGITUDINAL DEFICIENCY:

•    The affected arm is smaller, and stiffness of the fingers and elbow are often present
•    The forearm curves inward because the radius is malformed or missing
•    The thumb is either very small or missing
•    The severity of the condition is different in each child

CAUSES OF RADIAL LONGITUDINAL DEFICIENCY:

A baby’s arm forms between week 4 and week 8 of pregnancy, and by week 8, the arms are fully formed but very small.  In some instances, a cause cannot be determined for radial longitudinal deficiency. In other cases, it can be part of a syndrome that affects multiple body parts, including VACTREL, Holt Oram Syndrome, Fanconi’s Anemia, and TAR Syndrome (Thrombocytopenia Absent Radius syndrome).

The heart, kidneys, intestines, blood cells, and limbs form at about the same time. Therefore, problems in these other areas need to be evaluated and often treated before the arm is treated.

DIAGNOSIS:

Radial longitudinal deficiency can sometimes be seen on ultrasound.  After the baby is born, diagnosis is confirmed through a physical exam and x-rays.

radial longitudinal deficiency

TREATMENT:

The main goal and benefit of treat is to improve the child’s ability to function with the condition, in addition to improving the appearance of the hand.

Treatment is based on each child because it depends on the complexity of the condition.
•    Stretching
•    Splinting or casting
•    Physical therapy (to help increase strength and function)
•    Prosthetics (in the case of missing parts or bones)
•    Adaptive Aids (to help with daily activities such as getting dressed and personal hygiene)
•    Surgery (to help reposition the wrist, stabilize or create a thumb, or lengthening the shorten arm to help with daily care.

In most cases, surgery is done before the child reaches school age but generally not before 6 months of age. In all cases, the goal of surgery is to repair any associated abnormalities, and improve range of motion and function.

Radial longitudinal deficiency requires a comprehensive approach to the child and family to give the best possible outcome.

Don’t Let Your Laptop Ruin Your Posture

fb_laptop_blogLaptop computers are everywhere. They’re portable and lightweight – so much so, that many people use them throughout the day, be it at work, at home, or at the local coffee shop. But laptop use can lead to posture problems, if you’re not careful.

The very thing that makes a laptop computer so popular – its convenient all-in-one design – also makes it a potential hazard. Unlike a desktop computer, a laptop’s keyboard and screen are attached to each other. Ergonomically speaking, an optimal computer setup would have your monitor in your direct eye line, your keyboard near your waist, and your forearms at a 90-degree angle to your upper arms. But due to its attached screen, this is not possible with a laptop.

With a laptop, you make sacrifices. Your typing position may be too high, which can cause issues such as carpal tunnel syndrome. And your monitor position may be too low, which can cause neck- and shoulder-strain issues.

To minimize laptop-related issues, you should consider the following suggestions:

  • Purchase a docking station and external monitor for your laptop. Not only will this monitor be larger and easier to read, it can be adjusted to a proper ergonomic level.
  • Consider a second keyboard. A second keyboard can be placed in a keyboard tray under your desk that can help you maintain an optimal 90-degree elbow angle.
  • Try to find a chair that can be adjusted to provide the best compromise between monitor angle and keyboard position.
  • If you are unable to work at an ergonomic laptop station, make sure you take frequent breaks—usually every 20 minutes or so. This will help minimize joint and muscle strain.
  • Be aware of warning signs. If you notice tingling, numbness, or pain, take a break. If it persists, see a doctor.
  • And, finally, never use a laptop on your lap. Not only does this force you to look down at your monitor at a very awkward angle, it also creates the risk of heat damage. Modern portable computers have become thinner and smaller as they’ve become more powerful. This means they generate more heat with less space to dissipate it. Consequently, laptops get extremely hot, especially when used for intensive tasks or for long periods of time. In fact, this risk of burning your skin is why laptops are no longer called laptops but are instead referred to as notebook computers by the computer industry.

For more information on laptop ergonomics visit our workstation tips page.

Hand Care 2016 Video From Nancy Cannon, OTR, CHT

Nancy Cannon, OTR, CHT has made a short video that previews Hand Care 2016 and what it offers therapists.  To watch the video click here.

Hoverboards Causing Large Number of Broken Wrists and Other Injuries

One of the best selling gifts of the holidays were hoverboards (also called FloBoards or Handsfree Segway) and they are landing children and parents in the emergency room.  Hoverboards are a hands free device that riders balance on and are propelled by two wheels.  As of December 28 there were 70 reports of emergency room visits due to hover boards, according to the U.S. Consumer Product Safety Commission in a CNN article. Common injures from hoverboard accidents include fractures, strains, contusions and lacerations.

Hoverboards have been in the news after being banned from airlines and causing a variety of explosions and fires.  Amazon stopped selling some models due to quality concerns.  However, despite the bad press they remained one of the top selling must have gifts for Christmas this year.  The post Christmas novice hoverboard riders are flying off the somewhat mercurial boards, landing on their wrists, and then landing the patient a visit to the emergency room.  One emergency room in Indianapolis had 7 broken wrists from hoverboards the day after Christmas.  Comedian Stan Boardman , Boxer Mike Tyson and Congressman Carlos Curbelo are the better known adults who have fallen victim to hoverboard accidents. A search of the hashtag #hoverboardfail on social media is a trending topic on Twitter and Instagram.

“The Indiana Hand to Shoulder Center is seeing a significant number of these injuries locally.  We are an internationally recognized center for upper extremity care and would like to make sure parents and their children aware of the increased number of injuries from this new toy.” says Greg A. Merrell, M.D.

Dr. Merrell suggest the following precautions:

  • Wear a helmet
  • Wear wrist braces, elbow and knee pads
  • Have a spotter with you as you learn to ride
  • Practice on a carpeted surface to learn the feel of the board

A Patients Story: Jon A.

James J. Creighton, Jr.

Jon’s x-ray shows the nail polish glass still in his arm.

On March 6, 2015, 7-year-old Jon A. had decided it would be fun to set up an obstacle course in his house around 10 p.m., which basically meant he was jumping from one piece of furniture to the next.  He was on the recliner jumping to the inn table where there was a fingernail polish bottle sitting. He missed the table with his body falling to the floor between the table and the chair but his arm came down on the fingernail polish bottle, busting the bottle into pieces. A large piece of the bottle severed the FDP, FDS, FCU tendons; the palmaris, the median, ulnar, ulnar sensory nerve; and ulnar artery. A piece of the broken bottle was still in his arm.

“When we heard the screams we knew something was really wrong and we found Jon with our oldest daughter trying to get him to us, blood everywhere and pumping out fast.  My husband who is a PA got him to the sink so he could try to see what was going on and yelled at me to call 911 and I knew then if he was panicked then it wasn’t good.  Brandon was able to get the bleeding stopped before the medics arrived thankfully.” said Jon’s mother Amber.

The medics tried to assess Jon but if pressure was removed the bleeding resumed. They had no idea the glass was still in his arm until he got to St. Johns Hospital in Anderson where they did an x-ray. So while the pressure applied to the arm had to happen to keep Jon from loosing too much blood it may have also contributed to the extent of the laceration to the internal structures. The physician at Johns Hospital assessed him and decided he needed to go on to Peyton Manning Children’s Hospital in Indianapolis for surgery.

They drove Jon to the Peyton Manning Children’s Hospital and the intake nurse from the Indiana Hand to Shoulder Center was there waiting to assess Jon when we arrived to see if they needed to go straight to surgery or wait until the morning. With the extent of the injury they decided they needed to operate as soon as possible.

“The staff in the emergency room at Peyton Manning Children’s Hospital as well as the surgical staff were great with Jon and two very nervous parents. Dr. James J. Creighton, Jr.  took Jon into surgery around 3:30a.m., Brandon and I set in the surgical waiting room for what seemed like FOREVER.” said Amber

Jon after surgery with James J. Creighton, Jr.

Jon after surgery with James J. Creighton, Jr.

Dr. Creighton came out around 6:30 to tell the parents the extent of Jon’s injuries, which was much worse than they originally anticipated. The broken glass had to be removed as well as the fingernail polish before Dr. Creighton could even begin to repair all the arteries, nerves and ligaments.

“Dr. Creighton was very frank with us when he came to talk to us. Not making any promises on what kind of recovery Jon would have. We didn’t know if he would have recurring infections after surgery due to the fingernail polish, we didn’t know if he would have ever have normal function in his hand or any at all. Because he not only severed the ulnar nerve, he also partially severed the median nerve which controls your intrinsic muscles and the intrinsic muscles control the individual movement of the fingers. In the grand scheme of things this injury could have cost Jon his life, we knew we had already been given that blessing. But we did grieve for the things we knew Jon, who loves baseball, basketball, football, and all things little boys love may have to give up.” said Amber.

After recovery they spent two nights at Peyton Manning Children’s Hospital for them to administer pain medication and antibiotics. Jon went home with a huge cast and orders to come back in 10 days to remove his sutures and to get recast. Jon’s family had planned a spring break trip and left the day after Jon’s sutures came out. He was placed in a removable cast which was okay to get wet on vacation.

James J. Creighton, Jr

Jon getting his stitches out and enjoying Spring Break vacation

Jon started therapy with Barb in Anderson as soon as the family got back from spring break and continued therapy twice a week from April-August, then went to once a week in August-September where he was released after meeting all his therapy goals.

“Barb was so good with Jon, and he loved her.  She made him work hard but was very encouraging to him.”

Throughout the therapy sessions Jon had lots of different casts and splints to target one area of rehab or another. When Jon started his therapy with Barb his grip strength in his Left hand was 4lbs, 5 months later in September his grip strength was 20lbs. His progress was impressive.

“Jon saw Dr. Creighton monthly and He is so good with Jon, making sure he knew the importance of continuing to work to regain his strength and movement. Dr. Creighton was also impressed by the progress Jon was making.” said Amber

Jon was very guarded with his Left arm for a very long time and wouldn’t use it. Dr. Creighton assured the family that when he got the feeling back in his hand he would use it like he used to, and now he does.

“There are now times where I forget the accident happened because He is a normal boy, doing normal things, who just happens to have a really cool scar.  We can never give enough thanks to everyone who played a role in Jon’s treatment and recovery.  Dr. Creighton had a BIG challenge that night and he rose up like a superstar.  We are so thankful for him and his staff at the Indiana Hand to Shoulder Center. Plus the nurses and staff on the recovery floor after surgery, who were also wonderful and the multiple prayers that were said for our boy not only that night but all through his recovery.” said Amber

“While Jon will always have to be mindful to keep the scar tissue stretched as long as he continues to grow to make sure he doesn’t have retraction of his muscles and hand he is one blessed little boy who is back to enjoying all the things he could do before his injury.  He is just wrapping up his first season of tackle football, where he plays maybe a little more guarded, and his Dad and I are a little more nervous than we would have been prior to his injury.  But he plays center where he guards the biggest opponents and snaps the ball to the quarterback, and no one would ever know that just 6 months ago we weren’t sure Jon would ever have use of that hand.  We will continue to see Dr. Creighton once a year until Jon stops growing to be sure he is progressing as he should.  And we look forward to those visits to thank Dr. Creighton and remind him of the difference he has made in our lives.”

James J. Creighton, Jr. with Jon.

James J. Creighton, Jr. with Jon.

Jon's note to Dr. James J. Creighton, Jr.

Jon’s note to Dr. James J. Creighton, Jr.

James J. Creighton, Jr, the indiana hand to shoulder center

Jon is now back playing all the sports he loves so much.