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Indiana Hand to Shoulder Center in the News, Issue 5

A Helping Hand


Overuse injuries of the hand and wrist can occur on the job, at home, or during sports activities. And hand or wrist pain can negatively affect virtually every aspect of your life, from buttoning a shirt to signing your name or simply opening a door. Learn more about the conditions and the treatment options available for hand and wrist pain.

According to Indiana Hand to Shoulder Center hand, wrist, elbow, and shoulder specialist Gregory A. Merrell, M.D., “The repetitive use of the tendons and ligaments surrounding your wrist can result in the pinching of a nerve or the inflammation of your wrist joint. These two symptoms are better known as carpal tunnel syndrome and wrist tendonitis.”

Wrist tendonitis, also known as tenosynovitis, is characterized by the irritation and inflammation of the tendons surrounding the wrist joint (the suffix itis means inflammation). The wrist has tendons that cross over each other and over the bone. When those tendons thicken and constrict from overuse, it makes the movement of the tendons painful.

Dr. Merrell says, “If the symptoms involve numbness, tingling, or weakness, the condition could be carpal tunnel syndrome.” He explains, “Pressure in the carpal tunnel compresses a nerve and causes the nerve to function improperly, which results in numbness and weakness, in addition to pain.”

Treatment options for both of these overuse injuries are similar. The most conservative treatment options are attempted first, and if those prove unsuccessful, surgical options may be considered.

Conservative (nonsurgical) treatment options include:

Surgical treatment options include:

To find out more about overuse injuries in the hand and wrist, or to schedule an appointment with our hand and wrist specialists at Indiana Hand to Shoulder Center, call (317) 875-9105 today.

When Should You Use Heat or Ice?

Icepacks and heat pads are among the most commonly used treatments in orthopedics. So which one is the right one to use for your injury—and how long should you use it?

Ice Treatment

Ice treatment is most commonly used for acute (short-term) injuries. If you have a recent injury (within the last 48 hours) where swelling is a problem, you should be using ice treatment. Icepacks can help minimize swelling around the injury, reduce bleeding into the tissues, and reduce muscle spasm and pain.

Icepacks are often used after injuries such as a wrist sprain have occurred. Applying an icepack early and often for the first 48 hours will help minimize swelling, and decreasing swelling around an injury will help to control the pain. Ice treatments may also be used for chronic (long-term) conditions, such as overuse injuries in athletes. In this case, ice the injured area after activity to help control inflammation. Never ice a chronic injury before activity.

You can make icepacks with ice cubes in a plastic bag or wet tea towel. A pack of frozen peas also makes an ideal icepack and can go in and out of the freezer. Never place ice directly on an injury and keep the pack moving to avoid ice burns. Never treat with ice for more than 30 minutes, and remove the pack immediately if the injury appears bright pink or red.

Don’t use icepacks on the left shoulder if you have a heart condition, and don’t use icepacks around the front or side of the neck.

Heat Treatment

Heat treatments should be used for chronic conditions to help relax and loosen tissues and to stimulate blood flow to the affected area. Use heat treatments for chronic conditions, such as overuse injuries, before participating in activities. However, do not use heat treatments after activity, and do not use heat after an acute injury. And never use heat where swelling is involved (swelling is caused by bleeding in the tissue, and heat just makes more blood come to the area).

Heating tissues can be accomplished using a heating pad or even a hot, wet towel. To avoid burns when using heat treatments, be very careful to use only moderate heat for a limited time. Never leave heating pads or towels on for extended periods of time or while sleeping.

Other Precautions

Don’t use cold or heat packs:

To learn more about injuries or conditions of the hand, wrist, elbow, or shoulder and the treatment options available visit our patient center.

Coping With a Cast

After a bone is broken, either accidentally or for a surgical procedure, a cast is often used to let the bone heal properly. While uncomfortable and cumbersome, casts are extremely important in the treatment of fractures and preventing further problems. And caring for that cast is an essential part of that healing process. So how do you deal with a cast - especially when it starts to itch?

Keep the cast dry

Keep the cast and the cotton wrap around the injury dry at all times. If you want to wash, carefully wrap the cast in plastic and protect the cast from any water.

Don't stick anything under the cast.

Try to keep objects out from under the cast, and especially avoid the urge to stick coat hangers under the cast—this can damage both your skin and the cast material.

Trim rough edges.

Rough edges of the cast can be trimmed with an emery board. Do not cut the cast with scissors or attempt to break off rough edges.

Relieve itching the right way.

To relieve itching under the cast, try pointing a hairdryer on a cool-air setting down the cast to relieve the itch. Over-the-counter medications such as Benadryl can sometimes help.

Inspect the cast carefully.

Examine the cast regularly and alert your doctor if it cracks, breaks, or becomes loose. Also look for reddened or raw skin around the cast edges—your doctor can pad these areas to prevent problems.

Tips for comfort:

Don’t Let Your Laptop Ruin Your Posture

Laptop 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:

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.

Preventing Vibration White Finger

If you use vibrating power tools, such as jackhammers, sanders, chainsaws, and lawnmowers, you may be susceptible to a condition known as vibration white finger (VWF). Those who suffer from VWF experience a loss or change of color in their fingers, tingling, and throbbing. Over time, the condition may get worse, especially in cold weather, and in extreme cases, may lead to the loss of one or more fingers.

When someone is experiencing an occurrence of VWF, the tiny blood vessels in the fingers constrict (called a vasospasm), causing a reduction of blood supply to the fingers. This lack of blood initially turns the fingers white. After the oxygen in the remaining blood is used up, the fingers turn blue (a condition known as cyanosis). Once the spasms subside, the fingers turn red as oxygen-rich blood rushes back to the fingers.

The link between vibrating power tools and VWF symptoms has been known since 1918, when Dr. Alice Hamilton studied the phenomenon reported by quarry cutters in Bedford, Indiana. She also discovered the link between VWF symptoms and cold weather.

To help prevent VWF, the following should be considered:

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, call Indiana Hand to Shoulder Center at (317) 875-9105, or visit our workstation tips page.