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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.

white finger preventionWhen 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.

To help prevent VWF, the following should be considered:

•    Stay warm and dry when operating machinery
•    Take regular breaks
•    If possible, use a tool that has some form of vibration-damping technology
•    Ensure tools are properly maintained (poorly maintained tools may vibrate more or at a different frequency)
•    Ensure that the right tool is used for a particular job (the wrong tool may take longer, exposing you to more vibration)

Preventing Frostbite

Exposure to cold temperatures for a prolonged time can result in frostbite, which causes the skin and surrounding tissues to freeze. Frostbite commonly occurs in the fingers, which may lead to loss of feeling and skin discoloration. In severe cases, frostbite can also cause permanent damage and/or loss of fingers. If you’re going to be outside in the cold weather, be sure to protect your hands.

Frostbite can occur even when the temperature is above 32 degrees fahrenheit. Wind chill and moisture contribute to frostbite conditions. Dress in layers, including warm insulated gloves and always carry a pair in your car in case you become stranded or encounter car trouble.

Recognize frostbite symptoms

• Numbness/tingling feeling
• Skin discoloration
• Hard or waxy skin
• Blisters or blackened skin

If you suspect frostbite, follow these guidelines and seek immediate medical attention:

• Go immediately to a warm place.
• Carefully remove wet gloves.
• Refrain from rubbing or scratching the affected area.
• Carefully submerse affected affected fingers in warm (not hot) water for 30 minutes until medical care is available.
• Cover the area with a warm towel or blanket to thaw.
• If available wrap each frostbitten finger loosely with sterile gauze.
• Thaw a frostbitten area only if it can be kept warm. Refreezing a frostbitten finger can result in permanent loss.
• Do not touch blisters occurring from frostbite.

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:
• Elevate the injured extremity to prevent swelling in the initial days following the injury.
• Exercise the extremity. Even if your arm is in a cast, don’t neglect the fingers. Alert your doctor if the exercise causes pain.
• Apply an ice bag to the cast to help reduce swelling. If you attempt to ice the broken bone, be certain you keep the cast dry.

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

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


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.


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


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.