DESCRIPTION

Applying heat or ice is a common method for treating injuries, stiffness, swelling and pain. When used for fingers, hands and wrists, it can be very helpful for:

• Recent injuries (bruises or fractures) or chronic injuries
• Swelling
• Stiffness
• Irritation

Benefits of Heat Treatments

Heat or warmth will help get things moving by speeding up the molecules in tissues and increasing blood flow. Heat is helpful for stiff joints and muscles, and can be useful prior to an activity. We often see an athlete warming up before a workout.

A warm shower or bath can help sore, stiff joints, especially in the early morning. A warm compress or heating pad can also relieve stiffness; however, too much heat could cause fainting, swelling, or burns to skin and tissues, so use heat treatments with moderation.

Benefits of Ice Treatments

If there is pain, swelling and irritation after an activity, ice treatments can reduce these symptoms. Cold slows down the molecules in tissues and reduces blood flow.

The most common cold treatments are ice or something that has been made cold by placing it in the freezer, such as a gel pack. Apply ice for 15 minutes, then allow a 15-minute rest before reapplying.

As with heat, too much cold can slow down and stiffen sore joints, so use this treatment with moderation. Applying ice or anything extremely cold to bare skin can cause injury. Always wrap the source of cold in some sort of fabric. If a bandage or splint is too thick and the cold is not getting through, apply the cold near the area on exposed skin. Stop using ice if you feel extreme pain or numbness due to the cold.

Special Treatments

Some special and more advanced heat or ice treatments may be used under the supervision of a therapist or physician. Some options may include:

• Therapeutic ultrasound: A qualified therapist will use ultrasound to slowly heat deeper tissues to help motion.
• Contrast bath: This is a bath that involves alternating heat and cold.
• Paraffin or warm wax: This can be used to apply heat via machines that are highly regulated and use a wax mixture that avoids skin burns.

Use caution when implementing ice or heat treatments. Monitor time and the condition of your skin, and always test the hot or cold item before applying. Contact your physician or therapist for assistance.

—Authorised by ASSH.ORG to use the content

DESCRIPTION

Anesthesia is a way to control pain during a surgery or procedure by using medicine called anesthetics. It can help control breathing, blood pressure, blood flow, and heart rate and rhythm.

There are several types of anesthesia for patients undergoing hand surgery. These include local, regional or general. The type used depends on the type and length of the surgery, the patient’s health and medical conditions, and preferences of the patient, surgeon, and anesthesiologist.

The numbing medications used in regional can provide between one and 24 hours of pain relief, depending on the medication used. Some local anesthetics may last as long as three days.

General Anesthesia

The patient is unconscious and does not feel anything during the surgery. The patient may receive the medicine by breathing it in or through an intravenous (IV) line.

Local Anesthesia

This typically means anesthetics for a small area. Numbing medicine is injected at the site of surgery. The patient is wide-awake during the surgery and can fully cooperate with any instructions from the surgeon, such as to move the hand or fingers. It contains medicine to stop excessive bleeding and to minimize pain in the operated area. Other medications to help you relax can also be given with this type of anesthesia. The relaxing medications are typically given through an IV line.

Regional Anesthesia

Parts of the body are put to sleep by injecting numbing medicine through a needle placed along the path of nerves. This may be around the collarbone or neck, under the arm, at the wrist, in the palm, around your finger, or through an IV in your arm. As with local anesthesia, the anesthesiologist or nurse anesthetist may add relaxing medication given through an IV line.

The injection of numbing medicine with a needle can be slightly uncomfortable or painful, but you will have IV medication to help you relax and feel comfortable during the injection. Sometimes, the anesthesiologist may use a needle connected to a nerve stimulator to precisely locate the nerve. This causes the arm or hand muscles to twitch and move, which is not painful, although it can feel strange.

Some proven advantages of this type include less need for pain medicine after surgery, faster recovery, less nausea, and, for some surgeries, less blood loss and lower risk of blood clots.

Will I be Awake During Surgery?

Some patients prefer to be awake during surgery. Others prefer to be asleep. During your surgery you can be awake or asleep, depending on what you and the surgical team decide. You will not be able to see the surgery itself because a large sterile drape is placed between you and the surgeon. This is to protect the “sterile field,” the important area of your surgery, from any contamination of germs that can cause infection.

What Are the Risks?

Some risks associated with regional or local anesthesia include pain, soreness or bruising at the needle site, or tingling that lasts for several days. Serious complications can occur, such as bleeding, infection or nerve injury, but these are very rare. Your surgeon and anesthesiologist will check to make sure you are comfortable before, during and after the procedure. Do not hesitate to tell them if you are not.

—Authorised by ASSH.ORG to use the content

DESCRIPTION

Arthroscopy is a surgical procedure that allows a surgeon to look inside a joint using small cut with instruments the width of a pencil. Most people are aware of knee and shoulder arthroscopy, but the elbow joint has many conditions that can be treated with this procedure as well.The elbow is the joint that connects the upper arm bone and the forearm bones. Be-cause the cuts used with elbow arthroscopy are smaller and disrupt less soft tissue than conven-tional open surgery, pain, swelling and stiffness are minimized, and recovery is often faster.

When is elbow arthroscopy performed?

There are a variety of conditions for which this procedure can be useful in diagnosis as well as treatment, including:

• Arthritis
• Loose bodies in the joint
• Tennis elbow
• Stiffness
• Fractures

Fractures and other injuries to the elbow can lead to significant stiffness of the joint. Stiff, con-tracted elbows are being released more frequently by elbow arthroscopy. Although not curable by arthroscopy, patients with arthritis of the elbow can enjoy significant improvement in symptoms and function after arthroscopy. After physical examination, including x-rays or other studies such as CT or MRI scanning, your surgeon may recommend an arthroscopic procedure for treatment of your elbow disorder.

How is elbow arthroscopy performed?

The procedure is performed under general or regional anesthesia. A fiberoptic camera is inserted through a small cut in the elbow. The camera lens magnifies and projects the small structures in the elbow onto a television monitor, allowing the surgeon to accurately diagnose the condition. Several other small cuts in the elbow allow the surgeon to place the camera in different positions to see different structures inside the joint and to place various small instruments into the joint to help treat various problems.

Recovery

After your arthroscopy, you may be placed into an elbow splint that still allows you to use your hand. The amount of time in the splint will vary depending on what was performed at the time of surgery. Elevating the arm is important to prevent excessive swelling and pain after your surgery. Certain conditions require that you begin therapy right away, and others may not require it at all. This procedure often allows the patient to go home the same day, but occasionally, depending on the condition, a hospital stay may be needed.

Risks and limitations

As with any surgery, this procedure has risks. These include infection and potential damage to nerves and arteries. Stiffness may need to be addressed through rehabilitation. Elbow arthrosco-py is not appropriate for all elbow conditions and is dependent on the surgeon’s training, exper-tise and comfort level.

—Authorised by ASSH.ORG to use the content

DESCRIPTION

Splints and casts are supports that are used to protect injured bones and soft tissues. A cast completely encircles the limb with a hard, rigid outer shell. A splint provides rigid support along just the side(s) of the limb, with soft or open areas in between (Figures 3 and 4). Splints are often used in the immediate post-operative or injury phase, when there is a greater chance of swelling. A splint can better allow for swelling. Your doctor will decide which type of support is most appropriate for you and your arm condition.

Materials

Casts are made with plaster or ‘fiberglass’ to form the hard supportive layer, and a soft lining of cotton or similar material for padding. Fiberglass is lighter, more durable, and “breathes” better than plaster. Plaster is less expensive and shapes better than fiberglass for some uses. Both materials come in strips and rolls, and are dipped in water to start the setting process. Most casts have a layer of padding underneath the hard material. X-rays can be taken through casts, but they do block some of the x-ray detail.

Splints can be made with these same materials or with plastic, fabric, or padded aluminum. They can be custom-made, or they may be pre-made. They come in a variety of shapes and sizes, depending on the specific need. They often have Velcro straps, which makes them easier to take on and off.

For fiberglass casts, water compatible padding does exist; ask your doctor if they have it available. Not all injuries can be treated with a waterproof cast.

Waterproof casts can be submerged. It is best to avoid water from lakes, rivers and oceans when wearing a waterproof cast because your skin can become irritated if dirt or sand gets inside the cast. When you come in contact with chlorinated water or dirty water, rinse the cast with fresh water when you are done swimming. Allow the inside of the cast to drain as much as possible after it gets wet. If you have a cast that goes past your elbow, be sure to drain the area around the elbow well. The rest of the water will evaporate. Sweat will not harm the cast liner, but consider rinsing the cast with clean water after excessive sweating.

SIGNS AND SYMPTOMS

Swelling

Swelling due to your injury or surgery is usually worst during the first 2 or 3 days. Swelling can cause pressure in your splint or cast, making it feel tighter. To help avoid or reduce swelling, you should put your hand and arm above your heart by propping it up on pillows or some other support if possible. Elevation helps gravity to drain the blood and fluid that causes swelling out of your hand and arm. This can also decrease pain. If swelling increases too much, a cast or splint can become too tight.

The following signs and symptoms should be watched for, and if they occur, you should contact your doctor promptly for advice:

• Worsening pain
• Numbness and tingling in your hand or fingers, which may indicate excessive pressure on the nerves
• Burning and stinging, which may result from too much pressure on the skin
• Excessive swelling of the hand, which may mean the veins are being blocked
• Loss of active movement of your fingers, which may indicate muscle damage

Sometimes a cast may need to be changed if the cast is too tight or if it gets too loose when the swelling goes down.

TREATMENT

Cast and Splint Care

Keep your cast or splint clean and dry. Being in contact with damp padding can irritate your skin. Plaster gets softer and weaker when it gets wet. Use plastic bags or a waterproof cast cover to keep your splint or cast dry when bathing. Seal the bag with tape or rubber bands. Elevate your hand in the shower above your head, because otherwise water can still run under the seal and into your cast. Do not keep it constantly covered because moisture may build up from normal sweating.

Do not let dirt, sand, or other materials get inside of your splint or cast. If you feel itching, do not place anything inside your cast because you can injure your skin; ask your doctor for advice. Never trim the cast or splint by yourself. If there are rough edges or if your skin gets irritated around the edges of the cast, notify your doctor, who has the proper tools to fix it. If the cast or splint develops cracks or soft spots, contact your doctor to see if it needs to be repaired or changed.

Cast Removal

Never try to remove a cast yourself; you may cut your skin or prevent proper healing of your injury. A cast should be removed only by a professional with the proper tools and training. Casts are removed with a special type of saw that will not cut your skin.

Remember, a cast is there to protect you while your injury heals. It is only a temporary inconvenience, with the goal of helping you recover.

—Authorised by ASSH.ORG to use the content

DESCRIPTION

Amputation is the removal of an injured or diseased body part. It may be the result of a traumatic injury, or it may be a planned operation to prevent the spread of the disease in an infected finger or hand. Some traumatically amputated fingers may be replanted or reattached. In many cases, reattachment of the amputated finger is not possible or advisable because the patient will be more comfortable and have better function if the part is not reattached.

Surgery

When an operation is necessary, the surgeon removes the injured body part. Prior to surgery, the surgeon will do a careful examination of your hand. Often the surgeon will obtain x-rays or other imaging studies to assess the damage to your finger/hand. The area removed is based on the extent of the injury and the health of the remaining body part. In many cases, the surgeon is able to close the site of the surgery by rearranging skin and shortening bone or tendon. Sometimes, the surgeon may have to use skin, muscle or tendons from another part of your body to close the site of the surgery. In most finger tip injuries, the surgeon is able to close the site directly. In more extensive injuries, the surgeon may shape the finger or the hand to be able fit a prosthesis later.

For the first couple of weeks, you should expect some pain. Pain will be controlled with pain medications. While you are healing, your doctor will tell you how to bandage and care for the surgical site and when to return to the office for follow-up care. You may be given exercises to build your strength and flexibility. You may be asked to touch and move your skin to desensitize it and keep it mobile.

Prosthesis

The type of prosthesis depends on the location and length of your residual finger or hand and your functional and lifestyle needs. The prosthesis replaces some of the function and appearance of the missing body part. It is important to share the activities that you feel are most important with your surgeon and prosthetist, so an appropriate prosthesis can be provided for you. Prostheses can restore length to a partially amputated finger, enable opposition between the thumb and a finger or, in the case of a prosthetic hand, stabilize and hold objects with bendable fingers. If your hand is amputated through or above the wrist, you may be given a full-arm prosthesis with an electric or mechanical hand. Some patients may decide not to use a prosthesis.

A prosthesis is made from an impression cast taken from the residual finger or limb and the corresponding part on the undamaged hand. This process can create an exact match to the details of the entire hand. The finger or hand prosthesis is made from of a flexible, transparent silicone rubber. The colors in the silicone are carefully matched to your skin tones to give the prosthesis the life-like look and texture of real skin. It is usually held on by suction, and the flexibility of the silicone permits good range of motion of the remaining body parts. Fingernails can be individually colored to match almost perfectly. The nails can be polished with any nail polish, and the polish can be removed with a gentle-action nail polish remover. Silicones are resistant to staining, so inks wash off easily with alcohol or soap and warm water. With proper care, silicone prosthesis may last 3-5 years. Usually, three months after you are completely healed from surgery and all swelling has subsided, creation of your prosthesis can begin. You may need therapy to learn to use your new prosthesis.

Emotional Recovery

The loss of a body part, especially one as visible as a finger or hand, can be emotionally upsetting. It may take time to adapt to changes in your appearance and your ability to function. Talking about these feelings with your doctor or other patients who have had this condition often helps you come to terms with your loss. You may ask your doctor to recommend a counselor to assist with this process. It is important to remember that with time, you will adapt to your situation by finding new ways of doing your daily activities. The Amputee Coalition of America www.amputee-coalition.org/index.html is another helpful resource. These resources can help you to be strong during the course of recovery. Remember that quality of life is directly related to attitude and expectations – not just obtaining and using a prosthesis.

—Authorised by ASSH.ORG to use the content