Dr. Jeffrey C. Wint, MD

No

A common injury is a thumb ligament injury that may have a normal X-ray. A younger child with open growth plates can have a fracture in the growth plate that may not be obvious. Sometimes a "jammed" joint with no complete ligament injury or no fracture can still hurt for many months.

Diabetic patients can have surgery for Carpal Tunnel. Check with your doctor for details regarding individual needs for diabetic care and surgery.

There are many types of congenitally deviated or bent fingers. Some are amenable to surgery, some are not. It depends upon the type of congenital difference ie the type of crookedness of the finger and how it impacts or affects current function. Straightening a finger for cosmetic reasons is generally not done. See a hand surgeon for a consultation

Blood under the nail after trauma could be just bruising or it could represent a fracture. The only way to surely tell is with an X-ray. A fracture may be minimal, but may also represent a tendon avulsion or joint injury that needs further care.

Jeffrey Wint, MD

Compartment syndrome results when muscles have increased internal pressure within their fibrous coverings or compartments such that the blood flow to the muscle is restricted. This typically occurs from trauma or from chronic exertion, but trauma is the typical scenario. I’m not aware of any hereditary component in most typical compartment syndrome unless there is a hereditary tendency for blood to be thinner and more prone to exacerbate an ongoing problem. In those cases, the person would most likely know about the hereditary risk for having thinner blood or blood not clotting as well as normal.

The obvious answer is to not sleep on that side of course you should get evaluated find out why you’re having so much pain is it from nerve compression or swelling that’s making tendons or joints stiff. Or is it because of pain from your shoulder or neck that’s radiating down towards your hand.

Swollen injured tissues in the upper extremity tend to get more swollen at night because of the negation of the effect of gravity in other words when we stand up all day to move around fluid runs downhill when we lie down and sleep at night the fluid that normally runs downhill tends to end up in our face and hands.

It is very difficult to qualify what one means specifically in terms of size, concentration, area of configuration of this darkened area to expand upon a discussion. However, I would start with your PCP and perhaps a dermatologist to have this lesion or pigmentation looked at in a timely fashion.

Carpal tunnel surgery is used to take the pressure off the median nerve in the carpal tunnel. Outcome is dependent upon the severity of the compression both acute and chronic components as well as understanding that there, like any operation has minor and major risks as well as the potential benefits. Conservative treatment can involve , rest, activity modification, NDAIDs, and splinting as well as corticosteroid injections . These can lower the pressure in the carpal tunnel and improve symptoms as well as in mild or even moderate cases work to relieve the need for surgery. Medications such as nuerontin may suppress nerve pain buyt do nothing to the pressure either acute or chronic on the nerve. Chronic nerve changes may not be reversible even with uncomplicated carpal tunnel surgery but having a chronic case is not a reason to hold off surgery as even if complete relief and cessation of all symptoms such as tingling and muscle weakness is not acheivable, halting progression is often important and often in the chronic cases the neuropathic pain can be alleviated even if there is not full recovery.

So while non surgical alternatives exist, if they do not take care of all the symptoms be sure to talk to your surgeon about the potential impact of waiting if surgery has been recommend.

Rheumatoid arthritis has in the past ten years had its disease course altered and modified by many drugs knows as DMARDs which act upon the immune system to suppress inflammation. However no drug to date an reverse joint or tendon destruction that has occurred . It is also a progressive disease that may seem controlled yet slowly still affects the joints, ligaments ans tendons of the hand despite medication. And each year there are newly diagnosed patients who may not even know the have RA or even one of the so called sero negative spondyloarthropathies. Recovery froma surgical procedure depends upon what procedure is done. Joint replacement, joint fusion, ligament reconstruction, tendon transfer, tendon repair, are some of the more common hand and wrist procedures. Each has its own unique circumstances but a very basic ballpark figure for reconstructive hand surgery is that is it is a 2 -3 month process involving surgery, splinting, and therapy of differing degrees and magnitudes and frequencies. Still for "recovery" it is different for a wrist vs a single finger vs multiple locations. Talk to your surgeon for the specifics with respect to what you are correcting or fixing and what you do.

Prognosis for recovery is multi-factorial and depends upon the extent and location of the stroke and is best discussed with a neurologist .

Hand Surgeon however can contribute to care of the hand after a stroke;especially those who are slowing down in recovery. A stroke can affect sensation, position sense and muscle strength, endurance and most important balance and synchronous use in the hand. There are many very small muscles that delicatley work together to tell you when to softly hold a childs hand or strongly togrip a hammer. Hand surgeons and hand therapists are often called upon to offer help in the form of rehab, OT, splinting and even surgery.

Radiation therapy has been popular in countries such as Germany for many year and recently NHS trials are undergoing in Great Britain IN the US there are indivudual practitioners who offer this and some are enrolled in well contracted trials ( where the results are monitored for efficacy) The literature typically states that radiation may be helpful for early nodules but not if cords have started to form. There are many treatments avaialabel for DUpuytrens, some are for early nodules but the bulk are for cord formation associated with contracture. There are many variables in terms of hereditary, and outside factors that affect how Dupuytrens will play our but iit is very hard to predict who will be held at a ny ally stage, thus the need for more well crafted clinical trials for Radiation. seek out additional information from http://www.dupuytren-online.info and https://dupuytrens.org as well as our website http://www.handctr.com/dupuytrens-disease-faq.html and also www.assh.org to find a hand surgeon in your area

Massage, tape and scar ointments help loosen skin, often it is not just the type of intent or tape but the mechanical act of rubbing and softening that is more important. Regular plain paper tape ( like a small version of the Kinesiotape we see athletes wear) can give compression to a scar if worn at night or when not moving, do not make tape tight or restricting of circulation or motion. finally ask your surgeon to recommend a hand therapist who can also help with these things. many scars change over time and the way it looks at a few months post op is not the way it will look or feel 6-12 months later!

Certainly another nerve can be a problem, there are three nerves that supply sensation to the hand as well as all nerves come from the cervical spine and a herniated disc in the lower cervical spine in your neck can give referred pain. Other common causes of hand pain that may not concurrent with carpal tunnel or evolve at a separtate site or location are trigger fingers, arthritis of the base of the thumb, wrist tendonitis and many others. Speak to your surgeon regarding your concerns, sometimes the carpal tunnel overwhelms your attention and the symptoms caused by other coexistent or subsequent issues arise and it is confusing even to experienced health care providers

An implanted pin can become loose or infected. However typically long before that occurs pins are removed as the fracture heals. Proper care of the pin and the broken bone is very important postoperatively. Speak to your surgeon SPECIFICALLY to see whether they want you to care for the pin it is is sucking out of the skin and how much ( if any) motion they want you to do of the injured finger while the pin is in.