Foot and Hand

In case your hands, elbows, wrists and feet are in severe pain then you must get yourself checked up by our expert doctors. We know the importance of human extremities which is why we have established the Foot and hand Clinic to treat all surgical problems related to hands and feet. Emirates Hospital introduces you to the best Foot and Hand Clinic in Dubai and Abu Dhabi.
Our doctors have specialized in the fields of hand and upper limb, foot and ankle and can cure foot and hand disorders such as lateral ankle sprain, bunions, calluses, ingrown nails, trigger finger, hand arthritis and many more. If you are facing any of the mentioned adversities then feel free to call us and book your appointment now! Place your trust in the hands of our expert doctors and we promise to not let you down.

Human extremities are very special organs. This newly established clinic is dedicated to treat the medical and surgical problems of the feet and hands. It is directed by Dr Kaissar Cesar Yammine who is our Orthopedic surgeon specialized in the fields of foot and ankle, hand and upper limb and sports medicine with the help of our dermatology, internal medicine, diabetes and vascular doctors.

Dr Kaissar was the Ex- Director of the Foot and Hand Clinic in Beirut for 5 years. He was appointed as Professor of Orthopedic and Sports Sciences at the Antonine University in Lebanon. Recently he has been nominated as Dean of the College of Health Sciences at the American Univeristy in the Emirates.


Foot and Hand Clinic Overview

The goal of the Foot and Hand Clinic is to provide comprehensive, timely and quality foot and hand medical care, to allow you to quickly return to pain free activity.

The Foot care

All foot and ankle problems are treated including:

  • Heel pain / plantar fasciitis
  • Tendonitis (tendon inflammation)
  • Neuromas (nerve tumors) and nerve compression.
  • Bunions, hammertoes, bone spurs – Arthritic joints and deformities
  • Arthritic joints and deformities
  • Tendon and ligament tears
  • Acute and chronic ankle pain, chronic instability
  • Ankle arthroscopy (keyhole surgery) for intra-articular loose bodies, cartilage lesions and ankle arthritis.
  • Diabetic foot care, chronic and non-healing ulcers
  • Pediatric deformities like flatfeet, inward foot rotation
  • Sports-related injuries.

The Hand care

We treat a wide variety of conditions and injuries, such as:

  • Fracture complications (non-union, malunion or stiffness) to the fingers, wrist, forearm and elbow
  • Tendon injuries
  • Painful wrist
  • Joint deformities (mallet finger or Boutonniere)
  • Nerve disorders such the carpal tunnel syndrome
  • Trigger finger
  • Congenital abnormalities of the hand
  • Cysts and tumors of the hand
  • Sports-related injuries


Foot and Hand Problems

High mileage mature feet

Worn out and tired?
Feet with lumps and bumps growing in funny places?

Evaluating how your feet work can help us determine the features you require in a shoe. Knowing what to look for when purchasing shoes can short cut the selection process and ensure you get a shoe that suits your foot.

Sporty feet

Young or old, professional or non-professional, we take a special interest in sports medicine and we are familiar with the wide range of lower limb overuse injuries associated with individual sporting activities. Along with measuring joint alignment, testing muscle strength and evaluating your footwear, we can design a treatment program specific for your needs.

Kid’s feet

Children and babies feet matter too. Growing pain, knock knees, pigeon toes, wearing shoes out fast, frequent tripping, tired legs, curly toes, warts and all. An early examination of growing feet can be the key to the prevention of further problems developing.

Highly stressed feet

Diabetes, arthritis, congenital abnormalities, missing toes, poor circulation, numbness. All these conditions can stress feet out to the maximum. Knowing how these conditions affect your feet allows better foot health management. We can advise you how best to care for your specific condition.


Flat Feet Disorder

The human foot is a complicated structure, consisting of about 26 bones, numerous joint, ligaments, muscles and tendons. Each set of feet are unique, but may share certain basic structural qualities. Flat feet are low arched and fairly common. Closer examination of the weight-bearing foot reveals:

  • Turning out of the heel bone away from the centre of the body
  • Inward rotation of the leg
  • Bulging of the inner aspect of the ankle
  • Shifting of the forefoot outward from the heel

Flat feet may be the result of abnormality in the alignment of bones, excessive elasticity of the ligaments, muscle imbalance, or some combination of these. Flat feet alter the alignment of the foot, ankle, leg, pelvis, and lower back. Problems may develop at any level. The pronated foot is unstable. This results in excessive and abnormal motion across joints, and may result in fatigue and strain – often describes as “tired feet”.

Causes

  • Genetic predisposition
  • Abnormal bony architecture
  • Laxity of ligaments
  • Neuro-muscular disease
  • Trauma to the leg muscles or major tendons
  • Inflammatory diseases of the joints e.g. Rheumatoid arthritis
  • Surgical procedures on the leg and ankle
  • Limb length inequality
  • Tight Achilles tendon

What you can do

  • Wear shoes with a good fit in the arch
  • Keep active and fit to strengthen leg and foot musculature
  • Control body weight to decrease load on the feet
  • Avoid prolonged periods weight bearing with bare feet

What the doctor may do

  • Apply orthopedic taping to support strained ligaments and joints
  • Prescribe physical therapy modalities
  • Prescribe functional foot orthotic devices (insoles) to stabilize the foot and control motion
  • Prescribe an ankle-foot orthosis when greater control is required
  • Surgically correct a severe symptomatic flatfoot


Lateral Ankle Sprain Disorders

This occurs when the foot inverts, or turns inward. A sprain denotes an injury to a ligament. The diagnosis of lateral ankle sprain is primarily clinical, with a history of turning in of the foot, occasionally with a ‘pop’ heard or felt. Swelling and bruising occur shortly after the injury.

A common classification applicable to all ligament injuries classifies sprains according to degree of severity into:

Grade I  ligament stretch (microscopic tear)

Grade II ligament partly torn

Grade III ligament completely torn


Foot Disorders Bunions Treatment

The bunion, or hallux valgus, is a condition that affects the bones and joints associated with the great toe. It is one of the most common deformities of the forefoot. The condition develops slowly and results from the gradual dislocation of the joint, usually because of instability during gait. There is a displacement of the first metatarsal bone toward the mid-line of the body, and a simultaneous displacement of the great toe away from the mid-line (and toward the smaller toes). This causes a prominence of bone on the inside (medial) margin of the forefoot, this is termed a bunion.

Overview of the bone anatomy of a bunion:

  • Apply special pads and dressings to protect the bunion from shoe pressure.
  • Inject steroid and local anesthetic around the bunion to reduce inflammation. This is especially useful if there is an associated bursitis.
  • Recommend commercially available or custom made shoes.
  • Prescribe functional orthotics (insoles) to correct faulty foot function, and help prevent worsening of the deformity.
  • Recommend bunion surgery to correct the deformity


Calluses Foot Disorders

Calluses are hyperkeratosis of the skin. This is a thickening of the surface layer of the skin, usually in response to pressure or friction. Calluses usually form on the ball of the foot, the heel, and the underside of the big toe.

Causes

  • High heeled shoes
  • Misalignment of the metatarsal bones
  • Abnormalities of gait
  • Flat feet and High arched feet
  • Excessively long metatarsal bone
  • Obesity
  • Bony prominence
  • Loss (atrophy) of fat pad on the underside of the foot
  • Short Achilles tendon

What you can do

  • Avoid high heeled shoes
  • Buy shoes with a good arch and shock absorbing rubber sole
  • Use an insole which absorbs shear forces inside the shoe
  • Keep skin moist and supple with regular application of a moisturizer
  • Use a pumice stone or other abrasive to reduce the thickness of the callus
  • Apply non-medicated pads around the callus to relieve pressure
  • Apply moleskin over areas that tend to callus

What the doctor may do

  • Provide temporary relief by debriding (pare down) the callus and any deep seated core it may have.
  • Apply various pads to relieve pressure
  • Recommend appropriate shoes
  • Prescribe orthotics (insoles) to correct functional problems and/or redistribute weight.
  • Surgically realign metatarsals, or remove bony prominence


Corns Foot Disorders

Corns are hyperkeratosis of the skin. This a thickening of the surface layer of the skin in response to pressure. Corns usually form on the toes, where the bone is prominent and presses the skin against the shoe, ground, or other bones. As a corn becomes thick the tissues under the corn are subject to increased irritation. As corns become inflamed, there is pain and sometimes swelling and redness. Common places where corns form are: the top surface of the toe, at the tip of the toe and between the toes.

Causes

  • Tight fitting shoes
  • Deformed and crooked toes
  • Tight socks and stockings
  • Seam or stitch inside the shoe which rubs against the toe
  • Sometimes a shoe which is too loose, with the foot sliding forward with each step.
  • Prolonged walking on a downward slope

What you can do

  • Avoid shoes which are too tight or too loose
  • Buy shoes with an extra depth toe box (the part of the shoe over the toes)
  • Do not apply socks or stockings tightly around the toes
  • Use a pumice stone or other abrasive to reduce the thickness of the corn
  • Apply non-medicated pads around the corn to relieve pressure
  • Corn removing solutions and plasters contain acid and should NEVER be used by diabetics, those with diminished circulation, or diminished sensation.

What the doctor may do

  • Carefully debride (pare down) the corn and any deep seated core it may have. This provides only temporary relief.
  • Apply various pads and devices to the toes to relieve pressure.
  • Recommend appropriate shoes.
  • Surgically straighten crooked or deformed toes (e.g.. hammer toes), or remove bony prominences.


Diabetic Foot Disorders

Diabetes is a disease which causes changes in many organ systems. Those with diabetes, especially those with poor control of their disease, have a high risk of eye disease, kidney disease and amputation. It is estimated that 15% of diabetics will undergo an amputation of the foot or leg.

Foot ulceration, infection and amputation are the result of the effects of diabetes on the vascular system, the nervous system and the immune system. Nerves can be injured by high blood sugar resulting in pain, burning sensations and eventually numbness. The nerves that relay pain and temperature are injured first. The damage starts in areas furthest from the brain and spinal cord: the feet. This is called peripheral neuropathy. It inhibits the ability to feel pain from injuries to the feet. Simple injuries such as blisters or small cuts can lead to limb threatening infections. Diabetes can also decrease blood flow to the feet. This inhibits the body’s ability to heal small wounds and can also limit the amount of antibiotics available to fight bacteria in an area of infection. It also causes skin changes including dryness and tightness. The ability of the immune system to fight infection is also affected by diabetes.

Signs of diabetes include, but are not limited to, constant thirst, hunger, frequent urination, visual changes and sometimes burning or numbness in the feet.

What You Can Do:

  • Control your diabetes. Your risk is decreased by good control of the disease.
  • Wash your feet daily. Dry carefully between the toes.
  • Apply a moisturizer to feet lightly after bathing. It is important for you to keep your skin soft and supple.
  • Do not cut toenails too short. The corners of the nails should always be visible. If you have difficulty reaching or seeing your feet have someone else cut your toenails.
  • Stop smoking. Smoking reduces blood circulation and increases your risk of amputation.
  • Wear comfortable, well-fitting shoes.
  • Examine feet every day for cuts, blisters, dry blood, redness or swelling. Call your podiatrist immediately if you notice a problem. Hours can make the difference between saving your foot and losing it.
  • Inspect the inside of shoes for foreign objects.

What You Should NOT Do:

  • Never use hot water bottles or heating pads. These can cause serious burns.
  • Don’t walk barefoot, even indoors.
  • Don’t trim corns or calluses with any type of blade. An emery board can be used safely if necessary.
  • Don’t use corn removal pads, liquids or wart treatments. These products contain acids that can cause an ulcer or hole in the skin.
  • Don’t wear open-toed shoes, particularly sandals with thongs between toes.

What Your Doctor Can Do:

  • Educate you regarding diabetes and foot complications.
  • Care for areas that are at risk for ulceration.
  • Consult nerve and vascular specialists where appropriate.
  • Make protective insoles to decrease pressure on problem areas.
  • Perform surgery to reduce the risk of ulcer and infection.
  • Perform wound care for ulcers.


Plantar Fasciitis Foot Disorder

The most common cause of deep pain on the bottom surface of the heel is plantar fasciitis (inflammation of the plantar fascia). The plantar fascia is a broad band of fibrous tissue which runs along the bottom surface of the foot, from the heel to the toes. Long standing inflammation causes an inflammation at the point where the fascia inserts into the heel bone. These results in the appearance of a bony heel spur on x-ray. The spur itself is not the source of the pain.

  • Excessive load on the foot from obesity or overuse
  • Excessive flattening of the arch on weight bearing
  • Tight plantar fascia, common in persons with high arched feet
  • Over pronation of the foot (a complex motion including outward rotation of the heel and inward rotation of the ankle).

What you can do

  • Application of ice to the heel area after prolonged activity
  • Wear supportive shoes with a stiff heel counter (the part of the shoe which wraps around the heel) and a good arch. A well made running or walking shoe is a good example.
  • Sometimes a shoe with a moderately high heel will relieve pressure on the fascia
  • Stretching and strengthening exercises will stretch the plantar fascia and strengthen the small intrinsic muscles which stabilize the arch. This should not be attempted when the heel is sore.
  • Over-the-counter anti-inflammatory medications containing ibuprofen or aspirin, when tolerated

What the doctor may do

  • Prescription doses of anti-inflammatory medication
  • Inject powerful anti-inflammatory medication to calm inflammation around the painful area
  • Apply taping to relieve strain on the plantar fascia
  • Administer physical therapy (e.g. ultrasound, cold laser)
  • Control foot function with an orthotic (insole)
  • Prescribe special splints to help stretch the fascia
  • Surgical release of the plantar fascia and excision of the heel spur (rarely required).


High Arched Foot Disorder

Pes cavus is defined as foot having an abnormally high medial longitudinal arch.. These feet retain their high-arched appearance when weight bearing, this is the supinated foot type. It is a less common deformity than flat foot. Pes cavus is usually bilateral and apparent at an early age. The sudden appearance of the deformity or its presence unilaterally, may be the result of trauma or neuro-muscular disease.

Symptoms

  • Pain and stiffness of the medial arch or anywhere along the mid-portion of the foot
  • There may be associated discomfort within and near the ankle joint
  • The knees, hips, and lower back may be the primary source of discomfort
  • Pain in the ball of the foot, with or without calluses
  • Heel pain

What you can do

  • Wear shoes with a good cushioning and arch support
  • Control body weight to decrease load on the feet
  • Home care of associated corns and calluses

What the doctor may do

  • Prescribe physical therapy modalities
  • Recommend shoes
  • Prescribe functional foot orthotic (insoles) devices to support the foot, redistribute weight, and absorb shock.
  • Surgically correct a severe symptomatic high arched foot


Ingrown Nails Foot Disorder

Ingrown toenails are one the more common foot problems treated by the Podiatrist. They can be very painful, with people limiting their activity to keep off their sore feet. Ingrown toenails are caused by impingement of the skin along the margins of the nail by the nail plate. Some ingrown toenails are chronic, with repeated episodes of pain, inflammation, and infection. Infection results when inflamed tissues are colonized by pathogenic bacteria or yeast. Pain can be present without infection, and occasionally infection is present without pain. The usual signs of infection include; redness, swelling, increased warmth, and pain.

Causes

  • Improper trimming of toenails
  • Tight fitting shoes which compress the toes together
  • Hose or socks that are too tight
  • Abnormally shaped nail plate
  • Other toenail deformities (e.g.. excessively thick nail plate)
  • Trauma to the nail plate or toe

What you can do

  • Cut toenails straight across, and leave slightly longer than the end of the toe
  • Avoid tight fitting foot wear
  • If discomfort develops try soaking the foot in a basin of warm water two or three times a day. If you are diabetic or have poor circulation the water should never be more than 95 degrees Fahrenheit. Contact your podiatrist or physician immediately.
  • An infected ingrown nail requires prompt professional attention.

What the doctor may do

  • Trim a small spicule of nail to relieve the pressure. Callus (dead skin) may have accumulated in the nail groove, which needs to be removed. Routine ingrown toenail care may need to be done periodically.
  • Surgically drain an infection
  • Prescribe special soaks and/or antibiotics
  • Surgically correct a chronic ingrown toenail
  • Completely remove a deformed toenail so it will not grow back.


Achilles Tendonitis Treatment

A condition affecting the achilles tendon and characterised by progressive pain and swelling of the same. Painful in the morning usually or more so if the day before involved increased activity or participation in sports. May improve following a short period of activity or a warm up with stretchingor when wearing high heels.
This condition left untreated carries the risk of achille’s tendon rupture. Most cases are caused by poor foot and lower limb mechanics, tight and or poor muscle balance.
Mechanical therapy plays an important role in the management of this condition if surgery is to be avoided.
Treatment of achille’s tendonitis involves the use of orthoses (insoles) to address any poor foot function and posterior leg night splints. This combined with appropriate exercises and physiotherapy will provide impressive results.


Carpal Tunnel Syndrome Treatment

Carpal tunnel syndrome (CTS) begins with numbness and tingling in the hand and progresses weakness of thumb and clumsiness in holding objects. . It is a very common condition that is caused by pressure on nerve in the palm of the hand. The symptoms may occur intermittently during the daytime and sometimes occur at night and one may wake from sleep because of pain/discomfort. Pain may radiate to the forearm and elbow. Symptoms are most often bilateral.

Repetitive motions typically cause carpal tunnel syndrome. Any activity that involves grasping, squeezing or clipping motions such as using a computer, using power tools, knitting or playing the piano can result in carpal. Initially one can treat carpal tunnel syndrome with splint and medications. Later on surgery is recommended to avoid permanent changes to occur because of long standing pressure on the nerve.
Pressure on the nerve is relieved by releasing ligament (transverse carpal ligament) which covers the carpal tunnel through which nerve passes. In standard open carpal tunnel release 2-3 inch incision in palm and wrist is given, one of the major draw backs to this is the slowness of recovery in the palm side surgical scar. Often, the 2 inch palm side scar would remain sensitive to direct pressure for approximately six to eight weeks or sometimes more. In the working patient, this scar sensitivity could preclude return to normal work activities.
Here at our clinic we perform this minimally invasive procedure either by the endoscopic technique or by the trans-illumination technique. The wound is less than half inch incision and it heals well. Minimally invasive carpal tunnel release is a highly technical procedure and is best performed by a surgeon, who performs this surgery often. Such a surgeon can maximize the benefit and minimize the risks. It is a 15-20 minutes operation which requires special instruments. Patients are allowed to move their hand and wrist immediately after surgery. The surgery is out patient surgery so the patient goes home the same day as the surgery.


Hand Arthritis

In a normal joint, cartilage covers the ends of the bones and allows them to move smoothly and painlessly against one another. In osteoarthritis (or degenerative arthritis), the cartilage layer wears out, resulting in direct contact between the bones. In the hand, the second most common joint to develop osteoarthritis is the joint at the base of the thumb. The thumb basal joint, is a specialized saddle-shaped joint that is formed by a small wrist bone (trapezium) and the first of the three bones in the thumb (metacarpal).

It is a common problem that affects mainly women in their 50s. Osteoarthritis is sometimes the consequence of a fracture, rheumatism or infection.

The most common symptom of thumb basal joint arthritis is a deep, aching pain at the base of the thumb. The pain is often worsened with activities that involve pinch, including opening jars, turning door knobs or keys, and writing. Little by little the joint deteriorates and later it dislocates. . In severe cases, progressive destruction and mal-alignment of the joint occurs and a “bump” develops at the base of the thumb, which is caused by the thumb metacarpal moving out of position in relation to the trapezium. Anterior/Posterior radiographs allow confirming the clinical diagnosis and appreciating the significance of joint destruction and the conservation of certain osseous volume.

Less severe thumb arthritis will usually respond to non-surgical care. Pain medication, topical agents, splinting, and limited use of corticosteroid injections may help alleviate pain. A hand therapist might provide a variety of rigid and non-rigid splints to support the thumb during activities.

If this treatment is insufficient, despite being performed from 6 months to 1 year, surgery may be indicated. Patients with advanced arthritis or who do not respond to non-surgical treatment may be candidates for surgical reconstruction. A variety of surgical techniques are available that can successfully reduce or eliminate pain and improve thumb position and function There are two types of surgical procedures proposed, depending on the age, joint destruction, work, specialization and habits of the surgeon:

  • Trapeziectomy, which consists in removing the involved bone. A ligamentoplasty is also performed to stabilize the thumb, that is, the utilization of a surrounding tendon which is adhered to the base of the first metacarpal.
  • The trapeziometacarpal prosthesis. This implant (similar to a mini hip prosthesis) has a round metallic head which articulates in a metal or polyethylene trapezium capsule. The aim of the fusion of the prosthesis to the bones is either bone regeneration (sealed prosthesis) or cement (non-sealed prosthesis).


Trigger Finger Treatment

Trigger finger is a discrepancy in the relationship between the flexor tendon and the tunnel through which the flexor tendon glides resulting in a painful clicking or locking or a pain at the base of the finger in the palm. Trigger finger is made worse by underlying disease conditions including diabetes and rheumatoid arthritis.

Treatment involves proper diagnosis and steroid injection. If steroid injection is unsuccessful at resolving the trigger finger, surgical decompression is undertaken.

The procedure includes a small 1⁄4 inch incision in the palm and release of the proximal pulley in the flexor tendon system. The recovery time is approximately two weeks, at which time return to full activity is expected.


Dupuytren's Disease

Dupuytren’s disease describes a disease where in scarring beneath the skin occurs causing contraction of the fingers into the palm.  This is a hereditary disease affecting adults in their 40’s and upward.  The presence of scar in the palm itself does not demand intervention. However, any flexion of the fingers requires immediate attention to prevent long term deformity.  A fasciectomy is indicated for Dupuytren’s contractures that result in flexion of the fingers.  This involves direct excision of the scar tissue from underneath the skin to allow full extension of the digit.  The recovery time is approximately two to four weeks during which time the sutures are removed, range of motion is improved and full activity is expected at approximately four to six weeks.


Mucous Cyst Treatment

Digital mucous cysts develop in the distal interphalangeal joint. They show a few diagnostic problems.

They appear in adult people in the form of a small, cold, firm mass, covered with a transparent layer at the dorsal joint level.

When observing the skin, some cysts are not apparent, it is only known they are there because of a nail groove at the base of the cyst. This deformation may appear before the transparent sac. Cystic lesions are located in the proximal ungual recessus compressing the matrix, thus creating this groove.

In most cases, these cysts are adjacent to the DIP joint by means of a lining.

DIP joint arthrosis is related in 75% of the cases and explains the appearance of the skin lesion.
Average age for this pathology is around 60, more frequent among women. The three first fingers are most commonly affected, particularly the middle finger.

In most cases the injury is painless. Patients resort to consultation due to the appearance and enlargement of the cyst. Grooving of the nail is present in 30% of the cases.
Fistulisation of the cyst is not rare; whether it is performed spontaneously or therapeutically, its major risk is bacteria contamination and arthritis, as the cyst is adjacent to the joint.

Strict Anterior/Posterior standard radiographs will show joint impingement in 15% of the cases. The anterior view will show presence of osthephytes, in around 40% of the cases, even in the anterior view, joint dislocation can be observed in certain cases. These signs are directly associated with the arhtosic process.

The literature has described various treatments such as abstention, aspiration, injections, CO2 snow, radiotherapy, etc. However, surgery has been studied in a precise manner.
Surgical protocol should be meticulous and broad in order to avoid recurrence.
full skin-cyst excision
excision of dorsal joint osteophytes
excision of the pathological joint capsule. The delicate extensor tendon region should be protected
Joint lavage and intra-joint synovectomy.
Coverage of skin substance loss through complete skin grafting or rotation local flap.
Scarring requires 2-3 weeks and the cosmetic result is achieved in 3 months.

In order for the surgical treatment to be effective, it should be broad. However, the extensor should be protected to prevent the distal phalanx from dropping, which can naturally happen if the osteophytes are bulky. Recurrence risk is around 2%, thanks to this treatment.

Arthritis will keep evolving and the joint pruning performed in the per-operative period does not have any influence in the degenerative joint injuries. Therefore, progressive stiffness of the finger is not related to surgery.


Hand Disorders - Mallet Finger

You will notice that you cannot fully extend the extremity of your finger. The last phalanx remains bent, it does not “react any longer”. This is sufficient evidence to diagnose “mallet finger” or “doigt en maillet”: analogous the small hammers of a piano. This accident is very frequent in sports (with balls, boxing, and other wrestling sports). It is also very common when tucking in the sheet under the mattress.

The loss of extension of the last phalanx is due to the extensor tendon rupture. When there is a forceful flexion motion of the finger (crushing of a ball, or the hooking of your finger in the inside part of the mattress), the abrupt strengthening of the tendon causes its rupture. This rupture is usually closed, painless and without ecchymosis (bruise). Diagnosis is established due to the deformation of the finger.

Postero-anterior finger radiographs are essential to see if there is bone laceration at the insertion of the tendon.

The aim of the treatment is to obtain union of the tendon at its exact length. Surgical intervention is not required for suture: it is enough for the two extremities of the tendon to be in contact during the union period. A simple splint will suffice, in order to keep the extremity of the finger in extension.
It is required to keep this position -by using a splint- during the time of consolidation, that is, a month and a half. A slight flexion of the finger during this time makes the treatment ineffective.

This treatment is therefore simple but demanding:

  • very simple because it is enough to keep the splint in place.
  • very demanding : because you should never remove the splint , not even for hygienic matters, or if is uncomfortable, or you feel the need to remove it. It is also necessary to control the position of the splint; a slight movement may make it ineffective.
  • After a month and a half, you will be able to remove the splint during the day, but you should wear it at night for another one and a half month.

Surgery is indicated when the tendon laceration involves a thick bony fragment of the base of the second phalanx. This bony structure involves a joint surface that sometimes may require relocation and surgical fixation. You may also consider surgical intervention in case the orthopedic treatment failed. Various techniques can be performed, but most times a transfer of mobility is applied with a loss of full flexion of the F3.

The treatment helps regain a normal finger in most cases, provided the treatment had been strictly followed. Sometimes, a reduced extension deficit persists; when it is around 10-15°, it can be corrected with time (3-6 months).


Hand Disorders - Syndactyly

Syndactyly means joined fingers. This definition also applies to toes. It is about a frequent congenital abnormality which is caused by a separation defect of the digit radius.

In the embryo, the hand has the shape of a blade. The cartilaginous union which will later turn into phalanges is previously separated in 5 digit radius, but everything is covered by embryologic tissue (future skin).

The tissue between fingers is meant to disappear. This normal “programmed cell death” process is called apoptosis. An alteration in the apoptosis results in the persistence of the skin between two or more fingers: this is the most frequent type of syndactyly: skin syndactyly. With lesser frequency, it is about an embryologic cartilaginous union abnormality. Two or more cartilaginous radius is joined, which results in fusions between the phalanges of two adjacent fingers; this is called the complex type of an osseous syndactyly.
Syndactyly may be hereditary –there are similar cases in the family -; however, depending on the type of transmission, syndactyly may skip generations.

In other cases, it is about a first familial case. Sometimes, it is said to be an external influence which prevented the separation of the fingers at the beginning of the pregnancy period. Many factors may influence on apoptosis between the 4th and 6th week of embryologic development (viral disease, medications, pelvic radiographs..) However, no evident cause is usually found.

Diagnosis is simple when the new born baby is inspected. The level of syndactyly is determined: partial, to the third or half length of the fingers, that is, more distal or complete.

Fingernails are most often separated, but they may be joined. Joint mobility and possible finger deviation are examined.

In clinical practice, a simple hand anterior radiograph is taken when the baby is born or mainly at the age of 6 months. This x-ray allows eliminating bony union.

Exceptionally, in case of complex hereditary abnormalities, the surgeon will prescribe a renal or cardiac scan, and guide the family towards some genetic advice.

Fingers are surgically separated (surgical release). The age and type of operation depends on the location and severity of syndactyly. Basically, for the skin syndactyly, located at the central fingers (most common case), surgical release may be carried out at the age of 18 months. For partial syndactyly, we utilise Z plasty/ an original plastic technique in the shape of a trident which allows a perfect and lasting release without resorting to skin grafts.

In case of the 1st webspace syndactyly, between the thumb and the index finger, or in case of bony union, an early release before the age of 1 is proposed.

Surgical post-operative is usually simple. Fingers scar in 2 to 3 weeks. Dressings are replaced each 3 days.
The follow-up must be made for several years, as the finger growth may sometimes involve a small surgical correction (webspaces operated on with a skin graft may migrate distally as growth occurs).


Hand Disorders - De Quervain's Disease

This condition is common among secretaries, dress makers, washer women, and frequent in certain sports and manual activities such as trimming in gardening. Occurrence during pregnancy is also common.

This pathology prevails among women at the age of 40 or 50.
It refers to an entrapment of the tendons contained within the first dorsal compartment at the wrist.
The major symptom is pain in the external side of the wrist. It appears progressively for several weeks, sometimes abruptly which disturbs thumb motion. This pain may become intense and sharp and may radiate to the forearm. It is possible to determine inflammation at the tendon sheath on the external side of the wrist. These tendons tighten when moving the thumb towards the ring finger.

Sometimes cure is spontaneous. However, in some cases after 6-18 months, pain becomes permanent, thus restraining labor tasks.

  • Treatment is primarily medical. If performed correctly, healing is achieved in 80% of the cases. It should be accompanied by rest of the thumb (avoidance of provocative activities) oral and local anti-inflammatory drugs.  If necessary, one or two local cortisone injection is administered. Return to labor activities will be reorganized.
  • In case of painful recurrence or if the treatment described fails, surgery is indicated. If tumefaction is significant, operative intervention should be immediate. It is performed under anesthesia of the upper extremity; hospitalization is not required.
  • The cutaneous incision -3-4 centimeters- on the external side of the wrist, allows exposure and treatment of lesions, a splint keeps the thumb at rest for 21 days.

Full recovery is achieved in 3 months. Return to normal activities should be gradual, and if possible, tasks should be reorganized to avoid recurrence.


Hand Disorders - Finger Joint Dislocation

Dislocation involves straightening of a ligament until it is completely torn; it is about a serious dislocation. Finger joint dislocations are extremely common, and they occur during sports activities, ball games, in children and adolescents at school age.

After forced hyperextension, the person often feels significant pain associated with functional impairment of the injured finger.
The aim of the treatment is to favor ligament consolidation and regain motion and stability of the joint.
Torn ligaments should be protected during the healing period (3 to 6 weeks)

  • At first a splint will keep the joint in extension for 8 to 10 days. This splint only involves the injured joint,. A dressing is placed between the two fingers to prevent them from rubbing each other.
  • Then, the splint is removed, and the finger is coupled with the neighboring finger by means of elastic bands, performing a strapping. These bands should be narrow so as not to disturb mobility of joints.

This system of digital coupling allows protecting and rehabilitating the injured finger thanks to the non affected neighboring finger, which behaves “like a big brother”. This should be kept for 15 days when the person is taking part in sports activities. Surgical intervention is exceptional; it is only resorted to when the fingers are chronically unstable or stiff.

How to prevent musculoskeletal problems at work?

  1. Monitor screen is at eye level (+/- 10°)
  2. Shoulders are aligned.
  3. Elbows are bent between 60 and 90°.
  4. Wrists are in neutral position.
  5. The wrists lean on a rest.
  6. Knees are level with, or slightly lower than hips.
  7. Soft seat soft.
  8. Feet rest on the floor or footrest.
  9. The seat has a mechanism to adjust height.
  10. Seat width.
  11. Seat depth.
  12. Chair height according to height of the person
  13. Desk height according to height of the person

Your heightDesk heightChair height
1 m 500.58 cm38 cm
1 m 600.60 cm40 cm
1 m 700.63  cm43 cm
1 m 750.65 cm45 cm
1 m 900.70 cm50 cm


 

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