This is a summary of a Dr. Jay Show broadcast on 1560TheGame. Dr. J. Michael Bennett is a Board Certified Orthopedic Surgeon and a Fellowship Trained Sports Medicine Physician serving patients from Katy, Fort Bend County, Metro Houston and Southeast Texas from offices in Houston and Sugar Land, TX. Call 281-633-8600 for an appointment. Our special guest today is Dr. Alan Rodgers, a hand specialist with offices in the Katy area.
Here’s the transcript of the sixth portion of the Show:
Dr. J. Michael Bennett: Dr. Rodgers, as far as just educating the general public out there as far as hand issues, what is considered a hand emergency? Say somebody is out there and they’re working on their table saw and they lop a finger off, that is obviously an emergency and they need to get to the emergency room as soon as possible and that needs to be fixed since you can actually do a re-plant and repair it if you get there quick enough. But for patients who see some swelling in the hand or have injured themselves, how long do you recommend they watch it, and when should they visit the ER or see a physician?
Dr. Alan Rodgers: In general, if there’s something wrong with your hand that you can’t explain – sudden swelling, sudden acute sharp pain – it’s best to get that evaluated for sure. What truly constitutes an emergency from a surgeon’s standpoint may be different than what constitutes at least a visit to the emergency room and that’s why you want to go to a good ER that has qualified physicians who can identify what truly needs surgery and what doesn’t. If you let me comment on what’s a true surgical emergency, that would be any kind of major infection of the hand, and that’s diagnosed through redness, swelling, heat, oftentimes there’s going to be a history of gardening or some kind of sharp puncture, maybe even an insect bite of some kind; and these can cause deep space infections. What that means is it’s not just an infection of the skin, it’s actually down deep, in by where your tendons are, and tendons are very susceptible to infection because they don’t have good blood flow, they don’t have good natural defenses like our skin does. So anytime there’s infection around a tendon, that is a surgical emergency, we need to go to the operating room that day, we need to evacuate it, we need to clean it out, that’s to prevent you from having a tendon rupture.
Dr. J. Michael Bennett: For the weekend warrior out there who’s playing football, grabs a jersey and feels a pop, what exactly are their symptoms if they have a rupture or some other problem that needs to be evaluated pretty quickly?
Dr. Alan Rodgers: Well the fingers, they get put through a lot. When you do grasp something and it’s going a different direction than where you’re trying to pull it, sometimes what you’re trying to hold wins and it can avulse tendons. Now there are two different types: you can avulse or break tendons that flex the fingers or you can break tendons that extend the fingers. And one of the most important things to do after you’ve sustained this injury is to look at your hand and try to make a fist. Do all the fingers bend well? If you just injured your finger the swelling won’t be there immediately, it will swell if you give it an hour and then try to do it and you probably won’t be able to bend it. If you’re able to bend it afterwards and all joints bend, then it’s pretty safe that you did not avulse a tendon. Another very common thing that happens is you sprain the joint or you even dislocate the joint. Clearly if the finger truly looks deformed – you can’t move it at all – that needs immediate attention; that needs an X-ray. A lot of people talk about resetting their own joints right there on the field but that’s usually best left to professionals with X-ray guidance. I know sometimes it’s an instinct to try and pull your finger and slip it back into location, but you could do more damage than you would know by doing that.
Dr. J. Michael Bennett: The key is to have it evaluated. I’ve seen some patients come in and they’ll say, “Well, doc, five years ago I popped something in this finger and I can’t move it now.” Obviously, just like anything else, these are a lot easier to fix early. Rest is okay for certain things, but, if you cannot move your hand, your finger or a joint, or anything like that, then you need to be evaluated, you need an X-ray, you need to see a doc who’s comfortable dealing with those type of things because it can turn into a big disaster, it can turn into a problem that you will have forever and it’s obviously easier to fix early on because if you do not fix it early on, then you’ve got to do some things like possibly a tendon transfer.
Dr. Alan Rodgers: You really want to avoid those because the success rates and just the whole complexity of the surgery just increase exponentially when you try to reconstruct something that could have been repaired much simpler in the beginning.
Our office is part of the highly-regarded Fondren Orthopedic Group and we refer complex wrist and hand injuries to hand specialists at Fondren for treatment. The Fondren hand surgeons are board certified and have added qualifications in hand surgery. Call 281-633-8600 for more information or to make an appointment.
Dr. J. Michael Bennett treats certain wrist and hand injuries including carpal tunnel syndrome, distal radius fractures (broken wrist), trigger finger and metacarpal fractures of the hand. He specializes in using the endoscopic approach to carpal tunnel syndrome, when appropriate for the patient, which means that the carpal tunnel surgery consists of two small incisions instead of a longer incision across the middle of the palm of the hand.
