The human body is capable of producing a whole array of peculiar noises. Think about your most recent knuckle cracking experience - you manipulate your finger, hear a pop, and enjoy the feeling of relief. That popping sound you heard was your joint passing gas! Knuckles produce that cracking sound when gas bubbles inside the joint burst.
Joints are covered by a layer of tissue called the joint capsule. The joint space (area within the joint capsule) contains synovial fluid, which lubricates the joint and provides nutrients for the adjacent bone surfaces. The synovial fluid contains dissolved gases. When you stretch or bend your fingers to crack your knuckle, the bones of the joint pull apart and stretch the joint capsule. When the joint capsule is stretched, the volume inside the joint space is increased, creating a vacuum. This causes dissolved gases in the joint fluid to become less soluble and form bubbles. When these bubbles burst, they produce the popping sound associated with knuckle cracking. It takes about 30 min for the gases to re-dissolve into the synovial fluid, which is why the same knuckle cannot be re-cracked immediately.
A common question that my patients ask is, “Does knuckle cracking cause arthritis?” The answer is no. In limited studies, there is no evidence to suggest habitual knuckle cracking as the cause of arthritis. However, experiencing pain during knuckle cracking may be due to a dislocating tendon, ligament injury, or arthritis.
Many people associate fireworks with ushering the New Year or celebrating Independence Day, but Memorial Day is another holiday frequently commemorated with fireworks. Although fireworks are fun, they can quickly turn tragic especially if a child is injured. According to the U.S. Consumer Product Safety Commission, ~40% of all reported fireworks-related injuries are to fingers, hands, and arms. These injuries include burns, lacerations, fractures, and traumatic amputations. Of the finger, hand, and arm injuries, the majority of injuries were caused from accidents involving firecrackers, bottle rockets, and sparklers. Sparklers cause 10% of all firework injuries and are associated with the most injuries to children under 5 years of age.
The American Society for Surgery of the Hand urges the public to leave fireworks in the hands of the professionals. ASSH encourages individuals to attend public fireworks displays, which are monitored for firework safety by a local fire department, rather than setting off fireworks near or around the home. In general, holiday fireworks may be discharged from 9 a.m. to 11 p.m, however, you should check your local ordinance as it may further restrict fireworks usage. Contact your local fire department if you have any questions about fireworks practices in your locale.
Fireworks safety tips
Have a safe holiday!
One of my few guilty pleasures is watching the Sons of Anarchy, a TV drama series about a California-based motorcycle club. Although my wife insists that the show is a soap opera for men, I claim to watch it purely for educational purposes. Some of my patients are motorcycle enthusiasts and it is in their best interest that I continue watching the Sons of Anarchy saga.
Although, motorcycle accidents resulting in traumatic fracture injuries continue to be the leading cause for orthopedic visits, frequently, motorcycle riders seek my help for less obvious motorcycle-related symptoms. The most common cluster of symptoms is related to the compression of the median nerve in the wrist and includes numbness, tingling, muscle weakness, or pain in hand and forearm. This condition is commonly referred to as the carpal tunnel syndrome.
Carpal tunnel syndrome is prevalent in patients who perform frequent repetitive wrist movements or experience prolonged pressure on their wrist joints. The motorcycle handlebars produce an immense amount of vibration, which is generated by the engine and the tire contact with the road surface. The biker’s right hand controls the throttle and the front brakes while the left hand controls the clutch. The constant handlebar vibration along with repetitive hand and wrist movements required to control these functions exert pressure on the median nerve in the wrist resulting in carpal tunnel syndrome symptoms.
For more in-depth information on the non-surgical and surgical treatment options of the carpal tunnel syndrome, please visit my Omaha Carpal Tunnel website. In the mean time, if you ever wondered what was wrong with Clay’s hands, he had hand arthritis. I audibly gasped every time I watched Gemma inject cortisone in his knuckles. It is best to leave administering steroid injections to your hand surgeon rather than take a chance with your soon to be ex-wife!
Every Halloween season patients come to my office with very unique hand and finger injuries. The top three reasons for these injuries are 1) got attacked by a large pumpkin, 2) not sure, I swear its the pumpkin's fault, and my most favorite, 3) the pumpkin did it!
After carefully explaining that pumpkins do not attack unless provoked, the real story emerges behind missing fingertips and severed hand and finger tendons and it always has to do with carefree pumpkin carving using a regular kitchen knife instead of a less dangerous pumpkin carving kit.
Many of the pumpkin carving induced injuries involve nerves and tendons in the fingers, which may require complex reconstructive surgery and months of physical therapy. It is not uncommon for patients to never regain full finger or hand function due to the severity of their injuries.
Do not use kitchen knives
Whether they are serrated or smooth, kitchen knives are usually very sharp and cut through fingers and hands with ease. Often, they get stuck in the pumpkin and the injury occurs when the knife is coming out of the pumpkin after an attempt to get it dislodged. You should never use a kitchen knife to carve a pumpkin or let your child use a kitchen knife. Instead, invest in an inexpensive re-usable pumpkin carving kit that is kid-friendly. These are available in most stores and include small serrated pumpkin saws that work better because they are less likely to get stuck in the thick pumpkin tissue.
Keep your hand and fingers parallel to the sharp edge of the carving tool
The most common underlying cause of hand and finger injures among my "Halloween" patients is the way they were holding the pumpkin and the carving tool when their injury occurred. Most often, they were holding one side of a pumpkin with one hand, which would find itself in the path of the carving tool in the other hand. Those of you with cuts between your index finger and thumb, in that first web space - I know what you were doing! If you were trying to relieve some of your frustration by stabbing the pumpkin through its face but instead ended up with a cut through your palm, I hope you learned never to hold the pumpkin from behind, in the direct path of the carving tool.
When to call a hand surgeon?
If you cut your finger or hand and have bleeding from a minor cut, this type of bleeding will stop on its own by applying direct pressure to the wound with a clean cloth. If continuous pressure does not slow or stop the bleeding after 15 minutes, you should call my office or visit the nearest emergency room. Please, do not bring your pumpkin with you!
by Anela Izadi
Just when you thought the worst was over with nausea and vomiting making a sudden exit out of your daily pregnancy routine, your husband notices that your ankles have lost their sex appeal and have gained an appearance of the infamous cankles (calves merged with ankles). Of course, if he had any smarts, he would have thanked you for carrying his child, and proceeded to massage your cankles after propping them up on a pillow. However, it is more likely that in his own moment of shock, he forgot himself, and proclaimed…”Baby, where did your ankles go?”
After a couple of months and the cankle related emotional upset, you start noticing that your cankles now have a companion called wankles – the wrist equivalent of “fat” ankles. And to make things worse, these wankles seem to be causing you hand pain, numbness, and occasionally even weakness to the point that you can’t open that pickle jar with your usual intensity….What in the world is going on?
Don’t panic – there is a simple explanation!
It is very likely that you have developed pregnancy related carpal tunnel syndrome, which is very common. In pregnancy, there is an overall increase in body fluid, which can cause swelling and compression of the median nerve in the wrist. This may cause pain, “pins-and-needles” sensation, numbness, or weakness.
Luckily, carpal tunnel syndrome symptoms usually get better after the delivery – just in time when you need your hands the most! If your symptoms don’t improve or worsen, it is important that you see a hand and wrist orthopedic specialist for an in depth evaluation. If left untreated, carpal tunnel syndrome can result in irreversible median nerve injury, which could markedly impair the use of your hand.
For more information on carpal tunnel syndrome and its surgical and non-surgical treatment options, please visit Omaha Carpal Tunnel. Most importantly, forgive your husband for his moments of ignorance!
Like most people, I enjoy great guacamole - especially homemade. One of the best ways to ruin a fantastic guacamole experience is to cut your hand while preparing it!
A little known fact about avocados is that they are one of the most dangerous kitchen fruits. I have seen many patients who have severed their tendons, nerves, and arteries while preparing this seemingly harmless fruit. They’re soft on the outside and have a hard smooth pit inside, which makes them tricky to slice.
Injuries occur when people hold the avocado in the palm of their hand while slicing into it with a knife and removing the pit with the sharp end of a knife. The knife can slip and pierce the palm or a finger. These wounds may appear small, but often are deep and require surgery.
Here’s a simple safe method to prepare your avocado…. Place the avocado on a hard flat surface, such as a cutting board (not your hand). Use a sharp knife to cut the avocado lengthwise around the pit and then gently twist the two halves in opposite directions to separate them. Insert a spoon between the pit and the fruit and use the spoon to remove the pit. Finally, use the spoon to remove the fruit from the skin.
Using this technique, you can serve your avocado dish without a piece of finger in it. I have seen similar injuries in patients who were slicing bagels and separating frozen hot dogs or hamburgers with a knife.
Cooking can be dangerous. Please be careful. If you happen to have a cooking misadventure, you can find me in my office… I’ll be waiting for you.
There are 206 bones in the human body and not a single one of them is the funny bone!
There is nothing funny about the funny bone except its name, which is actually a misnomer. The funny bone is not a bone – it's the ulnar nerve!
We all have experienced that strange feeling after bumping the back of our elbows. You know what I'm talking about... that sharp, tingling, electric shock sensation, which shoots from the elbow into the ring and small fingers. The sensation is confusing because it makes you want to laugh and cry at the same time as you frantically rub your elbow and shake your hand to make it stop.
The ulnar nerve travels from the neck to the ring and small fingers where it controls wrist and hand movements in addition to providing sensation to the ring and small fingers. Along it's course, the ulnar nerve passes behind the elbow where it is not very well protected. In this location, it rests on the humerus bone (arm bone) and is only covered by a thin layer of skin and fatty tissue, leaving the nerve exposed to external stimuli.
When you bump this region of the elbow, you directly hit your ulnar nerve, creating the “funny bone” sensation. You can recreate the same sensation by tapping on the ulnar nerve with your fingers. However, if you apply continuous pressure on the ulnar nerve, such as when leaning your elbow on a hard surface, you can cause ulnar nerve compression with finger tingling and numbness. This is exactly what people with cubital tunnel syndrome experience.
There are several theories about how the funny bone got it's name. Some people believe it was named after the funny sensation that is experienced when bumping the elbow. Others attribute it to the fact that when bumped, the ulnar nerve becomes compressed by the humerus bone, which is pronounced "humorous."
I'll leave it up to you to decide if you feel the funny bone is really all it's cracked up to be.
On occasion, a patient will come to my office and proclaim, “I'm double-jointed!” A second later, I become a one-man audience to Circque de Solei performance of the hands.
For starters, the term “double-jointed” is commonly used, but it is not accurate. Double joints do not exist. More appropriately, this highly bendable condition is due to exceptionally stretchable joints. In the medical community, this condition is referred to as joint hypermobility, joint hyperlaxity, or ligament laxity.
Joint hypermobility is largely caused by genetic factors, because the shape and structure of ligaments, tendons, and bones determines the amount of joint motion. The severity of the condition can range from mild to severe, as seen in Ehlers-Danlos syndrome.
Approximately, one out of every 100 people has hypermobile joints. It is more prevalent in females and young people. With hypermobile joints, there is an increased risk of injury and osteoarthritis, especially in fingers. Please, don't worry - in most cases, ligament laxity is a harmless condition.
If you feel inclined to wow your friends and relatives with your “double joint” performance, make sure to tell them that Dr. Izadi thinks you are special!
Imagine having pain-free surgery while you are wide awake. At first, you might think that this sounds crazy. Why would anyone want to be awake during surgery? Actually… there are many reasons to want to stay awake.
When I counsel my patients about surgery, many of them express concern about undergoing general anesthesia. Most of them admit to postponing surgical treatment because of their fears. They usually say, “I don’t want to be put to sleep” or “I always get very bad nausea after I wake up.” They want to know, “Is there any other way to do this?”
YES, there is!
Since 2009, I have been using a technique called Wide Awake Hand Surgery for a majority of my hand and wrist patients. Yes, it’s exactly as it sounds. My patients are awake during their operation and do not experience any pain. Certainly, some feel anxious or nervous in the beginning, however, it is amazing how many are pleased with their experience at the end.
There are many benefits to Wide Awake Hand Surgery. In addition to time and cost savings, you can eat and drink up until the time of your operation. You can drive yourself to and from the surgery center without supervision, and in some cases, go back to work. To learn more about Wide Awake Hand Surgery, click here.
If you’re one of my patients and are considering surgery, ask me if this is an option for you.
If you have a hand condition or injury, you will want to locate a hand surgeon (also known as a hand doctor or a hand specialist) who has the expertise to evaluate and diagnose your hand or wrist condition and provide you with appropriate treatment options.
A hand surgeon is trained to work on hands, fingers, wrists, and elbows, and this type of specialist in hand surgery treats patients with conditions just like yours every day.
The right hand surgeon is the one who is not only technically competent, knowledgeable, and experienced, but who also has the personality and bedside manner that suits your needs. The patient - surgeon relationship is extremely important, and you need to feel completely comfortable with your hand surgeon before undergoing any procedure.