Ask the Expert: Dr. Michelle Carlson Answers Your Questions About Hand & Upper Extremity Injuries/Conditions

by Dr. Michelle Carlson

Q1. I had UCL surgery on my thumb in August of ’09. Can anything be done if the surgeon made the ligament too tight? I cannot hold a 2 liter soda bottle and I cannot go back to the surgeon as he passed away last spring. Another hand surgeon took an x-ray and said it was “anchored well.” He suggested more OT but the OT is recommending seeing another doctor.

It is uncommon for the ligament to be too tight. Usually the stiffness of the joint is a result of scarring of the covering of the joint either from the initial trauma that tore the ligament in the first place or from the thickening of the covering of the joint which can happen as a result of any surgery. Hand therapy can often help with this stiffness, in addition, sometimes a cortisone injection into the joint can bring down the inflammation and improve motion.

Q2. I’m a snowboarder and broke my wrist after landing a jump. I just had surgery involving plates and screws. I’m concerned about range of motion after recovery. Any advice?

The recent plates and screws that have been developed in the past ten years have revolutionized the treatment of wrist fractures. Often you can have almost full range of motion after having surgery for a broken wrist. Ideally, depending on the fracture, your surgeon will recommend you start range of motion of your fingers and wrist. Usually I tell patients “no pain, no gain,” but you should check with your surgeon first to make sure that it is a good idea for your wrist. A combination of hand therapy and working on range of motion on your own can often produce excellent results.

Q3. I was told I have a Dupuytren’s contracture in one of my fingers. I noticed it because it started to affect the way I play violin. What are the options for treatment?

There are several options available for the treatment of Dupuytrens. The gold standard has always been surgical excision of the involved diseased tissue causing the contracture. Newer options involve rupturing the cord by chemical means (Xiaflex) or cutting it with a needle or small incision. There are pros and cons of each technique and you should discuss it with your surgeon. The good news that there is a very good chance it can return your hand back to full function.

Q4. I have arthritis in my hand and have been shying away from the gym and golf to avoid pain. I was told that avoiding activity could actually make this worse – is that true?

It is unlikely avoiding activity will make your arthritis worse. With arthritis of the hand, typically more activity causes more wear of the joint and worsens the arthritis and symptoms. A good adage is that “if it hurts, don’t do it.” Usually I tell patients to avoid gripping activities at the gym, including free weights. With golf, it is obviously hard to avoid gripping, but enlarging your club grips to senior grips can often help. Ask your doctor about taking an anti-inflammatory medicine like ibuprofen or using certain splints – these can alleviate discomfort.

Q5. I had dislocated my wrist when I was much younger, over 20 years ago, and it was never treated properly. Over time, it has healed on its own, where the wrist bone no longer aligns properly. I have full functionality of my hand, but the pain to my arm & wrist has been increasing over time. Are there any non-surgical solutions to repair and re-align my wrist?

There are no non-surgical solutions to realign your wrist however, there are some non-surgical options can alleviate your pain. Ask your doctor about trying a drugstore wrist splint and anti-inflammatory medicine. If your pain persists you should see a surgeon. A cortisone injection may give you relief for a while and ultimately there may be a surgical reconstruction that can get rid of your pain but maintain the functionality of your hand.

Dr. Michelle Carlson is an orthopedic surgeon at Hospital for Special Surgery.