What Is Mallet Finger?

What Is Mallet Finger?

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Description

A mallet finger is a deformity of the finger caused when the tendon that straightens your finger (the extensor tendon) is damaged.

When a ball or other object strikes the tip of the finger or thumb and forcibly bends it, the force tears the tendon that straightens the finger (see Figure 1a and 1b). The force of the blow may even pull away a piece of bone along with the tendon (see Figure 2). The tip of the finger or thumb no longer straightens. This condition is sometimes referred to as baseball finger.

Signs & Symptoms

In a mallet finger, the fingertip droops: it cannot straighten on its own power. The finger may be painful, swollen and bruised, especially if there is an associated fracture, but often the only finding is the inability to straighten the tip. Occasionally, blood collects beneath the nail. The nail can even become detached from beneath the skin fold at the base of the nail.

Treatment

Diagnosis

The diagnosis is evident by the appearance of the finger. Doctors will often order x-rays to see if a piece of bone pulled away and to make sure the joint is aligned.

Nonsurgical Treatment

The majority of mallet finger injuries can be treated without surgery. Ice should be applied immediately and the hand should be elevated (fingers toward the ceiling.) Medical attention should be sought within a week after injury. It is especially important to seek immediate attention if there is blood beneath the nail or if the nail is detached. This may be a sign of a nail bed laceration or an open (compound) fracture.

There are many different types of splints/casts for mallet fingers. The goal is to keep the fingertip straight until the tendon heals. Most of the time, a splint will be worn full-time for eight weeks (see Figure 3). Over the next three to four weeks, most patients gradually begin to wear the splint less frequently. The finger usually regains acceptable function and appearance with this treatment. Nevertheless, it is not unusual to lack some extension at the conclusion of treatment. Your surgeon or hand therapist will instruct you about how to wear the splint and will also show you exercises to maintain motion in the middle joint (the proximal interphalangeal joint) so your finger does not become stiff. Once your mallet finger has healed, your surgeon or hand therapist will teach you exercises to regain motion in the fingertip.

In children, mallet finger injuries may involve the cartilage that controls bone growth. The doctor must carefully evaluate and treat this injury in children so that the finger does not become stunted or deformed.

Surgical Treatment

Surgical repair may be considered when mallet finger injuries have large bone fragments or joint mal-alignment. In these cases, pins, wires or even small screws are used to secure the bone fragment and realign the joint (see Figure 4). Surgery may also be considered if splint wear is not feasible or if non-surgical treatment is not successful in restoring adequate finger extension. Surgical treatment of the damaged tendon can include tightening the stretched tendon tissue, using tendon grafts or even fusing the joint straight. Your surgeon will advise you on the best technique in your situation.

Orthopedic Sports Medicine Center of Oregon is located in Downtown Portland Oregon. Dr. Dominic Patillo, one of our Board-Certified Orthopedic Surgeons, specializes in hand surgery. His practice focuses on the treatment of both simple and complex hand and upper extremity conditions as well as general orthopaedic trauma. He is experienced with modern microsurgical techniques including nerve and vessel reconstruction.

Common problems treated include:

  • carpal tunnel syndrome
  • tennis elbow
  • wrist pain
  • sports injuries of the hand and wrist
  • fractures of the hand, wrist, and forearm
  • trigger finger

Other problems treated can include arthritis, nerve and tendon injuries, and congenital limb differences (birth defects).

If you have pain in your fingers, hand, wrist or arm, or if you have other upper-extremity related concerns, please consult our hand specialist Dr. Dominic Patillo for a consultation.

Osteoarthritis

How To Diagnose & Treat Osteoarthritis

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Desciption

Arthritis— which literally means “inflamed joint” — can affect any joint in the body, including the joints between the 29 bones of the wrist, hand, and fingers.   Arthritis of the hand can hurt and keep you from being able to do what you want or need to do. The most common forms of arthritis in the hand are osteoarthritis, post-traumatic arthritis (after an injury), and rheumatoid arthritis. Osteoarthritis is a degenerative joint disease in which the smooth cartilage that covers the bone surfaces at the joints either is injured or wears over time.

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Hand Infections

11 Common & Rare Hand Infections

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Description

Hand infections can cause severe problems that persist even after the infection has resolved, such as stiffness, loss of strength, and loss of tissues such as skin, nerve and bone.  Thus, early and aggressive treatment of infections is essential.  When seen early, some types of infection can be treated with antibiotics and local rest and soaking.  However, many infections begin to cause severe problems, after a day or two, if not treated with antibiotics, surgical drainage, and removal of infected tissues.  Any drainage or pus should be sent for laboratory testing to determine the type of bacteria causing the infection and the appropriate antibiotic for treatment.

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Extensor Tendon Injuries

Extensor Tendon Injuries

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Description

Extensor tendons are just under the skin. They lie next to the bone on the back of the hands and fingers and straighten the wrist, fingers and thumb (Figure 1). They can be injured by a minor cut or jamming a finger, which may cause the thin tendons to rip from their attachment to bone. If not treated, it may be hard to straighten one or more joints.

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Do I Need Carpal Tunnel Surgery

Do I Need Carpal Tunnel Surgery?

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Carpal Tunnel Syndrome

Carpal tunnel syndrome is a common condition that causes pain, numbness, and tingling in the hand and arm. The condition occurs when one of the major nerves to the hand — the median nerve — is squeezed or compressed as it travels through the wrist.

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Rheumatoid Arthritis

An Overview of Rheumatoid Arthritis

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What Is Rheumatoid Arthritis

In its most literal sense, arthritis means “inflamed joint.” Arthritis describes any condition where cartilage in the joint breaks down. Normal joints consist of two smooth, cartilage-covered bone surfaces that fit together as a matched set and glide against one other. Arthritis can result when these smooth surfaces become irregular as the cartilage breaks down and don’t fit well together anymore, essentially “wearing out.” Arthritis can affect any joint in the body, and it can be debilitating when it affects the hands and fingers.

Rheumatoid arthritis is one of the most common forms of arthritis in the hand, in addition to osteoarthritis and post-traumatic arthritis. Rheumatoid arthritis affects the cells that line and normally lubricate the joints (synovial tissue). This is a systemic condition (can affect the whole body), which means that it may affect multiple joints, usually on both sides of the body.

The joint lining (synovium) becomes inflamed and swollen and erodes the cartilage and bone. The swollen tissue may also stretch the surrounding ligaments, which are the connective tissues holding the bones together, resulting in deformity and instability. The inflammation may also spread to the tendons, which are the rope-like structures linking muscles to bones. This can result in fraying and eventual breaking of the tendons.

Rheumatoid arthritis of the hand is most common in the wrist and the finger knuckles (the MP and PIP joints (see Figure 1)).

Signs & Symptoms of Rheumatoid Arthritis

Stiffness, swelling and pain are symptoms common to all forms of arthritis in the hand. In rheumatoid arthritis, some joints may be more swollen than others. There is often a sausage-shaped swelling of the finger. Other symptoms of rheumatoid arthritis of the hand include:

  • A soft lump over the back of the hand that moves when straightening the fingers
  • A creaking sound during movement
  • Fingers shifting away from the direction of the thumb (see Figure 2)
  • Swelling and inflammation of the tendons that bend the fingers, resulting in clicking or triggering of the finger as it bends, sometimes causing numbness and tingling in the fingers (carpal tunnel syndrome)
  • Inability to straighten or bend certain fingers or the thumb
  • A bent middle finger (Boutonnière Deformity (see Figure 3))
  • An over-extended middle joint and bent fingertip (Swan-Neck Deformity (see Figure 3))

Diagnosis

Your doctor will examine you to determine whether you have similar symptoms in other joints and to assess the impact of the arthritis on your life and activities. The appearance of the hands and fingers helps to diagnose the type of arthritis. X-rays will show certain characteristics of rheumatoid arthritis such as narrowing of the joint space or erosions of the bone. If your doctor suspects rheumatoid arthritis, he or she may request blood or other lab tests to confirm the diagnosis.

Treatment

Rheumatoid arthritis is primarily treated with medication. Typically, medications for this condition are prescribed by your primary care provider or a rheumatologist.  Steroid injections are sometimes helpful, particularly when the condition is more active. Surgery may be needed to relieve pain or improve function during the course of the disease, but it is not needed in all cases of rheumatoid arthritis.

Article Featured on ASSH

Orthopedic Sports Medicine Center of Oregon is located in Downtown Portland Oregon. Dr. Dominic Patillo, one of our Board-Certified Orthopedic Surgeons, specializes in hand surgery. His practice focuses on the treatment of both simple and complex hand and upper extremity conditions as well as general orthopaedic trauma. He is experienced with modern microsurgical techniques including nerve and vessel reconstruction.

Common problems treated include:

  • carpal tunnel syndrome
  • tennis elbow
  • wrist pain
  • sports injuries of the hand and wrist
  • fractures of the hand, wrist, and forearm
  • trigger finger

Other problems treated can include arthritis, nerve and tendon injuries, and congenital limb differences (birth defects).

If you have pain in your fingers, hand, wrist or arm, or if you have other upper-extremity related concerns, please consult our hand specialist Dr. Dominic Patillo for a consultation.

Psoriatic Arthritis

What Is Psoriatic Arthritis & How Do You Treat It?

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What is Psoriatic Arthritis

Arthritis describes any condition where cartilage in the joint breaks down. Normally, a joint consists of two smooth, cartilage-covered bone surfaces that fit together as a matched set and glide against one other. Arthritis can result when these smooth surfaces become irregular as the cartilage breaks down. This results in surfaces that don’t fit well together anymore, essentially “wearing out.

Psoriatic arthritis is a condition in which the lining of the joint gets inflamed and swollen.  Because this inflammation stretches the tissues that keep the joint strong, the joint may become loose or crooked.  Also, the smooth ends of the bones wear out, and the bone may lose its normal shape.  Psoriatic arthritis can affect any joint in the body, and it affects men and women equally.

Psoriasis is a skin condition where people’s skin becomes dry, red, and flaky (Figure 1).  It can affect any part of the body. Up to 30% of people with psoriasis develop psoriatic arthritis, according to the National Psoriasis Foundation.

Arthritis can be debilitating when it affects the hands and fingers.  The most common forms of arthritis in the hand are osteoarthritis, post-traumatic arthritis (after an injury), and rheumatoid arthritis. Other causes of arthritis of the hand are infections, gout, and psoriasis.

The changes in the joints with psoriatic arthritis are a lot like those in rheumatoid arthritis. These symptoms can include:

  • Red and swollen joints
  • Joints that sometimes feel warm
  • Decreased joint motion and stiff-feeling joints

With this condition, the hands may not be affected equally.  It may be hard to tell psoriatic arthritis from other types of arthritis because most types of arthritis have symptoms of stiffness, swelling, and pain.  In psoriatic arthritis, the swelling often affects the whole finger but more at the middle joint (figure 2).  There may be pitting, ridging or crumbling of the fingernails.  The joint at the end of the finger may become deformed (figure 3).  Other parts of the hand and wrist are not usually affected.

Diagnosis

Psoriatic arthritis is suspected when people have psoriasis and develop problems with their joints.  The doctor will mainly look at and feel the hand and look at x-rays.  X-rays may show loss of the normal shape of the bone, mainly at the end joint.  X-rays may also show swelling around the bone, and the space between the bones may become narrow.  The bones may fuse together at a joint.  There is no special blood test to find out if one has this arthritis.  A piece of skin can be removed to help find out if a person has psoriasis.

Treatment

There is no cure for psoriatic arthritis, but there are medications available to help lessen swelling, redness, and pain to keep the hands functioning as well as possible.  Different medical specialists usually work together to help with the treatment of this arthritis, including physicians and therapists.

Surgery may help treat the problems of psoriatic arthritis.  The type of surgery needed depends on the problems one has with use and pain.  A hand surgeon will help guide you to the best treatment for your particular concerns.

Orthopedic Sports Medicine Center of Oregon is located in Downtown Portland Oregon. Dr. Dominic Patillo, one of our Board-Certified Orthopedic Surgeons, specializes in hand surgery. His practice focuses on the treatment of both simple and complex hand and upper extremity conditions as well as general orthopaedic trauma. He is experienced with modern microsurgical techniques including nerve and vessel reconstruction.

Common problems treated include:

  • carpal tunnel syndrome
  • tennis elbow
  • wrist pain
  • sports injuries of the hand and wrist
  • fractures of the hand, wrist, and forearm
  • trigger finger

Other problems treated can include arthritis, nerve and tendon injuries, and congenital limb differences (birth defects).

If you have pain in your fingers, hand, wrist or arm, or if you have other upper-extremity related concerns, please consult our hand specialist Dr. Dominic Patillo for a consultation.

Shoulder Fracture Treatments at Ortho Sports Med in Portland Oregon

Types of Shoulder Fractures

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Shoulder fractures can result from a fall on the shoulder, a motor vehicle accident, contact sports, etc.

The shoulder is a complex joint connecting the arm to the body. The shoulder bones include the humerus (upper arm bone), the scapula (shoulder blade) and the clavicle (collarbone) (Figure 1). The upper end of the humerus has a ball-like shape that connects with the socket of the scapula, called the glenoid. Disruption of any of the parts of the shoulder can create difficulty with its function.

Types of Shoulder Fractures

The type of fracture varies by age. Most fractures in children occur in the clavicle bone. In adults, the most common fracture is of the top part of the humerus (proximal humerus). Some types include:

  • Clavicle Fractures: This is the most common shoulder fracture, frequently the result of a fall (Figure 2).
  • Scapula Fractures: Fractures of this bone rarely occur. They usually result from high-energy trauma such as motor vehicle accidents or a far fall.
  • Proximal Humerus Fractures: Fractures of the upper part of the arm are more common in the older (over 65 years of age) population. Sometimes, there are just cracks in the bones, but they have not moved very far out of their normal position.

Some fractures are diagnosed using x-rays. Sometimes, a CT scan is needed to see more detail.

Treatment

Treatment for these fractures can vary. Some options include:

  • Simple sling or “figure 8” strap worn for three to eight weeks, depending on the patient’s pain.
  • Surgery, which may include placing plates and screws or wires and sutures (Figure 3). This is more often needed when there is injury to the glenoid (shoulder socket) or when broken bone pieces are severely out of place.

Once healed, there may be a bump over the fracture site which may decrease with time, but sometimes a bump will remain permanently. Shoulder movement can begin as soon as pain goes away; return to sports cannot occur until full shoulder strength returns. Return to contact sports would be considered only when the fracture is fully healed as shown on an x-ray.

Selection of treatment depends upon the patient’s activity level, the location of the fracture and the severity of the fracture.

Recovery

Shoulder fractures may leave a patient with permanent shoulder stiffness, regardless of how well the bones were repaired or joint replacement performed. Recovery may require the use of physical therapy to assist in improving motion and strength. Consult your physician for the best option.

Orthopedic Sports Medicine Center of Oregon is located in Downtown Portland Oregon. Dr. Dominic Patillo, one of our Board-Certified Orthopedic Surgeons, specializes in hand surgery. His practice focuses on the treatment of both simple and complex hand and upper extremity conditions as well as general orthopaedic trauma. He is experienced with modern microsurgical techniques including nerve and vessel reconstruction.

Common problems treated include:

  • carpal tunnel syndrome
  • tennis elbow
  • wrist pain
  • sports injuries of the hand and wrist
  • fractures of the hand, wrist, and forearm
  • trigger finger

Other problems treated can include arthritis, nerve and tendon injuries, and congenital limb differences (birth defects).

If you have pain in your fingers, hand, wrist or arm, or if you have other upper-extremity related concerns, please consult our hand specialist Dr. Dominic Patillo for a consultation.

Dr. Petit Presents at the Vail International Shoulder Summit

Dr. Petit Presents at the Vail International Shoulder Summit

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Dr. Petit gave lectures on complex shoulder replacement (arthroplasty) along with shoulder arthroscopy and biceps tenodesis to the international audience. Attendees included shoulder surgeons from around the world as well as physical therapists, athletic trainers, and primary care providers. Top shoulder surgeons from around the world making presentations during Summit at Sonnenalp Vail April 6th and 7th.

VAIL, Colo., April 6, 2018 – The latest and most up-to- date methods and technologies in shoulder surgery will be the primary topics of discussion at the Vail International Shoulder Summit on April 6th and 7th at the Sonnenalp Hotel in Vail. The Summit is sponsored by Steadman Philippon Research Institute (SPRI), with The Steadman Clinic’s own Peter Millett, MD, MSc serving as the primary host of the event.

The two-day session begins today, Friday, April 6th with SPRI clinical fellowship and International scholar alumni attending. The Summit continues Saturday the 7 th and is open to all orthopaedic surgeons, athletic trainers, physical therapists and professionals in orthopaedics and sports medicine.

Dr. Millett – who is a shoulder, knee and elbow specialist at The Steadman Clinic and has practiced sports medicine there since 2005 – looks forward to the variety of topics that will be discussed at the weekend’s Summit.

“The meeting is truly an international one with surgeons coming from all over the world to speak and present on their areas of expertise,” said Millett. “One of the benefits of the meeting is that, by design, there is ample time for discussion and one-on- one interaction between the presenters and the audience. It’s more like a think tank, incubator type of meeting than a convention, and that’s by intent.”

While Millett and SPRI have played host to numerous national and international conferences over the years that have focused on shoulder surgery and injuries related to the shoulder, this marks just the second time that they have included a day solely for returning alumni.

“Since so many of us know each other so well,” continued Millett, “it creates more openness and frank dialogue. This format allows us to be less reserved, more candid, and therefore more likely to get real advancements. It leads to some great discussion and helps us all learn more about the latest innovations in shoulder care.

“I think the venue in Vail really facilitates a lot of interaction, which no doubt creates a good cross-pollination of ideas,” added Millett. “Hopefully it not only serves as a forum where there is a lot of sharing of knowledge, but also spurs innovation.”

The Shoulder Summit begins Friday with presentations on the AC joint, bicep tendon, shoulder instability and rotator cuff tears. Saturday’s agenda includes segments on shoulder joint preservation and shoulder arthroplasty (total shoulder replacement surgery).

In addition to Millett, Burak Altintas, MD and Robert Boykin, MD will be serving as course directors for this year’s Shoulder Summit. Altintas, a German orthopaedic surgeon—originally from Turkey—is currently serving as an International scholar at SPRI, working closely with Millett and specializing in shoulder injuries and surgery. Boykin, who trained at Harvard, is a former sports medicine fellow at The Steadman Clinic and now practices as an orthopaedic surgeon in Asheville, N.C.

Other key presenters include The Steadman Clinic and SPRI’s own Matthew Provencher, MD and Johnny Huard, PhD. Provencher—a shoulder, knee and sports surgeon at The Steadman Clinic—will concentrate his talks on shoulder instability. Huard—Chief Scientific Officer and Director of the Center for Regenerative Sports Medicine at SPRI and recently named a recipient of the prestigious 2018 ORS (Orthopaedic Research Society) Kappa Delta Award—will talk about the use of biologics in the shoulder during Saturday morning’s discussion on shoulder preservation.

Treating Finger Fractures at Orthopedic Sports Medicine in Downtown Portland Oregon

Will I Need Surgery on My Broken Or Fractured Finger?

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Although the bones in the hand are small, a broken (fractured) finger is not a minor injury. The bones in a normal hand line up precisely. They let you perform many specialized functions, such as grasping a pen or manipulating small objects in your palm. When you fracture a finger bone, it can cause your whole hand to be out of alignment. Without treatment, your broken finger might stay stiff and painful.

Anatomy

Your hand consists of 27 bones: eight bones in your wrist (carpals), five bones in the palm of your hand (metacarpals), and 14 bones in your fingers (phalanges). Fractures of the metacarpal bone that leads to the little finger account for about one-third of all hand fractures in adults.

Cause

Generally, a fractured finger occurs as the result of an injury to the hand. You can fracture a finger when you slam your fingers in a door, when you put out your hand to break a fall, or when your finger jams while trying to catch a ball. Carelessness when working with power saws, drills, and other tools can result in a fractured finger.

Symptoms

  • Swelling of the fracture site
  • Tenderness at the fracture site
  • Bruising at the fracture site
  • Inability to move the injured finger in completely
  • Deformity of the injured finger

Doctor Examination

If you think you fractured your finger, immediately tell your doctor exactly what happened and when it happened. Your doctor must determine not only which bone you fractured, but also how the bone broke. Bones can break in several ways: straight across the bone, in a spiral, into several pieces, or shatter completely.

Your doctor may want to see how your fingers line up when you extend your hand or make a fist. Does any finger overlap its neighbor? Does the injured finger angle in the wrong direction? Does the injured finger look too short? Your doctor may x-ray both of your hands to compare the injured finger to the uninjured finger on your other hand.

Treatment

Nonsurgical Treatment

Your doctor will put your broken bone back into place, usually without surgery. You will get a splint or cast to hold your finger straight and protect it from further injury while it heals. Sometimes your doctor may splint the fingers next to the fractured one to provide additional support. Your doctor will tell you how long to wear the splint. Usually a splint on a fractured finger is worn for about 3 weeks. You may need more x-rays over this time so that your doctor can monitor the progress of your finger as it heals.

Surgical Treatment

Depending on the type and severity of the fracture, you may need surgery to put the bones into alignment. Small devices, such as pins, screws, or wire, will be used to hold your fractured bones together.

Rehabilitation

You may begin using your hand again as soon as your doctor determines it is okay to move your finger. Doing simple rehabilitation exercises each day will help reduce the finger’s stiffness and swelling. You may be required to see a physical therapist to assist you in these exercises.

Orthopedic Sports Medicine Center of Oregon is located in Downtown Portland Oregon. Dr. Dominic Patillo, one of our Board-Certified Orthopedic Surgeons, specializes in hand surgery. His practice focuses on the treatment of both simple and complex hand and upper extremity conditions as well as general orthopaedic trauma. He is experienced with modern microsurgical techniques including nerve and vessel reconstruction.

Common problems treated include:

  • carpal tunnel syndrome
  • tennis elbow
  • wrist pain
  • sports injuries of the hand and wrist
  • fractures of the hand, wrist, and forearm
  • trigger finger

Other problems treated can include arthritis, nerve and tendon injuries, and congenital limb differences (birth defects).

If you have pain in your fingers, hand, wrist or arm, or if you have other upper-extremity related concerns, please consult our hand specialist Dr. Dominic Patillo for a consultation.