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About Wayne Weil

Wayne Weil, MD Dr. Weil is a board-certified orthopedic surgeon who is well known in the community for his expertise in hand surgery. He sees patients with a wide variety of hand ailments, including carpal tunnel syndrome, cubital tunnel syndrome, dupuytren’s syndrome, thumb arthritis, wrist fractures, and more.

Hand Rejuvenation – New Trend with Women and Plastic Surgery

June is the quintessential month for weddings. The phrase “June Bride” is in our vernacular, conjuring up images of a beautiful bride, a handsome groom, family and a spectacular and exotic honeymoon.

Before the wedding takes place however, there is the all-important engagement photo shoot and for that, women throughout the country are acting on a new trend – plastic surgery for their hands, also known as hand rejuvenation or “handlifts” to show-off their beautiful diamond ring.

This new trend is rooted in today’s social media practice called the “selfie”. Newly engaged women are excited to show off the ring on their finger and post it in social media outlets like Facebook and Instagram. “Selfies” have made society more self conscious of their appearance including their hands. “Handlifts” have gone up 40% since the rise of social media.

According to Dr. Weil, “Next to our faces the hands are the most recognizable and exposed parts of the body. The hands are often forgotten when it comes to rejuvenation procedures. However, they are one of the first areas which are noticed by others, especially when there are years between the appearance of your face and hands. Just like our faces, our hands will show the signs of aging. In some cases our hands may even make us look older than we are. As we age our hands lose fat– along with collagen– which decreases the elasticity and leads to thinning of our skin. This can cause the skin to become loose and wrinkled and cause the veins and tendons of our hands to become more prominent. Today, however, Dermal Fillers (Juvederm, Restylane, Perlane, Radiesse, etc.) have become an excellent option for restoring the volume and smoothness that our youthful hands once had.”

Dr. Weil’s dermal filler of choice for hand rejuvenation is Juvederm Ultra XC. Juvederm Ultra XC works by restoring the volume of hyaluronic acid in your skin, helping to reduce wrinkles and smooth out folds. Hyaluronic Acid (HA) is a naturally occurring sugar found in the human body.

Hyaluronic acid creates volume in the skin by delivering nutrients and by holding in water, making sure the skin stays hydrated. Its function is very similar to that of a sponge–it soaks up and absorbs water–which in this case creates volume in the skin of your hands. Dr Weil goes on to say, “Think of hyaluronic acid as the body’s internal moisturizer!”

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Youthful hands have a fullness of the skin and subcutaneous tissues. The skin is soft and without wrinkles except for the natural lines seen over the finger joints and knuckles. Veins may be visible, but not obvious.
Hand2
Loss of skin thickness and volume in the tissues underneath the skin make the veins easily noticeable and unattractive.

Pigment changes and dark spots occur as a result of sun exposure. The thin skin becomes wrinkled and has far less elasticity.

Hand3
Hand rejuvenation with dermal fillers is an affordable, non-invasive way to treat volume loss and thinning of the skin that occurs with aging.

Using dermal fillers to restore the volume and smooth away wrinkles of the hands is a procedure with little discomfort and no downtime.

If you would like more information about hand rejuvenation, call Orthopedic Specialists of Seattle at (206) 633-8100 to schedule an appointment with Dr. Weil.

The 21st Century Thumb – Texting Can Lead to Thumb Arthritis

Texting Can Lead to Thumb ArthritisLet’s face it we’re all guilty of overusing the text feature of our cell phones! The 21st century thumb has been introduced to ranges of motion that are now being overused. Irregular motion of the thumb due to texting has presented new aches and pains that our bodies are not accustomed to performing.

Texting involves that our thumbs move at a higher frequency than normal and a higher frequency at which you may be texting with your thumbs causes an unnatural motion that may potentially lead to tendonitis or arthritis.

The texting thumb usually refers to the “trigger thumb” – The constriction of a flexor tendon in the thumb, which may result from repetitive gripping motions such as texting or holding a smartphone. Its symptoms include painful popping or snapping when the thumb bends and straightens; sometimes the thumb even becomes locked in a curled position.

Cortisone injections to treat the thumb eliminates the pain and restore mobility 80 to 85 percent of the time; in more severe cases, a brief surgical procedure may be required to release the pulley at the base of the thumb so that the tendon can move more easily. If you have thumb pain or stiffness that seems to worsen with use of a smartphone, change the way you use your phone and hold your phone with the hand you use less frequently or type messages with your index finger to give your thumbs a rest.

Dr. Wayne Weil at OSS frequently diagnoses and treats trigger finger. In mild cases, splints to rest the finger, or over-the-counter pain medications and/or corticosteroid injections may be recommended. Injections are less likely to provide permanent relief when a person has experienced trigger finger for a long time, or if there is an associated medical problem such as diabetes. Surgical treatment may be recommended for more severe cases.

If the finger is stuck in a bent position, or if the symptoms are severe, surgery may be the best course of treatment. Surgery’s goal is to widen the opening of the tunnel so that the tendon can slide through it more easily. It’s usually an outpatient surgery performed through a small incision. Dr. Weil frequently performs surgery for patients with trigger finger at OSS’ on-site surgery center.

According to Dr. Weil, “The modern day thumb is required to perform an incredible amount of repetitive activities with use of computers, cell phones and gaming systems. This can lead to significant tendonitis and inflammation of the thumb flexor and extensor tendons. If not adequately treated conditions such as trigger finger and de Quervain’s tendonitis can compromise the ability to perform activities of daily living. I often see patients with these conditions and if caught early can treat them with hand therapy, activity modifications, cortisone injections and sometimes surgery.”

Thumb arthritis – Arthritis of the carpometacarpal joint, where the thumb connects to the wrist is also sometimes called “texting thumb” where forceful pinching motions occur when gripping your phone or texting with your thumbs may lead to more severe symptoms. This condition requires rest and treatment to alleviate the pain and restore mobility. Treatments may include splints and cortisone injections. Patients with persistent symptoms may need a procedure called carpometacarpal arthroplasty, in which a surgeon removes part or all of the arthritic trapezium bone to relieve pain and improve function.

If you believe you are suffering from a hand-related injury and need specialized orthopedic care, Orthopedic Specialists of Seattle provide excellent treatment options available for you. Please feel free to contact OSS at (206) 633-8100 to schedule an appointment.

Carpal Tunnel Syndrome Article

Dr. Wayne Weil is a board-certified orthopedic surgeon who is well known in the community for his expertise in hand surgery. He sees patients with a wide variety of hand ailments, including carpal tunnel syndrome, cubital tunnel syndrome, dupuytren’s syndrome, thumb arthritis, wrist fractures, and more.

Below is an article written in the New York times that he would like to share with you regarding carpal tunnel syndrome.

Carpal Tunnel Syndrome Article

Wrist and Hand Injuries From Bike Falls

I have always enjoyed cycling. There is something about grinding your way up a steady incline for a mile or greater and then riding over the hillcrest to claim your reward. Turning all the responsibility of propelling the bike over to gravity is one of those great feelings that only vigorous exercise can produce.

Here in Seattle, we have great opportunities for cycling, whether for fitness or just getting around the city. Seattle offers numerous roadways with bicycle lanes as well as separate bike paths for those who wish to stay clear of automobile traffic. Because of the popularity with riding in and around the city as well as on mountain trails, I do tend to see numerous wrist and hand injuries during the warmer months from bicycle falls.

The natural reaction when one falls off of or is thrown from a bike is to break the fall with their arms, and is the most common mechanism of injury. The impact of falling on an outstretched hand can cause several different types of injury that we will discuss.

Fractures

The impact of falling on an outstretched hand can be several times an individual’s body weight, leading to broken bones. In fact, 20% of all upper extremity injuries caused by bicycle falls are fractures.

Wrist Fracture

One of the most common fractures is of the distal radius, the large bone of the forearm that articulates with the smaller carpal bones in the wrist. The break will often lead to pain in the forearm, approximately one inch away from the wrist.

More severe breaks could show some deformity if the bones are displaced, which will likely cause the rider to seek immediate medical attention; however, it is important to know that the blood vessels and nerves that supply the hand are funneled into a fairly compressed area in the wrist, and a fracture or the subsequent swelling that occurs could disrupt this neurovascular integrity.

These symptoms include numbness or tingling, discoloration, and temperature change in the hand. Most bike injuries happen over the weekend, when your doctor’s office is closed. If this is the case and you have any of the above symptoms, then you should go to the emergency room. Even without these symptoms, it is important to get evaluated by a hand surgeon soon after the injury occurs in order to initiate treatment.

Wrist fractures, if non-displaced, may be treated with immobilization in a cast; however, any misalignment may cause a loss of function in the wrist and is difficult to correct without surgical fixation. Screws and plates may be placed internally, or a device called an external fixator may be placed to hold the fracture in place.

Scaphoid Fracture

The scaphoid is a small bone located in the wrist, at the base of the thumb. When a bike rider falls on an outstretched hand, the scaphoid is compressed and could fracture. The primary symptoms are acute pain and tenderness on the thumb side of the wrist lasting longer than a few days, swelling, and limited thumb function. Diagnosis is usually confirmed with X-ray; however, this type of fracture often will not be visible on X-ray until a week after the injury. In this case, I will splint the patient’s hand and have them return in one week for a repeat exam.

If the fracture is located further toward the thumb, then the treatment may be immobilization in a short arm cast for several weeks. If the bone is fractured more toward the forearm, surgical treatment may be necessary as the scaphoid has poor blood supply in this area.

Surgical treatment consists of placing a small screw or wire through the bone fragments to create proper alignment. In some cases where the scaphoid has broken into several pieces, a bone graft taken from another part of the patient’s body may be used to stimulate healing. In all cases, there will be a period of immobilization and limited activity, followed by physical or occupational therapy by one of our therapists that specialize in hand rehabilitation.

Wrist and Finger Sprains

A sprain occurs when a ligament holding one bone to another bone at a joint is torn, either partially or completely. With a fall from a bike, the ligaments most likely to be torn are on the palm side of the wrist and where the fingers meet the hand. Again, this is due to the extreme backward bending (extension) of the wrist and fingers as one tries to break their fall with the arms. Pain and swelling in the affected joint are likely, but should start to subside after a few days. If pain is severe or persistent, you should see a doctor in order to rule out a fracture.

Treatment for wrist sprains could be as simple as careful observation over several weeks or splinting and activity modification to allow the ligament to heal. In severe cases, surgical reconstruction using tendon grafts may be necessary to restore optimal function.

Not all bike falls will be avoided, but there are a few things that we can do as riders to prevent injuring ourselves:

  • Being aware of your surroundings is paramount, which includes being able to hear approaching vehicles from the rear. Avoid listening to music when sharing the road with motorists.
  • When cycling with others, break up your party into groups of no more than 3 riders in line. This will help avoid a driver from squeezing you off the road in the presence of oncoming traffic.
  • Mountain bikers may want to reconnoiter a new obstacle or downhill challenge prior to attempting it at full speed.
  • Wear padded gloves to avoid skin abrasions on the hands if you fall. They also protect against nerve compression in the wrists.

The FAQ’s on Thumb Arthritis

Try this experiment. On your dominant arm, take a piece of masking tape and strap your thumb to the side of your hand. Then leave it in place for a few hours as you try to go about your normal activities. You will soon find out just how integral this appendage is to getting through the day. Answering your cell phone, grabbing the coffee creamer from the refrigerator, turning the key to unlock the front door, are all activities that depend on proper functioning of your thumb.

Recreational activities such as golf or tennis – forget it. Now, if you have arthritis in the thumb joints, then this experiment does not end after only a few hours. It keeps going until treated medically by a qualified hand surgeon.

Degenerative arthritis of the thumb is one of the most common types of hand arthritis. It usually strikes at the base of the thumb where it meets the wrist. This joint, known as the carpometacarpal (CMC) joint, is a highly mobile joint that allows motion in all directions. It is also the joint that allows for a strong pinching motion.

However, because of its wide range of mobility, the bones that comprise the CMC joint must give up some stability, similar to the shoulder joint. Because of this, the ligaments around the joint are forced to bear most of the burden of stabilizing the thumb during hand use, and if they are unable to do it effectively then the aberrant motion in the joint over time can contribute to arthritis.

Diagnosis

The bones of the body at the joint surfaces are covered with cartilage, a slippery coating that allows smooth motion at the joints. Arthritis is an inflammation and eventual wearing away of the cartilage, creating rougher surfaces and painful motion. In my practice, arthritis of the thumb is a common occurrence with a straightforward diagnosis. Palpation of the joint as the patient moves the thumb will often reveal the typical grinding sensation as if the joint surfaces were lined with sandpaper. There also may be an audible grinding sound known as crepitus. I may also order an X-ray to confirm the extent of the arthritis and determine the most effective treatment options. Other tests such as the CT scan or MRI are most often unnecessary.

Treatment

In the earlier stages of the disease process, this type of arthritis is usually treated with anti-inflammatory medication. This is often successful for months to years, allowing the individual to fully use the hand at home and work. Thumb splinting may also be advantageous as it allows the thumb to rest in a neutral position where mechanical stress is at its least, which in turn may settle the inflammation.

However, arthritis is a generally a progressive condition and because the thumb is used so frequently and strenuously, the disease often progresses despite these measures. As more conservative treatments fail to provide adequate relief, I will attempt to reduce the joint inflammation with one or more cortisone injections to the affected joint.

In the later stages of arthritis, as more and more hand function is lost, surgical reconstruction is often the best course of action. Part of the diseased joint is removed and reconstructed using a tendon graft from another part of your body. Following surgery, you will have to wear a splint for several weeks to allow the surgical repair to strengthen. If your occupation depends upon heavy use of your hands, then you may need to be out of work during this time if you are not able to find restricted duty work.

It is important to factor this into your overall planning prior to surgery. After removal of the splint, occupational or physical therapy with a therapist who specializes in rehabilitation of the hand will be prescribed. This will help you regain strength and motion and allow you to fully utilize the thumb and hand.

If you believe you are suffering from degenerative arthritis of the thumb and need specialized orthopedic care, Orthopedic Specialists of Seattle has excellent treatment options available for you.