Common Winter Fractures and Ice Safety

FractuWalking in Winterres (or broken bones) of the ankle and wrist are common injuriesduring the winter months. We thought it might be useful to review some of the common injuries that often require urgent treatment.

Wrist (Distal Radius)Fracture
A “Colles” (distal radius) fracture is a particular type of wrist fracture involving the distal radius. This very common fracture occurs with a fall on an outstretched hand, often breaking a fall. Diatal radial fractures also occur during skiing, snowboarding or other falls . This particular fracture type is relatively common and can often be treated in a cast. In our clinic, we can usually treat these with waterproof Goretex casting that allows the cast to get wet during the treatment process However, some cases of Colles’ fractures require surgical intervention when proper alignment is necessary. … read more

Does Your Shoulder Hurt at Night? It could be a Rotator Cuff Tear

Shoulder pain is common, but it is not normal.  Perhaps you have a rotator cuff tear?  How would you know? 

Here are a few questions may highlight common symptoms that are common to those with rotator cuff tears –

Have you recently injured your shoulder?
Do you have pain with overhead activities? 
Do you have shoulder pain at night? 
Does your shoulder feel weak?

Don’t worry, not all rotator cuff tears need surgery, but it is important to identify the particular source of your shoulder painbecause the particular treatment and rehabilitation can drastically reduce your suffering.

One note – there is no anatomic structure called the “Rotatory Cup”!  You are right, the spherical end of the humerus does rotate in the glenoid (cup), and is actually the most mobile joint in the body. However, the “Rotator Cuff” is not directly involved with the joint surface, so problems with your rotator cuff do not necessarily mean that you have shoulder arthritis.

Common demographics of a patient with a rotator cuff tear include age 30-60, a specific traumatic episode or chronic heavy use of the shoulder, specifically difficulty with overhead activity. Symptoms include pain and weakness with initiating activities about the shoulder, night pain, pain on the side of the shoulder radiating down the arm.  Symptoms that suggest another disorder include grinding shoulder or popping shoulder, shoulder dislocation, pain in the front of the shoulder, stiff shouder, numbness, neck pain.

Once again, shoulder pain is common, but not normal. Proper systematic evaluation is critical identify your particular diagnosis to lead you down a rational treatment pathway with maximal chance of success.

For an appointment, call 206-633-8100 or you can submit a question that I will answer here.

Finger Numbness at Night

Many people experience numbness that occurs at night or even persists throughout the day. There are many causes of such symptoms and if the problem is consistent and persistent, it is important to undergo an evaluation by someone trained in such conditions such as an upper extremity specialist. Usually, with a simple exam and occasionally an electrical study, the problem can be identified and often corrected.

One of the most common causes for such numbness the hand is Carpal Tunnel Syndrome. There is a wealth of information available on the subject, but not all is necessarily reputable or helpful. As carpal tunnel syndrome is one of the most frequent conditions that I see, I thought it would be worth preparing an informative article on the subject that can help my patients start the process of learning about Carpal Tunnel Syndrome here.

In short, Carpal Tunnel syndrome is a progressive compression of one of the major nerves of the hand that causes numbness in the thumb, index, middle, and half of the ring finger, along with weakness and clumsiness in hand function. The compression on the nerve starts out initially as a transient and reversible condition, but reliably progresses to permanent and irreversible nerve damage if left untreated for years.

Treatment starts with education and interventions such as splinting or injections, but if the compression persists and progresses, so far the only reliable way to relieve pressure permanently is to surgically release the Carpal Tunnel in a relatively minor day procedure that takes less than a half an hour. Patients can often work the next day if their work allows a soft dressing.

If you have Carpal Tunnel Syndrome or are simply interested in learning more, please contact me – I would consider it a privilege to help you learn more and will take the time necessary to help you understand your options. You can contact me by email here or by contacting my office at 206-633-8100.

I Broke My Wrist!

Ok, I didn’t break my wrist, but I treat many people who have sustained such an injury.  Due to the common nature of the injury, I have prepared answers to the common questions that arise in such situations.

Other common names:  Distal Radius Fracture, Fracture of the end of the Radius, Broken Wrist, Wrist Fracture

What is a Broken Wrist? 

Though there are 10 bones that make up the wrist, and each bone has the potential to fracture (medical term for broken bone), by far the most common broken bone in the wrist is a fracture of the end of the radius bone.

Typically, a patient sustains a broken wrist from one of two scenarios; one is that they were in an accident, or fell with such force on their hand that the otherwise normal wrist crushed under significant forces.  The second scenario involves one with less than ideal bone density who falls on an outstretched hand in a way that causes the bone to break.

The difference between the two is the difference in the quality of the bone and the amount of force required to break the bone. The distinction between the two mechanisms is significant as the patient with higher quality bone often has multiple injuries due to the significant force of the injury, and in the patient with poorer bone quality, a thorough bone quality investigation should be considered.

How are Fractures to the end of the Radius evaluated?

X-rays and a physical exam can usually give the information needed to evaluate a distal radius fracture. Occasionally, further imaging such as a CT or MRI may be considered, but this is rare.  In addition to the bone, there is certainly injury to the surrounding soft structures such as tendons, ligaments, muscles and nerves which will affect your outcome.

How is my broken wrist going to be treated? Do I need surgery?

Many factors go into deciding the best treatment for your wrist fracture, but typically I choose the treatment regimen which will allow the best recovery potential, both in the short term and in the long term. This usually initially involves an attempt at manipulating the fracture into the most ideal healing position and holding that position with a splint or cast.

If the wrist fracture falls into an unacceptable position for healing despite maximal non-operative care, then surgical intervention is considered. With experience, training and careful review of current research, I can often predict which fractures can be treated without surgery and which ones will need further surgical stabilization.

How long is the recovery from my broken wrist?

Most patients, regardless of the type of break, have very good long term results. Most fractures treated without surgery will require 6 weeks in a cast, and another 6 weeks to regain most of the strength that was lost. Distal Radius fractures which require surgical stabilization often only need 2 weeks of splinting, followed by 4 weeks of exercise to regain range of motion and another 6 weeks to regain strength.

Most patients are able to do most activities by three months after the injury, but individual circumstances certainly vary.

Educational Feature: Common Shoulder Injuries

Common shoulder injuries typically involve the muscles, ligaments and tendons – and rarely, fractured bones.

Repetitive, stressful sport activities as tennis, pitching, or weightlifting can weaken the shoulder and injure the ligaments.

Intensive training routines, involving excessive, repetitive overhead motion of the arm and shoulder, can over time cause shoulder instability and impingement, and a great deal of pain. … read more