Nearly 1.5 million Americans were treated for addiction to prescription opioids or heroin in 2015, according to federal estimates, and when those people get seriously hurt or need surgery, it’s often not clear, even to many doctors, how to safely manage their pain. For some former addicts, what begins as pain relief ends in tragedy.
Max Baker is one such case. He started using prescription pain pills as a teenager in New England and quickly moved on to heroin. His father, Dr. James Baker, is a physician in the Worcester, Mass., area, and says he saw signs that his son was high on opioids — in Max’s pupils and skin tone. He begged Max to stop.
“He would have slurred speech, and be nodding off at the dinner table, and we’d go to a concert together and he would disappear and come back acting differently,” James Baker says.
It was a long, painful slog, but Max eventually sought help. When he was 22, he was prescribed an opioid called suboxone, a standard relapse prevention drug that helps wean people off opioids. After a year, he’d worked his way off that medication, too.
Tendon transfer surgery is a procedure during which a tendon is shifted from its original attachment to a new one (see figure above). There are many reasons that this procedure may be necessary. Your hand surgeon will determine if this is the right surgery for you. Here are four potential reasons for tendon transfer surgery:
- Nerve Injuries: If a nerve is injured and cannot be repaired, it no longer sends signals to certain muscles, which paralyzes those muscles. This surgery can make those muscles work again. An example of this is a spinal cord injury.
- Muscle Injuries: If a muscle has been cut or broken and cannot be repaired, this surgery can help. A tendon can rupture due to something like Rheumatoid Arthritis.
- Disorder of the Nervous System: Sometimes, a disease may prevent nerve signals from being sent to muscles. Examples are cerebral palsy and a stroke. Tendon transfer surgery may help.
- Birth Defects: Sometimes, babies are born without certain muscle functions, and this surgery may bring back function.
Joint replacement surgery is a procedure in which bone and structures that line the joint are removed and replaced with new parts. This procedure is necessary when the articular cartilage (the substance on the surface of a bone) wears out or is damaged, which means the bones will no longer glide smoothly against one another. It may also stem from abnormal joint fluid.
The new parts may be made of metal, plastic, or materials that are carbon-coated. They allow the joints to move again without pain, increase range of motion, and can improve the look of the joints. Finger joints, knuckle joints, and wrist joints are commonly replaced.
After joint replacement surgery, you will most likely work with a hand therapist and could possibly wear a splint. However, with this procedure, there are always risks. There could be an infection, or the implant could fail, causing more joint pain. The implant could also wear out over time, resulting in the need for another surgery. In addition, vessels, nerves or other structures near the surgery site could be damaged. Talk to your doctor about the risks of joint replacement surgery before agreeing to the procedure.
The wrist joints lie between the many different bones in the wrist and forearm. Many wrist injuries (such as fractures, also known as a broken bone) involve the joint surface. There are three joints in the wrist:
- Radiocarpal joint: This joint is where the radius, one of the forearm bones, joins with the first row of wrist bones (scaphoid, lunate, and triquetrum).
- Ulnocarpal joint: This joint is where the ulna, one of the forearm bones, joins with the lunate and triquetrum wrist bones. This joint is commonly injured when you sprain your wrist. Some people are born with (or develop) an ulna that is longer than the radius, which can cause stress and pain on the joint, known as ulnocarpal abutment (impaction) syndrome.
- Distal radioulnar joint: This joint is where the two forearm bones connect. Pain with this joint can sometimes be a challenging problem to treat.
Learn more about the joints of the wrist and also the bones of the wrist in our Anatomy section. You can also visit www.HandCare.org for information on conditions and injuries of the hand, wrist, arm and shoulder.
Dr. David J. Bozentka answers your questions about MP joint arthritis.
What is the MP joint?
The metacarpophalangeal (MP) joint is the large knuckle joint located where the fingers and thumb meet the hand (Figure 1). The metacarpal bones lie within the palm and the phalanges lie within the digits. The metacarpal head, or ball part of the MP joint, meets with the proximal phalanx which makes up the socket part of the joint. The bones on each side of the joint have a cartilage surface that allows smooth gliding. Multiple tendons cross this joint. Flexor tendons and small additional tendons in the hand promote flexion, or bending. The extensor tendons promote extension, or straightening, of the joint. A collateral ligament on each side of the joint provides stability for a pinching motion. The bones, ligaments, and tendons of the MP joint allow motion and stability for optimal hand function.
from The Guardian
“Life drawing”, “still life” and “life class” are all fairly mundane terms I thought only applied to nude figures or fruit bowls in an art studio. However, in November, I stood and drew in the corner of a plastic surgeon’s theatre in Lalgadh hospital, near Janakpur in Nepal. The theatre was set up to operate on the paralysed hands of leprosy patients. “Life drawing” became very appropriate very quickly.
Like many infectious diseases that predominantly affect those in poverty, leprosy is alive and well; there were more than 200,000 new cases were reported in 2015. The sad fact is that the disease is difficult to contract and relatively straightforward to treat. Many patients present late, when paralysis sets in. Although medication can make patients non-infective, the paralysis requires surgery to correct.
Each year, Working Hands – a Bristol-based charity run by hand surgeon Donald Sammut – spends two weeks, pro bono, operating on the backlog of patients in Lalgadh, training staff and providing hundreds of kilos of medical equipment and consumables. The work is highly skilled, but in many cases the objective is simple: to generate enough movement and power in a hand for the patient to go back to work, or to eat, or to look after themselves in a society where stigma is attached to those with the disease. Most of these patients are illiterate farmers whose only means of support depends on how much they can dig, or carry.
Hand infections can cause serious problems and symptoms, both before and after the infection is resolved. They can result in stiff hands, weak hands, and loss of tissues such as skin, nerve and bone. It is important to visit a hand surgeon immediately and get early treatment if you have signs of one of these hand infections:
1. Atypical Mycobacterial Infection: This infection can result from puncture wounds from fish spines or contamination of a wound or cut from stagnant water (in nature or from aquariums). It will come on gradually, and you may feel stiffness and swelling.
2. Bite Wound Infection: This can be caused by a human or animal bite due to bacteria in the mouth. Seek treatment immediately after a bite wound.
3. Cellulitis: This is a skin infection that can cause skin redness, warmth, and pain. People with cellulitis may have a fever or feel sick. Seek treatment immediately, as this infection can cause serious problems.
4. Deep Space Infection: One of the compartments or “deep spaces” of the hand can become infected even from a small puncture. A pocket of puss may form at the base of the thumb, on the palm, or between the fingers.