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Wednesday, November 25, 2015

Help others by Participating in Dupuytren's research

Participate in Dupuytren's research

The International Dupuytren Data Bank is now live.
Independent. Crowdsourced. Massive. Free.
The biggest Dupuytren research study ever.
If you have Dupuytren disease, enroll now at 

Dupuytren Nodules
Dupuytren Knuckle Pads
Dupuytren Cord
Dupuytren Contracture

Friday, July 17, 2015

Firecracker or Fireworks Injuries

Firecracker or Fireworks Injuries

With all the recent media attention on Fire works HAND injury it important to review safety tips and to remind the public that this is not a new problem. The ASSH, State Fire Marshalls, Public officlals and Health Care Personnel have been advocating for Fireworks Safety for years to try to  prevent these injuries.

According to the Consumer Product Safety Commission, national losses involving fireworks amount to 3 deaths and 10,527 injuries annually.  Hand and finger injuries are the most common and account for 32 percent of all injuries. Head and eye injuries occur with about the same frequency, equaling 19 and 18 percent of total injuries.
Furthermore recent data from the U.S. Consumer Product Safety Commission,revealed that 50% of all reported fireworks-related injuries from June 17-July 17, 2011,  were to fingers, hands, and arms. These injuries included burns, lacerations, fractures, and traumatic amputation.
2013 Report Data reveals In 2013, there were eight deaths and an estimated 11,400 consumers who sustained injuries related to fireworks. This is an increase from 8,700 injuries in 2012. Sixty-five percent, or 7,400, of the injuries in 2013 occurred in the 30 days surrounding July 4, 2013. CPSC staff reviewed fireworks incident reports from hospital emergency rooms, death certificate files, news clippings and other sources to estimate deaths, injuries and incident scenarios. Injuries were frequently the result of the user playing with lit fireworks or igniting fireworks while holding the device. Consumers also reported injuries related to devices that malfunctioned or devices that did not work as expected, including injuries due to errant flight paths, devices that tipped over and blowouts.
Of the finger, hand, and arm injuries, the majority of injuries were caused from accidents involving firecrackers, bottle rockets, and sparklers— the three firework-types most often used in a backyard environment. Accidents involving firecrackers, bottle rockets, and hand-held sparklers totaled 57% of all firework injuries (source: American Pyrotechnic Association).
A review of firework mishaps shows a variety of factors contribute to the typical mishap. Most pre-school age victims are injured by fireworks ignited by someone else, while older children who are injured are usually lighting the fireworks themselves. Children under age five are commonly hurt by rocket-type fireworks; small firecrackers and ground spinners injure the majority of children between the ages of 5 and 14. Most of the injuries associated with large, illegal firecrackers such as M-80's are to older teenagers or adults.

For more information concerning fireworks safety click here.

Wednesday, July 8, 2015

Dupuytren's Disease new VIDEO UPDATE

Dupuytren's Disease

A brief video  which highlights various stages of untreated Dupuytren's. NOTE: having a small bump or nodule or even a small cord DOES NOT MEAN that this will progress. MANY DO NOT PROGRESS. This video is a composite of many patients. READ ON FOR MORE INFORMATION and for explanation of these terms.

Dupuytren's Disease

What is Dupuytren's disease?

Dupuytren’s disease is an abnormal thickening of the tissue just beneath the skin known as fascia. This thickening occurs in the palm and can extend into the fingers (see Figure 1). Firm cords and lumps may develop that can cause the fingers to bend into the palm (see Figure 2), in which case it is described as Dupuytren’s contracture. Although the skin may become involved in the process, the deeper structures—such as the tendons—are not directly involved. Occasionally, the disease will cause thickening on top of the finger knuckles (knuckle pads), or nodules or cords within the soles of the feet (plantar fibromatosis).  Dupuytren's Disease is named after a French anatomist and military surgeon Baron Guillaume Dupuytren(1777-1835).

What causes Dupuytren's disease?

The cause of Dupuytren’s disease is unknown but may be associated with certain biochemical factors within the involved fascia. The problem is more common in men over age 40 and in people of northern European descent. There is no proven evidence that hand injuries or specific occupational exposures lead to a higher risk of developing Dupuytren’s disease.

What are the symptoms and signs of Dupuytren's disease?

Symptoms of Dupuytren’s disease usually include lumps and pits within the palm. The lumps are generally firm and adherent to the skin. Thick cords may develop, extending from the palm into one or more fingers, with the ring and little fingers most commonly affected. These cords may be mistaken for tendons, but they actually lie between the skin and the tendons. These cords cause bending or contractures of the fingers. In many cases, both hands are affected, although the degree of involvement may vary.

The initial nodules may produce discomfort that usually resolves, but Dupuytren’s disease is not typically painful. The disease may first be noticed because of difficulty placing the hand flat on an even surface, such as a tabletop (see Figure 3). As the fingers are drawn into the palm, one may notice increasing difficulty with activities such as washing, wearing gloves, shaking hands, and putting hands into pockets.  Progression is unpredictable. Some individuals will have only small lumps or cords while others will develop severely bent fingers. More severe disease often occurs with an earlier age of onset.

What are the treatment options for Dupuytren's disease?

In mild cases especially if hand function is not affected, only observation is needed.
For more severe cases various  techniques are available in order to straighten the finger(s). Your treating surgeon will discuss the method most appropriate for your condition based upon the stage of the disease and the joints involved. The goal of any treatment is to improve finger position and thereby hand function. Despite  treatment the disease process may recur. Before treatment, your doctor should discuss realistic goals and results.
Types of treatment may include Needle Aponeurotomy, Partial or Complete Fasciectomy, and limited release as well as on Collagenase injections or cortisone injection in a nodule.  The rationale behind each treatment depends upon the treating physician and the patient.
Surgical Fasciectomy (Partial or Complete) uses open incisions and the cords and nodules are removed
Incisonal Aponeurotomy or Fasciotomy uses small incisions  or portals and the cords are released or perforated
Needle Aponeurotomy  (NA) or Percutaneous Aponeurotomy (PA) or Percutanoeous Needle Fasciotomy (PNF)
Needle aponeurotomy uses a small gauge needle or a microblade as a cutting device to sever the abnormal cords of tissue in the palm and digits which cause the fingers to flex down.  The tissue is not removed it is essentially perforated or cut in multiple places along the palm  to release the contracture (see figure 3) Incisional aponeurotomy fasciotomy is done in some instances.
Collagenase Injection (Xiaflex)
Collagenase is an enzyme that digest collagen a structural protein in tissues.  Xiafllex is a collagenase derived  from the bacteria Clostridium Histolyticum.  Xiaflex is a mixture of several types of collagenase, titrated to achieve digestion of  tissue or cords that are present in the hands  of those who have Dupuytren's disease. (Figure 4)
Corticosteroid Injection (cortisone shot)
When a steroid or cortisone injection  is given to the palm, in a nodule or small cord  it will often soften the cord. There are studies that state that this may limit progression of the disease While there have been no large scale prospective double blinded studies or dose dependent studies many surgeons now will attempt to inject a nodule or soft cord that is not ready for surgery in an attempt to treat it.

IMPORTANT considerations:

  1. The presence of a lump in the palm does not mean that surgery  or treatment is required or that the disease will progress.
  2. Correction of finger position is best accomplished with milder contractures and contractures that affect the base of the finger. Complete correction sometimes can not be attained, especially of the middle and end joints in the finger. no matter what method is used.
  3. Skin grafts are sometimes required to cover open areas in the fingers if the skin is deficient during open fasciectomy or open removal of cord tissue..
  4. The nerves that provide feeling to the fingertips are often intertwined with the cords and may be affected by any treatment
  5. Splinting and hand therapy are often required after surgery  or other treatment procedures in order to maximize and maintain the improvement in finger position and function.
  6. All treatments for Dupuytren's may involve the risk of tendon, nerve, joint, skin: injury, infection, and stiffness. as well other conditions that may negatively affect the result.
Figure 1: Dupuytrens disease may present as a small lump, pit, or thickened cord in the palm of the hand
Figure 2: In advanced cases, a cord may extend into the finger and bend it into the palm
Figure 3: In Needle Aponeurotomy, a cord may be released or perforated without the need for standard incisions.
Figure 4: Xiaflex is a collagenase, a drug that is injected into a cord  to dissolve a small segment of that cord, to treat the contracture.
These pictures are before and one day after injection  (just after manipulation). Xiaflex  treatment requires that a manipulation take place the next day
*Based on Phase I clinical trials, collagenase injections work better for metacarpophalangeal (MP) joint contractures than for proximal interphalangeal (PIP) joint contractures, and for lower severity contractures than for higher severity contractures.
*Ideally, patients for collagenase injection should have a well-defined, palpable cord, ideally one that is strung away from the flexor tendon system. The worst patient is probably someone who has a small finger IP contracture that’s more than 50 degrees and has been there for 5 or 10 years. Collagenase can only affect the cord itself; it won’t be able to act on the secondary tissues that have changed. *(source; http://www.aaos.org/news/aaosnow/oct10/clinical2.asp)
portions © 2009 American Society for Surgery of the Hand. Developed by the ASSH Public Education Committee
  dupuytrens pdf from assh
taken modified from ASSH and other sources including AAOS by www.handctr.com
XIAFLEX® is a registered trademark of Auxilium Pharmaceuticals, Inc. 0510-013.c
WARNING: THE INFORMATION offered in links from this page IS TAKEN FROM pages that include AN AUXILIUM SPONSOREDSITE BY WWW.HANDCTR.COM for PATIENT EDUCATION way to offermore information from its  DUPUYTREN'S DISEASE UPDATE WEB PAGE. It is meant only as a starting point for education does not represent medical advice or the opinion of handctr.com. It is manufacturers information and may also not be current. In addition  all content may be subject to  previous copyright, warnings and disclaimers t at its sources.  THE HAND CENTER OF WESTERN MASSACHISETTS HAS NO FINANCIAL RELATIONSHIP WITH AUXILIUM AND IS NOT INTENDING TO REPRESENT ITSELF AS AUXILIUM. THE SOLE PURPOSE OF PRVODING THIS IS FOR INFORMATION ONLY . ANY AND ALL DECISONS SHOULD BE MADE BY AN INFORMED PERSON IN CONJUCTION WITHTHEIR HEALTH CARE PROVIDER(s)

Thursday, June 11, 2015


Applying heat or ice is a common method for treating injuries, stiffness, swelling and pain.When used for fingers, hands and wrists, it can be very helpful for:

  • Recent injuries (bruises or fractures) or chronic injuries
  • Swelling
  • Stiffness
  • Irritation

Benefits of Heat Treatments

Heat or warmth will help get things moving by speeding up the molecules in tissues and increasing blood flow. Heat is helpful for stiff joints and muscles, and can be useful prior to an activity. We often see an athlete warming up before a workout.

A warm shower or bath can help sore, stiff joints, especially in the early morning. A warm compress or heating pad can also relieve stiffness (Figure 1); however, too much heat could cause fainting, swelling, or burns to skin and tissues, so use heat treatments with moderation.

Benefits of Ice Treatments

If there is pain, swelling and irritation after an activity, ice treatments can reduce these symptoms. Cold slows down the molecules in tissues and reduces blood flow.

The most common cold treatments are ice or something that has been made cold by placing it in the freezer, such as a gel pack (Figure 2). Apply ice for 15 minutes, then allow a 15-minute rest before reapplying.

As with heat, too much cold can slow down and stiffen sore joints, so use this treatment with moderation. Applying ice or anything extremely cold to bare skin can cause injury.Always wrap the source of cold in some sort of fabric. If a bandage or splint is too thick and the cold is not getting through, apply the cold near the area on exposed skin. Stop using ice if you feel extreme pain or numbness due to the cold.

Special Treatments

Some special and more advanced heat or ice treatments may be used under the supervision of a therapist or physician. Some options may include:
  • Therapeutic ultrasound: A qualified therapist will use ultrasound to slowly heat deeper tissues to help motion.
  • Contrast bath: This is a bath that involves alternating heat and cold.
  • Paraffin or warm wax: This can be used to apply heat via machines that are highly regulated and use a wax mixture that avoids skin burns.
Use caution when implementing ice or heat treatments. Monitor time and the condition of your skin, and always test the hot or cold item before applying. Contact your physician or therapist for assistance.
© 2014 American Society for Surgery of the Hand

A blue reusable soft gel-filled cold and hot pack to relieve pain inside a fabric pouch

Close-up Of Hand Holding Ice Gel Pack On Elbow

Monday, April 27, 2015


help us to promote

Lawnmower Safety

These Injuries can be devastating to the hand ...or any part of the body that is involved.
  • 22% of injuries involve the hand, fingers or wrist.  25% of which result in amputation

  • Lawnmowers should be considered potentially lethal in the hands of children.

  • Children under age 6 should be inside when the lawn is being mowed.

  • Children under age 12 should not be allowed to go near a power lawnmower and should be at least 16 before using a riding mower.

  • Safety training is essential always.



Keep Your Hands Safe: Follow Lawnmower Safety Tips

Each year, more than 74,000 small children, adolescents and adults are injured by rotary, hand and riding power mowers due to improper handling. The American Society for Surgery of the Hand would like to provide you with patient information to help you avoid these injuries.
Kinetics of Rotary Power LawnmowersKinetic energy (motion) imparted by a standard rotary blade is comparable to the energy generated by dropping a 21-pound weight from a height of 100 feet or is equal to three times the muzzle energy of a .357 Magnum pistol. Blade speed can eject a piece of wire or an object at speeds up to 100 miles per hour.
Injury Profile
Adults 25-64 years
Children under age five
22% involve wrist, hand or finger
14% involve foot, ankle or toes
25% of all hand and foot injuries result in amputation
Deaths occurred in children under six years of age
Common Injury Patterns
  • Direct contact with rotating or jammed blade
  • Serious avulsion (tearing/separating) injuries to soft tissue and bones
  • Gross contamination from contact with grass and soil harboring pathogens
  • Injuries requiring multiple staged surgeries to cleanse wounds and provide soft tissue coverage (to regenerate healthy tissue/skin)
Common Weather Conditions
  • Wet grass
  • Damp ground
Other Causes of Injury
  • Passengers (adult/child) on riding mowers or in cart towed behind mower
  • Mower being pulled backward
  • Sloping lawn mowed by power mower up and down slope, instead of across
  • Sloping lawn mowed by riding mower across slope, instead of up and down
  • Wearing sandals or open-toed shoes
  • Operator attempts to unclog blades with hand or foot
Lawnmowers are safe if used properly.
Remember the following:
  • Read your mower's instruction manual prior to use.
  • DO NOT REMOVE safety devices or guards on switches.
  • NEVER insert hands or feet into the mower to remove grass or debris. Even with the motor turned off, the blade remains engaged.
  • ALWAYS use a stick or broom handle to remove any obstruction.
  • NEVER cut grass when it is wet or when the ground is damp.
  • NEVER allow a child to operate the mower at any time or be in the area to be mowed.
  • NEVER allow passengers, other than the operator, on riding mowers.
  • Keep your mower in good working order with sharp blades.
  • DO NOT DRINK before or while using your lawnmower.
  • Wear protective boots, goggles, gloves and long pants.
  • Do not operate the lawnmower while barefoot.
  • Be cautious when mowing hills or slopes.
Copyright © American Society for Surgery of the Hand 2009.

2008 AAOS Position Statement taken from AAOS website by www.handctr.com 

Power Lawnmower Safety.
This Position Statement was developed as an educational tool based on the opinion of the authors. It is not a product
of a systematic review. Readers are encouraged to consider the information presented and reach their own
More than 210,000 people – including approximately 16,000 children - were treated in doctors’ offices, clinics and
emergency rooms for lawnmower-related injuries in 2007, according to the U.S. Consumer Product Safety
Commission. Lawnmower injuries often result in partial or complete amputation of both lower and upper extremities.
The American Academy of Orthopaedic Surgeons believes that the great majority of these injuries are
preventable. The Academy recommends the following safety guidelines when using lawnmower

Never let children operate lawnmowers. Keep kids 15 years of age and younger away when lawnmowers are in use.

Children should not be in the yard while the lawn is being mowed.

No riders other than the operator, regardless of age, should be allowed on a riding mower.

Be sure the motor has been turned off before inspecting or repairing power lawnmower equipment.

Do not tamper with safety release switches.

Keep lawnmowers in good working order with sharp blades.

Remove stones, toys and other objects from the lawn before you start mowing.

Wear protective gloves, goggles, boots and long pants when you use lawnmowers. Never mow barefoot or in

Use caution when mowing hills and slopes. Mow across with a push mower; mow up and down with a riding
mower. Do not cut wet grass.

Be sure the motor is off before inspecting or repairing lawnmower equipment.

Read the instruction manual before using a lawnmower.

Be sober (i.e., don’t drink and mow.)

Do not remove safety devices, shield or guards on switches, and keep hands and feet away from moving parts.

Stay away from the engine cowling, as it can become very hot and burn unprotected flesh.

Add fuel before starting the engine, not when it is running or hot.

Use a stick or broom handle (not your hands or feet) to remove debris in lawnmowers or snowblowers.

Do not leave a lawnmower unattended when it is running. If you must walk away from the machine, shut off the

March 1998. Revised December 2008 American Academy of Orthopaedic Surgeons.
This material may not be modified without the express written permission of the American Academy of Orthopaedic
Surgeons .
Position Statement 1142
For additional information, contact Public Relations Department at 847-384-4031.
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or in part without written permission. "American Academy of Orthopaedic Surgeons" and its associated seal and "American Association of Orthopaedic
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Lawn Mower-Related Injuries to Children:Committee on Injury and Poison Prevention

Monday, January 26, 2015



Snow Blower Safety

Recommendations for safe use of a jammed snow blower snow blowers include: (OCD STICK)

1. If the snow blower jams, immediately turn it OFF
2. Disengage the CLUTCH
3. DELAY...Wait 10 seconds after shutting of to allow Impeller Blades to stop rotating
4. Always use a STICK or broom handle to clear impacted snow. The stick most be strong enough to avoid breakage or eye injures can result from flying fragments.
5. Never put your hand near chute or around blades
6. Keep all shields in place. Do not remove safety devices on machine
7. Keep hands and feet away from moving parts
8. Keep a clear head, concentrate and ...
    Do not drink alcoholic beverages before using a snow blower

As physicians dedicated to the care of the Hand and Upper extremity we want to inform the public concerning the perils and pitfalls of improper snow blower use.  Physicians, nurses, allied health professionals and therapists who deal with these injuries live in fear of the first heavy wet snow of the season. Invariably injuries are seen despite general knowledge that these injuries occur. These safety tips cannot guarantee against injury but hopefully if you are reading these or even better spreading these, it is one more step towards preventing these types of injuries.

News organizations and weather services can help.

Conditions that are associated with a higher incidence of injuries, hay wet snow exceeding 6 inches of accumulation and temperatures above 28 degrees Fahrenheit offer good opportunities to provide warning for the public. We need your help to reduce the incidence of these preventable injuries.