HAND CENTER CONNECTICUT:The Hand Center of WMA in CONNECTICUT

The Physicians and Staff of the Hand Center of Western Massachusetts are proud to announce that we are opening another Hand Center office, in Connecticut. Our new office will be at 140 Hazard Avenue, Enfield CT 86082. 

The Hand Center 

Hours will be by appointment. 

We are now the only medical practice in Western Massachusetts and Northern Connecticut dedicated exclusively to the Hand and Upper Extremity. 

Our office has been known regionally as The Hand Center  since 1999 and has continued to serve the residents of an ever expanding geographic circle during that time.

As many of our patients come from the Northern Connecticut region now, we at the Hand Center are excited to begin working at our new Connecticut office and doing surgery near there. As residents of  towns very nearby in Western Massachusetts the Hand Surgeons Drs. Wint, Wintman and Martin all spend significant time in Enfield, Somers, Stafford, East Windsor, Ellington, Vernon, Tolland and the surrounding area. We feel that Northern  Central Connecticut is part of our home  and are eager to make our  Hand Center services available there. For more information about our us and our practice of Hand and Upper Extremity surgery visit www.handctr.com.

THE HAND CENTER OF WMA  in CONNECTICUT
140 Hazard Avenue
Suite 103
The Hand Center of WMA, Enfield, CT 06082
(413) 733 2204 
currently if you are seeking an appointment with oneof our Hand Surgeons in connecticut, please call the springfield number.

THE HAND CENTER of Western Massachusetts now in North and Central CT  www.handctr.com  140 Hazard Avenue, Suite 103, Enfield (860) 272-2996

Prevent Sports Injuries in Young Athletes

Tips to Prevent Injuries

-from the Hand Center of Western Massachusetts -  

Every year thousands of people in western Massachusetts hurt or injure their fingers, hands and wrists at home, at work and while playing sports. Many of these injuries could have been easily avoided. Many of these injuries are alos in CHildren and Young Athletes. At the Hand Center we want to support helping to curtail "the escalation of injuries in youth sports." These tips below are availalble through the ASSH and AAOS.

Knowing a few preventative measures can help to keep hands safe.

The physicians and staff at the Hand Center of Western Massachusetts have important safety tips that can protect you and your family from unnecessary harm.

•   Prevent Heely Injuries
•   Hockey
•   Football
•   Tips To Prevent Soccer Injuries
•   Tips To Prevent Volleyball Injuries
•   Skateboarding Safety
•   Playing it Safe on the Tennis Court
•   Playing it Safe on the Baseball Field
•   Prevent Scooter-Related Injuries
•   Prevent Falls!
•   Tips To Prevent Tennis Injuries
•   Tips To Prevent Basketball Injuries
•   Playground Safety Checklist
•   Prevent Golf Injuries
•   Prevent Inline Skating Injuries
•   How Safe Is Your Child's Playground?

Articles

Sports and Fractures

You may have seen professional athletes on TV playing with casts or splints on their hands or wrists.  Other people, including family, friends, and trainers, may have told you and your child that it won’t be a problem participating in sports immediately after a fracture. The truth turns out to be more complicated.
There are many factors involved in the care of a fracture and the ultimate return to sports.
Every fracture has its own personality.  Some fractures are very stable and start off in relatively good position.  Other fractures can be unstable and require surgery with pins, plates or screws.  Some fractures may involve the joint surfaces and may require more care to prevent displacement and complications later on.  Different bones also have different healing potentials with some taking longer to heal.  The age of the patient and severity of the trauma also play an important role in determining the prognosis and ultimate course of treatment.
Different sports also have different requirements regarding return to play.  A soccer player or cross country runner may be able to avoid using his or her hands all together.  Still other sports run a high risk of reinjury due to the increased contact, unpredictable nature, and significant force involved in the activity, i.e. football, hockey, and wrestling.  Different positions in a particular sport may also affect the decision of when to return to play: kicker vs. quarterback or striker vs. goalie.
The decision of when to return to sports must be individualized for every patient.  A parent must realize that a child is not the same as a professional athlete.  With a professional athlete, there may be significant financial considerations which factor into whether an athlete should return to play – a professional athlete may be willing take on the risk of reinjury or irreparable problems in the future for immediate glory or fortune.  For most children and teenagers with a fracture – and indeed most adults not competing at a professional level – a more conservative approach is warranted.
The discussion of when your child can return to sports should take place between you and your doctor.  If your doctor feels that your child may participate in sports with some restrictions, one must realize that there is still a chance that some unforeseen event may occur.  There are rarely if any certainties in medicine as in life.  Your treating hand and upper extremity surgeon must try to weigh all these factors in order to determine the best course of action for your child’s injury.  If your doctor tells you that your son or daughter should not participate in sports at this time, it is because he feels this will ensure the best outcome for your child’s fracture.

Additional Information

• Thumb Sprains
• Mallet or Baseball Finger

Video

The Hand Center of Western Massachusetts encourages you to stop sports injuries.

http://www.stopsportsinjuries.org/

STOP Sports Injuries | Sports Injury Prevention

PRESS RELEASE

Contact:  The Hand Center of Western Massachusetts

 413 733 2204

FOR IMMEDIATE RELEASE

Keep Kids in the Game for Life Through the STOP Sports Injuries Campaign

Healthcare and, Business Leaders, and Professional Athletes Join Forces to

Help Young Athletes Play Safe and Stay Healthy

Springfield, MA –– Today, leaders at The Hand Center of Western Massachusetts are coming together with the American Orthopaedic Society for Sports Medicine, American Academy of Orthopaedic Surgeons, American Academy of Pediatrics, American Medical Society for Sports Medicine, National Athletic Trainers’ Association, National Strength and Conditioning Association and Safe Kids USA to promote the STOP Sports Injuries campaign. 

The campaign educates athletes, parents, athletic trainers, coaches and healthcare providers about the rapid increase in youth sports injuries, the necessary steps to help reverse the trend and the need to keep young athletes healthy. The STOP Sports Injuries campaign highlights include teaching proper prevention techniques, discussing the need for open communication between everyone involved in young athletes’ lives, and encouraging those affected to sign The Pledge to be an advocate for sports safety. The campaign website and pledge are available at www.STOPSportsInjuries.org.

Sports injuries among young athletes are on the rise.  According to the national Centers for Disease Control and Prevention (CDC), high school athletes, alone, account for an estimated two million injuries, 500,000 doctor visits and 30,000 hospitalizations every year. 

Sports injuries are a common part of our practice according to Drs. Wint, Wintman and Martin at the Hand Center. The hand surgeons  have devoted a portion of our website at http://www.handctr.com/sports-fractures.html  to these injuries as they know the best way to treat a sports related injury is to prevent it, but if the injury occurs, timely appropriate follow –up care is needed.

The high rate of youth sports injuries is fueled by an increase in overuse and trauma injuries and a lack of attention paid to proper injury prevention. According to the CDC, more than half of all sports injuries in children are preventable.

“Regardless of whether the athlete is a professional, an amateur, an Olympian or a young recreational athlete, the number of sports injuries is increasing – but the escalation of injuries in kids is the most alarming,” said Dr. James Andrews, former president of the American Orthopaedic Society for Sports Medicine (AOSSM) and STOP Sports Injuries Co-Campaign Chair.  “Armed with the correct information and tools, today’s young athletes can remain healthy, play safe, and stay in the game for life.”

Supporting the STOP Sports Injuries campaign are the country’s leading sports medicine organizations along with professional athletes and business leaders who have signed on as members of the campaign’s Council of Champions. This Council will help raise additional awareness about this growing epidemic of youth sports injuries.  Some of the founding members of the Council include former Olympic champions Christie Rampone, Eric Heiden and Bonnie Blair, professional golfer Jack Nicklaus, NFL Hall of Fame quarterback Bart Starr, MLB baseball player John Smoltz, NFL Hall of Fame defensive end, Howie Long, and Heisman Trophy winner and St. Louis Rams quarterback Sam Bradford.

Every year thousands of people in western Massachusetts hurt or injure their fingers, hands and wrists at home, at work and while playing sports. Many of these injuries could have been easily avoided. Knowing a few preventative measures can help to keep hands safe. 

The physicians and staff at the Hand Center of Western Massachusetts have important safety tips that can protect you and your family from unnecessary harm. Our office has taken a lead in Western Massachusetts to educate children and adults in the prevention of sports injury. and other accidental injuries. Our injury prevention tips are a popular feature of our website at http://www.handctr.com/prevent-hand-injuries.html as well as at our WWLP website listing at  http://www.wwlp.com/dpp/health_experts/hand_surgery/Tips_to_Prevent_Injuries

For more information contact the Hand Center of Western Massachusetts.

Be safe this season leave fireworks to the professionals

Hand Surgeons Agree: Leave Fireworks to the Professionals

The American Society for Surgery of the Hand (ASSH) has urged the public to leave fireworks in the hands of the professionals.

According to the U.S. Consumer Product Safety Commission, 38% of all reported fireworks-related injuries from June 22-July 22, 2001, were to fingers, hands, and arms. These injuries included burns, lacerations, fractures, and traumatic amputation.

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).

One solution that has been offered by the ASSH to individuals is to attend public fireworks displays, which are monitored for safety by a local fire department, rather than setting off fireworks near or around the home.

The following precautions should be taken when attending a public fireworks display:

• Obey safety barriers and ushers.
• Stay back a minimum of 500 feet from the launching site.
• Resist the temptation to pick up firework debris when the display is over. The debris may still be hot, or in some cases, the debris might be “live” and could still explode.
• Never give children hand-held sparklers. Sparklers cause 10% of all firework injuries (source: American Pyrotechnics Association)—and were associated with the most injuries to children under 5 years of age. (source: U.S. Consumer Product Safety Commission)

The Hand Center of Western Massachusetts agrees -- keep your hands safe this fourth of July. Enjoy the day and leave fireworks to the professionals

portions Copyright © American Society for Surgery of the Hand 2008.
Modified/adapted altered by www.handctr.com from assh.org

ALERT ****SNOW blower snow thrower safety

Snow Blower Safety

Conditions that are associated with a higher incidence of injuries, heavy 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.

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.

Snowblower safety video




Snowblower safety tips





Snowblower Safety Brochure








Snow shoveling and snow blower tips

 from AAOS

Wrist Ligament Injury Scapholunate and Lunotriquetral Tears

Wrist Sprains and Ligament Injuries

What is a sprain?
A sprain is an injury to a ligament.  Ligaments are the connective tissues that connect and stabilize one bone to another bone; they could be thought of as very strong tape that holds the bones together at a joint (see Figure 1).  The degree of ligament injury may vary over a wide range of severity.  Sprains are generally classified into three types: Grade I – stable injury to a ligament; Grade II – partial tearing/stretching; and Grade III – complete tear of the ligament, either within the mid-portion of the ligament, or as an avulsion (“pulling away”) from its attachment into bone.  A sprain may upset the normal coordinated movements of the wrist bones resulting in persistent stiffness, pain, swelling, and possible instability.
How do wrist sprains occur?A sprain of one or multiple wrist ligaments occurs when there is excessive loading or force transmitted across the wrist.  These frequently occur as the result of a fall forwards or backwards onto an outstretched hand. Force may be applied in other ways, such as with a violent twisting injury (torsion).  Often, these injuries are associated with sports and other outdoor activities such as biking, skiing, or snowboarding.
What are the most common types of wrist sprains?
There are many ligaments which stabilize the wrist joint.  One of the most common ligament injuries involves the scapho-lunate ligament, the ligament which links the scaphoid and lunate bones (Figure 2).
Another wrist ligament injury that often occurs is the Lunato-triquetral ligament which connects two bones in the wrist called the lunate and the triquetrum.

Scapho-Lunate ligament injury
is the most common and most significant ligament injury of wrist;  
    Many  risk factors for this  injury such as ulna minus configuation, slope of radial articular surface, and lunotriquetral coalition; 
   As in all wrist ligament injuries there is a range of injury from that of a mild teat to that of increasing severity such as
  dynamic scapholunate instability  Some would call this spectrum  a range from a intrinsic intraosseous ligament microtear vs a large full scale tear and associated extrinsic ligament injury. While x-rays may not show any initial  radiographic evidence of malalignment is present  a diagnosis is established by dorsal S-L tenderness and positive shift test; late finding may include rotatory subluxationand later dynamic or static changes to the alignment of the carpal bones




Lunatotriqetral injury or LT ligament injury

is often associated with Lunotriquetral Dissociation or ulnar side carpal instability;
that involves disruption of lunotriquetral & volar radiolunotriquetral ligaments and attentuation or rupture of dorsal radiotriquetral attachments. There are several different degrees of injury.
 A grade one injury involves a isolated tear of the LT interosseous ligament and there will be only a small amount of increased motion, however, even this is enough to cause symptoms; A grade three injury represents a complete disruptionand there can be malrotationof the bones if a high grade or grade three injury is left untreated. The mechanism of the injury occurs with forced extension or extension and simultaneous radial deviation, as scaphoid induces the lunate into a further flexion stance while triquetrum extends;
As mentioned with a grade three or advanced injury, lunotriquetral, volar radiolunotriequetral, and dorsal radiotriquetral ligaments are torn and malrotation or a VISI collapse deformity develops either acutely or over time.
   

How are wrist sprains diagnosed?The diagnosis of a wrist sprain includes a careful patient history (how the injury occurred), a clinical examination, and diagnostic testing.  The patient typically presents with complaints of wrist pain and stiffness, and loss of strength is also common.  Examination of the wrist will allow your hand surgeon to pinpoint tenderness and thus localize the site of injury, and also assess wrist stability.  Usually X-rays are obtained to evaluate for potential fractures and for signs of ligament insufficiency.  While ligaments themselves are not seen on X-rays, the consequence of a ligament injury may be appreciated indirectly based on abnormal alignment of the wrist bones (Figure 3).  Additional diagnostic testing may be required, such as an MRI or an MRI-arthrogram, which involves an injection of contrast into the wrist to enhance the sensitivity of the MRI.  Wrist arthroscopy is a very precise, direct way to examine the wrist ligaments.  It is a surgical procedure in which a small scope and specialized instruments are placed into various parts of the wrist joint via several small (approximately 3mm) incisions. However, the risks and benefits of the surgery must be considered relative to the severity of the wrist injury.
How are wrist sprains treated?The goals of treating a wrist ligament injury are to:
 - provide pain relief
 - minimize potential stiffness or loss of motion
 - restore wrist joint stability
 - reduce the risk of long-term consequences of an untreated wrist ligament injury (arthritis, pain, instability)


The treatment of a wrist sprain is guided by the severity of the injury.  Similar to a sprained ankle, milder ligament sprains of the wrist may be treated with protected activity, supportive splinting or casting, strategies to minimize inflammation and discomfort, and gradual return to activity.  Evaluation by a hand surgeon will help grade the severity of the injury, identify associated injuries, and determine the need for more specific diagnostic testing.


For less severe wrist sprains, the ligaments usually heal well – occasionally, the injury and healing response may cause stiffness and your hand surgeon may recommend stretching and motion exercises to minimize the potential for longer term loss of wrist mobility.


In the case of a ligament tear, treatment may or may not involve surgery; treatment depends on the specific ligament injury and individual patient needs and considerations.  For certain injuries, wrist arthroscopy may be recommended to evaluate the wrist and to possibly trim loose or inflamed flaps from the injured ligament.  If the findings are more severe, your surgeon may need to proceed with an open ligament repair or reconstruction.  The ligaments themselves are not always very substantial, and so repairs may need to be augmented with additional tissue such as the joint capsule or various tendon grafts, especially if the injury is not being treated acutely.  There is much research underway searching for better methods to treat these serious injuries. They include stronger and more precise ligament reconstructions using either local tissues (tendons) or distant tissues (ligaments from the hand or foot).  Pins or screws are often used to help stabilize the repairs as well.  Your surgeon will discuss the various options based on the specifics of your injury.




Treatment of Lunate Triquetrum ligament tears

Arthroscopy allows the best method of determining whether LT instability is present;
 In severe or chronic cases lunotriquetral arthrodesis may be indicated for disabling pain after non operative treatment measures have failed.  Most patients may expect good to excellent relief of pain, up to 80% of normal wrist motion and upto 90% maintenance of grip strength


Chronic wrist sprains
Unrecognized or untreated ligament injuries may result in wrist instability which leads to progressive cartilage degeneration (arthritis) in the wrist joint. This arthritic change may result in pain, stiffness, and swelling; these symptoms may be intermittent and vary in their severity.  A common pattern is seen with scapho-lunate ligament tears that alter the normal wrist joint mechanics.  The unlinked scaphoid rotates away from the lunate.  As a result of the abnormal rotation of the scaphoid, its joint surface no longer makes contact with the radius bone properly.  Instead of broad contact along the entire joint surface, there is “edge on edge” contact of the joint, wearing it down in a predictable progressive pattern of arthritis.  This form of arthritis is known as scapho-lunate advanced collapse, or “SLAC” wrist, which progresses to involve a greater amount of the wrist over time, thereby limiting treatment options.  A good analogy is that of placing two spoons into a drawer; normally they are placed flush with one another, with the greatest surface area of contact. However, if the spoons are rotated slightly, they match up “edge on edge” and no longer have a good, broad surface area where they touch each other.


In the presence of a chronic wrist ligament injury and associated arthritis, mild / intermittent symptoms may be treated with splinting, activity modifications, and analgesics, such as anti-inflammatory medications.  Persistent symptoms or a symptom flare may be treated with a steroid injection.


Should these conservative measures fail, surgery may be considered in order to remove the offending, arthritic joint surfaces, such as with a proximal row carpectomy (remove the arthritic first row of wrist bones, which includes the scaphoid), or scaphoidectomy and partial wrist fusion (remove the arthritic scaphoid bone and fuse four small wrist bones together for stability).  In the case of more widespread wrist arthritis, wrist arthroplasty (joint replacement) or total wrist fusion may be performed.

Figure 1:  Ligaments of wrist

Figure 2:  Diagram of the scapholunate ligament (circled)
 
Figure 3:  X-ray showing gap between scaphoid and lunate from ligament rupture (right) and normal x-ray of opposite wrist (left)


parts© 2006 American Society for Surgery of the Hand but modified and appended by www.handctr.com

REFERENCES

Treatment of isolated injuries of the

lunotriquetral ligament

A COMPARISON OF ARTHRODESIS, LIGAMENT

RECONSTRUCTION AND LIGAMENT REPAIR

BEWARE THE SPRAINED WRIST

THE INCIDENCE AND DIAGNOSIS OF SCAPHOLUNATE INSTABILITY

W. A. JONES

SNOW BLOWER SAFETY TIP... (O. C. D. STICK)

BE PREPARED THIS WINTER PRACTICE SNOW BLOWER SAFETY

Snow Blower Safety

Conditions that are associated with a higher incidence of injuries, heavy 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.

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.