Search for tag: "hand"

Interviewer: You're wearing your homemade cloth mask in public just to be a good citizen to protect others in case you are asymptomatic and you cough and sneeze so you don't spread those droplets. But the next question is, how should you handle and care for your mask to make sure you minimize the chance of contamination?

Dr. Jeremy Biggs is from University of Utah Health. And what's the first thing I should consider when it comes to my mask?

Dr. Biggs: Anytime you touch your mask, you wash your hands. So either when you take it off, wash your hands, or sanitize if you have hand sanitizer. Wash your hands. And then when you put it back on, if it hasn't been just washed, right, then again you would do the same hand hygiene, either washing and/or hand sanitizer.

Interviewer: All right, yeah. Washing your hands, that makes total sense, because you're putting your hands up by your face, and you want to be sure that, you know, they're clean if they're going to be that close to your face. And you also don't want to contaminate that mask. So what about putting on your mask? Is there a certain way that I should be doing that?

Dr. Biggs: As you're taking the mask on and off, look at it as possibly contaminated on the outside. So don't ever touch the outside of your mask. Okay. When you take it on and off, grab it by whatever. If it's tied, untie it. Untie the neck first and then the upper. So the lower one first and then the upper one. Place it down, face down, onto like a paper towel or a towel or something so that when you go to put it back on, you again only grab the straps. Don't touch the mask itself. Put the mask on. You don't ever want to take the mask, put it below your chin. You don't want to take your mask, put it on your arm or hang it from your ear or any of those things, because, again, whatever may be on that mask will then be all over those surfaces.

The biggest thing is when you are wearing it, do your very, very best to just leave it on. Don't take it on and off unless you absolutely have to. The theory there is you have a greater chance of contaminating both yourself and other surfaces if you're constantly taking that mask on and off.

Interviewer: Yeah. So it sounds like one just has to kind of develop a routine where they kind of get into this vibe of making sure that they're washing their hands always before and after they touch the mask and grabbing it by the strings like that so you're not touching the front or the inside. So what about cleaning the mask? Are there any . . . do I need to do something other than soap and water?

Dr. Biggs: Luckily, when we're talking about the COVID-19 virus, it's an enveloped virus, right, so it has an envelope of lipids on the outside. Pretty easy to break that down and kill it. Heat does it. Soap and detergent do it. So when you're washing the masks, the hotter you can have the water, the better, and the hotter you can have the air if you're drying it, the better. And if you add a detergent, good. I'm also . . . at our house, we're adding vinegar to our laundry, because vinegar has also been shown to help kill the virus.

Interviewer: All right. And I think, earlier, you said wash it every day. You mean, do I really have to wash it every day?

Dr. Biggs: I recommend washing it every day, depending on how often you have to wear it. Some people aren't wearing their masks all day, every day. If you wear it for 20 minutes to go to the store, and right now that's all you're wearing it and you have a nice safe place to keep it, you could probably do a couple of days before you wash it. The virus doesn't seem to live super long on cloth. There's still some information that we don't know. We don't know exactly how long that is, but it's probably not much more than a couple of days at the most.

Interviewer: All right. Dr. Biggs, thank you very much for giving us some tips on keeping ourselves safe when we're wearing our mask to keep others safe.

This information was accurate at the time of publication. Due to the changing nature of the COVID-19 pandemic, some information may have changed since the original publication date.

Interviewer: If you have carpal tunnel syndrome, it might seem like surgery is the only means of relief from your symptoms. But what about simple splinting? Could that be an effective, non-invasive alternative? Dr. Douglas Hutchinson is a hand surgeon. Does splinting work for carpal tunnel syndrome?

Dr. Hutchinson: You know, it's very effective actually, and splints alone are the mainstay of our treatment. And if a person can sleep at night and not wake up with numb fingers, they're going to feel a lot better, they're going to do better during the day, their hands are not going to hurt them, and/or go to sleep on them as much during the day as well, and they're going to get several years out of that type of treatment before they may get to the point where despite splinting they're still getting numbness, and that's when they probably should talk about surgery.

updated: November 23, 2020
originally published: March 28, 2018

Interviewer: Starting to get some wrist pain. Maybe it's carpal tunnel. Well, maybe not. Dr. Douglass Hutchinson, what is carpal tunnel syndrome, and what are the symptoms?

Dr. Hutchinson: Carpal tunnel syndrome is a common diagnosis, and, frankly it's commonly misdiagnosed. Carpal tunnel syndrome, primarily, is numbness in your fingers. Carpal tunnel syndrome is not primarily wrist pain, so if you have wrist pain, it's a different story. Carpal tunnel syndrome is numbness in most your fingers. Sometimes they feel as though it's all their fingers. Usually, it's the thumb, index, and third finger primarily. It usually comes at night because of the way we sleep, and that is part of the treatment right there is to change the way we sleep with our wrists bent.

Interviewer: So if you have numbness in your hand like that, visit your primary care provider for treatment options.

updated: January 8, 2021
originally published: March 6, 2019

Interviewer: Common ways that people cut themselves that lands them in the ER. That's next on The Scope.

Announcer: Health tips, medical news, research and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: Dr. Troy Madsen is an emergency room physician at University of Utah Health Care. What are some of the ways that you see that people come into the ER that they've cut themselves that lands them in the ER? The whole point of this is to maybe make us all a little bit aware.

Dr. Madsen: Sure.

Interviewer: When we're doing one of these things that, you know, this is a common way that somebody could cut themselves.

Dr. Madsen: Yeah, it is, and we do see lots of lacerations. Probably when you think of the ER, you think of going there because you were cut at some point and maybe had to have stitches. One of the common ways I often see people cutting themselves is cooking. This is something where I oftentimes see people who work in restaurants, who cook on a regular basis and are slicing and cutting things up and they'll catch a finger.

That's the most common site. They'll sometimes cut off the end of the finger, just the tip of it, not through the bone but slice off a piece there or cut down through the fingernail and then it seems to stop once it hits the bone. That's not an uncommon thing I see just from rapid cutting and just getting their finger in the wrong spot and getting that knife right through it.

Interviewer: Yeah, restaurant workers. What about just regular people? Not quite as much?

Dr. Madsen: Oh, sure. We see it with regular people, too.

Interviewer: Yeah, sure.

Dr. Madsen: But I guess for me it's always a surprise when you see the restaurant worker where they're doing this all the time and then they cut themselves and they always say they feel stupid, but it happens quite often.

Interviewer: Okay, so kitchen accidents. Watch those kitchen knives.

Dr. Madsen: For sure.

Interviewer: Be careful.

Dr. Madsen: Watch the kitchen knives and watch your fingers when they're near the kitchen knives.

Interviewer: Because that's the common kitchen cut, is a bit of finger.

Dr. Madsen: Exactly.

Interviewer: More so than a [makes cutting noise].

Dr. Madsen: Oh, yeah, for sure. I usually don't see someone who sliced down through their hand. It's almost always on the finger.

Interviewer: Okay. All right, what's the second kind of most common cut that you might see?

Dr. Madsen: The next common cut I see is someone who falls. They either land on their elbow and that will split the elbow open causing a laceration there, or they hit their knee and slice their knee open, or sometimes they'll fall and hit their head.

These head injuries, when it hits the scalp, that's where you really see a lot of bleeding. A lot of times they'll just come in with all sorts of bandages or holding towels on their head and just saying, "I must have a huge laceration on my scalp because it's bleeding like crazy." We'll pull these towels off and it's maybe only an inch long.

Interviewer: Oh, no.

Dr. Madsen: But scalp lacerations bleed like crazy. That's the bottom line. That is probably the next most common thing I see.

Interviewer: So they look much worse than they really are?

Dr. Madsen: They really do.

Interviewer: Generally?

Dr. Madsen: I think they really scare people and it's something you've got to go to the ER for typically, or maybe an urgent care because you do have to have it repaired, but a lot of times it looks much worse than it actually is.

Interviewer: All right. So I guess I didn't even consider a cut caused by blunt trauma.

Dr. Madsen: Sure.

Interviewer: That's interesting.

Dr. Madsen: Not an uncommon thing.

Interviewer: What are some other common ways that you see people with cuts?

Dr. Madsen: So another common thing we see is power tools. I've got to throw this one in here because probably the biggest surprise for me when I started working in the ER was all of the table saw injuries I saw. It's funny because at the time I had this old table saw in my garage. I'm not an experienced woodworker, but I thought I'm going to pull that saw to make some stuff with it.

Within the first month I probably saw four people who came in who had had their fingers amputated, cut off, from table saws. So I immediately got rid of the table saw. These were experienced carpenters and woodworkers that just said, "You know, it just happened." As they were pushing the wood through this table saw it just jumped or whatever, it hit a knot and their finger jumped forward, just cut right through the finger. So household equipment, power tools, table saw injuries, we do see a lot of those.

Interviewer: Watch those sorts of things. You've got experienced people that are cutting their fingers. Is there anything you can do to avoid that?

Dr. Madsen: Well, there are certain techniques you can use. I know there actually are some power tools and table saws that, I don't know how they're designed to do it, but somehow it's able to sense if that saw hits flesh. I don't know how it knows this. It's pretty remarkable.

Interviewer: I know, I took a woodworking class and the guy said you could take a hot dog and go to run it through this blade and it would stop it without cutting that hot dog.

Dr. Madsen: Yeah, it's amazing, but apparently you don't want to try the hot dog because if you do that, the way the mechanism works it just throws some steel right up into the blade and pretty much destroys the tool. Apparently, that's an option. I think there are other techniques where you're just not getting your hand close to . . . like, using a piece of wood or something to push that wood through rather than getting your hands right in there.

Interviewer: So three ways that people tend to cut themselves. Is there kind of a fourth category that you could lump in, two or three of the more minor ways?

Dr. Madsen: Yeah there are always knives. People who have pocket knives or maybe something where they're using their knife or some kind of tool to try and use it in a way maybe it shouldn't be used. Something slips or . . . you know I've got to tell you a personal story. I once made the mistake of trying to separate several frozen hamburgers using a butter knife. The butter knife slipped and went right into my hand.

Interviewer: A butter knife?

Dr. Madsen: Yeah, a butter knife. It was not good. I threw a little suture in that and tried to sew it up myself. It actually worked okay, but that's the kind of stuff we see, too. People with different household items, maybe screwdrivers, things like that, trying to use them in certain ways and something slips and cuts themselves.

Interviewer: Using them in a way that they weren't intended.

Dr. Madsen: Exactly.

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Dr. Miller: Hand trauma and the hand surgeon. We're going to talk about that next on Scope Radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists, with Dr. Tom Miller, is on the Scope.

Dr. Miller: Hi I'm Dr. Tom Miller and I'm here with Dr. Andrew Tyser. He is an orthopedic surgeon specializing in hand surgery and also microvascular surgery of the hand. Andy, talk to us a little bit about what types of hand trauma you see in your practice.

Dr. Tyser: Hand trauma is unfortunately a pretty common thing to happen to people. It turns out the hands are the way you interact with environment in many different walks of life, on the job, for play, and sometimes just randomly things that happen to your hands. In that case, sometimes the trauma can range from fairly common, simple fractures of the fingers to fairly severe, even loss of fingers and thumbs and things like that.

Dr. Miller: And you mostly see these in perhaps automotive accidents or industrial accidents.

Dr. Tyser: We do. I think most commonly for very severe hand trauma, for instance if you were to lose fingers or a hand, that's involving industrial type accidents, or people working with table saws in their own garage.

Dr. Miller: So if one is to lose a finger or even a thumb, which would be a catastrophic loss, you can re-attach those at times.

Dr. Tyser: We can, at times. It's for select indications as we say. So not every single person is a perfect candidate to have their finger put back on, depending on where it's cut off or the mechanism. However, that's the first consideration that we have here at the university is we try to put things back on when able.

Dr. Miller: Let's say that a patient or a person cuts off that finger by mistake using a table saw, while they're trying to build a table in their garage. What do they need to do? Do they need to put the finger on ice, I mean we see in the movies and all the TV shows about ER, what steps should they take if that thumb is to be saved or that finger is to be saved? What do you recommend?

Dr. Tyser: That's a great question. I think the first thing that patients in that situation should do is make sure that they have their bleeding controlled, either with a pressure dressing, or having even a little tourniquet on their finger because we don't want them to lose too much blood and compromise everything else.

The second thing is trying to find the parts. Sometimes if it happens with a table saw, it actually can kind of fly off into the saw dust or something like that, and we want them to find the part, and surprisingly, people will sometimes come to the emergency room without the part and then it's pretty hard to put it back on.

Dr. Miller: If they do find the part or the digit that has been amputated, what do they bring it to the emergency room in? Should they put it on ice or cool water, put it in a plastic bag, or does that even make a difference?

Dr. Tyser: Yeah, great question. We have a recommendation. We're not sure how much of a difference it makes. I think the main thing is finding the part and bringing it with you. But we typically tell people to put it in a soft kind of damp rag or gauze if you have it, and then put that inside of a plastic bag and then that bag inside of another plastic bag that has ice inside of it so to keep it cool.

Dr. Miller: What is the likelihood of success of reconnecting the amputation? Is there a time limit to that? Is, I suppose the type of trauma related to whether that's successful or not?

Dr. Tyser: Yeah, that's a great question and it's one we're commonly asked, and we tell them the same thing, which is please come as soon as you can. Ideally be within about eight hours to have the best results. I think the overall success rate really varies in the literature if you critically look at it. However, most recently with relatively large level-1 academic centers involved with the studies, it's about a 50:50 chance of making it work.

Dr. Miller: Now fortunately, these types of accidents, these amputation accidents are more rare than they were maybe 15 years ago.

Dr. Tyser: Yeah, I think that's true. It's something we talk about in hand surgery. It's kind of as a consequence of the loss of lot of industrial jobs in the United States unfortunately, and also a consequence of the increased occupational standards that we have in America. I think that in general that we see less amputations of fingers and hands and things like that.

Dr. Miller: Now that's not the only problem or injury that people have to their hands, crush injuries, degloving injuries, could you talk about those a little bit, and actually what would be the most common injury that you would see in a hand injury?

Dr. Tyser: We talked about table saws a little bit earlier and the table saw injury right around Christmas time in particular when people are making things for the family, unfortunately it's kind of a sad story when that happens. However, table saws typically don't actually cut off the finger completely. They just damage it pretty significantly.

That is very common. Using knives for cooking and other things when people accidentally slip and cut their fingers and many times can lacerate either tendons or nerves or arteries or all of the above. Those are common.

Dr. Miller: What do you see in automotive accidents?

Dr. Tyser: In automotive accidents, we call that more typically blunt trauma and that's typically fractures due to things like crushes or high-energy impacts.

Dr. Miller: Are those difficult to repair?

Dr. Tyser: They can be. They can be very complicated. At times it's not just the bones that are fractured but it's also the soft tissues that are injured around the bones and that can lead to need for not just one surgery but sometimes multiple, depending on the severity of the injury.

Dr. Miller: It sounds like if you have a hand trauma you need to get to an emergency department as quickly as possible and then obviously if you amputate a digit, you need to try to recover that digit, prepare it as you suggested, and then bring that to the emergency department in the hopes it could be reattached microscopically.

Dr. Tyser: Yeah, I think that's very accurate. And I think we have a very well-run trauma unit here at the University of Utah, staffed by hand surgeons who are very comfortable with all sorts of trauma and it's part of our job that we actually really enjoy restoring function to people's hands, if possible.

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Dr. Miller: What is carpal tunnel syndrome? We're going to talk about that next on Scope Radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope. Dr. Miller: Hi, I'm Dr. Tom Miller and I'm here with Dr. Doug Hutchinson. He's a Professor of Orthopedic Surgery here at the University of Utah. Doug, what is carpal tunnel syndrome? What is that?

Dr. Hutchinson: Tom, carpal tunnel syndrome is a common diagnosis, and frankly, it's commonly missed diagnosed in the lay public. Carpal tunnel syndrome primarily is numbness in your fingers. Carpal tunnel syndrome is not primarily wrist pain. That's the first misconception I'd like to solve. So if you have wrist pain, it's a different story. If you primarily have numbness, sometimes it comes with pain, but mostly it's numbness.

Dr. Miller: What causes that numbness?

Dr. Hutchinson: What's happening is the median nerve, with is a main nerve that goes into your hand through your wrist, goes through a tight tunnel where all the tendons for your fingers are also located, and basically our assumption is that the space is so limited that if you use your tendons a lot, which we all do over the course of years, there will be a little bit of a buildup of tissue in there, and maybe a little bit of inflammation, though it's not much, but enough to make it so that the nerve feels claustrophobic, if you will, and pressured. Therefore, pressure on a nerve creates numbness where that nerve is going or coming from, and in this case that nerve is coming from those fingers.

So carpal tunnel syndrome is numbness in most of your fingers. Sometimes they feel as though it's all their fingers. Usually it's the thumb, index and third finger primarily. It usually comes at night because of the way we sleep on our wrists, and that is part of the treatment right there, is to change the way we sleep with our wrists bent. Dr. Miller: Now, are some people at greater risk of developing carpal tunnel than others?

Dr. Hutchinson: The common person who has carpal tunnel is 40s, 50s, 60s, and a little bit more often in a female than in a male. There's a lot of history of whether these come from repetitive activities and computers, and probably the bias and my answer is it doesn't. It's primarily genetic. It's primarily something that you were going to get anyhow even if you lived in rubber room your entire life and didn't do anything with your hands. It's just something that eventually can happen to some people because the nerve's in a tight spot in the wrist, and certain movements and certain positions will make that nerve a little bit unhappy over time and it will want a little bit of a bigger house.

Dr. Miller: Does it usually occur in the dominant hand or in both hands?

Dr. Hutchinson: Usually it's in the dominant hand first, but it usually occurs in both hands eventually.

Dr. Miller: Now, I heard that it's more common in pregnant women. Is that true?

Dr. Hutchinson: Pregnant women are very common, and anybody else who has major fluid changes, etc., and even can come in some women around their periods because of that type of change. Post-menopausal women are clearly the most common when it comes in. So yeah, there are changes that can occur. Some people will have something like a ganglion cyst that will actually put pressure in that area, and that can cause carpal tunnel syndrome. But usually it's idiopathic, and that means that there's no real cause for it, it just is happening to them.

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Interviewer: Amputees move prosthetic hands with their thoughts. Up next, on The Scope.

Announcer: Examining the latest research and telling you about the latest breakthroughs. The Science and Research Show is on The Scope.

Interviewer: I'm talking with Dr. Greg Clark, Associate Professor of Bioengineering at the University of Utah. Dr. Clark, I love you work because you're turning what sounds like science fiction into reality. Tell us what you're doing.

Dr. Clark: One example of what we're trying to do is to restore sensory function and motor function back to people who may have lost their hands and long term amputations. So one of the limitations with present prostheses is having enough control over them. The limitation isn't simply in making a hand. That's an engineering challenge for sure, and a very real one. But even if you have that hand, the problem is how does the user control it? Especially if they've lost a lot of their limb, they don't have very many muscles left. So what do they use?
And one idea is to plug that hand right into the user's own nervous system. The brain thinks about moving, just as it normally does with a normal hand. The signals come flying down the nerve, just as they normally would. And if we could wiretap into that nerve, and capture those signals, and translate them, and send them into the artificial hand, the hand would move just as it always did. So one of the beautiful aspects of that approach is that the person doesn't have to learn anything new. They don't have to learn anything counter intuitive.

Interviewer: Well, and I think one of the amazing things is that this has gone beyond the planning stages. I mean, you've actually been able to try parts of this with people, correct?

Dr. Clark: Yes, and we're not the only ones. This actually builds on a pioneering technology and set of studies here done a long time ago, or a decade ago at the University of Utah, by one of my present colleagues Dr. Douglas Hutchinson and Ken Horchin, and others. And they showed that, perhaps surprisingly, the nerves that used to be attached to the hand still work after the hand is lost. And that opens up lots of possibilities both for capturing motor signals, but also talking back to the user and providing sensory experiences.

Interviewer: And that's another interesting aspect of it. Is that the user will not only be able to just move their hand, like you said, they can also feel the hand. What will they be able to feel? Just pressure, or pain, or...?

Dr. Clark: We're hoping to not activate pain, if that's your question. So there's really two important aspects of this, and the best way to think about this is to imagine yourself picking up an object. So imagine picking up, say, a Styrofoam cup filled with water. Close your eyes, reach out, grab that cup. Pick it up, and you know what it is. That's almost self-evident, but think about what it means.
So in our brains, without our even being consciously aware of it, we take all of this type of sensory information and build this mental image. So, although we call it a sense of touch, it's actually conveys lots of information about pressure. That's one example. About vibration when we first hit it. About where our hand is in space. The shape of our hand, both from stretch receptors in our skin, and also from joint receptors that tell us what our joint angle is, and also from muscle receptors that tell us how we're contracting our muscles.

So the two basic types of sensory experience we want to be able to restore are the sense of touch, and the sense of movement so that the person can move his or her own hand through space and know where it is, without having to watch it, but actually feel it. And in the end, we hope that this very rich sensory experience will allow the person to integrate the hand into their own body image, and so the hand will feel like part of themselves.

Interviewer: So you're really sort of the technology behind this ability to move things with their thoughts, and to feel, and...

Dr. Clark: There's many aspects to that technology, and one is actually developing the electrodes, the actually interface that will plug into the nervous system. But if you think about it just a moment more, there's other aspects about that that are very challenging and extraordinarily important. And one reason this is a huge multidisciplinary project is that all of these have to work in order for it to work together.
So for example, suppose I had the perfect electrode technology and I could record the neural signals coming down the nerve, I still have to know how to interpret those, and then send them to the muscle.

So a big part of our project is doing what's called the decode. That is the interpretation of the signals. Another aspect of it is talking back to the nervous system so that the user can understand that the hand has just touched something, or that it's moving through space. And that's called the encode problem. That is sending information into the brain in such a way that the user understands what's out there in the real world. And then there's the whole clinical aspect of it, and then we also have testing the user's ability to use a real physical hand. And so the real benchmark is how well does this prosthetic hand compare with a real biological hand?

Interviewer: This must have an incredible kind of emotional, or psychological impact on the person who's using it.

Dr. Clark: Indeed it does. Today we've done four human subjects. They've been able to control an advanced prosthetic hand on, in virtual realities. That is on a computer screen, and they've also been able to get a sense of touch and movement back from that virtual hand. And it truly is as emotional as you say. One user describes it as, "The loss of hand is like losing a family member, except you're reminded of it every day of your life." And so, as he sat there using it for the first time, it turned out that we provided movement back to him 21 years to the day after he lost his hand, and he could watch it and see it move again.
And one time we began to also provide sensory feedback to it. He could feel his hand, and he described what he had been through. He had been through some 10 surgeries, and after his hand was first damaged they tried to save his thumb, and it didn't quite work. And he went back again, over and over again, 10 times, to try to save his hand. And ultimately it didn't work, and he said, "Just please it out. Take it away." And that day it woke up again for the first time and he could feel it and he could move it, and it was truly overwhelming experience for him. And that's we hope to be able to do. To restore a sense of touch and motion back to individuals, included wounded warriors who have given their, literally their arms for our country, but also we hope this technology to disseminate into the larger community.

Interviewer: What was your reaction when you saw this technology work with a real person?

Dr. Clark: One of the truly poignant aspects is that you do get to know them. We work together with them, and they become truly a part of the team. They tell us what it's like, and what they like and what they don't like, and we try to incorporate that into present work and future designs. And, to be honest, they win your heart as well as your mind. And when you begin to restore some of that sensation and motion back to them, and see how important it is to them, you share a little bit in that joy.

Announcer: Interesting, informative, and all in the name of better health. This is the Scope Health Science Radio.

Interviewer: You come back from the slopes, and your thumb is hurting really, really badly. Is it something you should worry about or not? We'll find out next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Dr. David Rothberg is an orthopedic surgeon at the University of Utah Hospital. We're going to talk about something called "skier's thumb" right now. So you go for a day of skiing, you come back, your thumb hurts. Do you have skier's thumb or not? How do you even know? First of all, what is skier's thumb?

Dr. Rothberg: Skier's thumb is a relatively common injury of the upper extremity suffered when someone falls on a pole. So the most common scenario is with a grip-fitted poles, you fall, and the pole is forced into the palm as you place your hand down to slow your fall.

People know when they have it because the actual ligament that's hurt is your ulnar collateral ligament on your thumb, and it supports your thumb as a post. So when you pinch with your forefinger and your thumb . . .

Interviewer: Kind of making the "OK" symbol except for against the side of your thumb . . .

Dr. Rothberg:That's putting pressure on that collateral ligament.

Interviewer: Okay.

Dr. Rothberg: If you think about all the daily tasks we do with grip strength and manipulating objects with your hand, it's really common that we use your thumb as a post. So the quickest and dirtiest way to figure this out is to use your thumb as a post. Press your forefinger against the side of your thumb and see if it hurts at the large knuckle at the base of your palm, or your MCP joint.

Interviewer: So it refers pain down, because you're touching at the very top part of the thumb, and it's kind of coming down, the base of the nail almost, off to the side.

Dr. Rothberg: Right, and you're going to feel that.

Interviewer: Okay. And if you feel that, is it for sure that you've got skier's thumb?

Dr. Rothberg: It may not be for sure, because like all ligament injuries, it can really come with a grade of injury, from a sprain, which the vast majorities will be, to complete tears, to fractures of the insertion of the ligament.

Interviewer: So if you're feeling pain, should you go see somebody right away? Is it important that you see somebody or should you just kind of wait and see if it goes away?

Dr. Rothberg: I think, in the very beginning, if this is something that gets better very quickly, then you're probably safe. But if you have a persistent pain lasting more than a day or two, and it's causing dysfunction, it's worthwhile to get checked out by an orthopedic hand surgeon.

They're most commonly going to take an X-ray to rule out that scenario where there may be fracture associated with it. The reason that you want to take care of this is it can lead to a chronic instability of that joint, meaning that you're no longer able to fully use your thumb as a post because of non-healing of the ligament.

So the typical course of treatment is in a non-operative setting, which is the vast majority, is a brace. That brace is going to hold your thumb in a position that protects it from being used as a post or really straining or stressing that ligament as it attaches at the MCP joint.

Interviewer: So it sounds like kind of a big deal, because it could hinder your usage of that for the rest of your life if you don't have something done to it, and it's simple. It's a brace.

Dr. Rothberg: That's exactly right. When chronically injured, then it becomes something kind of interesting historically. It's called a "gamekeeper's thumb," and that referred to when people who farmed chickens they would break the neck of the chicken over their thumb, and it could lead to repetitive stress on the ligament, that then loosened it and then caused chronic disability.

So that's the worry when you don't take care of this skier's thumb is that it becomes a chronic instability that causes pain and dysfunction.

Interviewer: How long does it take for this to recover at this point, after you get the brace?

Dr. Rothberg: Typically, people are in the brace from four to six weeks, and then depending on the range of motion and tasks that they have in their daily life, they may start some hand therapy. Motion tends to help with the healing process. All in all, people can be back to activities around the six week mark.

Interviewer: So just for perspective, not something to be taken lightly. Not to go, "Aw, it's just my thumb. I won't worry about it."

Dr. Rothberg: That's very true, and I think it's a real common one that people get and take lightly, and then are presenting to us later with problems.

Interviewer: Then it's too late. Is it too late at that point? I guess that's a good question. What if three years down the road, I come in? Is it too late to fix that problem?

Dr. Rothberg: It isn't necessarily too late, depending on whether you've developed any arthritis in the joint because of instability. Certainly, there are late reconstructions, where we can reconstruct the ligament to give you stability. In most people, this tends to be something they pick up and don't really miss, because it does cause quite a bit of dysfunction. But getting it looked at sooner is always better than later.

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Dr. Miller: You have a tremor in your hand. What's that all about? This is Dr. Tom Miller here today to tell you about that on Scope Radio.

Hi, I'm here with Dr. Lauren Schrock. She's an assistant professor of neurology and specializes in movement disorders. Today, she's going to help us try to figure out what tremors are about. Lauren, my patients talk to me about tremors pretty frequently, and there are different kinds, right? Could you clue us in and tell us a little bit about the different kinds of tremors that people might experience.

Dr. Schrock: There are several types of tremors, but there are two most common ones that people will see in friends or family. Those include Parkinson's disease tremor and . . .

Dr. Miller: That's the one you don't want to have, right? That's what people, I think, might be worried about.

Dr. Schrock: That's what people worry about most commonly when they come in, actually, but they happen to have something called essential tremor.

Dr. Miller: That's more common.

Dr. Schrock: That's more common than Parkinson's disease. There are clear differences between the two. With essential tremor it's mostly tremor, and that's your main symptom. What's unique about it is it doesn't occur when you're resting. If you're resting and not doing anything, your hands are very still, whereas when you try to do something with your hands, such as writing or even holding a coffee cup, your hands will be tremoring. That's something unique.

Dr. Miller: This is interesting, because I remember my grandfather when he reached out to pick up his peas with a fork he would have a lot of trouble with that. Then, of course, when he was resting he didn't have that tremor. He would always tell me that he thought this was Parkinson's, and I guess that's not true.

Dr. Schrock: That's a common misconception, and people really worry about it. That's what they come in frequently to my office worrying about. The reason why they worry is they think of Parkinson's disease, correctly, as more of a progressive disorder.

Dr. Miller: They worry that that might be the start of a long, progressive problem. Essential tremor, it can start mild and stay mild, or does it progress also? Does the essential tremor get worse?

Dr. Schrock: Essential tremor definitely can get worse. Really, when it comes down to it, probably two decades from now we're going to find out there are many different types of essential tremors. There are a lot of varieties of the different severity of tremor, what part of the body it includes. Most commonly . . .

Dr. Miller: So it's not just the hands?

Dr. Schrock: It's not just the hands. Head tremor can be involved, head and voice tremor.

Dr. Miller: I've heard some people that sound like their voice is almost trembling when they talk, and you wonder if they're anxious. Actually, it's the essential tremor, that type of tremor at least, right?

Dr. Schrock: It definitely can be. There's one other thing that can be mixed up or misdiagnosed as essential tremor, and that's something that's much more rare, so most people haven't heard of it. It's something called dystonic tremor, something when someone has dystonia, meaning abnormal spasm of a muscle that causes either pulling or abnormal postures.

Dr. Miller: Is essential tremor mostly in both hands, or is it usually in one?

Dr. Schrock: In most people, essential tremor will come on in both hands. Most patients who come in will complain of it more in their dominant hand, of course, but when you actually examine them they'll have the tremor in both hands. Whereas with Parkinson's disease, by definition it starts with one hand and at rest, so the Parkinson's tremor will be where someone is just sitting down. You see their hand moving on its own, tremoring rhythmically. Often, people describe it as a pill rolling tremor. You'll see the movement of the thumb and the finger kind of together.

Dr. Miller: But the essential tremor is a little finer tremor, it's worse as you move towards something or try to do something. It's a finer base tremor. I guess sometimes it can actually be a pretty marked tremor, depending on who has it.

Dr. Schrock: Yeah, it can become severe. Most people don't come into a doctor for essential tremor. There's a lot more essential tremor out there than we see in our clinics.

When people have done studies just knocking on doors and seeing if someone has tremor, the rates are much higher than would be estimated just by how many people come to clinic. Because the majority of people, really it's probably relatively mild, so they don't see a physician about it. In general, when you look at essential tremor you can have some people who have a very fine tremor, almost even a jerky sort of tremor, and then you can have other people who will have a tremor that is much more severe. For example, when they hold up their hand in front of them their finger may move up to three inches.

Dr. Miller: Wow, that would be very difficult to live with, I would think. Do essential tremors travel in families? Are they associated with a family history? Because many of my patients will say, "Yeah, I really haven't worried about it because I knew my dad had it and his mother had it."

Dr. Schrock: Yes. It's very common to see essential tremor strongly travel in families. In medical school, we're taught that it's what they call autosomal dominant disorder, so that each child has a 50 percent chance of getting the gene.

Dr. Miller: Is that still true? Does that hold?

Dr. Schrock: I would say there's definitely a sub-group where you definitely see that, but as I mentioned before, essential tremor probably includes many different tremors, some of them where you see clear family inheritance and others where you actually don't.

Dr. Miller: What about the age difference when these tremors might develop? Does the Parkinson's tremor occur a little bit later, that pill rolling tremor you described? Is that a little bit later on in life, or essential tremor earlier in life?

Dr. Schrock: On average, when you look at the large groups, you will see that essential tremor comes on a little bit earlier than Parkinson's disease. However, even within a single family who has multiple family members with this essential tremor, you may have one family member who has the onset at age 20 and another family member at age 75. There really is not a clear indicator of what your diagnosis is based on the age of onset.

In Parkinson's disease, the large majority of patients have their onset in their 60s, 70s. However, there is a small subset of patients who can have early onset Parkinson's disease. A great example of that would be Michael J. Fox who had his onset around age 30.

Dr. Miller: Also, tremors are related to certain drugs, I think. A lot of us think about people who maybe are withdrawing from alcohol having a tremor. Is that actually a tremor? Is that something that is separate from what we've been talking about?

Dr. Schrock: The answer is yes and no. You can get that with certain drugs. Most commonly, I'm thinking of drugs that block dopamine. That would be in a class of medicines called anti-psychotic medications or medications that can be used for mood stabilization. An old one is called Haldol. Those can cause a Parkinsonian tremor. That's a very true tremor. The tremor will go away when the medication is taken away, but it may take up to six to 12 months for the tremor to actually go away.

Dr. Miller: A long time. I didn't know that.

Dr. Schrock: Then, there is another. You're talking about withdrawal of alcohol, for example, or someone who is under stress. This is something I often describe to my patients who have tremors, because tremors always worsen with stress, whether it be stress of having the flu or stress of having your mother in law coming to dinner.

Every single human being has the potential to have tremor. What we call that is physiologic tremor. Whenever someone is extremely hungry, didn't get enough sleep, they will get some very fine tremor in their hand. There are sayings called to shake with rage. Well, there's a reason for that. Because humans . . .

Dr. Miller: I've had that. It seems like that's about three times a week.

Dr. Schrock: . . . have a natural inherent tendency to have some tremor during times of stress.

Dr. Miller: What would you say to the person that develops a tremor? Should they see a physician about the type of tremor they have if they're concerned? Could they by looking on the web to figure out if it was an essential tremor and maybe diagnose themselves?

Dr. Schrock: In self-diagnosis, I've definitely had patients who've correctly done that, but I would beware. I think that anyone who has a tremor and has a concern about it should bring it up to his or her primary physician. If you're worrying and it's bothering you, then you definitely should see a physician about it.

Dr. Miller: Finally, there's treatment for both types, correct?

Dr. Schrock: Yes. There are treatments for both types. They are very different, the approaches to treatment.

Dr. Miller: That would require a physician to make the diagnosis and provide the treatment. Thanks very much, Dr. Schrock.