2015 NCECA - D.E Gary Branfman

Forty-Ninth Annual Conference

MARCH 25-28, 2015 Providence, Rhode Island

AILMENTS OF THECERAMICISTS HAND:Diagnosis, Treatment & Prevention

PRESENTED BY GARYS. BRANFMAN, MD., FACS

With the hand,

The parent cares for an Infant,

The musician plays a sonata,

The laborer toils,

The blind can see

And the deaf can “hear”

GARY S. BRANFMAN, MD.

Certified by the American Board of Plastic SurgeonsFellow of the American College of Surgeons

Aesthetic & Reconstructive Plastic Surgery,

& Surgery of the Hand

Hmmm… Well no one can argue. This a little Humorous!

What is “Plastic Surgery”?

Which describes the ability to be

“shaped or molded”

PLASTIC is from the Greek word,

We do more than just Facelifts and Breast Augmentations!

The hand comprises only 1% of the

body’s surface area,

yet of the human skeleton’s 206 bones,

over 25% of them are contained within

the hand and wrist.

The hands’ unique abilities

are carefully orchestrated by a

precise amalgam of arteries, nerves,

tendons, ligaments, bones and muscles

encased within a specialized

envelope of skin and fascia.

Prior to World War II,a severely injured hand required an

ENTIRE TEAM OF SURGEONS:

•Plastic Surgeon

•Neurosurgeon,

•Vascular Surgeon

•Orthopedic Surgeon

U.S. Army Surgeon General

Norman T. KirkandDr. Sterling Bunnella surgeon from San Francisco,

Thanks to

he was instrumental in the reconstruction and rehabilitation of over 20,000 hands of soldiers.

During Dr. Bunnel’s career as a consultant to U.S. Army,

The Specialty of Hand Surgery was born, and Specialized

Training Programs were established

We’ve Come A Long Way!

An all-encompassing

discussion detailing

every ailment possibly experienced by the

ceramicist’s hand is beyond the scope of

this review.

STRAINSSPRAINS

CUTS

BURNS

Today’s dialogue will emphasize a category

of chronic conditions referred to as

Overuse Syndromes or

Repetitive Stress Injuries (RSI).

Prevention will be

emphasized, and

treatment, both

conservative and

surgical will be

reviewed.

your hands, wrists and arms absorb the strain of your skills and the turmoil of

your talents.

As you masterfully manipulate

mud on the wheel

or sculpt away

the day

creating visual delights

This presentation will focus

on the diagnosis, prevention

& treatment of these ailments

as they relate to YOU.

These repetitious motions of

musculotendinous units can

result in Repetitive Stress

Injuries (RSI).

When forces are applied to your tissues

(nerves, tendons, ligaments, muscles)

for prolonged periods of time,

Injuries Develop!If untreated, irreversible changes can

occur in these structures which cause

Permanent Impairment.

Repetitive Stress Injuries (RSI)

Your Goal:Know when your ailment needs more than just an Advil and some Stretching.

A permanent Impairment is Way Way

To high a PRICE to Pay!

No, I’m sorry, but the doctor isn’t in yet.

Three common conditions can

result from a combination of:

1. Repetitive 2.Strenuous3.Chronic

Use of our Hands, Wrists & Elbows

AILMENTS OF THE CERAMICISTS HAND:

1. Tenosynovitis

(“Tendonitis)

2. Neuropathy

3. Arthritis


Is the

most common

repetitive use

injury

related to the hand.

TENDONITIS


TENDONITIS can occur

anywhere there are tendons.


1. Rest and immobilization

2. Cool Packs if injury is acute

3. Local Heat

4. Anti-inflammatory

medications

5. Steroid Injection

6. SURGERY

Treatment of Tendonitis



TENDONS:

connect muscles to bones

and as they glide,

joints are

flexed and extended.

Repetitive movements cause

persistent friction which can

Disrupt the smooth gliding mechanism.

Two Specific Tendon Disorders

Endemic to Ceramicists are:

1. Stenosing Tenosynovitis

(“Trigger Finger”)

2. DeQuervain’s

Tenosynovitis

FLEXOR TENDONShave a series of fibrous pulleys

which keep the tendons aligned.

Swelling can result in a

“tendon nodule”

which can get caught in a pulley

TRIGGER FINGER:

The result is a snapping or“Triggering” when bending the finger.

Swollen Tendon “Nodule”

“Locked” finger

Released Tendon

Finger can Straighten

DEQUERVAIN’S

DISEASE:

On the dorsal-radial

aspect of the wrist

there are 2 tendons

which pass through a tight tunnel.

Painful Inflammation

radiates from the

thumb to the forearm.

DEQUERVAIN’S DISEASE:

If these tendons

become swollenInflamed Tendons

Tight Tunnel

DEQUERVAIN’S DISEASE:

Diagnostic Test:

With thumb inside closed fist,

Bend wrist down, away from thumb

Tendon

A Positive Test is obvious by the sudden desire to yell:

MOTHER F-#@*%

DeQuervain’s Release

Tight Tunnel

Released Tendons

Your snake has a case of A Reptile Dysfunction..


1. Tendonitis

2. Neuropathy

3.Arthritis

NERVE COMPRESSION SYNDROMES

Can result in

–Pain–Numbness –Weakness

If untreated,

permanent nerve damage can result!

AILMENTS OF

THE CERAMICISTS HAND:

Carpool-Tunnel Syndrome

Careful of tight overpasses when you are the driver,

overloading your vehicles heading to meetings, shows, etc…

is the most common

“nerve compression syndrome”.

The term CARPAL is derived from

the Latin word for

On the volar surface of the wrist

there is a passage from the forearm

to the hand, called the Carpal Tunnel.

CARPAL TUNNEL SYNDROME

WRIST

The Carpal Tunnel

This nerve within the tunnel

(The Median Nerve)

is responsible for sensation to the

•Thumb

•Index

•Middle finger

•½ of the ring finger

as well as

the function of

three thumb muscles.

The Carpal Tunnel

The roof of the tunnel is

a firm fibrous ligament

Avoidance of prolonged wrist flexion

is the first line of defence.

Anti-inflammatory medications

may alleviate symptoms

Carpal Tunnel Syndrome

Any condition causing

swelling within this tunnel

can result in

•Pain

•Numbness

• “tingling” sensation

•weakness

Delay in treatment can result in

If conservative management fails,

Surgery Becomes Crucial !

Carpal Tunnel Syndrome

Surgery is designed to

release the ligament and enlarge the tunnel.

permanent

irreversible

nerve damage.

To help preventCarpal Tunnel Syndrome

AVOID PROLONGED

WRIST FLEXION!

Be aware of your wrist position!

Take Breaks!


Stretch those Wrists !

is the second most common nerve

entrapment condition of the upper

extremity.

Cubital Tunnel Syndrome

This tunnel is

located at the

medial aspect of

the elbow,

in the Ulnar Groove (the “Funny Bone”)

and contains the ULNAR NERVE.

Early symptoms of

Cubital Tunnel Syndrome include:Numbness:

of the Fifth and part of the Fourth Finger


•Weakness of the fingers

Ulnar Nerve

Median Nerve

Late symptoms include:

1. “clawing” position of the 4th & 5th fingers.


2. Atrophy of the

1st dorsal interosseous

muscle

• Avoidance of prolonged elbow flexion as

well as compression to the area are the

first lines of defence.

• Anti-inflammatory medications may

alleviate symptoms if employed early.

• If conservative management fails, surgery

becomes crucial.


Ulnar NerveEntrance to tunnel

Releasing tunnel with scissor

Decompressed

Ulnar Nerve

• Many other nerve compression syndromes can

occur in the hands, wrists, forearms and elbows

of potters.

Repetitive twisting and

strenuous use of the arms

and wrists can cause

muscle swelling and

subsequent compression

to nerves coursing

between these muscles.

• Symptoms can be confused

with Carpal Tunnel syndrome.

• As opposed to Carpal Tunnel

Syndrome, symptoms include

an aching in the forearm

particularly with the palm

facing upward and the elbow

extended.

PRONATOR SYNDROME

the median nerve is compressed in the forearm.

ANTERIOR INTEROSSEUS

NERVE SYNDROME

is another Median Nerve entrapment

occurring in the forearm.

There is no loss of sensation.

A diagnostic finding

is the inability to

make a circle with

the thumb and index

finger (the “OK”

sign).

ULNAR NERVE COMPRESSION

at the wrist

As opposed to Cubital Tunnel Syndrome,

muscle weakness is uncommon.

Numbness of the fifth and ½ of the fourth

fingers is typical.

The anatomical location of the

compression is in Guyon’s Canal Ulnar Nerve

occurs where the Radial Nerve crosses the

elbow and enters the forearm.

Sensation is NORMAL.

Vague forearm pain shooting to the wrist is

the common complaint.

Weakness of finger, wrist and thumb

extension (“Wrtist Drop”)

POSTERIOR INTEROSSEUS NERVE SYNDROME

POSTERIOR INTEROSSEUS NERVE SYNDROME

Radial Nerve

FasciaMuscle

Radial Nerve


1. Tendonitis

2. Neuropathy

3.Arthritis

ARTHRITISis a general term referring to any

inflammation of a JOINT.

JOINTS are the hinges between our

bones that permit or impede motion.

But Doc, it hurts when I push here, or here, and it really hurts when I press here…. or pretty much

Everywhere!

Well Fred, that’s pretty much what you could expect with a Broken Finger.

Ligaments

JOINT That PERMITS

motion

JOINT That IMPEDES

motion

Symptoms:• crepitus*

(*a crunchy sound when joints move),

• pain,

• stiffness,

• swelling

• formation of cysts over the joints.

Osteoarthritisoccurs when the protective cartilage wears out

and bone-on-bone contact occurs.

BASE OF THUMB ARTHRITIS

occurs when the cartilage between the thumb and wrist bone (First metacarpal

and Trapezium) wears out.

When this “shock absorber”

fails, the two bones grind

Causing Pain and

Decreased Function.

The End is in Sight!Fear Not…

Hand Exercises and Stretching Positions

The End

2015 NCECA - D.E Gary Branfman

Art & Photos

Transcript of 2015 NCECA - D.E Gary Branfman