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
What is “Plastic Surgery”?
Which describes the ability to be
“shaped or molded”
PLASTIC is from the Greek word,
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!
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:
Is the
most common
repetitive use
injury
related to the hand.
TENDONITIS
AILMENTS OF THE CERAMICISTS HAND:
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
AILMENTS OF THE CERAMICISTS HAND:
AILMENTS OF THE CERAMICISTS HAND:
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.
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-#@*%
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.
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.
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
Cubital Tunnel Syndrome
•Weakness of the fingers
Ulnar Nerve
Median Nerve
Late symptoms include:
1. “clawing” position of the 4th & 5th fingers.
Cubital Tunnel Syndrome
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.
Cubital Tunnel Syndrome
• 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
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.
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.
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