The latest news and updates in Hand and Upper Extremity Care.


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April 9, 2018

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Hand Pain

Carpal Tunnel Syndrome: Why do my fingers go numb at night?

April 23, 2018  by Blane Sessions, MD -  Louisiana Hand to Shoulder Center

    Ever wake up with your hand feeling “asleep” or have to “shake” your hand out? Ever notice your fingers going numb or tingling when you are driving or sitting at your computer?

    When people have pain or numbness in the hand, they can have a condition called carpal tunnel syndrome or CTS. There are different reasons why your hands can go numb or hurt, and carpal tunnel syndrome is one of them. How can you know you if this is what is going on with your hand?

    CTS is a condition where the median nerve gets compressed at the wrist. The carpal tunnel is in the area in the wrist where the median nerve travels from the arm into the hand along with the tendons that bend your fingers. There is a strong ligament over this area and these structures have limited room in this area. As we mature (we never age!), the nerve can get compressed by the overlying ligament and surrounding tendons to the fingers.

    CTS can cause numbness in the thumb, index finger, middle finger and thumb side of the ring finger, usually at night. People can also complain of pain in this area with shooting or “shock-like” symptoms.

    One in five people (20 percent!) will have carpal tunnel symptoms in their life with peak age groups from 50-70 years of age. There are many causes of CTS - the position of the wrist while performing everyday tasks such as typing or heavy work, genetics, pregnancy, arthritis or injury from a fracture. Along with a through history and physical, some patients may need a nerve conduction study to show whether one has carpal tunnel and the severity of the condition. A mild case can be treated with activity modification, braces, and/or steroid injection. Severe cases often need an in-office or outpatient procedure to simply release the nerve.

    With release of the nerve, most patients experience great relief of their symptoms. The worse the carpal tunnel is prior to the procedure, the less predictable the outcome, but outcomes are generally excellent for this procedure. 


Shaquem Griffin, one handed linebacker drafted by Seattle Seahawks, sparks inspiration.

April 30, 2018 by Jim Axelrod CBS News


Why Does My Small Finger Go Numb?  What is Cubital Tunnel Syndrome?

May 2, 2018 by Blane Sessions, MD - Louisiana Hand to Shoulder Center; illustration by Angie Schnatz, PT/CHT

    The ulnar nerve, also know as the "funny bone" nerve, can cause real issues in the hand!  Ulnar Nerve entrapment can cause numbness in the ring and pinky finger.  Typically people complain of the symptoms at night, when waking up, driving, talking on the phone, or sitting at the computer.  People also can complain of aching down the forearm on the pinky side of the hand, or pain located on the inside of the elbow along with numbness.

    The ulnar nerve is very important for the function of your hand, as this nerve controls the bending of your fingers on the pinky finger side, and the ability to make a strong fist.  It also affects the strength and control of your thumb, making it harder to pinch or hold items.  It is the largest superficial (closest to the skin) nerve in the body, so there's more opportunity for injury.  It can be injured near the shoulder, at the elbow, or at the wrist.

    The most common area of injury or entrapment of this nerve is at the cubital tunnel (at the elbow).  Cubital Tunnel Syndrome is the name given when the ulnar nerve gets squeezed at the elbow and it's the second most compressed nerve in the arm!  As the ulnar nerve goes behind the elbow into the forearm, it gets compressed, leading to numbness and tingling into the ring and pinky finger and weakness into the hand.

    The more common cause of this compliant is the ulnar nerve getting pressed when the elbow is bent for the long period of time...such as sleeping with your hand under your head, or sitting with the elbow bent while driving or typing.  When people come to the doctor with complaints of this numbness, it's very important to get a good history and physical exam.  Often a nerve conduction study or an EMG is ordered to determine when the nerve is entrapped, as the site of compression can vary, as well as the severity of the entrapment.

    Conservative management of cubital tunnel symptoms includes avoiding the positions that cause the compression, therapy, and sometimes using splints to keep the elbow fro getting into the position that puts pressure on the nerve.

    If a person does not improve with conservative management, surgical release of the trapped ulnar nerve is an option.  The nerve can surgically be decompressed using a small open or endoscopic technique at the elbow.  Results are excellent in restoring function and getting rid of numbness and tingling to the hand.  Recovery time can vary depending on a person's age, the demands of one's occupation, and the severity of compression.


My Shoulder Hurts, Is It A Rotator Cuff Issue?  

May 9, 2018 by Blane Sessions, MD - Louisiana Hand to Shoulder Center; 

     Rotator cuff tears are a common source of pain and disability for many adults. A tear of the rotator cuff can weaken your shoulder, causing pain and difficulty doing many daily activities, like combing your hair or sleeping at night.

     The shoulder works likes a ball-and-socket. The upper arm bone or humeral head fits into a shallow socket in your shoulder blade. The arm is kept in your shoulder by your rotator cuff and works to lift and rotate the arm. There is also a lubricating sac called a bursa that sits on top of the rotator cuff which allows for the rotator cuff tendons to glide smoothly. When the rotator cuff tendons are injured or damaged, this leads to pain and weakness.

     Most rotator cuff tears are caused by the normal wear and tear that goes along with aging (or maturing!) so people over 40 years of age are at greater risk. Also people who do repetitive lifting or overhead activities, such as painters, carpenters, and mechanics, are at a higher risk for tears. Athletes, such as tennis players, golfers, and baseball pitchers, are at an increased risk as well. While younger individuals can have overuse tears, most rotator cuff tears in young adults are caused by a traumatic injury, like a fall or dislocation.

     Most common symptoms include:

             1) Pain at rest and at night, particularly laying on the affected shoulder.

             2) Pain and weakness when lifting and lowering the arm.

             3) Crackling sensation when moving the shoulder in certain positions.

     After discussing your symptoms and history, your doctor will examine your shoulder for any tender areas, check your range of motion and strength, and make sure the other conditions are ruled out.

     X-Rays are the first imaging tests and are usually normal with a rotator cuff tear. A magnetic resonance image (MRI) or ultrasound can better show the soft tissues like the rotator cuff tendons. These studies can show whether a rotator cuff tear exists, and if so, where the tear is located and the size of the tear.

     The goal of any treatment is reduce pain and restore function. In about 50% of patients, nonsurgical treatment relieves pain and improves function to the shoulder. Shoulder strength usually does not improve without surgery. Nonsurgical options may include rest, activity modifications, non-steroidal anti-inflammatory medications (ie. ibuprofen), physical therapy, and steroid injections.

     Surgical treatment may be offered if your pain does not improve with nonsurgical methods. Continued pain is the main indication for surgery and surgery involves re-attaching the tendon back to the head of the humerus (ball part of shoulder). Most repairs can be done arthroscopically with smaller incisions and the recovery time depends on the size, location, and chronicity of the tear.

hand wrist

Wearable Ring, Wristband Allow Users to Control Smart Tech With Hand Gestures

May 11, 2018 by David Mitchell - Atlanta, GA

hand wrist

Why Does My Finger Click?

May 16, 2018 By Blane Sessions, MD - Louisiana Hand to Shoulder Center; illustration by Angie Schnatz, PT/CHT

     One of the most common conditions I see in my office are trigger fingers. A trigger finger is a condition which affects the tendons in your fingers or thumb and limits finger movement. When you try to straighten your finger, it will lock or catch before going out straight….it can be quite painful!


     The tendons that move the fingers and thumb come from muscles in the forearm above the wrist. These long tendons, called flexor tendons, attach to the small bone of the fingers and thumb. When you bend or straighten your finger, the flexor tendon glides through a snug tunnel, called the tendon sheath, which keeps the tendon in place next to the bones. The flexor tendon can become irritated as it slides through tendon sheath. If the tendon continues to get irritated, the tendon can thicken and form nodules, making the tendon “click” in tunnel. Some patients can feel a “pop” which is painful and for some the tendon momentarily gets stuck or “locks.” The finger, as it’s extended, will suddenly shoot straight, hence the name “trigger finger.”

     The cause of trigger finger is usually unknown, but  there are factors that put people in great risk for developing.

              1. More common in women than men.

              2. Most frequently between the ages of 40 to 60 year of age.

              3. More common in certain medical conditions such as diabetes, rheumatoid arthritis, and those with thyroid conditions.

              4. May occur after heavy labor to the hand.

     Symptoms include a tender lump in your palm, swelling, catching or popping sensation, and pain when bending or straightening your finger. Stiffness and catching often are worse with inactivity and in the morning. Treatment options include nonsurgical treatments, including rest, non-steroidal anti-inflammatory medicines (NSAIDS), splints, steroid injections, and therapy. In some cases these only provide temporarily relief and outpatient surgery is considered.

     Outpatient surgery consists a minor procedure to release the tendon sheath tunnel and is very successful. Full recovery is usually complete within a few weeks, but can take longer for all stiffness and swelling to subside. Some patients require hand therapy after surgery to aid in the recovery.

hand wrist

Why Does My Thumb Hurt when I Pinch or Grasp Something?

May 30, 2018 By Blane Sessions, MD - Louisiana Hand to Shoulder Center

It may be thumb arthritis!

What’s the condition?

      Thumb arthritis or basal joint arthritis is caused by a combination of many factors such as age, job description, and previous injuries. One of the major causes of thumb arthritis is repetitive use of the carpometacarpal joint between the thumb and the wrist.  As we mature (we never get old!), use causes “wear and tear” of cartilage that the body cannot repair quickly enough. The degeneration of cartilage causes bones to rub against each other which in turn causes joint damage and pain, so called degenerative arthritis.

What are the symptoms?

    Some of the common symptoms of thumb or basal joint arthritis include:

       • Pain with opening up jars or doors

       • Turning the ignition switch with keys in a car

       • Thumb pain with pinch, especially with needle point and croquet

       • Loss of strength in pain & thumb

       • Swelling and grinding of thumb

     Since the thumb joint controls grasping, weakness of the hands, and inability to grasp objects is a common symptom of thumb arthritis. It can be really painful!

What are my options for treatment?

     Thumb or basal joint arthritis is usually treated by anti-inflammatory medications (such as pills or creams), splinting, and/or resting the hand. If that does not alleviate the symptoms of thumb arthritis, then hand therapy and cortisone steroid injections can help. Lastly, minimally invasive outpatient surgery may be the last option. This involves removing the arthritis, rebuilding and reconstruction the joint, and providing cushioning for the thumb. The surgery does work well with excellent results, but involves an investment of time and energy, similar to hip or knee replacement surgery.  

hand wrist

National Hand Therapy Week - American Society of Hand Therapists

June 4, 2018 By Blane Sessions, MD - Louisiana Hand to Shoulder Center

The Louisiana Hand to Shoulder Center would like to thank all the hard working Hand Therapists out there! Happy Hand Therapy Week! https://www.facebook.com/HandTherapyASHT #HTW2018👍🖐️👊👏🤙🤟

hand surgery

How to Safely Cut an Avocado

June 11, 2018 By American Society for Surgery of the Hand (ASSH)

In light of the “latest casualty of avocado hand” (https://dailym.ai/2sNm4mT ), you might want to review how to safely cut an avocado on our HandCare blog: https://bit.ly/2JNhJcX #avocadosafety #avocadohand

Ulnar collateral ligament

Ulnar Collateral Ligament Injuries of the Elbow

June 25, 2018 By Blane Sessions, MD - Louisiana Hand to Shoulder Center

The first ulnar collateral ligament (UCL) injury in a professional athlete was identified in a javelin thrower and reported in the literature in 1946. Today, these injuries are common among overhead-throwing athletes, especially baseball pitchers.

In 1974, Frank J. Jobe, MD, performed the first reconstructive surgery for the UCL on pitcher Tommy John, for whom the surgery was later named. Today, it’s now estimated that one in three professional baseball pitchers has had UCL reconstruction surgery!

Although many UCL injuries are acute, they typically are acute-on-chronic, meaning a degenerative UCL sustains an acute injury and becomes clinically significant. With regard to mechanism, these injuries result from repetitive overhead throwing. The valgus stress imparted to the elbow creates microtrauma in the ligament, leading to fiber degeneration and, sometimes, calcification. Over time, this can lead to ligament insufficiency with resultant pain and laxity.

In youth baseball players, it appears that playing too much, playing when fatigued, and other factors come into play. In these young players, UCL injuries are due to over-utilization—not only playing year-round baseball, but pitching too much in a given game or a given week—and not getting enough rest. This is why pitch counts are so important. Also, playing on multiple teams is not recommended. All youth baseball players need a "rest season" where they don't play baseball for several months and year-round baseball is a huge problem in regards to UCL injuries.

Nonsurgical treatment is often very difficult and unsuccessful. Conventional rehabilitation is recommended to rest the ligament, improve neuromuscular control and flexor pronator strength, and normalize motion, building in some plyometrics or towel throwing at 8 to 10 weeks.

Often times these injuries lead to surgery where the ligament is reconstructed and an autograft tendon is passed through bone tunnels. Sometimes the ulnar nerve is moved as well. After surgery, extensive rehabilitation is necessary to gain muscle strength. It can take up to one year for an athlete to return to competitive competition.  


Firework Injuries to the Hand

June 25, 2018 By American Society for Surgery to the Hand (ASSH)

Fireworks are a staple for Fourth of July celebrations in the U.S. The thrill of fireworks, however, can be dangerous. On average, 230 people visit the emergency room every day with fireworks-related injuries in the weeks around July 4. Most of these injuries are to the hands and fingers. Fireworks can also cause serious injuries to your eyes. 

Typical fireworks injuries can be caused by firecrackers, bottle rockets, sparklers and more. Sparklers can burn at about 2,000 degrees, hot enough to melt metal!

While the American Society for Surgery of the Hand (ASSH) encourages you to attend public fireworks displays, which are monitored for safety by a local fire department, here are some safety tips to follow while setting off fireworks at home:

* Never allow young children to play with or ignite fireworks. If older children are playing with fireworks, always have adult supervision.

* Avoid buying fireworks that are packaged in brown paper. This is often a sign that the fireworks were made for professional displays and could be dangerous. Make sure fireworks are legal in your area before buying or using them.

* Never place any part of your body directly over a fireworks device when lighting the fuse. Back up to a safe distance immediately after lighting fireworks.

* Never try to re-light or pick up fireworks that have not ignited fully.

* Keep a bucket of water or a garden hose handy in case of fire.

* Never carry fireworks in a pocket or shoot them off in metal or glass containers.

* After fireworks complete their burning, douse it with plenty of water from a bucket or hose before discarding it to prevent a trash fire.

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

      * Obey safety barriers and ushers.

      * Stay 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. In some cases, the debris might be “live” and could still explode.


British Hand Society responds to NHS England

July 2, 2018 By British Society for Surgery of the Hand

    The British Society for Surgery of the Hand (BSSH) believes that a proposed move by NHS England to cut patient access to treatment for common hand conditions will be damaging to patients and, over the long term, more costly to the UK economy.

    Speaking in response to the medical director of NHS England Steve Powis’s interview in the Times (published 30 June 2018) and the NHS England consultation which goes live on 4 July, BSSH President David Shewring said:

“Those of us working in the NHS are committed to providing value for money. As hand specialists we are fully focused on delivering effective, evidence-based treatment for our patients.

    “Carpal tunnel syndrome, Dupuytren’s contracture and trigger finger are common conditions which have a significant detrimental effect on quality of life. Timely treatment for these conditions is effective in relieving symptoms, preventing irreversible loss of function and keeping patients in employment.

“We have extensive data on the efficacy, success and cost effectiveness of these treatments, which are relatively low cost in terms of resources.

“For these procedures to be branded ‘unnecessary or risky’, ‘useless’ or ‘harmful’ is incorrect and is grossly misleading to patients and the public.

“Having said this we accept that there needs to be some rationing and we look forward to seeing the consultation paper and to working with NHS England and others to ensure the evidence available is fully understood.”


hand surgery

Wrist Fractures - It Matters Where You Seek Care

July 11, 2018 - Blane Sessions, MD - Louisiana Hand to Shoulder Center

The skill to move our wrists is often taken for granted…until it’s injured. The wrist is the link that connects the arm to the hand and is involved in just about all complex movements of the hand. This intricate structure is made up of bones, ligaments, and tendons. An injury to the wrist is serious and may have permanent consequences as it is vital for our ability to carry-out daily activities. When is comes to a distal radius fracture, you will want to seek the most qualified experts for your treatment. The Louisiana Hand to Shoulder Center offers comprehensive, board-certified, upper extremity fellowship trained experts who care for complex wrist injuries.

Wrist Fracture Types

A distal radius fracture involves the bone that is within the inch closest to the wrist. While there are many variations, most fall under three of the following categories:

  - Nondisplaced fractures occur when the bone breaks but doesn’t move out of place

  - Displaced fractures occur when the bone breaks and moves out of place

  - Open fractures occur when the bone breaks and becomes visible outside the skin

The type of distal radius fracture occurs most often is called a Colles’ wrist fracture. This fracture maybe caused by an assortment of events like falling, contact sports, and car accidents.

What Are the Symptoms of a Distal Radius Fracture?

A distal radius is also known as a wrist fracture. The wrist is a complex joint comprised of eight small bones and two long bones of the forearm. Of these two long bones, the radius is the larger bone of the forearm and supports a majority of the weight – hence why is breaks most often.

Symptoms include:

  - Pain located at the wrist or with movement

  - Swelling, bruising, or tenderness

  - Redness

  - The wrist may hang or bend in an abnormal way

Will I Need Surgery?

The best answer to this question is to seek the opinion of a board-certified, orthopedic hand and upper extremity specialist who will examine your wrist, view x-rays, and recommend the best treatment for your long-term well-being.

Sometime surgery is indicated if the fracture is severe or significantly displaced. The purpose of surgery is to stabilize the joint and bring it back into proper alignment. This will ensure optimal healing and maximum return to prior function. It’s also important to have the surgery done right the first time to prevent unexpected outcomes.

What to Expect: Typical Recovery Time

Typical recovery time for healing will vary from person to person and depends on the extent and severity of the injury. Most people, if treated appropriately, can make a full recovery. This often takes time, patience, and a can-do attitude.

Where to Go for Treatment for a Distal Radius Fracture

With the right team working with you to ensure the absolute best treatment, full recovery from a wrist fracture is possible. It’s critically important to find a team you trust and a physician who specializes in orthopedic hand and upper extremity care. The Louisiana Hand to Shoulder Center specializes in distal radius fractures and upper extremity conditions – that’s all we do!  


Advice from a Certified Hand Therapist: What to Expect When You’re Expecting Surgery

July 24, 2018 - by American Society of Hand Therapists

   Surgery generally falls into two categories, elective and emergency. Outcomes from these two types can vary greatly. Emergency surgery is usually done to preserve life or function and usually follows some sort of serious incident or injury. Elective surgery means you may have some choice about the surgery as well as some time to discuss options with your doctor or medical team.



What is Tennis Elbow?

July 30, 2018 - Blane Sessions, MD - Louisiana Hand to Shoulder Center

     Tennis elbow or lateral epicondylitis, is a tendonitis of the outside of the elbow unlike golfer’s elbow which affects the inside of the elbow. Tennis elbow is mainly caused by repetitive use during tennis or any other activity that uses the hand or wrist muscles. These muscles share a common tendon which is connected to the portion of the elbow bone known as the lateral epicondyle. Tiny tears happen over time and with age, the body has a more difficult time repairing itself which leads to symptoms of tennis elbow. Common sports that can aggravate tennis elbow include racquetball, golf, weight-lifting, and, of course, tennis.

Symptoms of tennis elbow or lateral epicondylitis include:

   • Pain while bending wrist

   • Tenderness or pain on the outside of the elbow

   • Difficulty picking up heavy objects

   • Weakness in hand and wrist

    When the pain and/or weakness is interfering with your daily activities, it is time to seek tennis elbow treatment from an orthopedic hand and upper extremity specialist.

    Treatment for tennis elbow includes physical therapy, stretching, rest, and/or anti-inflammatory medication, such as NSAIDs. Platelet rich plasma or PRP has also been shown to have benefits. Elbow straps work well for some.

If the symptoms of tennis elbow persist with conservative treatments then cortisone injections can be beneficial. These injections usually last for a few months and can be repeated if necessary. If symptoms persist, minimally invasive surgery can be a cure for tennis elbow. This can be done arthroscopically or thorough an open approach.


The New ‘Golden Bridge’ In Vietnam Is Hands-Down The Coolest Bridge Ever

Aug 2, 2018 - Chris McGonigal - Huffington Post

Visitors to Ba Na Hills in Central Vietnam near Da Nang this summer have been enjoying some hands-on time with a beautiful new bridge that opened in June.

The footbridge, named Cau Vang or “Golden Bridge,” is nearly 500 feet long and sits 3,200 feet above sea level, according to Reuters. What makes the bridge attractive for tourists and locals is its unusual support system ― two giant concrete hands reaching toward the sky. 



Can you copy Dele Alli's "Impossible" Goal Celebration? 

August 15, 2018 - Heavy Sports

The Tottenham Hotspur Midfielder has got everyone trying to do it!  It's much more difficult than it looks!



Football Season is Back!  Wrist, Hand, and Finger Injuries in Football

August 23, 2018 - Blane Sessions, MD - Louisiana Hand to Shoulder Center

Football season is back! While most of us know about the major injuries that can occur during football games, did you know that over 50% of football injuries involve the wrist, hand, and fingers? Here are the most common football wrist and hand injuries that could put you on the side lines.

Hand and Finger Fractures

   These involve the smaller bones of the fingers called the phalanges or the larger bones in the hand called metacarpals. Often these fractures involve the small joints of the finger and/or hand which limit movement due to pain and swelling. Sometimes deformities in the skin are noted.

Scaphoid and Wrist Fractures

   The most common carpal bone fracture is a scaphoid fracture. Scaphoid and wrist fractures occur when athletes land on their outstretched hand (such as during a tackle). These often require surgery.

TFCC/Wrist Sprain

   The cushioning and ligaments on the inside of the wrist can be injured by falling on an outstretched hand. Pain with wrist motion, especially on the small finger side of the wrist, is common.

Jersey Finger

   A flexor tendon injury that prevents active bending of the finger. It is caused by grabbing onto the jersey during a tackle and the ring finger is the most common finger injured.

Mallet Finger

   A tendon injury that prevents active straightening of the finger usually caused by a “jammed” or direct blow to the tip of the finger. Offensive and defensive linemen are susceptible to this injury.

Preventing wrist, hand, and finger injuries is difficult because football players wear helmets to protect their heads and pads to protect shoulders, hips and thighs, but they don’t do much to protect their fingers and hands. Always wear properly fitted safety equipment such as wrist guards, gloves, and even buddy straps which can help to prevent some wrist and hand injuries.

Here’s to a safe and great football season! If you do suffer a wrist, hand, or finger injury, the experts at the Louisiana Hand to Shoulder Center can offer you the best treatment options available.


What is Wide Awake Surgery or WALANT?

September 9, 2018 - Blane Sessions, MD - Louisiana Hand to Shoulder Center

Hand, wrist, and elbow surgery has traditionally been performed under anesthesia due the common use of a tourniquet. While the tourniquet prevents blood flow to the operative limb in order to achieve a bloodless procedure, it is particularly painful for an awake patient.

This dynamic has changed somewhat with a newer surgical technique Wide Awake Surgery or “WALANT,” which stands for Wide Awake Local Anesthesia No Tourniquet. In this surgical technique, the tourniquet has been replaced by medications to avoid anesthesia. These medications are lidocaine (to block pain), epinephrine (to stop bleeding), and sodium bicarbonate (to buffer the solution to make nearly painless).

With this technique, many common procedures can be done safely without anesthesia or a tourniquet. These surgeries include carpal and cubital tunnel release, trigger finger release, Dupuytren’s excision, Dequervain’s release, flexor and extensor tendon repairs, tendon transfers, ganglion cysts excisions, excision of masses, and arthritis surgery of the hand and wrist. The technique particular benefits very sick or older individuals for whom anesthesia is contraindicated. Some people simply prefer not to be put to sleep, or have their children anesthetized, if it isn’t necessary. And It’s great for people who want to watch their surgery!

The benefits include:

- No IV insertion

- No preoperative labs/tests

- No need to stop medications including blood thinners like aspirin

- No fasting required

- No nausea or vomiting

- Avoid recovery time after sedation

- Avoid complications that may occur from anesthesia

-  Drive to and from surgery

Research studies have concluded patient satisfaction with this technique is very high and some patients even “enjoy” their surgery! 


What is De Quervain's?

September 27, 2018 - Blane Sessions, MD - Louisiana Hand to Shoulder Center

De Quervain's tendinosis occurs when the tendons around the base of the thumb are irritated or constricted. The word "tendinosis" refers to a swelling of the tendons. Swelling of the tendons, and the tendon sheath, can cause pain and tenderness along the thumb side of the wrist. This is particularly noticeable when forming a fist, grasping or gripping something, or when turning the wrist.


De Quervain's tendinosis may be caused by overuse. It also is associated with pregnancy and rheumatoid disease. It is most common in middle-aged women.

Signs of De Quervain's tendinosis:

• Pain may be felt over the thumb side of the wrist. This is the main symptom. The pain may appear either gradually or suddenly. Pain is felt in the wrist and can travel up the forearm. The pain is usually worse when the hand and thumb are in use. This is especially true when forcefully grasping objects or twisting the wrist.

• Swelling may be seen over the thumb side of the wrist. This swelling may accompany a fluid-filled cyst in this region.

• A "catching" or "snapping" sensation may be felt when moving the thumb.

• Pain and swelling may make it difficult to move the thumb and wrist.


To determine whether you have De Quervain's tendinosis, your physician may ask you to perform the Finkelstein test by placing your thumb against your hand, making a fist with your fingers closed over your thumb, and then bending your wrist toward your little finger.

If you have De Quervain's tendinosis, this test is quite painful, causing tendon pain on the thumb side of the wrist.


The goal in treating de Quervain's tendinosis is to relieve the pain caused by irritation and swelling.

Nonsurgical Treatment

• Splints may be used to rest the thumb and wrist.

• Anti-inflammatory medication (NSAIDs). These medications can be taken by mouth. This may help reduce swelling and relieve pain.

• Avoiding activities that cause pain and swelling. This may allow the symptoms to go away on their own.

• Injection of corticosteroids into the tendon sheath may help reduce swelling and pain.

• Physical or Occupational Therapy

Surgical Treatment

Surgery may be recommended if symptoms are severe or do not improve. The goal of surgery is to open the thumb compartment (covering) to make more room for the irritated tendons. During surgery, the tendon sheath over the inflamed tendons is opened.  At the Louisiana Hand to Shoulder Center, this procedure is performed under WALANT.

adapted from AAOS website


What is a Mucous Cyst?

October 24,  2018 - Blane Sessions, MD - Louisiana Hand to Shoulder Center

A mucous cyst is a fluid-filled sac that occurs on the finger joint closest to the nail. The cyst may thin the skin and may cause a groove to form in the nail. The cyst has a stalk that is connected to the joint and it is thought that underlying bone spurs from the arthritis weakens the joint lining allowing the cyst to form.

How is a Mucous Cyst diagnosed?

The mucous cyst typically has a characteristic appearance, and the diagnosis is straight-forward for most hand and upper extremity specialists. X-rays are usually ordered to confirm underlying arthritis of the joint and associated bone spurs.

Does the Mucous Cyst need to be treated?

Most mucous cysts are not painful. If they are not causing pain or dysfunction, they do not require treatment. In these cases, observation for changes in the cyst is all that is needed. If a patient develops pain, recurrent drainage, or nail deformity, treatment may be indicated. Even if not painful, diagnosis should be confirmed by a physician, as other diseases may mimic a mucous cyst or ganglion cyst.

What treatments are available?

Drawing the fluid off the cyst (aspiration) can be done, but there is a high recurrence rate. It’s very important to make sure this is done sterilely to prevent infection, which can happen. Aspiration and other techniques that only remove the cyst are often not effective because the joint spur is still present. To adequately remove the bone spur (osteophyte), surgical treatment is required.

What is involved with Surgical Treatment? 

The surgery takes approximately 10-15 minutes to perform, and the patient goes home the same day of the procedure (in-office surgery). The procedure is performed with a local anesthetic only which is safer and less expensive than general anesthesia. This also allows patients to have their regular meals prior to the surgery. After the surgery there will be a small bandage on the involved finger and the stitches are removed at about 10 days.

Is Surgery successful?

Patient satisfaction for this surgery is very high, but there is about a 10% chance the cyst will return with surgical treatment. Excision of the cyst does improve the nail deformity. Complications are uncommon but can include scar tenderness, infection, recurrence, and continued nail deformity.


Dupuytren's Contracture

November 10,  2018 - Blane Sessions, MD - Louisiana Hand to Shoulder Center

Dupuytren’s contracture is an abnormal thickening of the tissue or fascia just beneath the skin. This thickening occurs in the palm and can extend into the fingers. Firm pits, nodules, and cords can develop and cause the fingers to bend into the palm. Occasionally, the disease will cause thickening on top of the knuckles or cause lumps and cords on the soles of the feet.


The cause of Dupuytren’s contracture is a hereditary condition. The problem is more common in men, people over age 40, and people of northern European descent. There is no proven evidence that hand injuries or specific jobs lead to a higher risk of developing Dupuytren’s contracture, but trauma can quicken the disease process.


Symptoms of Dupuytren’s contracture usually include lumps and pits within the palm. The lumps are generally firm and stuck to the skin. Thick cords may develop from the palm into one or more fingers. The ring and small fingers are most commonly involved. These cords may cause bending of the fingers. In many cases, both hands are affected, but each hand can be affected differently.

The lumps can be uncomfortable in some people and can occasionally be painful. The disease may first be noticed because of difficulty placing the hand flat on a surface called a “table-top test.” As the fingers are drawn into the palm, it may be more difficult to wash hands, wear gloves, shake hands, and get hands into pockets. It is difficult to predict how the disease will progress. Some people have only small lumps or cords while others will develop severely bent fingers. The disease tends to be more severe if it occurs at an earlier age.


In mild cases, especially if hand function is good, only observation is needed. A lump in the palm does not mean that treatment is required or that the disease will progress. For more severe cases, various treatment options are available to straighten the finger(s). These options may include injectable medicines, such as Xiaflex, or in-office surgery, to release the contractures.

The goal of any treatment is to improve finger motion and function; however, complete correction of the finger(s) may not always happen. Even with treatment, the disease may come back. Before treatment, the surgeon will discuss realistic goals and possible risks.

Splinting and hand therapy are often needed after treatment in order to maintain the improved finger function. For more information or to schedule an visit, please contact the Louisiana Hand to Shoulder Center at 985-238-0045.

Selfie wrist

“Selfie Wrist”

December 23, 2018 - ABC 7 Chicago 

Do you suffer from “selfie wrist?”

“Selfie Wrist” occurs when

patients constantly hyper-flex their wrist inwards in a rush to capture that perfect angle.  It’s a form of carpal tunnel where the nerve gets inflamed and angry and the wrist becomes painful. 


wrist arthroscopy

One Year Anniversary!

April 9, 2019 - Louisiana Hand to Shoulder Center

The Louisiana Hand to Shoulder Center celebrated its one year anniversary in April 2019!  The center is dedicated to providing the highest quality Orthopedic Upper Extremity care on the Northshore. 

This site is not designed to and does not provide medical advice, professional diagnosis, opinion, treatment or services to you or to any other individual. Through this site and links to other sites, Louisiana Hand to Shoulder Center provides general information for educational purposes only. The information provided in this site, or through links to other sites, is not a substitute for medical or professional care. You should not use this information in place of a visit, call consultation or the advice of your physician or other healthcare provider. The Louisiana Hand to Shoulder Center is not liable or responsible for any advice, course of treatment, diagnosis or any other information, services or product you obtain through this site.