C. Noel Henley, MD

Hand and Upper Extremity Specialist

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Razorback Jared Cornelius Injury – What Is A Forearm Fracture?

September 19, 2015 by Dr. Henley Leave a Comment

This image of Jared Cornelius and his broken arm shows what looks like a forearm fracture.

What exactly is broken in a forearm fracture?

Also called a “both bone forearm fracture”, this injury involves the complete breaking in two of each of the two bones of the forearm: the radius (on the thumb side), and the ulna (on the pinky side).

Remember that break and fracture mean the same thing – these bones are broken in half!

This is different than a wrist fracture – the wrist is technically closer to the hand. The forearm bones are the two long bones between the elbow and the wrist.

How is a forearm fracture treated?

In children, these fractures can be treated with just casting or a couple of pins.

The first thing that happens after the injury is to put the patient’s arm in a temporary splint, usually made of fiberglass. This holds the bones still so the arm doesn’t hurt as much.

In adults, the standard treatment is to take the patient to surgery within a few days and fix each bone with a long metal plate and several screws. This is a fairly significant surgery involving making two large incisions over each bone, and moving muscles and nerves around to get access to the broken bones underneath. Surgery may take 1 or 2 hours and the patient can go home the same day.

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How long is the recovery time after a forearm fracture?

An athlete with this injury will not be able to play for at least six weeks after surgery. It takes six weeks for bone to heal after it’s lined up correctly in surgery. After the bone heals, the athlete can return to playing sports.

This video shows how the surgery is typically done. It’s all done on fake bones, but with real plates and screws – nothing gruesome:

Filed Under: Famous Hands and Arms, sports

Miley Cyrus Wrist Cyst Surgery Explained

December 15, 2014 by Dr. Henley Leave a Comment

What happened to Miley’s wrist?

Friday, Miley Cyrus posted pictures of her wrist surgery on Instagram. Here’s the most likely story behind the graphic picture that’s all over the internet.

The most likely diagnosis

Miley most likely had a ganglion cyst. It’s the most common tumor of the hand and wrist – and it’s completely benign. In this picture of Miley dancing you can see a subtle lump on her left wrist. Apparently this was taken recently, just before the surgery. This is the exact spot where the cyst is typically located. miley-dancing-cyst   A cyst is a fluid filled tumor (a tumor just means “a swelling”). A ganglion cyst comes from a joint and is filled with a clear jelly. Here’s a video of a ganglion cyst being removed in surgery.

Do they hurt?

Most patients do not have much pain with these. However, they can cause some discomfort, especially with hyperextension of the wrist. In rare cases they can push on a nerve and cause numbness or tingling in the hand.

What causes them?

Ganglion cysts occur in people of all ages. Little kids all the way up to elderly people. In young people like Miley, they’re almost always caused by small microtears in the joint lining that let fluid escape from inside the joint. The fluid collects outside the joint and forms a cyst.

How are they treated?

Cysts can sometimes be ruptured with a needle in the doctor’s office. When the cyst is on the palm side of the wrist (like Miley’s), it is right next to the radial artery, the major source of blood flow into the hand. So it can be risky to put a needle into these cysts – the artery may be damaged. Sometimes it’s safer to just leave the cyst alone or remove it in surgery. Risks of taking out Miley’s cyst include: small risk of infection, damage to a small nerve next to the cyst, and damage to the radial artery. The cyst could also come back – there’s about a 5% chance of that.

What’s going on in the surgery picture?

miley-cyst-surgery In this picture we see Miley’s left hand, palm up on a blue background. That’s a surgical towel covering up the table where the surgeon works. The gloved hands are either the assistant’s hands or the surgeon’s hands. The circulating nurse is probably taking the picture by holding the camera above Miley’s wrist while the surgeon holds the retractors. The retractor on the left side is closest to the radial artery – it’s a blunt retractor, probably called a Senn rake. It has one blunt end and a sharp, rake-like end. You can see what the other end looks like on the right side of the picture. On the right side of the incision you can see something white – that’s a large tendon called the Flexor Carpi Radialis tendon. These cysts poke up right between the radial artery and the FCR tendon. If you want to Google other pictures of the type of cyst Miley had – just type in “volar ganglion cyst” into Google Images. The ink around the incision is used by the surgeon to mark where the incision should be. Sometimes the surgeon uses a smaller incision than where he marks. You can see the incision doesn’t go quite as far up toward the fingers as he’s marked on Miley’s wrist. You can also see the marking pen on the towel at the bottom of the picture. The smiley face is drawn on the cyst itself – I can’t tell if this was done later after the photo was taken or drawn by the surgeon on the actual cyst.

Why isn’t there any blood?

The surgeon uses a tourniquet to prevent blood from flowing into the surgical incision so he can see all the anatomy. This lowers the chance he’ll cut something he shouldn’t.

Is Miley asleep for the surgery?

Probably. These surgeries can easily be done with the patient awake or just sedated, with their arm numbed up. She may be awake enough to look at the cyst but then probably laid back down to let the surgeon keep working. In this picture, Miley has an ID bracelet and what looks like an IV in her right arm, and nothing on the arm with the cyst on it. That means she was at least sedated for the surgery, if not asleep completely. miley-cyst-mirror

More Questions?

Post more questions about this type of surgery in the comments below!

Filed Under: Famous Hands and Arms

Rashad Johnson’s Fingertip Injury – How Are Fingertip Injuries Treated?

September 29, 2013 by Dr. Henley Leave a Comment

Rashad Johnson's bandaged left middle fingertip

Rashad Johnson’s bandaged left middle fingertip (ESPN)

Arizona Cardinals safety Rashad Johnson injured his fingertip in a game against the New Orleans Saints last week. How did this happen? What was the surgery like? What happens now? I’ll answer these questions and more in this article.


[Read more…]

Filed Under: Famous Hands and Arms

Did Ed Sheeran Cut A Tendon Or Nerve In His Hand?

September 21, 2013 by Dr. Henley Leave a Comment

Ed Sheeran's Bloody bandage

Ed Sheeran’s Bloody bandage (Sheeran/Instagram)

Ed Sheeran was in Nashville last night performing at Bridgestone Arena. He somehow cut his hand after the show and wound up in a Nashville ER. He posted pictures of his injury on Instagram – did he cut a tendon or a nerve? [Read more…]

Filed Under: Famous Hands and Arms

Dez Bryant – Finger Fracture Surgery Using Bone Graft

December 18, 2012 by Dr. Henley Leave a Comment

 

picture of dez bryant's finger splint

Credit: John Rhodes

The Dallas Morning News reports that Dallas Cowboys wide receiver Dez Bryant admits he needs surgery for his broken finger but wants to delay surgery until the off season. Apparently the surgery will require bone grafting. What does this involve? Is it a good idea for Dez to wait to have surgery? [Read more…]

Filed Under: Famous Hands and Arms, sports

David Ash’s Wrist Injury – What Causes Bruising In An Injured Wrist?

October 13, 2012 by Dr. Henley Leave a Comment

image credit: ABC

Texas QB David Ash goes to the locker room for x-rays of an injured, bruised wrist

What causes bruising in a wrist injury like David’s?

Bruising is caused by bleeding underneath the skin.

It’s usually a sign of severe trauma in a young person, whose bones are harder and ligaments thicker than an older person.

In a young person, several layers of anatomy have to be damaged to see bleeding underneath the skin after a wrist injury.

For example, bleeding from a broken bone has to pass from the broken bone edge, up through the muscles or tendons, through the tendon covering (called fascia), and spread underneath the skin and fat layer.

That’s why bruising after a wrist injury is often a sign of a broken wrist.

What is a wrist contusion?

A contusion just means an injury caused by a direct blow, or direct impact.

The blow can be from landing directly on the wrist on the ground or from another player’s pads or helmet striking the wrist.

Contusions are usually minor injuries, don’t require surgery, and heal quicker than sprains, though they can hurt a lot.

An example of what a smashed, broken, fractured wrist looks like

In the picture below, you can see the dark purple bruising in the wrist and hand (compare to the normal color in the fingertips) one day after this patient broke her wrist. X-rays of this wrist show a smashed radius fracture in several pieces. This is a fracture that needs surgery.

Keep in mind that she is older and her skin, bones, and ligaments are weaker, so bruising and swelling will be worse than in a young person.

 

 

Filed Under: Famous Hands and Arms

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