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October 11, 2021
Avocado Hand Injuries- What You Need to Know

Have you ever heard of an “avocado hand injury?” These injuries are surprisingly common and can usually be avoided. Avocado consumption has risen in the United States over the last decade. Ranging from avocado toast to their use in traditional Mexican dishes to their usage as a superfood supplement to a healthy diet, they are very versatile (and delicious) fruits. Unfortunately, their rise in popularity has also resulted in a rise in injuries associated with their preparation.

Our surgeons want to make sure you stay safe in the kitchen! But if an accident does happen, our team offers cutting-edge treatments to get you back to cooking and living your everyday life.

What is an avocado hand injury?

When cutting an avocado, most people opt to slice the fruit in half, then hold the fruit in the non-dominant hand while using a knife to remove the pit at the fruit’s center. When the pit is struck this way, a quick slip of the knife is an accident waiting to happen — a dangerous proposition, considering the number of critical tendons, nerves and blood vessels that live inside the hand.

How can I cut an avocado safely instead?

To avoid this accident from occurring, we recommend the following steps:

  1. Place the avocado on a cutting board.
  2. Stabilize the avocado with the non-dominant hand, with fingers curled inward.
  3. Cut into the side of the fruit and while cutting, gently spin the fruit 360 degrees.
  4. Set the knife aside on the cutting board, and twist the fruit apart to expose the pit.
  5. Use a spoon rather than a knife to remove the pit.

How are avocado hand injuries treated?

In the past, reconstruction of tendon injuries often had a less than ideal outcome, with patients demonstrating stiffness and permanent loss of motion at the completion of their treatment. However, with recent advancements in techniques, our surgeons are now able to deliver amazing outcomes with their surgical treatment options for tendon injuries occurring from a variety of causes, including those in the kitchen. The new, cutting-edge technique known as “wide-awake local anesthesia, no tourniquet,” or WALANT tendon repair, gives a surgeon the opportunity to perform the surgery on the tendon and also test the strength and gliding of the repair in real time. In this technique, the surgery is performed with the patient awake and as an active participant, thereby ensuring a successful repair and outcome. Testing the tendon repair in the operating room, which is the basic premise of WALANT, allows the surgeon to test the integrity of the repair and also make sure the repair doesn’t get stuck on any internal structures. If the repair is strong, the surgeon can confidently enroll the patient in an early active range-of-motion hand therapy protocol after surgery. This leads to lower rates of tendon rupture, less stiffness and scar tissue, faster recovery, and, most importantly, better motion and strength.

A laceration in the kitchen is a matter to be taken seriously. “I have seen many patients who have not sought medical care quickly enough, only to find out far too late that they have tendon and nerve injuries that required timely reconstruction.” Says Dr. Ajul Shah, “a delay in evaluation may lead to a delay in treatment, which could lead to permanent disability.”

September 8, 2021
Nerve Compression Syndromes of The Upper Extremity

Have you ever heard of Carpal Tunnel syndrome? Most people have, as it relates to nerve pain that many people experience from typing frequently or working with their hands in other ways. However, there are other nerve compression syndromes that occur commonly that can cause pain, numbness, and discomfort in the hand or arm. In this Q&A, we break down nerve compression syndromes and some of the differences between them.

Q: What is a Nerve Compression Syndrome?

A: Nerves of the upper extremity are subject to intense or excessive pressure known as compression, or “pinching” of the nerve. It commonly results in numbness, tingling and pain in specific areas of the forearm, wrist, hand, or fingers. A nerve compression syndrome is also known as nerve entrapment or a “trapped nerve.” There are many different types of nerve compression syndromes, each one affecting a specific nerve.

Q: What is Carpal Tunnel Syndrome?

A: Carpal Tunnel Syndrome is a commonly occurring nerve compression syndrome where one of the major nerves in the wrist (the median nerve) becomes compressed. The carpal tunnel is an enclosed space within the wrist where 9 tendons run adjacent to the median nerve. With limited space for all of these different residents of the tunnel, the nerve can easily become compressed. People commonly believe that carpal tunnel is caused by repetitive activities, such as typing, or spending a lot of times doing a continual motion with your hands, such as kneading pizza dough. However, the true cause is typically unknown. It is simply an issue of space – when the nerve does not have enough space, it can become compressed, and this can in turn cause symptoms. Other ways that the nerve can become compressed include swelling of the lining of the flexor tendons (called tenosynovitis), joint dislocations, fractures, arthritis, and fluid build-up during pregnancy.

Q: What is Cubital Tunnel Syndrome?

A: Cubital Tunnel Syndrome is the second most common type of nerve compression syndrome and involves the ulnar nerve. With Cubital Tunnel, the ulnar nerve becomes compressed in the small tunnel at the elbow. The ulnar nerve is the nerve that controls the sensation you get when hit your “funny bone.” The main symptom is numbness or tingling in the last one and a half fingers of the hand (half of the ring and small finger). Similar to carpal tunnel, cubital tunnel also occurs due to an issue of space and the nerve becoming compressed, which results in similar symptoms in the ring and small fingers. Flexing the elbow will often the numbness, tingling, or pain and extending the elbow may relieve the discomfort.

Q: What is Radial Tunnel Syndrome?

A: Radial Tunnel Syndrome is a less common nerve compression syndrome. In Radial Tunnel Syndrome, one of the major nerves of the forearm becomes compressed or pinched under multiple muscles inside the forearm. The radial tunnel is an enclosed space within the forearm where multiple muscles and vessels intersect. Within this tunnel, the posterior interosseous nerve can be compressed by muscles or vessels. The main symptoms indicating radial tunnel syndrome are pain or discomfort in the forearm and feelings of weakness when lifting objects. Patients will often go multiple months or even years with chronic aching forearm pain without an obvious reason, and may see multiple providers who are unable to provide them a reason for their pain.

Q: What are common symptoms of nerve compression syndromes in the upper extremity?

A: The most common symptoms associated with nerve compression syndromes in the upper extremity are pain, tingling/numbness, and muscle weakness. These symptoms can make everyday activities difficult.

Q: How are nerve compression syndromes treated at The Center for Hand and Upper Extremity Surgery?

A: Here at The Center for Hand and Upper Extremity Surgery, we begin with evaluating the severity of your diagnosis.  Depending on how severe your case is, your doctor may start with non-operative measures to improve your symptoms. This may include changing the patterns of how you use and position your hand as well as splinting to reduce pressure on the nerve. Next, a steroid injection may be performed in order to help reduce swelling and inflammation around the nerve, in addition to help diagnosing your condition.

If your symptoms continue, or if you have a more severe case, the next step would be surgical treatment to decompress the nerve. Nerve decompression surgery is usually performed on an outpatient basis and the technique varies based on the affected nerve(s). Surgical treatment for compression syndromes aims to relieve any abnormal pressure on the affected nerve(s).

If you are interested in learning more about Nerve Compression Syndromes and surgical treatment options that may benefit you, please explore our website or call us at 1.855.980.6981 to schedule your appointment!

August 12, 2021
Tips for Choosing a Hand Surgeon
  Picking a doctor, especially a specialty doctor is no easy feat. With many different doctors to choose from, it’s hard to know what qualifications or skills to look for or inquire about. If you are in need of hand surgery, it is important to know what to look for when it comes to choosing an experienced hand surgeon. Refer to this list when going through the process of selecting a surgeon to make your experience the best it can… Read More
May 17, 2021
May is Trauma Awareness Month- Lydia’s Story
Trauma can take many forms and impact an individual’s life in different ways. Individuals who have endured physical traumatic injuries, are often also impacted psychologically and emotionally. National Trauma Awareness Month aims to raise awareness for all types of trauma and trauma survivors. This month we want to highlight a very special patient, Lydia Gray. Lydia is a patient of Ajul Shah, MD, Physician who underwent a hand amputation following a traumatic accident. Her positive attitude and dedication to recovery… Read More