Do your hands hurt?

Wrist injuries are quite common and can result from a variety of causes, such as falls, sports activities, and repetitive movements. Here are the five most common wrist injuries:

1. Wrist Sprains 
A sprain occurs when the ligaments connecting the bones in the wrist are stretched or torn. It’s a common injury that can result from falling onto an outstretched hand. Symptoms include pain, swelling, and difficulty moving the wrist.

2. Wrist Fractures 
Fractures of the wrist bones, particularly the distal radius, are common, especially after falling onto an outstretched hand, such as falling off a bicycle or on mountain trails. Symptoms include severe pain, swelling, visible deformity, and difficulty moving the wrist and fingers.

3. Tendinitis 
Tendinitis is the inflammation of the tendons in the wrist, usually caused by repetitive movements or overuse, such as racket sports, gym workouts, or water activities. Several tendons may be affected depending on the physical activity performed. Symptoms include pain, swelling, difficulty moving the fingers, and even a creaking sensation.

4. Ganglion Cysts (Synovial Cysts) 
Ganglion cysts are fluid-filled sacs that often appear on the back of the wrist, though they can also be located elsewhere. They are benign but can cause pain and limit the range of motion if they press on nearby structures. They are often the result of an inflammatory response in the joints due to excessive or improper use. Ganglions can fluctuate in size and sometimes disappear on their own.

5. Carpal Tunnel Syndrome 
This condition is caused by the compression of the median nerve as it passes through the carpal tunnel in the wrist. Symptoms include pain, numbness, tingling, loss of sensation, and sometimes weakness in the hand and fingers, especially in the thumb, index, and middle fingers.

 Prevention of Wrist Injuries
- Protective Equipment: Use wrist braces or splints during sports activities. 
- Strengthening and Flexibility Exercises: Perform specific exercises to strengthen the muscles and improve wrist flexibility. 
- Avoid Repetitive Movements: Take regular breaks if you perform activities involving repetitive wrist movements. 
- Gradual Start to Sports Activities: Especially if you haven’t practiced for a while. 
- Ergonomics: Maintain good posture and ergonomics in your physical and work activities.

 Treatment of Wrist Injuries
- Rest, Ice, and Compression: These are the first steps to treating most mild injuries. 
- Immobilization with Splints: This may be necessary to allow the wrist to recover properly. 
- Anti-Inflammatory Medications: These can help reduce inflammation and relieve pain. 
- Physical Therapy: Essential for regaining strength and range of motion. 
- Surgery: In severe cases, such as complex fractures or ligament injuries, surgery may be required, such as wrist arthroscopy or fracture surgery. In case of any doubts, consult a hand specialist, especially if fractures or ligament injuries are suspected due to their potential severity.

It’s crucial to consult with a hand specialist if you feel wrist pain or suspect a fracture or ligament injury to avoid complications. Early diagnosis and treatment can make a big difference in recovery.

Taking proper care of your wrists and taking preventive measures can help reduce the risk of these common injuries.

All of us at TRAUMAUNIT are highly committed to staying at the forefront of all types of innovations and the latest techniques emerging in our specialty to always offer the best medical care and solutions to our patients.

Our only goal is to help our patients improve surgical outcomes, enhance results, and shorten recovery time. If you would like more information about wrist injuries or wish to schedule an initial consultation, please don’t hesitate to contact us.

How Does Weather Affect Joint Pain?
With the change of season and the arrival of autumn, many people suffering from joint pain or conditions like arthritis notice an increase in discomfort. While the relationship between weather and joint pain is not fully understood, several theories suggest that changes in barometric pressure, low temperatures, and humidity may worsen symptoms.
Main Causes of Joint Pain Due to Climate Changes
1.Barometric Pressure   : A drop in atmospheric pressure causes the tissues around the joints to expand, increasing pressure in inflamed areas, which leads to more pain. This is a common issue for people with arthritis or osteoarthritis.
2.Low Temperatures   : Cold weather reduces blood flow to the joints, which can increase stiffness and limit mobility. Many people find that their joints feel stiffer in the morning or after long periods of inactivity.
3.Humidity and Rain   : Those suffering from joint diseases often experience more pain on humid or rainy days. Although not fully proven, it is believed that humidity affects joint tissues.

Tips for Relieving Joint Pain in Autumn
While you can’t control the weather, there are ways to reduce the impact of climate changes on joint pain. Here are some practical tips:
-Keep Your Joints Warm   : Wear appropriate clothing to protect your joints from the cold. Thermal gloves and knee braces can be especially helpful in preventing morning stiffness.
  
-Regular Exercise   : Engaging in low-impact activities like walking, swimming, or yoga improves mobility and strengthens the muscles around the joints, reducing pain and stiffness.
-Heat Therapy   : Applying local heat to the joints, whether through hot baths, heating pads, or compresses, helps increase circulation and relieve pain.
-Anti-Inflammatory Diet   : Foods rich in omega-3, such as fatty fish, and antioxidants found in fruits and vegetables can help reduce joint inflammation.
-Consult a Specialist   : If symptoms persist, a trauma specialist can recommend joint supplements or medication to reduce inflammation and pain.
Benefits of Preventing Joint Pain During Climate Changes
Taking preventive measures not only helps reduce pain but also improves quality of life. Staying active, eating well, and protecting your joints from the cold can make a big difference for those who suffer from joint pain in autumn.
If you notice that your joint pain worsens with climate changes and affects your quality of life, don’t wait to seek professional help. At TraumaUnit, we are committed to your well-being and offer a comprehensive approach to treating joint pain. Schedule an appointment with us today! Together, we will find the best solution so you can enjoy autumn without discomfort. 🍂💪

As a surgeon specialized in peripheral nerves, we are addressing a complex surgery to treat a median nerve injury in continuity. This procedure involves the use of a sural nerve graft to restore the sensory function of the median nerve and a nerve transfer to reinnervate the abductor pollicis brevis (APB) muscle using the anterior interosseous nerve (AIN). Intraoperative neurophysiological monitoring (IONM) is employed throughout the surgery to guide and ensure precision in every step.

 1. Preoperative Assessment and Exposure of the Median Nerve

We begin by exposing the median nerve in the forearm using microsurgical techniques to minimize damage to surrounding tissues. In this surgery, we are dealing with an injury in continuity, meaning the nerve is not fully severed but has intraneural damage that affects its ability to conduct impulses. Our goal is to restore both sensory and motor functions using different techniques.

 Intraoperative Monitoring (IONM) to Identify Healthy and Damaged Areas

IONM is critical from the start of the surgery. We use this monitoring to assess the integrity of the nerve fibers in the injured area.

- Identification of the Healthy Stump of the Median Nerve: Using IONM, we stimulate the median nerve both proximally and distally to the injury. This allows us to precisely identify the point where the nerve is healthy, ensuring that the section of the nerve we use for coaptation is viable and will function properly.

 2. Identification of the Thenar Branch and Planning the Nerve Transfer

Once the healthy portion of the median nerve is identified, we proceed to locate the thenar branch, the motor branch responsible for innervating the thenar muscles, including the APB.

 Evaluating the Nerve Action Potential of the Thenar Branch

Using intraoperative neurophysiological monitoring (IONM), we stimulate the thenar branch to assess its motor response capacity. This confirms that the thenar branch is intact and viable for receiving a nerve transfer. We have detected an appropriate electrical response in the APB, which is essential for ensuring functional motor recovery.

 3. Nerve Transfer from the Anterior Interosseous Nerve (AIN) to the Thenar Branch

We decide to reinnervate the APB by performing a nerve transfer from the anterior interosseous nerve (AIN) to the thenar branch of the median nerve. This decision is based on the AIN's capacity to provide specific and effective motor reinnervation.

 Identification of the AIN Action Potential

Using IONM, we stimulate the AIN and verify that it has an appropriate action potential to act as a viable motor donor.

- Coaptation of the AIN to the Thenar Branch: Under microsurgical magnification, we carefully coapt the AIN to the isolated thenar branch, ensuring precise alignment of the motor fibers to restore the function of the APB.

 4. Sural Nerve Graft for Sensory Function of the Median Nerve

With the nerve transfer completed, we proceed to repair the sensory portion of the median nerve using a sural nerve graft. The sural nerve, which is purely sensory, is ideal for replacing the damaged sensory portion of the median nerve.

 Preparing and Suturing the Sural Nerve Graft

- Harvesting the Sural Nerve Graft: We harvest the sural nerve from the patient, selecting a suitable length to bridge the gap in the median nerve that has been resected.

- Suturing the Graft with Four Strands: The graft is sutured to the median nerve with four strands, ensuring precise alignment of the sensory fascicles to maximize nerve regeneration and restore sensory function.

 5. Creating an Additional Cable for the Motor Branch of the APB

To optimize motor restoration, we create an additional cable from the AIN branch directly to the thenar branch, specifically aimed at reinnervating the abductor pollicis brevis (APB) muscle.

 Placement of the Extra Cable

This extra cable is carefully sutured using microsurgical techniques and IONM to ensure proper coaptation and allow precise reinnervation of the APB.

 6. Final Evaluation with IONM and Surgical Closure

At the end of the surgery, we use intraoperative neurophysiological monitoring (IONM) to verify the integrity and functionality of all nerve repairs:

- Verification of APB Functionality: We stimulate the AIN and check the response in the APB. A proper response confirms that the nerve transfer has been successful and that the APB is receiving adequate motor innervation.

- Confirmation of the Sural Nerve Graft Integrity: We evaluate the conductivity of the sural nerve graft, ensuring it is properly aligned and that the sensory fascicles are prepared for regeneration.

 Conclusion and Prognosis

With careful wound closure, we have completed a surgery that combines advanced nerve transfer and nerve grafting techniques to restore both motor and sensory functions of the median nerve. The transfer of the anterior interosseous nerve to the thenar branch, along with the suturing of the sural nerve graft, offers the patient the best opportunity for complete functional recovery.

Thanks to the use of intraoperative neurophysiological monitoring, we were able to perform this surgery with maximum precision, ensuring that each nerve connection is optimal for regeneration and functional recovery. We expect to see signs of nerve regeneration in the coming months, with a favorable prognosis for both motor and sensory recovery.

This case highlights the importance of meticulous surgical planning and precise execution in repairing complex nerve injuries. The combination of nerve grafts, advanced technologies like intraoperative monitoring, and microsurgical techniques allows for the restoration of both sensory and motor functions in affected peripheral nerves, significantly improving the patient's quality of life.