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On The Move: Unstoppable

On The Move: Unstoppable

by | Sep 26, 2022 | Hand Conditions

Article previously published in Rite Up, 2022 – Issue 2.

It is not uncommon to see Michael, of Redmond, Washington, posing like his favorite superheroes. He loves playing Minecraft™, riding his bike, swimming, wearing costumes, acting, dancing and singing. In January 2021, this highly active and vivacious young man had a life-changing surgery performed on his left forearm by pediatric orthopedic experts from our hand and limb lengthening and reconstruction teams at Scottish Rite for Children.

“I have no words to describe the blessing it has been for Michael and myself,” Berenice, Michael’s mother, says. “Scottish Rite is simply amazing.”

Michael was born premature at 23 weeks and stayed in the NICU for four months. At 3-months-old, the family realized he had a bump on his left arm and worked with Michael’s doctors to investigate the issue. Following a biopsy, it was determined that Michael had congenital pseudoarthrosis, which caused a deformity in the bones in his left forearm.There are very few teams that could successfully manage the complexities and intricacies of Michael’s treatment, but Scottish Rite for Children could. “To me Scottish Rite is a place where miracles happen, where the prayers of many parents come true,” Berenice says. “The doctors really care, and all the staff understand you and want to help in any way they can. Somehow you know your child is in the best hands, and you trust they are going to be okay.”

 

Watch Michael’s Story and learn more about Scottish Rite’s extraordinary care.

Read the enitre issue.

Thumb Fracture Q&A

Thumb Fracture Q&A

by | Sep 23, 2022 | Hand Conditions

Thumb injuries are common, especially in young athletes, and can occur from direct hits, falls on outstretched hands or hyperextensions. We see them often in football, basketball, baseball and soccer.

Pediatric nurse practitioner Courtney Schneidau, P.A.-C., shares information about thumb fractures and how to handle these types of injuries in young athletes.

Anatomy of the thumb
The thumb is made up of two major bones — the distal phalanx and the proximal phalanx. The distal phalanx starts at the tip of the thumb, underneath the fingernail and extends to the knuckle. The proximal phalanx runs from the knuckle to the base of the thumb, where it connects to the hand. 
 
How do thumb fractures typically occur? 
A thumb fracture can occur anywhere in the thumb and is generally caused by a direct trauma, like from a fall or a hit to the hand. For example, if a player hits his hand/thumb on the helmet of another player while playing football.  
 
What are the main symptoms of a thumb fracture? How do you know if the injury needs medical attention? 
Symptoms can include: 
–    severe pain
–    swelling and tenderness
–    limited motion or inability to move the thumb
–    visible deformity or deformed appearance
–    a numb sensation or coldness in the thumb 

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You should seek medical attention if you are experiencing pain, bruising or swelling. It is important for a professional to examine the injury to determine the best course of treatment.

How is a thumb fracture diagnosed and treated?
Your provider will take a detailed history, including the activity that caused the injury, as well as perform a physical exam. X-rays of the hand and injured thumb will be performed to better evaluate the injury and rule out other injuries.

A fractured thumb can be treated through casting or the use of splints, which limit movement while the bones heal. Surgery is sometimes needed, depending on the location of the break. There are different techniques that are used to hold the bones in place, including the use of pins, plates or screws. Following surgery, a splint or cast is worn to ensure proper healing.

What is the outcome following a thumb fracture? 
Thumb fractures generally have good outcomes, following proper treatment and rehabilitation. Once the fracture has healed, hand therapy may be required to help restore motion.

Should you see a pediatric orthopedic specialist for a potential thumb fracture? 
Scottish Rite for Children treats children who need complex reconstruction following trauma or have hand disorders related to neurological conditions or nerve injuries. That includes fractures (shoulder to fingers), nerve injuries, tendon injuries and complex injuries. Our Sports Medicine team treats the comprehensive needs of athletes and provides management for sport-related injuries and conditions. Young and growing athletes are highly competitive and have unique conditions that require care by a pediatric team of experts. Learn more about our centers for excellence in Sports Medicine and Hand and how board-certified pediatricians, pediatric orthopedic surgeons, physical therapists, athletic trainers, psychologists and other specialists work side-by-side with each patient and their parents to develop the best game plan for treatment, rehabilitation and safe return to sport.

Learn more about our Facture Clinic.

Pollicization: What Parents Need to Know

Pollicization: What Parents Need to Know

by | Dec 23, 2021 | Hand Conditions

When it comes to pediatric orthopedic conditions, our team cares for the common to the complex. Through the process of deciding the best form of treatment for a child, parents have questions to better understand a procedure or plan of care. Our experts in the Center for Excellence in Hand specialize in the pollicization procedure – a hand surgery where the index finger is moved down the hand into the thumb position and then rotated in opposition to the other fingers.

The team compiled the most frequently asked questions from parents regarding a pollicization and what they need to know about the procedure.

What will the rehab for a pollicization look like?  
Your child will be in a cast for five weeks. On the day he/she comes out of the cast, your child will be referred to an occupational therapist who will fit your child with a neoprene thumb splint to hold the thumb (pollicized digit) in its new position. Your therapist will then instruct your child on therapy (play activities) to get the new thumb moving and functioning in its new position.

Will my son/daughter use his/her thumb after surgery? 
Some kids never miss a beat and start using their new pollicized digit right away. Others need a little help and encouragement to begin grasping and holding objects/toys. The best time to initiate use is at meal, bath and play time. Offering your child a toy or piece of food in their other hand first and then offering something similar to the pollicized hand next will encourage use. Don’t worry if the end of the thumb doesn’t move right away. It can sometimes take up to four to six months for the tip of the new thumb to move.

What if he/she bypasses the new pollicized thumb and uses the middle to ring finger to touch and pinch with? 
There are many tricks to get your child to use his/her new pollicized digit as a thumb. Buddy taping the middle finger to ring finger will encourage use and prevent scissoring. Encouragement is also very important to use when patients are learning a new way to pinch. Praise them each time they use their new thumb correctly.

What exercises will we need to do after surgery? 
Basically, we want the new pollicized digit to touch the other fingers on the hand and begin to function like a thumb. Because of the age of the child (this procedure is recommended for patients that are approximately 18 months old) toys, food and bath toys work best at achieving this goal. Make play time fun and intentional by giving them different sized objects to pick up, hold and manipulate.

Food cut up in different sizes works great. Food is motivating and can be used easily three times a day. Parents can start with larger size food items (ex: cut up chicken nuggets and popcorn, and then move to smaller food items such as cheerios or other small cut up foods). It’s easier to hold food if its placed in the hand versus trying to pick it up off the plate so handing your child these items is the best place to start.

Can my child put weight on his/her hand after surgery? 
Yes, your child can bear weight through that hand after surgery. He/she will be wearing a splint during the day for the first four weeks except for bath, meal and dedicated play times to protect the thumb. Bearing weight will not affect the surgery.

How should the scar be taken care of after the surgery? 
The day the cast comes off your therapist will educate you on skin and scar care. Skin care usually lasts for seven to 10 days and consists of washing the hand in warm soapy water three times per day, patting dry and following with lotion.

Scar care also begins the same day with light touching to the scar, slowly moving to gentle and then more moderate massage with lotion. Scar tissue will continue to grow and remodel for six to 12 months, so it will be a very important part of the therapy.

Learn more about our hand services.

Get to Know our Staff: Brittney Iagulli

Get to Know our Staff: Brittney Iagulli

by | Aug 4, 2020 | Hand Conditions

What is your role at Scottish Rite for Children? 
I am a nurse and work with the hand surgeons, both in Dallas and Frisco. My days are spent organizing and preparing their clinics, seeing patients with them and helping to provide an overall smooth patient experience. I work with patients on their post-operative routine and help educate them on how to care for their casts and wounds. I also coordinate referrals, make appointments, schedule surgeries and provide patient education prior to surgery. 
 
What do you enjoy most about Scottish Rite?
The sweet patients and all of my co-workers! Working here allows me to be both a mom and still feel like I am making a difference in this world by helping these kiddos.
 
What was your first job? Why did you decide to do the work you are doing now?
My first job was a cast/brace tech for an orthopedic practice in Ohio. That is where I met my husband and we moved to Dallas. I’ve always been an athlete and had interests in sports and orthopedics. My job as a cast tech gave me the experience to then become an orthopedic nurse. Plus, I just love kids! 
What’s the coolest or most interesting thing you’re working on right now?
I really like working with patients who have brachial plexus injuries or kids that have had to receive nerve grafts. I have seen Dr. Stutz do some amazing things and it is really cool to see nerve function return. 

What are you currently watching on Netflix/Hulu/TV/etc.? 
Ugly Delicious, Master of None, Outerbanks and The Dawn Wall. 

What would be the most amazing adventure to go on?
Right before COVID really hit, my husband and I went to Rwanda on a gorilla trekking trip. Hands down, it was the coolest thing I have ever done. I don’t think that my bucket list will ever end!

What are some small things that make your day better?
Hugs, kisses and giggles from my two babies.

What is special about the place you grew up?
GO BUCKEYES! OH-IO

What is your favorite thing to do when you’re not working? 
Travel the world or spend time at a lake or beach. We like anything with adventure or a body of water!

#SRHaccess Facebook LIVE Recap: Overgrowth Related Syndromes

#SRHaccess Facebook LIVE Recap: Overgrowth Related Syndromes

by | Jan 30, 2019 | Hand Conditions

On this week’s #SRHaccess Facebook LIVE, Director of the Center for Excellence in Hand Scott Oishi, M.D., joined us to discuss the hospital’s expertise in caring for children diagnosed with overgrowth related syndromes. Below is a recap of the conversation.

Watch the live segment.

Common overgrowth conditions:

  • Macrodactyly – abnormally large fingers and toes caused by an overgrowth of soft tissue and bone.
  • An overgrowth related syndrome can affect the upper and lower extremities, as well as muscles throughout the body.
  • The overgrowth can have vascular anomalies – an impact to the veins and lymphatic system.
  • In the hand, the thumb, index and middle fingers are the most common extremities affected. Those fingers are along the same nerve distribution area.

Fast facts about overgrowth related syndromes:

  • Every presentation is different.
  • Severe cases where an extremity (arm or leg) is significantly bigger than the other, it is possible for it to be detected on an ultrasound.
  • Once a child is born and taken to an orthopedic specialist, the diagnosis can be clear from the physical presentation.

Once diagnosed:

  • The hospital’s hand team will counsel the family.
  • As of now, research does not show any genetic cause to an overgrowth syndrome. It is also not related to anything the mother did or did not do while pregnant.
  • A blood/tissue sample may be taken from the affected extremity to be sent off for genetic testing to see if there is a mutation in the DNA.
  • Nothing is done immediately with an infant and the hand experts will observe the patient as they grow.
  • If a child is born with an extremely enlarged limb and have rapid overgrowth within their first year of life, a treatment plan will be put in place sooner rather than later.
  • In mild cases, the child will be observed until their limb is the size of the same sex parent. From there, the doctor will decide whether intervention is needed, such as surgery.

Learn more about the common hand conditions our experts treat.

Symbrachydactyly: Did You Know?

Symbrachydactyly: Did You Know?

by | Jan 28, 2019 | Hand Conditions

Our Center for Excellence in Hand cares for the common to the complex of upper extremity disorders. Depending on the patient and their hand difference, our experts put together an individualized treatment plan to help the child have the most function as possible.

One of the common hand conditions seen at the hospital is symbrachydactyly. Although the literal definition of this term is “short, webbed fingers,” many different presentations can be seen.

Here are the top things to know about the condition:

  • Symbrachydactyly occurs when an arm or hand does not develop completely while the child is in the womb. Depending on the case, it is possible for the child to be missing joints, fingers or an entire hand. A child could have small finger remnants called “nubbins.”
  • Children with the condition are generally healthy.
  • The direct cause of this condition is unknown and a genetic etiology is not thought to be present.
  • It does not cause any pain to the child.
  • Our team works with each patient to help them function independently and participate in normal activities.

Learn more about the common hand disorders our experts treat.