This is a transcript of a Dr. Jay Show broadcast on AM 1560TheGame. Dr. J. Michael Bennett is a Board Certified Orthopedic Surgeon and a Fellowship Trained Sports Medicine Physician serving patients from Katy, Fort Bend County, Metro Houston and Southeast Texas from offices in Houston, near the Houston Galleria and Sugar Land, TX. Call 281-633-8600 for an appointment. Our special guest today is Dr. Alan Rodgers, who is a hand specialist practicing in the Katy area.
This Show is presented in eight parts. Here’s the summary of the eighth portion of the Show:
Dr. J. Michael Bennett: The next topic I want to talk about is the nail bed injuries that we see a lot of. The guy is out there hammering, hanging stuff up on the wall on the weekend and boom, he slams the hammer right on his fingernail. I see a lot of these patients come in and their nail is all blue and black; sometimes you have got to decompress that blood in that area, to kind of save the matrix – and this is not the Keanu Reeves Matrix – I’m talking about the nail matrix which is the bed underneath that hard, shell-like surface of the nail. So can you tell us a little bit about nail bed injuries and when you need to fix them, when you don’t need to fix them, and what’s the recovery rate? And also, what kind of deformities can you end up with on a fingernail bed injury?
Dr. Alan Rodgers: The fingernail bed is a very sensitive structure and it’s really kind of a wedge between bone and that plate that we all call fingernails; neither of those is very forgiving. Anytime pressure’s increased in that area, it can destroy that special tissue that the nail grows on. It’s not normal skin under your fingernail. If you’ve ever had your fingernail lifted up or something stuck under your nail then you know it’s very sensitive, very painful, and it bleeds a lot. It’s a very specialized skin, or skin-like substance that we have under our nail that allows it to stick there, and when that bone is crushed through a hammer injury or any kind of injury, pressure can build up and it can deform the nail. That pressure can actually kill those cells that allow that tissue to do what it does and you can get scarring. If you don’t relieve that pressure and you develop scarring there, your nail will not adhere down to the bed as it should and then you will get either a hook in the nail, a deep ridge in the nail, or you can even get an area of the nail where it doesn’t stick and it is constantly getting caught on things and pulling up and causing pain where the nail is actually trying to stick down. So it’s very important that you treat that nail bed as the special material that it is and take that pressure off. Now if you hit yourself in the finger and the whole thing is purple and throbbing like crazy, it’s best to get attention for that. What will happen is just a small hole will be cut into the nail plate or the fingernail to relieve that pressure, and that’s usually all that’s needed in the acute phase. As it grows out, if you start to develop deformities of the nail, you may need to have grafting from additional nail beds to keep that nail adhering down like it should.
Dr. J. Michael Bennett: Where are you getting that graft from?
Dr. Alan Rodgers: It depends on the size of the defect. If it is a large portion of the nail, one of the best places to get it is from the big toe because that is the largest nail that we have and it has most of that type of tissue. When we take it from one to give to another we are not taking it at the full thickness, so it doesn’t deform the nail where we borrow it from; we’re taking only a split part of it – about half the thickness of it – so it grows back where we borrowed it from and we’re able to put some where it needs to be as well.
Dr. J. Michael Bennett: So the issue here is to just have it evaluated. It’s one of those things where if you get a bruised finger and you see that discoloration in the nail you got to get it looked at immediately because if you don’t, what happens is the blood that’s collected underneath that nail will solidify and become very difficult to decompress. It almost turns into a kind of Jello-like substance. What we do is take a needle and basically create a little puncture hole in the top of the nail – you don’t even feel it because the nail itself doesn’t have any nerve endings in there – and basically decompress it, kind of like creating a little spout in the top of the nail that allows the collected bloods to decompress. And just like anything else, it keeps the cells underneath there alive, like we mentioned before with the relieving of the pressure in the case of carpal tunnel syndrome. So you don’t want to sit on this for too long because you create more issues long term. And that can be a big issue. Our job here is to try and educate you guys and let you know what you can do to avoid surgery and, in those cases where you do need it, to let you know when to go see somebody and what questions to ask. Hopefully we’ve given you information you can use in the future regarding your hand pain and hand numbness or hand injuries and, generally speaking, you’ve obviously got to take into consideration hand fractures and broken bones of the hand and the big issue with those is the mechanism of injury, which means how it happened. The guy that punches the wall 20 to 30 times and wakes up with a swollen hand and a pinkie finger that’s pointing south – that usually means you’ve got a broken bone. You want to go in and see a doctor, get an X-ray, because that’s something that needs to be evaluated and treated. Luckily, if it’s non-displaced or non-rotated, a lot of these things can be treated without surgery or basically with a cast. So that being said, we tried to cover today about everything we could in regards to the hand. We want to thank Dr. Alan Rodgers for coming on board with us over here.
Our office is part of the highly-regarded Fondren Orthopedic Group and we refer complex wrist and hand injuries to hand specialists at Fondren for treatment. The Fondren hand surgeons are board certified and have added qualifications in hand surgery.
Dr. J. Michael Bennett treats certain wrist and hand injuries including carpal tunnel syndrome, distal radius fractures (broken wrist), trigger finger and metacarpal fractures of the hand. He specializes in using the endoscopic approach to carpal tunnel syndrome, when appropriate for the patient, which means that the carpal tunnel surgery consists of two small incisions instead of a longer incision across the middle of the palm of the hand.
