What do I do about previously broken fingers?
March 18, 2006 9:09 AM   Subscribe

Please help me find more information of what options I might have to correct previously broken and healed fingers.

Let's say that I have broken all of my fingers at various times of my life, from early childhood to my teens. I have never been to a doctor for any of the incidents. Some fingers have been broken multiple times and in multiple places. In the intervening years, my fingers have healed so that my fingers are visibly not straight. Furthermore, I can not physically move most of my fingers to a fully extended position without causing extreme pain, if it is even possible to force my finger that far. My range of motion is severely limited in all of my fingers.

Let's also say I understand that I have to go to a doctor, but am afraid of the consequences. I don't want to explain how I broke each finger and, furthermore, don't remember the specifics of each incident. It would be fair to characterize my fears as mostly about how I my fingers were broken. Perhaps I misunderstand how this might be corrected, but the rebreaking of fingers and the resulting healing times simply terrifies me. I'm asking this question as a first step toward resolving the many issues involved.

Let's also say that I work with my fingers every day and the limited mobility and flexibility causes issues daily. In addition, I now have frequent pain in my finger and hand.

Please help me evaluate my options. Issues of insurance aside, what kind of doctor should I seek? What type of options are available for corrective action? Are there alternative, non-surgical methods of regaining mobility and flexibility in my fingers? Can an occupational therapist or a physical therapist help mitigate the pain?

Have you had corrective surgery or other actions taken for a broken finger? What was done? How long did it take? How has it impacted your life?

For the record, I have never broken a finger. Please refrain from speculating about who I am referring to, how fingers might have been broken, and issues to do with mental health. Some here know more about me than others, and I'd ask that you continue to respect my privacy. I am not making this post anonymously so that I can answer questions that may come up. If you have something private you'd like to say, please do not hesitate to email me.
posted by sequential to Health & Fitness (9 answers total)
Generally, for evaluation of these kind of problems (particularly if severe enough to constitute the functional impairment and pain about which you've posted), a person suffering from them could approach an orthopedic or cosmetic (plastic) surgeon, preferably one with a sub-specialty in hand reconstruction. It may not be advisable or necessary to attempt to repair every old injury, but an overall plan for functional improvement may not only alleviate some functional problems now, but prevent or at least ameliorate additional degeneration. That is really important, because as time goes on, damaged hands can become arthritic to the point of making a person unable to do basic self-care tasks, like putting on socks and shoes, opening doors, cooking or handling eating utensils, etc.

I have had extensive orthopedic joint surgery and physical rehabilitation, although not on my hands. I do have significant joint damage to one finger for which I have had an evaluation (nothing much to be done), and I have known many people in occupations where carpal tunnel syndrome surgery was performed. IANAD.
posted by paulsc at 9:55 AM on March 18, 2006

Several points...

First, regarding your hesitation to see a doctor for fear of explaining some uncomfortable past. Within reason, I would assume this to not be a problem. A doctor needs to know about the state of your hand, and the state of your general health, and that's about it. Maybe also to be sure you are not so psychiatrically off-base so as to go mutilate your recently-fixed hand, but we're talking really extreme cases there.

Now, about your hand. I'm only speaking broadly here...

An improperly healed bone (referred to in the business as a malunion...) can be fixed be re-separating it (called an osteotomy) at an appropriate place, aligning it properly, and allowing it to heal. ("appropriate place" is usually close to the original fracture sight, but not always. Think of taking an angled piece of wood, and figuring out where to cut out or insert a wedge to make it straight. Orthopaedics really is like carpentry!) Notice that I don't use the common term "rebrake" here, because that sounds unnecessarily violent and scares people, as you demonstrate above. It's not like somebody is going to stomp on your hand with big workboots, until the fingers soften up :-) We're basically talking surgery here, and from the point of view of the patient, it is no different and no more painful than the original surgery would have been to fix the fracture. (Broken bones in the hand typically take 4-6 weeks to heal, followed by some weeks to months of therapy)

What is different, though, is the likelyhood and extent of success. This is where it becomes obvious that it's not all just carpentry. If your hand has been malformed for a while, the soft tissues will have become stiff and contracted (the more complicated your injuries, the more severe), and correcting all of this becomes harder and harder. The right people (see below) examining your hand can give you an idea of what's possible, what are realistic expectations, and what exactly it would take (as far as surgery, therapy, time, etc...)

Generally speaking, intervention is warranted when somebody can do something that will leave your hand better off, and is also of an acceptable risk/benefit balance. I say this, though apparently self-evident, because people generally fear that if you walk into a surgeon's office, you will be made to have surgery. The surgeon may go right out and tell you if your hand is too complicated to make worth the risk of fixing.

As to the who: A hand surgeon is one with with a background in either orthopaedic, plastic, or general surgery (nowadays most prevalent in that order), who has had additional subspecialty training in hand surgery. (BTW, paulsc, cosmetic surgery is a different subspecialty of, and not generally equivalent to, plastic surgery as a whole...) A hand surgeon will be able to lay out the options for you, be they surgical or non-surgical, refer you to an appropriate Hand Therapist (physical and/or occupational therapists specializing in the hand), or even refer you to another hand surgeon if your case requires some special advanced expertise.
posted by Dr. Sam at 11:02 AM on March 18, 2006

I'd be tempted to look into PT or OT for a while, just to see how much of this can be helped by working with the soft tissues first. Then you may have a clearer idea of what really needs surgical fixing. It's possible that there are tricks you can use to compensate for some of it.
Most surgeons are a lot more interested in good pictures of what is wrong right now than stories of how it got that way.
( /cut radial nerve in childhood, I type with 6 fingers.)
posted by unrepentanthippie at 11:42 AM on March 18, 2006

Another vote for going to see someone who's ABMS board-certified in hand surgery (not cosmetic surgery.) Hand surgery is an arcane art, taught only to trained orthopedists in a 3-year subspecialty fellowship program.

Once someone's gone through those 8 or 9 years of surgical training, they're qualified to take a look at your X-rays, sit you down, and compassionately explain to you what they would propose to do, the effects it would have, and the amount of pain it would entail (and how that pain would be dealt with.) If you didn't want to go over the painful details of how the fingers were broken, a short statement to the effect of "I'd prefer not to talk much about how my fingers got broken" would suffice. No doctor would be surprised at this sort of statement, nor unfamiliar with the reasons behind it.

I've never met a hand surgeon I didn't like; I've found that the people who've taken the extra time to go through such training are generally extremely bright, careful, and compassionate docs.

The thing to do is to go to abms.org, click on 'who's certified', register for free to search the site, and search by specialty/location. The specialty in question is called 'Hand Surgery'. There are 129 results in New York State and 36 in CT.

From a semi-relevant website:

Hand Surgery is the special field of medicine that includes the investigation, preservation, and restoration by medical, surgical, and rehabilitative means of all structures of the upper extremity directly affecting the form and function of the hand and wrist.

General Information

In 1982, the American Boards of Orthopaedic Surgery, Plastic Surgery, and Surgery were asked by the American Association for Hand Surgery and the American Society for Surgery of the Hand to consider special recognition of those Diplomates of these Boards who had demonstrated special qualifications in Surgery of the Hand. An Ad Hoc Committee was formed which included representatives from the three Boards and the two Societies. In 1984, the Ad Hoc Committee was reorganized as a Joint Committee and empowered by the Boards to explore further the feasibility of the certification process. The Joint Committee recommended that the three Boards apply to the American Board of Medical Specialties (ABMS) for authorization to offer a Certificate in the Subspecialty of Surgery of the Hand. The authorization was granted to each of the three Boards in 1986.

posted by ikkyu2 at 1:30 PM on March 18, 2006

Actually ikkyu2, 'tis but a one-year fellowship, once you've completed one of the other three primary residencies. And hopefully not too arcane :-)
posted by Dr. Sam at 7:06 PM on March 18, 2006

Thank you all for your responses. As simple as they may seem to you, they have helped a great deal.
posted by sequential at 10:49 PM on March 18, 2006

Hand surgeon for sure. As for explaining it: tell them you ride horses! Works for all unexplained injuries, bent fingers are nothing, at least you have all yours.
posted by fshgrl at 11:12 PM on March 18, 2006

I was a little puzzled by the wording of the question, but, no matter... As usual, IANAD, but as someone who has broken several fingers (5 total, I think), I'll throw in my $.02. Two of the fingers I broke are not straight (hey, I set them myself, so cut me some slack). But they've never caused me any inconvenience or pain. But the doctors have told me that broken bones can lead to arthritis, eventually.

But if you do have pain and limited range of motion, I'll second the physical therapist suggestion. When I had a toe (essentially) re-attached, getting PT seemed to help a lot.
posted by ObscureReferenceMan at 8:51 AM on March 19, 2006

The guy I talked to at LAC+USC med center when I was a med student was spending 3 years training in hand surgery, but I think that may have included a research year. He was an orthopedist by training, and I think he also may have spent some time with the reconstructive (plastic) surgeons.

Really devoted guy; I called him once from the jail ward because i had a 13 year old kid in there who'd laid the back of his hand open by hitting some other kid in the mouth. I was worried about infection and the tendons and so on; the hand surgeon came up to the jail ward, showed me how to examine the hand so as to learn that all the tendons and nerves were still intact, and set up a special bath of dilute betadine for the kid to keep his hand in so that the nasty pussed-out Eikenella corrodens infection he had going would subside faster. (the fascial compartments of the hand aren't particularly well penetrated by antibiotics, apparently - who knew?)

In conclusion, go hand surgeons!
posted by ikkyu2 at 12:07 PM on March 19, 2006

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