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» Hatrack River Forum » Active Forums » Books, Films, Food and Culture » Medic! Hand mobility question

   
Author Topic: Medic! Hand mobility question
Dr Strangelove
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So on Monday I gashed my left hand pretty good: Be warned - Slightly nasty looking.

Thus far I've just kept it bandaged up with neosporin. I've been cleaning it several times a day and all, so I'm not too worried about infection. I can still move all my fingers, so the tendons are fine (I think I actually caught a glimpse of a tendon when it happened). I was wondering though if anyone had any thoughts about stitches, or whether or not I am in danger of it scarring in such a way that I lose full mobility in my hand?

The people I've talked to have said that its in a rough spot for stitches and that it probably wouldn't make a difference (including the nurse who put the initial bandage on it, though she was more technically a physical therapist I think. Long story). I really don't want to go to the doctor, not least because we are dirt poor at the moment. But if it's between getting stitches and not having full use of my hand, I suppose I'll take the stitches.

I know no one can give me a diagnosis or really even that specific of an opinion based on a picture, but if anyone has any experience with these matters I'd be interested in perspectives. Thanks indefatigable Hatrack!

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Aros
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Clean it really well and cover it in superglue.
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MattP
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I would definitely see a doctor, but then I have health insurance so I don't have to make the decision about whether I can afford to get it looked at.

If you don't go to a doctor I'd do what you're doing - keep it clean and keep checking to make sure you've got full mobility (even if it hurts to check or makes you bleed more). If the tendon was damaged at all (including just being exposed) then tendon adhesion is a real risk. The only way to prevent that is to do a lot of moving of that digit even while the wound is not fully healed. If you get an adhesion then surgery may be necessary to correct it and the physical therapy that follows is painful and bloody (been there, done that.)

I wouldn't go the super glue route, especially if the tendon was exposed. Superglue should, IMO, only be used for superficial wounds or as an emergency dressing.

(Not a medical professional, but have first-hand experience with finger/tendon injury.)

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Samprimary
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Cover it in barbeque sauce and sugar and superglue or whatever and definitely don't have a GP look at it. America has the best healthcare in the world™ so you being too poor to have a tendon-exposing hand injury that looks like a significant risk candidate for localized cellulitis should be of no concern, in effect. Somehow. Law of averages right?

No seriously for serious for reals ignore any advice in this thread that is not essentially "Ah, yanno, you should probably have a doctor look at that, just in case"

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Aros
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Same thing happened to me. I spent three hundred dollars to have the doctor superglue it and tell me to reapply as necessary.

Then again, I'd be fairly concerned if the tendon is exposed. Regardless of the doctor's reaction, it might be good to be seen. Maybe you'll get a better doctor than I did.

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MattP
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So... how did you get the injury?
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AchillesHeel
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I have no medical wisdom to impart, but for recovery there is this awesome hand excersiser. I actually own one and works really well on the distal philanges, I don't know whether or not it could help you retain muscle control once you've healed but it could help.
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Dr Strangelove
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Saber tooth tiger fight. You should see the other guy.


Seriously though, I was overenthusiastic in pulling down a tile wall. I'd chipped out a big chunk and started yanking on it and part of my thumb came off with it. The funny part of the story is that I tend to get squeamish at the sight of blood, so I proceeded to pass out. The guy I was working with freaked out and yelled to call 911. I woke up half a second later and told them I was alright, but it got the attention of the nurse who was doing physical therapy for the old lady whose house we were in (she recently had her hip replaced), so I got a nice bandage and everything. Fun day.

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MattP
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For a hand injury like that the tendons are the real worry. You can rebuild atrophied muscle relatively easily, but if your tendons adhere to scar tissue or if they shrink from disuse it can be very hard to get them functioning normally again. Fixing that can require some pretty medieval stuff like The Joint Jack.
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MattP
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If you were doing this for an employer then workers comp may be an option for covering the medical costs.
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Dr Strangelove
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Nah, it wasn't that kind of work. It was a favor, not an actual job. I wish it was an actual job. And that tendon adhesion thing does sound nasty. *sigh*. I'll have to see what I can scrounge together.
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MattP
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Yeah, it sucks. To give you an idea:

I broke my little finger in a motorcycle accident (the only real injury aside from a few scrapes) and had to have surgery to get the broken bones pinned together. It then had to be immobilized for several weeks until the bones were strong enough that the pins could be removed. At that time we discovered that there had been some tendon damage and I was physically unable to bend the last couple joints more than a few degrees.

After several weeks of physical therapy (a few sessions of 20-30 minutes of exercises every day) I still could not bend the finger all the way closed though I could get it mostly straight. It was determined that tendon adhesion was the issue and that surgery would be needed.

The surgery involved cutting a zig-zag incision down the length of my finger so that the entire length of the tendon could be examined and freed from scar tissue. At one point during the surgery they wake you up and ask you to bend your finger to verify that the adhesion has been cleared. Then they put you back to sleep and sew you up.

This is where it gets bad.

Having just cut a huge swath of my finger open to free the tendon there is now a large amount of new scar tissue forming and a large risk of a new adhesion. The only way to prevent it is to repeatedly exercise that finger - the one with a big zig-zag freshly-stitched wound on it. At first it was extremely painful and it would bleed quite a bit as I flexed and extended that finger and its wound. I had to do this *every four hours for a week* (or was it two?) which meant I could never sleep for more than 4 hours at a time and I was often in enough pain at the end of this that I couldn't get back to sleep very quickly so it would be more like 3 or 3 1/2 hours.

This took care of the adhesion problem - I can now fully bend that finger shut so I can make a normal fist I cannot extend that finger all the way. It's a preferable situation to not being able to bend it, but it's still not ideal. I do own a Joint Jack but it's painful and tedious so I've been pretty lax in its use.

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Kwea
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That's funny, I've never heard of a Dr using superglue in the ER. Ever. There are medical glues, but they are not the same thing. (yes, I know why superglue was created. I also know why we don't use it)
Linky.

Cleaning it is good, but that alone won't make sure it won't get infected.


I am a nurse, and when my wife hurt her hand like that, between the fingers, she went to the ER right away. It could still be stitched, if necessary, although it isn't fun to get in there. I can't officially offer any advice other than see a doctor, but even if I could, guess what I would say...


$300 sucks, but not half as bad as losing even partial use of your hand.

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Aros
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I'm sure the doctor used medical glue. But he did tell me to follow up with superglue. Maybe he was a crap doctor.
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Stone_Wolf_
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I've used super glue for treatment of wounds for many years quite successfully. In fact it was the -only- thing that cured my Dyshidrosis (hand eczema) even when prescription strength steroids did nothing.
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Samprimary
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quote:
Originally posted by Aros:
I'm sure the doctor used medical glue. But he did tell me to follow up with superglue. Maybe he was a crap doctor.

in any other modern country: yes. In america: not necessarily, because they might have been taking into account the fact that, for instance, an uninsured person or underinsured person is probably not going to receive proper followup care and the best they can offer is instructions for an accessible DIY followup that will do more good than harm considering that they are probably not going to take on the cost of followup visits for reapplication, or a costly scrip for medical glue (if they dispense that with scrip, anyway).
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Kwea
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They don't, and as I said I've never heard of it in all my years, in and out of the Army.


SW, superglue can cause infection because penetrating woulds are really, really hard to clean properly even in the ER. You seal anything in, it festers, and you don't know because the glue holds it in until it gets worse. Also, it can cause scarring, as it dried out the edges of the would. It can actually PREVENT healing, prevent the wound ends from closing together. The main ingredients are so irritating that almost 1/3 of people in the US have at least a hypersensitivity to it, and many have an actual allergy to it.

There is a HUGE difference between cuts, puncture wounds, and Dyshidrosis. Dyshidrosis is a surface condition, and even then most dermatologists recommend staying away from superglue. It CAN be used to seal fissures in the hands then filed down, but it often causes more issues than it solves.

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Stone_Wolf_
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I guess I'm just lucky, as every single wound I've sealed with superglue (after pushing out some blood and cleaning it) has healed quicker and with zero infection then triple antibiotic ointment and a band aid. Every single one. For the last decade.
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TomDavidson
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Have you been cutting control wounds in your other limbs to compare?
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Stone_Wolf_
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At times I do not have access to superglue, or simply forget, at which point I have used triple antibiotic ointment and a band aid.

Those wounds healed slower, will more infection (I suspect because the would was not sealed, and new contagions were introduced) and produced larger scars.

But if that isn't good enough for you Tom, I'll drop you a note when ever I get a booboo and you can self inflict a similar wound and we can compare notes after treatment.

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TomDavidson
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You understand why cutting a wound in my body in the same place you injured yours would not in fact be a particularly useful test?
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AchillesHeel
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Science demands that you prove its futility, with proper notation and photographic timeline.
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Stone_Wolf_
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Oh, I understand Tom, but the idea of you sharing my pain is very appealing.
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