Dr. Knight on The Doctors TV

This is YouTube’s automatic transcript, so some of the anatomy terms are the words the machine heard rather than the words he said. We are working through them.

there's nothing more frustrating than hand pain especially if you spend a lot of your day at the computer but there are solutions and here to share a new option that could give you relief is orthopedic surgeon Dr John Knight welcome Dr

Knight so we're actually talking today about something relatively new knuckle replacement surgery that's correct uh knuckle placement is not for everybody but for patients that have SE severe arthritis of the hands limiting function severe pain deformity this can be a

lifechanger so it's an option and we have a really cool animation here we're going to walk everyone through this to show you exactly what happens in this procedure so you're looking at a hand walk us through what we're seeing here the red the red line either centrally or

going cut Crossways is an incision through the skin once we go down to the Joint we we're looking at the metacarpal bone and the fenial bone the knuckle of the hand right there and so we have to remove the disease joint with a little

microl that allows us to put a new joint in its place so there we're removing one side of the joint with the diseased cartilage and the other side of the joint here now we're putting a little alignment guide in so we have good alignment of the joint when it's put in

so it's parallel then this is a uh temporary implant for sizing and then finally put we're putting in a pyrocarbon graphite with carbon prosthesis very strong prosthesis and then this shows the wound after they're sutured up so I hopefully

everyone understands that because literally if you had severe arthritis say in this joint you're literally getting rid of that joint the cartilage and replacing it with this artificial prosthesis we have an example here of an x-ray these three have the artificial

joint this is the old normal joint right that's correct and and this is the prosthesis right that's a again it's a very sturdy flexible solid prosthesis made of graphite and carbon this is an example right here so that would just that becomes your joint right this small

yeah very similar to a knee or hip replacement but obviously on a much smaller scale and so after this is done what what type of Mobility will you get back the mobility could be normal I mean obviously we don't promise that but it's usually a lot better than what they had

before uh but it could be 90 Dees of movement which is normal for these joints and we actually have a patient here Lori in our audience who had a knuckle replacement surgery performed right Lori yes I'm very happy with it um before I could hardly move it it was

very swollen and painful and now I've got almost full movement back now and so lur you're happy that you had this done pain levels have decreased significantly and it looks a whole lot better too than it how it looked before um and that's a great point because you

can get a lot of deformity in the knuckle joints so who would be a candidate for this procedure Dr Knight well patients with any form of arthritis osteoarthritis or degenerative arthritis is what most Americans are afflicted with that get arthritis aging arthritis

rheumatoid arthritis which is more of a crippling arthritis and then what we call traumatic arthritis just one joint from a fracture that didn't heal right can also lead to disabling pain well thank you so very much for sharing with us appreciate itks

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This is YouTube’s automatic transcript, so some of the anatomy terms are the words the machine heard rather than the words he said. We are working through them.

today we're reviewing all of the side effects you can avoid and if you spend a lot of time at the computer texting on your phone or even overdoing it at the gym you could be causing serious damage to your hands just ask Sophie I've been suffering with pain from carpal tunnel

for about ten years now I worked as a sheriff's dispatcher for seven years where I was constantly typing for 10 to 12 hours every day carpal tunnel is affecting my life in a lot of ways I make a living as a teacher but with the carpal tunnel I have to stop when I'm

grading papers I'm not able to do things that I normally would do and just a regular routine day when I blow-dry my hair my hands fall asleep when I hold a cell phone up to my ear my hands fall asleep I have shooting pains that go from the bottom of my palm up towards my

fingers I have to take 800 milligrams of ibuprofen every night to help deal with the pain I sleep with braces on my hands if I don't wear my braces at night I'll wake up in my hand is like a claw and I'll have to literally massage my muscles out so that I can extend my hand

to a regular position I haven't had surgery yet because I was afraid of the type of surgery where they were cutting your hand from the middle of your palm all the way down my symptoms have gotten progressively worse and I just got to the point where I feel like I need to do

something we'll give you tips on how to prevent carpal tunnel syndrome in just a minute but first let's take a look at how Sophie's surgery went the procedure that I'm performing a day the endoscopic carpal tunnel release is a much quicker recovery than the standard open

procedure because you have just a small one and a half centimeter score at the wrist crease so we mark the Pam eight bone just on the edge of the carpal tunnel and that indicates the line that I want to put the scope so now we're going to make a little incision and then

I'm gonna make a cut through the fascia that's gonna be kind of my guide into the carpal tunnel the carpal tunnel is a tunnel deep within the risk and it's within that tight tunnel that the tendons that flex the fingers so with repetitive movement you can get a

buildup of inflammation leading to nerve symptoms of numbness and tingling weakness in the hand the ligament is the widest structure and we're cutting through the ligament right there now we're going to pull it back towards the incision

cutting the rest of it and now you can see that there's complete division of the ligament now that I've satisfactorily released the pressure on the tendons and nerves I'm optimistic she'll have a full recovery and I'm here with orthopedic surgeon dr. John Knight

from the handed wrist Institute right here in Beverly Hills and his patients Sophie how are you feeling I feel great surgery was in September right it was in September almost immediately I had wonderful results I haven't had pain

I haven't had to sleep with my braces anymore I don't take the ibuprofen I'm able to do everyday tasks that I wasn't able to do before it's it's been amazing so tell us what makes your stitch list and discove ik carpal tunnel release surgery so special the key is with the

older procedure or traditional procedure there's a three-inch score five to ten sutures this procedure is through a one centimeter incision we put the endoscope in as opposed to cutting down through the skin and fat we insert this device we pull a trigger that insert flips up a

little scalpel and cut the ligament from the bottom up so we minimize all that scarring the patients can start moving it right away compared to three weeks in a brace okay big question for all those sufferers out there what can they do to make it better and to prevent it first

in the first place well the first preventative thing is ergonomic s' posture there's a lot particularly if we're going to talk about this keyboarding or computer use there are split keyboards organ amma Klee correct keyboards I think here today we you have

a mouse that's organ Amma Klee correct and that it you can keep it in by the side and do a lot with finger movement as opposed to having to move the mouse around the key with anything you do with your hands whether it's a computer use or texting or driving a car is relaxing

beyond that the key is if you're doing repetitive use of the hand or arm you want to take frequent breaks and there are a lot of things that you can you know if you're on the tight you know keyboard for an hour at a time you want to take a five or ten minute break get

up stand up there are different stretches you can do that involve holding the hands out like this for count of five and here then here then here each with a count of five back to there and then just shaking your hands out and then sitting back

down but there's also other causes metabolic abnormalities inflammatory conditions like rheumatoid arthritis and lupus and things like that so it's not just the repetitive use gotcha well guess what everyone in the audience is getting an ergonomic

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These are Dr. Knight’s own words from the video. We corrected the anatomy and drug names the automatic captions got wrong and added the punctuation. Nothing he said was changed, added or taken out.

Host: Even as small as joints in our bodies can obviously cause us pain, as was the case for Leslie. Let's look at her story.

Leslie: About two years ago I woke up and my thumb was in extreme pain. When I actually bent it, it felt like it was breaking, and, but doctor told me I have trigger finger. This is as much as I can move it without pain right now. Day to day activities have become very challenging and difficult to do. Brushing my hair, using the curling iron, it affects everything that you do. I am so excited to get this problem resolved.

Host: Let's see how Leslie's surgery went.

Dr. Knight: Good morning. I know it's painful. Try to bend for me if you can, and just, let's look compared to the other thumb. Bend as far as you can, just kind of show the difference here. So that's how, all you can bend the left thumb. Okay. The condition is called a trigger digit, or in this case trigger thumb. I'll make a little cut through the skin here, and then I'll be looking at the band. I'll make a little snip of that band, and then we'll wake you up, and then three stitches later you're done.

Leslie: How long was the actual procedure take?

Dr. Knight: It's going to take about five to ten minutes total time. I think you'll see marked improvement, your mobilities, and while you're on the operating room table.

Leslie: And looking forward to bending my thumb again.

Dr. Knight: Now we're just gonna make a little incision for the crease of the thumb, and we're just going through the tissue to, down to the tendon. Here's the band we're gonna snip, and I'm just going to put my scissors right underneath this band.

We're just gonna wash the wound out with some antibiotic solution and put a few stitches.

This is what she couldn't do before surgery. Bend your thumb all the way for me, sweetie. There you go. See that? Right, she could see the, got the tendon completely released. Now she has full mobility. I think Leslie will be happy. Look at her right now, she's moving it completely.

Leslie: Hey, you know, good. I mean, my thumb, I can move it. I'm so excited, look at that.

Host: I'm here with hand surgeon Dr. John Knight from the Hand and Wrist Institute in Beverly Hills, California, along with this patient Leslie. So before we talk a little more about what this trigger finger is, can you show us?

Leslie: Oh, I can bend my thumb. I'm getting all the strength back. It's, I wish, I don't see it catching. Nope. No pain, no pain.

Host: Wow. Okay.

Leslie: And I wish I would have done it a year and a half ago.

Host: Well, I'm glad that you came to get resolution. A lot of people suffer from a trigger finger, right?

Dr. Knight: Right, it's the most common procedure we take care of as a hand surgeon, more common than carpal tunnel.

Host: So let's show people what trigger finger is. I know we have an illustration here.

Dr. Knight: Sure. On the illustration you'll see bands or tendons to go to the tip of the finger, and it's in the palm area that, that you get a little swelling or inflammation around the tendon. Eventually over time you actually may form a nodule, and that nodule is like a rope going through a pulley. It starts to snag. And we have a demo here. I don't know if this is really going to do justice, because it's obviously difficult sometimes with demos, but again, this is the tendon. It's going, it's going through that sheath, and this is one without.

Host: Right, no friction, smooth gliding.

Dr. Knight: And that's, and all the tendons that bend the fingers down go through a system of pulleys, and then there's what the, there's usually the first pulley that's in the palm or at the base of the thumb, and it forms a little knot on it, like this knot on this rope here, or this ball, and it impedes the thumb movement. So when we do the surgery, just snip it, and that relieves the pressure. So by getting rid of that, and it obviously moves freely through the pulley system, as evidenced by your quick recovery.

Host: Are there things that people can do in their daily life to hopefully prevent this from occurring in the first place?

Dr. Knight: Absolutely. Surgery is a last resort. You know, what the first thing is, looking at ergonomics, less repetitive use, too much texting, too much keyboard. Just said as much as you can, you know, over-the-counter anti-inflammatory medicine and just rest. There's a, no, really the hallmark of conservative treatment is a cortisone shot right where the tendon is. If it's mild case, then it can respond favorably of that. In her case though, when you can't bend it at all, that's a pretty severe case, it's not likely to respond to conservative treatment. So surgery is a last resort, but it is an option for people who just have no resolution with conservative treatments.

Host: So happy that you're feeling better.

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