A Word in the Hand
October 2001
Pennsylvania buck season is just around the corner. Hunting is a favorite outdoor sport enjoyed by men, women and children. Approximately 1 million hunters will head for the woods on November 26th. Unfortunately, hunting-related accidents will occur during this season. The Pennsylvania Game Commission (PGC) reports that from 01/01/2000 to 12/31/2000, there were 69 reported hunting-related shooting incidents, 15 were self-inflicted, and 54 were inflicted by others. Shotguns were responsible for 62% of these shootings, rifles accounted for 25%, handguns were involved in 10% of the incidents, and muzzleloaders accounted for the remaining incidents. 9% of the victims were 12-15 years old, 10% were 16-20 years of age, 55% of the victims were 21-50 years of age, and 26% were over 50 years of age. 90% of the incidents occurred under daylight conditions, 7% occurred at dawn, and 3% occurred at dusk or dark. 67% of the shootings took place in woodland areas, 26% occurred in a field, and 7% took place on the road, highway or in a vehicle. 74% of the victims had experience with firearms and hunting for over 10 years. According to the PGC, Pennsylvania hunting-related shooting incidents have declined by nearly 80 percent since hunter education training began in 1959. While hunting is safe and getting safer, even one such incident is one too many.
The risks related to firearm use are well known, while the hazards associated with deer stands are not fully appreciated. Unsafe hunting practices can result in bruises, broken bones, and possible death. Many falls are from hunter-constructed stands, and structural failure accounted for these accidents. Carelessness, fatigue, and alcohol were other causes accountable. Fractures of the spine and long bones generate a large percentage of the injuries. Falls from deer stands may result in lengthy hospitalization and rehabilitation, long-term disabilities, and even death.
Following basic safety rules and using common safety sense can save a lot of frustration, pain, and possibly your life.
At the Western PA Hand and Trauma Center, we recommend the following tips for keeping safety in mind while hunting:
Wear florescent orange clothing. Hunters in PA are required to wear 250 square inches of florescent orange material on the chest, head and back when hunting in the fall, and 100 square inches in the spring.
Dress warmly - Limit exposure to cold temperatures
Carry survival gear at all times, including a first aid kit, compass, and map
Wear eye and ear protection
Never mix alcohol or drugs with shooting
Make sure your gun and ammunition are compatible.
Carry only one gauge/caliber of ammunition when shooting.
Know the identifying features of the game you are hunting.
Familiarize yourself with the hunting site and surrounding area.
Always point the muzzle of your gun in a safe direction.
Keep your finger off of the trigger until you are ready to shoot. Make sure your shot path is safe, and never shoot at a sound or movement. Always be 100% sure of your target - and what’s beyond!
Never shoot at a hard flat surface or water
When sitting against a tree or rock, make sure it is wider than your shoulders to prevent a hunter from mistaking you for a target
Hold onto your gun – never lean it against a tree or any other object
Do not use weathered, homemade tree stands.
Always unload firearms before pulling them up or lowering them from the tree stand. Also unload you gun before scaling fences and logs or jumping over ditches. Carry unloaded guns to and from the hunting area.
Wear a safety belt or harness in a tree stand. Choose a healthy tree with branches to support additional weight. Never use a tree with dead branches or fungal growths nearby or on the trunk.
Never engage in horseplay using a gun.
Keep guns and ammunition out of the reach of children.
Never hunt alone
Western PA Hand and Trauma Center has a physician on call 24 hours every day. To reach the physician on call, contact the office at 724-933-3850.
Purpose: To determine if there is a difference in the outcome between revision open carpal tunnel release in workmens comp vs. non-workmens comp patients.
Methods/Materials: Retrospective study of 52 patients who underwent revision carpal tunnel surgery using a vascularized hypothenar fat pad. 27 were male and 25 female. The dominant hand was involved in 34/52 patients. 31/52 were non-workmens comp patients whereas 21/52 were workmens comp. Mean age was 47.8 (range 29-81 years). 50/52 patients had only one previous decompression. Positive nerve conduction studies were found in 91.8% of patients prior to their revision decompression. Mean time from initial surgery was 3.9 years (range 4 months to 18 years). Three separate hand surgeons at the same hand center were involved in the surgeries. All performed the same operation: open decompression of the median nerve and coverage using a vascularized hypothenar fat pad. Charts were reviewed to simply determine patients’ subjective response to surgery. The SF-36v2 and Visual Analog Scales were used to measure self-reported health. The survey comprises eight multi-item dimensions, including physical functioning, role limitations due to physical and emotional problems, bodily pain, general health, vitality, physical and social functioning, and general mental health. The SF-36v2 is a self-administered generic measure of health status containing 36 questions. Scores are transformed to a scale of 0-100, where higher scores indicate higher functioning. Summary scales are scored using norm-based methods. The scores can be interpreted in relation to the distribution of scores in the general US population. Scores above and below 50 are above and below the average in the general population. The pain scale is commonly used to describe the intensity of the pain or how much pain the patient is feeling. The visual analog scale is a straight line with the left end of the line representing no pain and the right end of the line representing the worst pain. Patients are asked to mark on the line where they think their pain is in relation to the two extremes.
Results: Only 38% of the workmens comp patients had relief of symptoms whereas 100% of the non-workmens comp group reported improvement in symptomatology. Scar sensitivity and pillar pain was often cited as causes of continued problems. 49 Patients received a questionnaire package. 22 questionnaires were returned which were completed, comprising 11 WC patients and 11 non-WC patients. The average VAS scores for the WC group and non-WC group were 6.34 and 4.76, respectively. The general health, vitality, social functioning, role-physical, and physical component summary were statistically significantly different across the two groups, and bodily pain was close to being statistically different between the two groups.
Conclusion: Revision open carpal tunnel decompression with vascularized hypothenar fat pad appears to have a beneficial result in non-workmens comp patients. Workmens comp patients tended to have a less favorable response. These results should be kept in mind when one is considering revision open carpal tunnel release.
Giunta R, Frank U, Lanz U. The hypothenar fat pad flap for reconstructive repair after scarring of the median nerve at the wrist joing. Chir Main 1998;107.
Jones NF, Shaw WW, Katz RG, Angeles L. Circumferential wrapping of a flap around a scarred peripheral nerve for salvage of end stage traction neuritis. J Hand Surg 1997;22:337.
Jones SM, Stuart PR, Stothard J. Open carpal tunnel release. Does a vascularized hypothenar fat pad reduce wound tenderness. J Hand Surg 1997;22:758.
Planchar KD, Idler RS, Lourie GM, Strickland JW. Recalcitrant carpal tunnel. The hypothenar fat pad flap. Hand Clin 1996;12:337.
Strickland JW, Idler RS, Lourie GM, Plancher KD. The hypothenar fat pad flap for management of recalcitrant carpal tunnel syndrome. J Hand Surg 1996;21:840.
Ware JE, Snow KK, Kosinski M, Gandek B. SF-36 Health Survey: Manual and Interpretation Guide. Boston: Nimrod Press, 1993.
That's not an option: Treating the Injured Musician
When you are the first chair clarinetist in the Music Department of Duquesne University by your sophomore year, when your life’s course is set upon becoming a professional musician, when you have worked so hard your whole life to this end, and when you are faced with playing your instrument with debilitating, progressive pain and loss of endurance, what do you do when your physician tells you, “I guess you’ll just have to stop playing”?
Alexis, an extremely talented 19-year-old sophomore with the Duquesne University Music Department was faced with a decision. Quit, or continue playing, perhaps risking a career in music due to debilitating pain. Though not widely known, many musicians like Alexis play with pain to the point of career ending injuries, never knowing exactly what is wrong or what to do about it. Every instrument has its own risk and what is beautiful music to our ears may be produced through the injured musician’s searing pain.
Alexis replied to her physician, “That’s not an option.” She knew she had pain. She knew she could only play about 5 minutes before she had to stop. However, she didn’t know what she could do about her problem. Her search for answers and a solution to her pain lead her eventually to the Western Pennsylvania Hand and Trauma Center Hand Therapy Division.
Many factors play into pain. Is it a posture problem? Is it an ergonomic problem with the instrument? Is it a music “technique” problem? Is it due to lack of strength? Does overall conditioning play a role? Is there inflammation? What is causing the pain? Is it changes in routines of practice and playing? Are there nerves compressed? Are there blood vessels compressed? Is it lack of rest? Is it too much rest? Is it nutrition? Is it repetition? Is it the warm-up? What kind of stretching is appropriate? What kind of conditioning? Most of all, what will make it better and let the injured musician play at their ultimate potential?
When the certified hand therapist of the Western Pennsylvania Hand and Trauma Center is faced with an injured musician who has a potentially career ending injury or condition, the therapist agrees with Alexis: “That’s not an option.”
The Grand Opening of the Surgery Center Building and Businesses
The Grand Opening of the Surgery Center Building and Businesses was held on Thursday, September 13, 2001. After three years of development, this was a day that the founding physicians have anticipated for a long time. They were pleased to welcome all in attendance to the modern surgery center.
More than 300 guests had an opportunity to view first-hand this state-of-the-art facility, which includes four operating rooms, minor procedure room, fully equipped preoperative and post-anesthesia care areas, conference facilities, administrative offices, laboratory testing service center, physical and occupational therapy departments, and clinical practices.
Children and adults were entertained by North Star Kids and DJ Mark Thomas. Numerous participants won raffle prizes. Refreshments were provided by Atria’s Restaurant & Tavern.
Participants in the event included Centers for Rehab Services, Quest Diagnostics, Inc., North Hills Pain Management, Western Pennsylvania Hand and Trauma Center, and the Western PA Surgery Center.
This was a day of opportunity to introduce physicians and professionals of the community to the building, known as The Surgery Center. It was also an occasion for employees to celebrate their work environment, which provides satisfaction, pride and excellence.
The staff, therapists, and physicians of the Western PA Hand and Trauma Center are dedicated to providing the highest level of care in outpatient surgery and comprehensive professional treatment.