Hand surgeon Dr. Mark Khorsandi, an esteemed board member of the Scleroderma Foundation’s Blue Bonnet chapter, recently spoke at the foundation’s 20th anniversary event in Houston.
In his speech he addressed several scleroderma-related issues that can develop in scleroderma patients. Dr. Khorsandi spoke about these conditions and treatment options. Scleroderma-related complications include the following:
Calcinosis is a condition in which well-defined calcium deposits form a tuft at the fingertip. These masses can appear in one finger or many. The elbows are also very prone to calcinosis.
The deposits build until the skin is penetrated, releasing a white, chalky discharge. These calcium pockets can also grow over bones and joints, even sensory nerves.
Some patients are able to live day to day with no pain caused by their deposits. Others experience serious pain and even develop ulcers or infections, which can begin to affect motion and nerves.
Raynaud’s attacks happen in three stages:
First, the finger turns from a normal color to white, indicating poor blood flow. The finger then turns blue, which means the area is lacking oxygen. When the attack is subsiding, the finger will turn red, indicating return of blood flow and the attack is ending. The disease can affect one or more fingers.
The blood vessels in the phalanges are small, which can make them likely to spasm, causing an attack. Avoiding triggers, the biggest of which is cold temperatures, can control these Rayndaud’s attacks.
If the avoidance method fails, there are medications that can keep the disease in check, both oral and topical. Recently, however, there has been evidence that Botox can treat Raynaud’s Phenomenon.
At Hand Surgery Specialists of Texas, we do offer Botox as a form of Raynaud’s treatment, however, not all patients qualify as candidates for its use. In extreme cases, a digital sympathectomy may need to be performed by a hand surgeon. This procedure has been beneficial in both the short-term and long-term.
To avoid hand surgery, Raynaud’s patients should focus on prevention: keep hands warm, wear gloves, prepare for cold temperatures, including the freezer section at the grocery store, or even the cold water in the washer machine.
In Latin, sclerodactyly means “hard skin”. The skin itself hardens, and patients experience hand contractures as a result. Unable to grip or hold onto ordinary objects, life becomes very difficult for those who suffer from this disease. Sclerodactyly may contribute to ulcers on joints, which are painful and cause further complications. There is no known cure for sclerodactyly as of now.
At Hand Surgery Specialists of Texas our hand surgeons have had success in partially treating this condition by performing arthrodesis of the PIP joints, which restores some function of the hand. Additionally, we sometimes place MP implants, which restore hand motion even further.
This condition results in red spots that show on the skin. This is caused by the dilation of small blood vessels (capillaries) in the skin. This condition is rare, but minor, and requires no hand surgery or treatment.
Ulcers are very common in scleroderma patients. The fingertips and areas over the PIP joints are where ulcers commonly form, though they can occur anywhere. They are painful and heal slowly.
Ulcers are caused by any number of factors. These include:shutt
- Decreased blood supply to the fingers, accompanied by increased pressure whether it is due to sclerodactyly or calcinosis.
- Constant pressure and friction between the skin and bone.
Local wound care and splinting are usually effective in treating ulcers. Additionally, there are many products available to treat and heal ulcers.
Infections from ulcers are rare, but possible. The ulcer should be closely monitored for signs of infection, as the infection can spread to adjacent bones in the fingers. In worst cases, the infection will fester within the bone as well. This is called “osteomyelitis.”
The hand specialists at Hand Surgery Specialists of Texas are prepared to identify and treat the aforementioned conditions. If you would like to make an appointment, fill our online form or call us at one of our multiple Houston locations,.