Kienbock’s Disease: Orthopedic Treatment In Frisco

by Administrator 25. April 2016 10:47

The wrist is made up of eight carpal bones-one of which is the lunate bone. Any damage or loss of blood supply to this bone is termed as Kienbock’s Disease. Also known as Lunatomalacia or Avascular Necrosis of the Lunate, the condition is characterized by severe pain, swelling and difficulty in wrist movement. In severe stages, it may affect the adjacent bones within the wrist joint. It can be categorized into four stages:

  • Stage 1 – At this stage, there may be a disruption in blood supply to the lunate. However, an X-ray may not show any signs of damage.
  • Stage 2 – The bone may become hard and dense, a condition known as Sclerosis. X-ray results may reveal the damage caused to the bone. 
  • Stage 3 – In this, the affected bone may begin to collapse and break into several pieces, causing the surrounding bones to dislocate.
  • Stage 4 – The lunate is completely collapsed during this stage and the other wrist bones may also weaken, leading to the development of Arthritis.


  • Loss of arterial supply to the lunate
  • Damage to the venous drainage of the lunate
  • Short length of the adjoining ulnar bone
  • Trauma to the wrist, such as during a car accident
  • Repetitive stress
  • Medical conditions such as Sickel Cell Anemia, Gout, Cerebral Palsy, Lupus etc.


  • Swollen wrist
  • Pain
  • Stiffness
  • Clicking sound in the wrist
  • Weakening grip strength
  • Tenderness to touch
  • Restricted range of motion, particularly during upward movement of the wrist


  • The doctor may recommend wearing a brace or splint to restrict the movement of the wrist.
  • Giving complete rest to the wrist and avoiding any movements that may trigger pain.
  • Anti-inflammatory medications may be prescribed to ease pain and reduce swelling.

Patients with Stage 4 Kienbock’s Disease may require surgery. The wrist specialist may recommend any of the following procedures:

  • Revascularization: This involves removing a portion of a bone along with the blood vessels and inserting into the lunate to augment or restore blood supply.
  • Joint Leveling: It may be performed if there is a difference in lengths of the forearm bones. The surgeon may either insert a bone graft to increase the length or remove a section of the bone to shorten it. 
  • Fusion: Joining the surrounding wrist bones, either partially or completely, may help to decrease pressure on the lunate.
  • Arthroplasty: In this procedure, the lunate is replaced with an artificial implant to help the patient find relief from the symptoms.


  • Avoid trauma to the wrist
  • Seek proper and timely of the wrist conditions that may cause Kienbock’s Disease, such as Septic Emboli or Sickle Cell Disease.

Dr. Knoll is a Frisco, TX based hand and wrist surgeon providing comprehensive treatment for Kienbock’s Disease. To schedule an appointment, you can call at (214) 618 – 5502.

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Scapholunate Ligament Tear: Causes, Symptoms And Treatment

by Administrator 23. November 2015 08:39

The wrist is a complex joint comprising of three bones:

  • Radius: The big bone of the forearm on the thumb side.
  • Ulna: The small bone of the forearm on the finger side.
  • Carpal Bones: There are eight carpal bones namely- scaphoid, lunate, triquetrum, pisiform, hamate, capitates, trapezoid and trapezium.

Scaphoid is a small bone located near the thumb. Lunate is a small crescent shaped bone present in the center of the wrist, right next to the scaphoid. Scapholunate ligament holds both these bones together and allows them to move in tandem. When this ligament is injured, it is known as a Scapholunate Ligament Tear. The condition may cause a gap between the two bones, hence, causing them to move away from each other, disrupting proper movement and giving rise to pain.


Scapholunate Ligament Tear is commonly seen in athletes involved in contact sports or racquet sports which require maximum wrist movement. Sudden fall or impact on the wrist may cause the ligament to tear away.


  • Pain in the wrist, mainly near the thumb.
  • Mild to severe swelling.
  • Bruising or redness around the wrist area.
  • The grip of the wrist may weaken.
  • There may be slight snapping or popping sensation in the wrist.


A wrist specialist will carefully examine the wrist joint through to diagnose exact cause and extent of damage caused to the ligament. Treatment options may include:

Non-Surgical Methods:

  • A splint or cast may be put around the joint to keep it stable and restrict mobility for a faster healing.
  • Anti-inflammatory medicines may be recommended to provide quick relief from swelling and pain.

Surgical Method:

Wrist Arthroscopy may be recommended if the ligament has suffered major damage. The procedure involves removing the damaged tissues from the ligament. In some cases, the ligament is realigned and the bones are held in place with the help of pins.

For complete diagnosis and treatment of Scapholunate Ligament Tear or any other hand/wrist conditon, visit Dr. Knoll in Plano, TX. To schedule an appointment with the hand doctor, you can call at (972) 985 – 1072 or 4031 West Plano Parkway Suite 100, Plano, Texas 75093.

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De Quervain’s Tendonitis: Orthopedic Carrollton

by Administrator 26. October 2015 14:07

De Quervain’s Tendonitis, also known as Washerwoman's Sprain is a medical condition which involves inflammation of the tendons around the base of the thumb. These tendons run through a tunnel made up of soft tissues which swells and narrows the tunnel. Swelling of the tendons may lead to pain while doing any hand or wrist movement.  People involved in activities that require repetitive hand and wrist movement have more chances to develop this condition.


  • Overuse of the thumb
  • High-impact blow to the thumb
  • Repetitive clutching
  • Rheumatoid Arthritis
  • Racquet sports
  • Activities such as gardening
  • Women can get it just after pregnancy


  • Pain along the back of the thumb
  • Pain that resonates from the thumb up to the forearm
  • Difficulty in moving the thumb
  • Hurting sensation, particularly when grasping things
  • Inflammation and pain side of the wrist


An orthopedic doctor may conduct Finkelstein test to confirm the presence of De Quervain. He may ask the patient to make a fist with thumb placed in his palm. While turning the wrist outwards, the tendons get pulled and stretched. If this test is painful then a patient suffers from this condition.


  • Splint: A doctor may advise to wear a splint to prevent thumb and wrist movement. All activities that worsen this condition have to be completely stopped.
  • Ice pack: Ice packs can be applied to the affected area at regular intervals as it may help in eliminating pain and swelling.
  • Medication: Anti-inflammatory medicines such as ibuprofen or naproxen, as prescribed by doctor, can be administered to reduce tenderness. Steroids can also be given if the pain is unbearable.
  • Avoiding strenuous activities: A doctor may suggest reducing the activities that cause pain and swelling as it may relieve the symptoms.
  • Corticosteroids: Corticosteroids injection may be recommended by a doctor to provide relief from pain and swelling.
  • Exercise: Certain exercises may be recommended by the doctor so as to strengthen the thumb and wrist. These help in the healing process by reducing pain and improving health of the patient.
  • Surgery: When a patient does not respond to non-surgical treatments, the doctor may recommend surgery.

If you are suffering from De Quervain’s Tendonits, consult Dr. Knoll. The orthopedic doctor specializes in treating a wide range of wrist and hand conditions. To schedule an appointment, call at (214) 618 -5502 or visit 5757 Warren Parkway Suite 180, Frisco, Texas 75034.

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Non-surgical Treatments For Carpal Tunnel Syndrome

by Administrator 23. September 2015 09:20

Carpal Tunnel Syndrome occurs when the median nerve gets compressed from where it passes through the carpal tunnel in the wrist joint. The condition can be caused due to repetitive movements of the wrist, health conditions such as Diabetes or Arthritis, deformity in joint structure, fluid retention during pregnancy etc. Carpal Tunnel Syndrome is symptomized by numbness, stiffness in fingers, pain in the forearm, difficulty in using the thumb, loss of range of motion of the wrist etc.

Treatment for Carpal Tunnel Syndrome usually depends upon the severity and cause of the condition. Here are some of the non-surgical options usually recommended for the treatment of Carpal Tunnel Syndrome:

  • Wrist Splint: Providing support to the wrist with a splint or cast can assist in healing Carpal Tunnel Syndrome. The splint provides support to the wrist and holds it in a stable position. This protects the joint from any jerky movement that many further aggravate the condition. The patient may also be advised to wear the splint while sleeping to prevent nocturnal symptoms such as tingling and numbness.
  • Medication: The patient may be prescribed anti-inflammatory medication to offer relief from pain and swelling.
  • Injections: The orthopedic doctor may prescribe injections for patients experiencing severe pain. When administered directly into the carpal tunnel, injections help to eliminate swelling, which lowers the pressure on the median nerve.
  • Activity Modification: The patient may need to take a break from the job if it involves heavy use of the wrist. This can prevent the condition from worsening and promote a speedier recovery.
  • Ice Pack: The doctor may advise applying ice pack to the affected area. This can assist in reducing inflammation and offer relief to the wrist.
  • Rest: Avoiding activities that require repetitive movement or excessive use of the wrist can also be beneficial. The doctor may recommend giving complete rest to the affected wrist and refraining of any strenuous movements.
  • Physical Therapy: Once the pain and swelling subside, the orthopedic surgeon may refer the patient to a physical therapist. Performing light stretching and strengthening exercises, under proper supervision, can help to restore the range of motion of the wrist joint.

For comprehensive diagnosis and treatment of Carpal Tunnel Syndrome, visit Dr. Knoll. To schedule an appointment with the wrist doctor in Plano, TX, you can call at (972) 985 – 1072.

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Orthopedic Treatment For Writer's Cramp

by Administrator 16. July 2015 07:18

Writer’s Cramp, also known as Mogigraphia, is a condition that involves involuntary and sudden cramping of the intrinsic muscles of the hand. It is caused due to excessive writing and other repetitive tasks involving the hand. As it is a task-specific focal dystonia of the hand, the pain and symptoms are limited to the hand, and are caused due to specific tasks. It is not a common condition and is more prone to men.

The two basic types of Writer’s Cramp are:

  • Simple: When suffering with simple Writer’s Cramp, the person only faces difficulty with one specific task such as writing or typing.
  • Dystonic: In this condition the symptoms are present when the person performs any activity with the hand such as shaving, eating, washing or applying make-up.


  • Excessive muscular or motor activity
  • Using faulty writing technique
  • Excessive writing
  • Activities such as typing
  • Injury to the hand
  • Genetics
  • Ruptured Intervertebral Disc
  • Defective blood vessels
  • Tumors of the brain
  • Stroke


  • Pain contractions
  • Chronic sustained pain
  • Inability to write
  • Changes in handwriting
  • Difficulty in carrying out occupational tasks such as typing, writing, playing instruments, etc
  • Excessive abnormal movement of the elbow and wrist
  • Difficulty with coordination of the hand
  • Shaking or twitching of hand while writing
  • Deformity


In order to diagnose the condition the orthopedic surgeon may physically examine your hand. He may discuss the symptoms, nature of any injury and past medical history of the patient. The orthopedic doctor may recommend certain imaging test such as MRI, Electromyography, etc. to determine the extent of the condition.


The condition often resolves spontaneously but there are chances of recurrence if you return to repetitive tasks that led to the condition. The orthopedic surgeon may prescribe certain medicines to offer relief from the symptoms. The doctor can also recommend physiotherapy to regain flexibility and strength in the hand. The physiotherapist can help by offering an exercise program that helps the patient stretch the hands and avoid spasms. Surgery is also effective but is only prescribed in extreme cases. Release surgery is used to decompress the affected nerve in the wrist, hand or elbow. It is a minimal invasive surgery, which involves a short recovery time.

Making significant behavioral and ergonomic changes can prevent writer’s cramp. You should limit the working hours, take regular breaks, use alternate devices for transcription such as dictation, speech-to-text recognition software, etc. and change the way you grip a pen.

For complete diagnosis and treatment of Writer's Cramp, consult Dr. Knoll. To schedule an appointment with the hand surgeon, call at (214) 618-5502.

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Scaphoid Fracture Of The Wrist: Orthopedic Treatment In Plano

by Administrator 18. June 2015 05:17

The scaphoid, also known as the carpal navicular, is one of the eight small bones that make up the carpal bones in the wrist. A fracture in this bone is the most common kind of wrist fracture. It can be caused due to a sudden blow or abrupt landing on an outstretched hand. It can occur to anyone at any age but is most common in gymnasts and shot putters.


  • Falls: Falling on an outstretched hand can lead to a traumatic injury in the wrist. Falls can apply a great amount of pressure on the bones and may cause cracks in the scaphoid.
  • Repetitive stress: Overuse of the scaphoid bone while activities like writing, leaning on the wrist while sitting or standing can lead to straining of the muscles and harm the ligaments of the joint and also cause fractures.
  • Accidents: Severe traumas like motor cycle accidents car collisions can also cause injuries related to the wrist including Scaphoid Fracture.


  • Pain on the thumb side of the wrist
  • Swelling and tenderness
  • Bruises around the wrist
  • Difficulty in grabbing or holding objects
  • Reduced range of motion


The doctor inquires about the patient‘s medical history and how the injury occurred. He may physically examine the joint to look for symptoms like tenderness and swelling. Imaging tests like X-rays can also be suggested to determine the severity of the injury. Sometimes a Scaphoid Fracture may not be visible in X-ray. In such cases, the doctor may also order an MRI or a CT- scan.


  • Cast: The orthopedic doctor may suggest the patient to put the hand in a cast to restrict motion of the wrist. The cast may be worn for 9-12 weeks or as prescribed by the doctor to let the joint heal completely.
  • Medication: The doctor may also prescribe some anti-inflammatory medications which can help in minimizing pain and swelling in the joint. Calcium supplements can also be recommended to build bone strength and speed up the healing process.
  • Physical Therapy: The patient may be suggested to attend physical therapy sessions in order to build muscle strength and regain mobility in the joint. Physical therapy can also be helpful in reducing stiffness in the wrist.

An orthopedic doctor should be consulted as soon as possible for a Scaphoid Fracture or it can lead to severe health conditions like Arthritis.

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Mallet Finger: Orthopedic Treatment In Frisco, TX

by Administrator 20. May 2015 13:19

Mallet Finger, also known as baseball finger, is an injury to the outermost joint of the finger that is responsible for making the tip of the finger bend towards the palm. It is caused by damage to the tendon, causing severe pain and swelling. It is a common sports injury but can also occur due to minor accidents.


Mallet Finger generally occurs while playing sport activities involving a ball, like baseball or basketball. When the ball hits the tip of an outstretched finger the tendons of the outermost joint of the finger swell up, leading to Mallet Finger. It can also be caused when any hard object hits the finger or cut with a sharp object like a knife.

Risk Factors

People with less flexibility or concurrent sprains in their fingers and sportspersons involved in sports with a ball are prone to suffer from this condition.


  • Pain and swelling
  • Bent finger
  • Redness and numbness
  • Tenderness
  • Blood clots under nail
  • Inability to extend the finger
  • A popping sound at the time of injury


The orthopedic surgeon physically examines the injured finger to determine the extent of pain, redness and swelling. He may also diagnose the severity of the condition and the movement possible by bending the finger. The doctor may recommend an X-Ray to check if the injury involves any broken bones. Accordingly, he devises a treatment plan to treat the condition.


Non-surgical treatment:

  • Ice: Applying an ice pack can be advised to reduce swelling and pain.
  • Splints: Wearing a splint to keep the injured finger in a straight position can help to heal the injury. The doctor advises on the duration that the splint needs to be worn, as it depends on the severity of the condition.
  • Exercises: The doctor may also advise certain exercises to improve motion and resume flexibility in the finger.
  • Medication: The orthopedic surgeon can also recommend anti-inflammatory medications to reduce pain and swelling.

Surgical treatment:

In severe cases, if the non-surgical methods do not provide relief, the surgeon may recommend surgery. The surgical procedure is usually followed by physiotherapy and it is advised that you visit the orthopedic surgeon regularly for check ups.

If you have suffered a finger/fingertip injury, Dr. Knoll in Frisco, TX. To schedule an appointment with the wrist doctor, call at (214) 618 - 5502.

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Orthopedic Treatment For Hand Fractures

by Administrator 21. April 2015 11:39

A severe or forceful blow to the hand can cause a hand fracture. The hand has multiple small and large joints that allow the hand to bend, straighten, rotate and move side-by-side. If a hand fracture is not treated on time, it can lead to temporary and permanent disability.


  • Falling on an outstretched hand
  • Forceful injury
  • Fall from height
  • Collision or car accident
  • Osteoporosis
  • Injury during sports or work related injuries
  • Stress fractures that occurs due to repeated overuse


  • Pain that worsens when you move the hand
  • Tenderness
  • Swelling
  • Bruising
  • Inability to hold or grab objects
  • Abnormal bump or any deformity
  • Numbness
  • Weakness
  • Bone that moves out of place


During physical examination, the orthopedic surgeon checks the injury to confirm a fracture. He carefully examines the symptoms, looks for any signs of damages to nerves, blood vessels and tendons. The doctor may also ask about the patients medical history and prescribe imaging tests such as X-ray, CT scan, MRI, or bone scan to identify any bone and tissue injuries in the hand.


The orthopedic surgeon devises the treatment plan depending on the extent and nature of the injury. If the injury is not severe, then the doctor may recommend non-surgical treatment of the Hand Fracture. This may involve using braces, cast or a splint to stabilize the hand and limit the motion of the hand. The surgeon may strap or tape the fracture fingers to the finger next to it, as this will decrease stiffness and limit motion. In order to reduce pain and swelling, the doctor often prescribes certain non-steroidal anti-inflammation medicines and antibiotics.

However if the injury is severe and non surgical methods fail to provide relief, surgery may be recommended. Post surgery the surgeon may prescribe physiotherapy to strengthen your hand with the help of stretching and strengthening exercises.

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Sprained Wrist: Causes, Symptoms, Prevention And Treatment

by Administrator 23. March 2015 07:05

Wrist sprain is a common condition that results due to stretching, wear and tear, and injury to ligaments in the wrist. The sprain ranges from mild to severe depending upon the damage to the ligaments. It is a common injury among players who play boxing, hockey, volleyball, basketball, wrestling, weightlifting, etc. and occurs due to repeated use of the wrist joint and twisting movements.


Wrist sprain can occur during day-to-day activities or during sports and other recreational activities. Some causes of wrist sprain include

  • Fall onto an outstretched hand
  • Falling on a hard surface while playing sports such as snowboarding, skateboarding, cycling, etc
  • Lifting heavy objects
  • Weak or inflexible tendons or ligaments
  • Repeated strain due to overuse

Many other factors often lead to wrist sprain and these include poor conditioning, fatigue, slippery surface, improper warm up etc.


  • Swelling
  • Pain at the time of injury
  • Bruising
  • Discoloration of the skin
  • Tenderness
  • A popping sound
  • Stiffness
  • Inability to move the joint


When the patient visits the orthopedic doctor he will physically examine the wrist and enquire about previous injuries and medical history. He will review your symptoms and recommend certain imaging tests that will help in confirming the sprain. These tests include X-rays, CT scan, MRI and Arthrogram.


If the sprain is mild, it can be treated with resting the joint for one or two days, applying ice pack to the swelled area for 20 minutes, compressing the swelling with an elastic bandage and elevating the injured wrist above the level of the heart. The patient can get relief with non-steroidal anti-inflammatory medicines. By immobilizing the wrist, the patient can treat the sprain without any surgery. To avoid the stiffness due to immobilization, the physician often recommends some stretching exercises.

In case of severe sprains, the ligament has to be reconnected to the bone surgically. The wrist doctor will decide whether the patient needs surgery. After surgery, the patient has to undergo a period of rehabilitation, which helps the patient recover the strength and motion to the joint.


As the wrist sprain occurs mainly due to falling on the wrist; therefore, to avoid the sprain, one should be careful while walking on wet or slippery surface. Sportspersons should use wrist guard splints or protective tape, which offers support to the wrist and prevents bending of the wrist.

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Carpal Tunnel Syndrome Risk Factors

by Administrator 18. February 2015 11:57

Carpal Tunnel Syndrome is an acute condition of the hands and arms that causes tingling sensation, numbness and pain in the wrist. There are a number of factors that may increase the chances of damaging the median nerve, which increases the risk of developing Carpal Tunnel Syndrome.

Some of the factors include:

  • Anatomic Factors: These factors can include wrist fractures or dislocation that alters the space within the Carpal Tunnel. People who have smaller Carpal Tunnels have more chances of developing the syndrome.
  • Chronic Conditions: Illness such as diabetes may increase the chances of nerve damage if the patient does not take proper care. This may lead to damage in the median nerve which is the main cause of the syndrome.
  • Inflammatory Conditions: Some conditions such as rheumatoid arthritis, which is characterized by inflammation can also affect the wrist and may increase pressure on the median nerve, thus leading to Carpal Tunnel Syndrome.
  • Changes In The Body: Alterations in the balance of the body fluids may also lead to the syndrome. These alterations can also be a result of pregnancy or menopause, which may increase the pressure within the Carpal Tunnel.
  • Other Medical Conditions: Some other medical conditions such as obesity, thyroid and kidney failure may also increase the risk of developing the syndrome.
  • Workplace: Many people are required to work with tools that vibrate or require prolonged repetitive movement in the same direction. This type of work may increase the chances of damage to the median nerve.
  • Smoking: If you smoke on a regular basis, you are likely to develop Carpal Tunnel Syndrome. Smoking effects the blood flow to the median nerve and causes more pressure on the nerve.
  • Gender: Females between the ages of 40 and 60 are more likely to develop the condition. Women who take birth control pills or are going through hormonal changes are at a higher risk to be effected by the condition.
  • Aging: Normal wear and tear of the tissues in the hands is a common cause of Carpal Tunnel Syndrome. Aging can also be regarded as one of the major reasons behind the condition as it leads to wear and tear of the tissues.

For more information about the wrist condition and the treatment options available, you can visit Dr. Knoll. To schedule an appointment with the wrist doctor in Plano, TX, call at (972) 985 - 1072.

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