what would be the effect of keeping a finger permanently bandaged ?

[gingeroots]

An X ray of my elderly mother's index finger shows most of the bone at the top is missing .
Doctor in elderly persons assesment unit ,on seeing this ,said keep it covered in a cloth dressing .

Tissue Viabilty Nurse said she couldn't see what support that would provide .

Further questioning of doctor ( in unit above ) gets response " well finger dressings aren't my field of expertise "

Similar response ( understandably )from all other HP my mum sees - district nursing team ,physio ,occupational therapist .

I suppose it should in splint ?

And I can see that under the dressing the finger seems to be shrinking and the skin becoming flabby .
So wonder if the proposed method of protection is a appropriate and b) causing other problems .

And who would give definitive advice ?

What does the tissue viability nurse recommend?
Is it a sore? If it is I would think it would need a moist dressing.
Sounds like one of the professionals needs to take proper responsibility re diagnosis or refer your mother to someone who can.

The TVN didn't recommend anything - presumably because it's not a wound .
She just passed the opinion that bandaging a vunerable ( ie bone missing ) finger wouldn't achieve much .

I had a feeling this would be you ginger.....fingers really are a grey area in healthcare.

My gut feeling is that immobilsing (if that's what you are proposing) could cause disuse atrophy to a degree but the finger is mainly tendons not muscles so maybe you would get away with it.

If nothing else a bandage is a visual reminder that that area is vulnrable, you can forget fairly easily if something doesnt cause pain.

What does your dm want to do?

If the finger is vunerable, then you could buddy splint it to another finger. Trouble is, your mums skin is probably very fragile, so taping could damage it.

What will happen to your mums finger is that all the tissues will shrink back, so I wouldn't have thought that it needed protection though

Yes fluffy still me banging on about DM and her tophaceous gout - still struggling with getting people to take the dressing side of it seriously .

They hear the word gout ,think pain ,when they learn that pain is not the issue they all run away .
They see a couple of fingers and a thumb neatly ( by me - gosh how my skills have developed ) dressed and somehow all the stuff about how my mum is supposed to cope with digits on both hands dressed with non waterproof dressings which must be kept dry goes in one ear and out the other .

Anyhow ..back to the digit in question with the missing bone ( suspect from tophi damage to bone )
I don't want it immobilsed - I just want someone to make an informed decision about how to treat this particular digit .
DM doesn't want it dressed because it's a pain keeping it clean and dry .

I honestly think it's a job for a podiatrist .

dibbler her fingers are very distorted by arthritis and lumps of tophi - I think it would be hard to tape them together .
And presumably that would have to be permanent as i can't see the bone growing back - tho happy to be corrected /surprised .

And would make it even more difficult for her to use hands .

Frustrated by all this - surely fingers as important as any other part of body ?

Sounds ghastly . I think ask a hand specialist- Royal Free Hospital if trauma, RNOH Stanmore if longterm cause. Dont take the advice of a nurse.

Yes a hand specialist sounds good .

There has been talk by hospital OT's of referral to a " hand therapist " but they ( the OT's ) aren't sure she's " bad enough " .
But I just don't think they get it ,how it impacts on mothers life ,the constant infections ,on and off antbiotics .They just see a few fingers in neat white dressings . ( and I have to buy the secondary tube dressings as apparently they're not on prescription .But they're necessary to secure the primary dressing as if not used edges of the film dressings work loose and stick to things and the whole lot comes off .)

We're SE London ( Kings ,major teaching hospital FFS ) and I think travel ( mother in 90's ) to Stanmore would be not on .
It's not trauma ,chronic gout condition .

I should perhaps explain that although this thread is about one finger where the problem is missing bone ,this is in addition to other digits that have to be dressed when the tophi erupts through the skin causing an open wound which then frequently gets infected .

I think seeing a hand therapist would be a vv good idea - they were brilliant helping me and my manky arm and great at understanding the reality of hand problems.
They also have resources to make things to help like custom splints, gloves etc

thanks dibbler I'll try and press for that .

The OT has spoken to the Hand Therapist and apparently there is no need for HT to see my mother .
Advice is to wear gloves .

No advice about dressing the finger with the missing bone - suspect OT didn't discuss this ,just the gout .

Feel p*ed off - "mother is lucky that pain isn't the issue " .
We should be positive and dwell on that .

Yes.....but doesn't help with a situation where someone has one or another fingers/thumbs permanently dressed and can't keep the dressings dry or intact . So they don't heal ,get infected ,so we're back on antibiotics .

And of course we've tried gloves - tricky for someone who can hardly see ,has misshapen /swollen joints and who would need to be putting them on and off every time they drink tea , eat soup ,make food ,go to the loo ..
And removing the gloves dislodges the dressings .

I can't see what the soloution is ,but don't really want to be told we're being negative ,dwelling on the difficulties rather than feeling glad that the pain isn't too awful .

And the other piece of advice was to use alcohol gel to clean hands - but if you've got thumbs and fingers bandaged that's going to require a dexterity my mother doesn't possess .
And as far as I'm concerned demonstrates a lack of understanding of things from my mother's POV .

Would fingerless gloves be ok ? Where its just the tip of the finger missing so you can do everything with them on. Like these

That's kind dibbler but I think her fingers are too deformed to get something so close fitting on .

They're like this <a class="break-all" href="http://www.google.co.uk/imgres?q=heberden%27s+nodes&start=260&num=10&hl=en&biw=1366&bih=499&addh=36&tbm=isch&tbnid=TiARCwoKDmFaQM:&imgrefurl=www.handtherapy.com/casestudies.asp%3Fcsid%3D37%26a%3Dy&docid=IgJ9Y7td4eEE3M&imgurl=www.handtherapy.com/images/CaseStudyImg/nodule.jpg&w=512&h=336&ei=0HEEUJblCqOP0AWCx9WjBw&zoom=1&iact=hc&vpx=102&vpy=169&dur=952&hovh=182&hovw=277&tx=166&ty=98&sig=105424935185448336310&page=15&tbnh=141&tbnw=204&ndsp=19&ved=1t:429,r:0,s:260,i:247" rel="nofollow" target="_blank">www.google.co.uk/imgres?q=heberden%27s+nodes&start=260&num=10&hl=en&biw=1366&bih=499&addh=36&tbm=isch&tbnid=TiARCwoKDmFaQM:&imgrefurl=www.handtherapy.com/casestudies.asp%3Fcsid%3D37%26a%3Dy&docid=IgJ9Y7td4eEE3M&imgurl=www.handtherapy.com/images/CaseStudyImg/nodule.jpg&w=512&h=336&ei=0HEEUJblCqOP0AWCx9WjBw&zoom=1&iact=hc&vpx=102&vpy=169&dur=952&hovh=182&hovw=277&tx=166&ty=98&sig=105424935185448336310&page=15&tbnh=141&tbnw=204&ndsp=19&ved=1t:429,r:0,s:260,i:247

Plus the tophi from the gout tends to erupt ( causing the open wounds that have to be dressed ) right on the pad of the finger or thumb tip .

Can't find a a good pic , the two digits she has affected at moment are considerably worse than this <a class="break-all" href="http://www.google.co.uk/imgres?q=tophi+fingertips&num=10&hl=en&biw=1366&bih=499&tbm=isch&tbnid=1HVp_E0a-1sKyM:&imgrefurl=www.sciencephoto.com/media/257153/enlarge&docid=2pGFNgk19vmhaM&imgurl=www.sciencephoto.com/image/257153/large/M1650158-Tophi_due_to_gout_on_fingers_of_patient-SPL.jpg&w=530&h=367&ei=Xm8EUJDcI-bA0QX0svGpBw&zoom=1&iact=hc&vpx=987&vpy=92&dur=206&hovh=187&hovw=270&tx=187&ty=104&sig=105424935185448336310&page=1&tbnh=147&tbnw=235&start=0&ndsp=12&ved=1t:429,r:5,s:0,i:88" rel="nofollow" target="_blank">www.google.co.uk/imgres?q=tophi+fingertips&num=10&hl=en&biw=1366&bih=499&tbm=isch&tbnid=1HVp_E0a-1sKyM:&imgrefurl=www.sciencephoto.com/media/257153/enlarge&docid=2pGFNgk19vmhaM&imgurl=www.sciencephoto.com/image/257153/large/M1650158-Tophi_due_to_gout_on_fingers_of_patient-SPL.jpg&w=530&h=367&ei=Xm8EUJDcI-bA0QX0svGpBw&zoom=1&iact=hc&vpx=987&vpy=92&dur=206&hovh=187&hovw=270&tx=187&ty=104&sig=105424935185448336310&page=1&tbnh=147&tbnw=235&start=0&ndsp=12&ved=1t:429,r:5,s:0,i:88

and then there's the finger with the missing bone that needs dressing and protecting as well .

but thank you for being interested !

Hi gingerroots, I'm sorry if you've already done this but I've google shopped Finger support (i'm ridiculously stupid and can't link sorry) and there looks like there are some fairly unintrusive splints that you might want to consider? Some of them are pricy though.

Also can you not approach a consultant in the rheumatology department directly via email? I didn't gather from you're post that you're dealing a rheumatology dr directly at the moment and I think you could perhaps get some better direction from your mothers specialist consultant. Sometimes their recommendations don't get results from the various branch specialists they refer back down to.

Thanks sparkly

pathetically grateful for anyone showing an interest in this saga

gosh - lots of finger sleeves etc .

But now I've looked at neoprene ,elasticated etc ,sleeves and loads of splints and descriptions of which joint they are meant to support I feel even more frustrated at the complete lack of advice we've had so far regarding protecting the finger with the missing bone .

I would worry about buying a sleeve that might cause too much compression or something .

Another month to go until we see rheumatologist about the gout .
But I kind of think somebody orthapeadic should advise about how we look after the finger with the missing bone .

sigh .