FAQ Category: Hand

Every year, 100,000 people of all ages from young to old receive medical care for hand injuries linked to power tools. The sharp, rotating blade can tear up soft tissues, blood vessels, nerves, and even fracture bones and amputate fingers. That’s a gruesome picture but one that should be considered by anybody using these tools at home or at work.

Since many of these tools do not have any real safety features, it’s up to all of us as consumers and concerned citizens to lobby for the development of protective features. It’s also up to each one using the tools to review safety rules and follow them at all times.

Older adults are a special group to be concerned about. Failing vision, decreased physical strength and coordination, and memory loss are all important factors in these kinds of injuries. Sometimes seniors are taking medications such as anticoagulants (blood thinners) that put them at even greater risk.

The first place to start may be with a sincere and loving, but frank talk with your father. This can be very difficult as the parent faces being parented or supervised by their child(ren). That doesn’t always sit well with older adults. Often the decline of motor function and vision is gradual enough that they are unaware of how unsafe some situations may be. And if memory is a problem, they may not remember your words of caution or even how to stay safe.

There may come a time when it’s necessary to remove all power tools from the area. Making this determination is often very difficult. Waiting until an unfortunate accident occurs is one way many families approach this problem, but it’s certainly not ideal.

There is a recent study from the Mayo Clinic where the cost of electric saw injuries was calculated in terms of dollars and cents. Lost wages, physician charges, emergency room treatments, rehab, and hospitalization costs are some of the major costs incurred.

The study was done by reviewing the records of 134 patients who came to the Mayo Clinic, a regional medical center in Rochester, Minnesota. Data was collected on type of patients treated (age, gender, occupation, educational level) as well as on the type of injury (number of fingers involved, type of treatment, complications).

Time lost from work and the economic value of that factor was calculated as well. The authors used the mean income from Minnesota to make calculations for their patients. But they also used some additional figures to calculate the nationwide cost of electric saw hand injuries.

They further divided the patients into three groups based on the severity of the injury and analyzed the data from that perspective. The three groups were 1) minor lacerations without damage to nerves, blood vessels or tendons; 2) finger amputation (at least one) but without repair of the blood vessels or tendons); and 3) patients who could have the finger reattached or who needed microsurgery to repair tiny blood vessels, nerves, or tendons.

Most people in group one who were employed were off work for an average of three weeks. Lost wages were around $2,700. Medical costs were an additional $2,900. These numbers all increased for the second group with a 60-day time span before being able to return-to-work and triple the lost wages. Medical costs were six times higher than for the first group.

The third group experienced a delay in return-to-work of 125 days (four months). Lost wages were around $14,000 with average medical costs just above the $40,000 mark. When added all together for the three groups, the total economic costs of electric saw hand injuries were slightly more than four million dollars.

That’s just from one study with a moderate number of patients included. And it didn’t include chain saw accidents and injuries from hand-powered saws. Cost calculation also did not include emotional and psychologic costs or the cost of vocational retraining. But it’s a good place to start.

You can also look into information provided by the Consumer Product Safety Commission. In 2003, they published a Hazard Screening Report with information on the number and type of injuries from on-the-job accidents. The report includes the cause of those accidents and the cost associated with them. Data is presented from comparisons taken in 1997 to 2001. Just in this four-year span of time, the number of emergency-room treated injuries from power tools increased dramatically.

It’s always a good idea wherever you work to review safety precautions and procedures. Prevention of injuries is vitally important in avoiding the potentially devastating effects of these kinds of injuries. That’s true whether they occur at work or at home.

Acupuncture has been shown to be safe and effective for short-term (two to four weeks) treatment of mild-to-moderate carpal tunnel syndrome. Long-term studies are needed to confirm the benefit of acupuncture for this same problem.

Symptoms of pain, numbness, tingling, weakness, and night pain improve within the first two weeks of treatment. In one study, the biggest difference was in night pain awakening the patient. Patients having acupuncture seemed to have the most improvement in this area with fewer night-time awakenings of pain. Motor function improves with acupuncture as well. This means that the previously compromised nerve is better able to send messages from the affected median nerve to the muscles.

There can be a few side effects of acupuncture. Needles used in acupuncture can cause skin tenderness, bleeding, and numbness and leave bruising of the skin. Treatment take anywhere from 15 minutes to an hour. Most patients report this as a very pleasant, relaxing, and calming time.

A recent study from Taiwan of 18- to 55-year-old patients with confirmed mild-to-moderate carpal tunnel syndrome says Yes to your question. They compared two groups of similar patients with carpal tunnel syndrome. One group was treated with oral steroids for a period of four weeks. The other group was given a series of acupuncture sessions twice a week for four weeks.

Measures used to compare the results of treatment included before and after ratings of symptoms. The main symptoms of carpal tunnel syndrome are wrist and hand pain, finger and hand numbness, tingling, weakness/clumsiness, and nighttime pain. Each one of these symptoms was rated from zero (not present) to 10 (very severe symptom).

When combined together, these ratings form the global symptom score (GSS). The before and after treatment GSS was also analyzed and compared between the two groups. Nerve conduction tests were repeated at the end of four weeks. These tests show how well the median nerve is firing to send motor messages to the muscles controlled by the median nerve.

The results showed that acupuncture is as effective and safe as oral steroids for short-term relief of mild-to-moderate carpal tunnel syndrome. That’s good news for anyone looking to avoid adverse side effects of either steroids and/or surgery.

The global symptom score (GSS) improved for all patients in both groups. The biggest difference was in night pain awakening the patient. The acupuncture group had much better improvement in this symptom compared with the steroid group. Motor function seemed to improve faster in the acupuncture group as well.

The authors conclude that acupuncture treatment for confirmed mild-to-moderate carpal tunnel syndrome is safe and effective with few side effects. Compared with oral steroids, acupuncture had slightly better results.

There is no difference. Both refer to an injury to the ulnar collateral ligament (UCL) of the thumb. This ligament is a strong band of tissue attached to the middle joint of the thumb, the joint next to the web space of the thumb. The joint that is affected is called the metacarpophalangeal joint, or MCP joint.

Any hard force on the thumb that pulls the thumb away from the palm of the hand (called a valgus force) can cause damage to the ulnar collateral ligament. If the force is too strong, the ligaments can tear. They may even tear completely. A complete tear is also called a rupture.

In the old days it was called a gamekeeper’s thumb. It was a common problem in European gamekeepers in the late 1800s and early 1900s. Gamekeepers killed small game by using the thumb and index finger in a way that put enough repetitive force against the UCL to cause an injury.

Today, it’s more likely to be from a sports injury. The most common way for this to happen is to fall on your hand with your thumb stretched out. When a skier falls down while holding a ski pole, the thumb may get bent out and back, leading to an injury in the ulnar collateral ligament of the thumb. That’s when it is referred to as skier’s thumb.

Skier’s thumb refers to an injury affecting the ulnar collateral ligament (UCL) of the thumb.Partial tears can be treated nonoperatively with conservative care. But complete ruptures (which it sounds like you may have) often require surgical repair.

The surgery can be done on an outpatient basis under a regional or general anesthesia. Sometimes the ligament can be repaired by reattaching it to the bone. If the ligament ruptured and pulled away a piece of bone with it, the additional injury is referred to as an avulsion fracture.

Small avulsion fractures can also be repaired this way with special sutures used to anchor the bone fragment in place. Any damage to the other soft tissues or joint capsule can be repaired at the same time. If the damage is too great to repair the problem, then a tendon graft may be needed to reconstruct the joint. No matter whether it’s a surgical repair or reconstruction, the goal is to return everything to as normal an anatomical orientation as possible. This will ensure a return of normal joint kinematics (movement).

The patient is put in a cast and immobilized for six weeks after surgery. When the cast is taken off, the pins and wires holding everything together can be removed. A hand therapist helps the patient get started with range-of-motion exercises. The therapist progresses the rehab program through strengthening and return to full activities without restrictions. All of this takes at least three months for a safe and effective result.

Studies show that this approach is quite successful. The earlier the repair is made, the better the results. Returning to activities when the thumb is unstable can cause further damage that could have been avoided with early diagnosis and treatment. Ninety per cent of the time, the results are good-to-excellent with surgical repair.

If someone breaks the scaphoid bone, the wrist bone that is at the base of the thumb, doctors often have a choice of treatment. In some cases, surgery is essential because of how severe the break is, but if the break isn’t complicated, they may have the choice of casting or surgery.

If both treatment options are equally acceptable, the surgeons should take into consideration other issues, such as how old the patient is, how well he would do with surgery, how well she would cope with a cast for an extended period of time, what the occupation is, and so on. These can all play a part in deciding which treatment plan to follow. Someone who is very healthy otherwise and is in a rush to return to work, but who can’t work with a bulky cast, may opt for surgery to heal more quickly. On the other hand, if the person can work with the cast because of the type of job he or she has, then the cast may be a better option.

Risks for complications do exist, but this is also something that is taken into account when any surgery is performed.

Research has been done into the costs of treatments for broken scaphoids and, for the most part, costs vary considerably in either direction due to the patient’s circumstances.

For example, people who have surgery may end up paying more for the actual procedure, but if they have a job that they can’t perform while wearing a cast, they will miss more work days, affecting productivity and sick leave. In this case, the surgery option comes out costing less overall. But, if the patients has a job where he or she can return to work with the cast, the amount of time lost would be significantly less, because of a much shorter sick leave period. In that case, the surgery would be more expensive than the casting.

A ganglion cyst is a mass or benign tumor (benign means not cancerous) on the top of a joint o on the sheath (covering) of a tendon. They can be large or small, and can feel spongy or firm. More women than men get them and they most often start appearing between the ages of 20 and 40 years.

Although ganglion cysts can appear anywhere, the most common spots are the back of the hand on the wrist, followed by the palm side of the wrist. They can also be found at the base of the fingers, around the shoulder, knee or ankle, or on the top of the foot. These cysts, for some reason, become inflamed and filled with fluid.

Doctors don’t really know what causes these cysts, but some people report injuring the area before they notice the cysts developing. Some of the cysts are painful, while others aren’t. Depending on their position and how big they are, they can cause tenderness and make it difficult for you to use the joint.

When deciding on a particular treatment for a particular problem, such as carpal tunnel syndrome, doctors look at what the ultimate goal is for each patient. Unfortunately, complete and total resolution of a medical problem isn’t always possible and sometimes doctors are looking at the best possible improvement.

For example, if you are going for carpal tunnel syndrome relief, it’s important for your doctor to know what you want out of it. Do you work or participate in a activity that you use your hands a lot and you want to get back into it as soon as possible? If this is the case, you may be someone who should be getting surgery, rather than waiting and trying something else first.

If you can wait and your pain and symptoms aren’t severe enough to warrant surgery, your doctor may want to try more conservative approaches, such as splinting and medications.

Usually, when checking to see how effective the treatment is, your doctor would look at how happy you are and what you are able to accomplish after the treatment. Some people may have complete resolution and be completely pain free forever. Others may have complete pain relief for a few months but then have some pain return later. However, if the pain was disabling before and not later on, those patients may be willing to accept that as a successful outcome of surgery.

Steroid injections into the carpal tunnel area are common in treating the disorder. The steroids are used to reduce inflammation so the nerve isn’t irritated within the carpal tunnel, which passes through your wrist.

Studies have shown that the steroid injection can be very helpful for some patients, but in others, the pain relief doesn’t last. The pain in your hand may be due to that, but the only one who will be able to tell you if it’s a return of your carpal tunnel syndrome or a new injury is your own doctor.

Carpal tunnel syndrome (CTS) is a common problem affecting the hand and wrist. Symptoms begin when the median nerve gets squeezed inside the carpal tunnel of the wrist, a medical condition known as nerve entrapment or compressive neuropathy. Any condition that decreases the size of the carpal tunnel or enlarges the tissues inside the tunnel can produce the symptoms of CTS.

The carpal tunnel is an opening through the wrist to the hand that is formed by the bones of the wrist on one side and the transverse carpal ligament on the other. (Ligaments connect bones together.) This opening forms the carpal tunnel.

The median nerve passes through the carpal tunnel into the hand. It gives sensation to the thumb, index finger, long finger, and half of the ring finger. It also sends a nerve branch to control the thenar muscles of the thumb. The thenar muscles help move the thumb and let you touch the pad of the thumb to the tips of each finger on the same hand, a motion called opposition.

Patients can be treated surgically for carpal tunnel syndrome with two different surgical approaches. One is the more traditional open carpal tunnel release. The second is an endoscopic release, which is an accepted, but not widely used, surgical procedure.

In both operations, the transverse carpal ligament across the carpal tunnel is cut and released. In the open surgery, an incision is made down the palmar side of the wrist and the carpal tunnel ligament is released. In the endoscopic procedure, a small opening is made in the skin and a special surgical device called the endoscope is slipped under the skin into the carpal tunnel area. The scope has a tiny TV camera on the end that allows the surgeon to see as the release is performed.

There are numerous studies published now that compare endoscopic with open release surgery. A recent landmark study from Sweden offers some interesting insight into the differences between these two approaches. Except for less pain postoperatively (first three months) for endoscopic patients, results are the same for these two types of surgery.

Patients reported the same (good to excellent) results in pain reduction. Time between surgery and return-to-work was the same. Function and need for repeat surgery due to persistent pain were also the same between the two groups. All of this mimics what you saw in the office setting in which you work.

Endoscopic surgery for carpal tunnel release may be less invasive and thus has a small benefit when it comes to postoperative pain. But in regards to complication rate, return-to-work status, or function, the endoscopic approach was not superior to the open technique.

Some patients experience immediate reduction in pain, numbness, and tingling — symptoms that are so common with carpal tunnel syndrome. Others develop some swelling postoperatively and that fluid puts pressure on the median nerve reproducing the same painful symptoms that were present before surgery.

It can take 10-days to two weeks for the symptoms to start to subside and go away. Most patients don’t need hand therapy after carpal tunnel release surgery, but those who have persistent symptoms may benefit from a supervised program of exercises to restore full nerve mobility. The therapist will teach the patient how to do exercises that help the tendons and nerves that go through the carpal tunnel to move smoothly and easily.

No one knows for sure why symptoms persist or come back after carpal tunnel release. It’s possible some tiny sensory nerves to the skin got cut. It’s possible that fibrosis (scarring) is holding the median nerve down and keeping it from moving.

If time and/or this type of conservative care doesn’t resolve the symptoms, a repeat (second) surgery may be needed. The surgeon will go back in and make sure the ligament and any scar tissue or adhesions are fully released. Symptoms that persist a year after surgery aren’t likely to go away. Surgery is usually indicated in those cases.

Carpal tunnel syndrome, the irritation of the median nerve that runs from your forearm to your wrist is a common repetitive stress injury. As you use your hand and wrist in the same motion over and over again, the tendon becomes irritated and inflamed, causing you pain.

The best way to avoid developing carpal tunnel syndrome is to be sure that you don’t do those repetitions that can cause the injury. If your work requires you to do certain functions, such as using a computer mouse, a cash register, or heavy equipment that vibrates, you need to protect your hands. You can do this by taking frequent breaks from the task and stretching and exercising your hand, wrist and arms. If your work place isn’t set up to help you be comfortable, speak with your supervisor about working on this.

Carpal tunnel syndrome can also be brought on by certain hobbies. If you don’t want to give up the activity, you may have to find different ways of doing it or take more frequent breaks to avoid aggravating the nerve irritation.

Surgery for carpal tunnel syndrome is not always a cure. Surgery should be done together with the patient modifying the activity that may have triggered the carpal tunnel syndrome to begin with. If your mother went back to that activity, it’s entirely possible that the tendon has, once again, become irritated and inflamed.

Without seeing your mother’s hand and doing a thorough medical history and taking tests, no-one can tell what the lump on your mother’s hand is. If you haven’t see a doctor, this is your best bet.

A bump on the back of the hand could be one of several things, such as a fracture, a cyst, a build up of tissue, or tendonitis, to name just a few.

People who have arthritis in the base of the thumb often find it quite painful and makes it difficult to use the hand properly. Surgery is usually the last treatment for arthritis in the thumb, only done if all other treatments (medications, physiotherapy, and so on) don’t help.

Surgery can mean fusing the bones together so they’re no longer painful or even replacing the joint.

The hand is the most common part of the body for rheumatoid arthritis. The arthritis may affect just a joint or to in a finger, a few fingers, the wrist, or any combination of joints. The base of the thumb is one area that is particularly vulnerable because of its work load.

The joint below your thumb has to be able to open and close, rotate somewhat, be able to grip strongly and be able to bear weight when being used for carrying. The thumb is actually the most important digit on your hand. While people can often accommodate well to the loss of a finger, losing the thumb can make it difficult since you can’t grip anything any more.

Extension osteotomy of the first metacarpal is considered extra-articular (outside the joint) procedure. First refers to the thumb as the digits on the hand are numbered from one to five, starting with the thumb. The metacarpal bone is the long bone of the thumb from the base of the wrist to the first knuckle on the thumb.

An extension osteotomy is done by removing a wedge- or pie-shaped piece of bone from the metacarpal above the CMC joint. A wire is used to pull the opening (made by removing the bone) closed. This procedure changes the angle of the metacarpal bone where it connects with the wrist and brings it more into a neutral position (normal alignment).

Younger patients and anyone with less advanced disease can qualify for an extension osteotomy. The main advantage of this procedure is that it doesn’t mess with the joint itself. That means rather than jump right to a joint replacement, patients have a few options. They can still have joint reconstruction or joint replacement sometime in the future should they need it.

The extension osteotomy hasn’t been studied very closely. The few studies published haven’t followed the patients long-term. They also didn’t collect much information before and after about the patient (e.g., demographics such as age, gender, education, marital status and so on) or about the patients’ outcomes. A small study from the Mayo Clinic in Rochester, Minnesota offers some insight into the long-term results of this little used management technique for CMC arthritis.

In this study, one surgeon followed eight patients over a period of six to 13 years after surgery for thumb arthritis. Measures used to determine the benefits of this procedure included pain, grip strength, pinch strength (thumb to index finger), oppositional pinch strength (thumb to any other finger), and function (e.g., lifting, opening jars, turning doorknobs).

Patients included in the study were those with Eaton stage I to III disease. They were all treated by extension osteotomy after conservative (nonoperative) care failed to resolve pain or improve function. Eaton classification of CMC osteoarthritis uses X-rays to grade the disease as normal, mild, moderate, or severe. The classification is done without taking the patient’s symptoms into consideration.

Grade I is a normal appearing joint on X-ray. With grade II, there is a narrowing of the joint space (less than two millimeters) and the presence of bone spurs. Grade III has more than two millimeters of joint narrowing along with bone cysts, bone spurs, and bone sclerosis (hardening). Grade IV is referred to as pantrapezial arthritis. This means there is evidence of arthritic changes affecting the wrist bones (scaphoid, trapezium, trapezoid) around the CMC joint.

None of the eight patients were candidates for just ligament reconstruction. But joint replacement wasn’t needed yet either. So the extension osteotomy was an acceptable alternative.

Before surgery, pain levels were reported as moderate-to-severe in all eight patients. Moderate pain was defined as present with daily tasks. Severe pain was constant and occurred at rest as well as with daily activities. Half the patients reported instability in the CMC joint. Sometimes this type of instability is referred to as a subluxation or shifting of the joint causing a partial dislocation.

After surgery, pinch and grip strength improved more than 100 per cent when compared with the other hand. Five of the eight patients were able to maintain status quo. In other words, their joint did not get worse as measured by the Eaton stages. The osteotomy healed without problems. Pain was improved. Activities improved with only mild pain occasionally when lifting heavy objects. The two patients who needed additional surgery had a lag time of at least seven years before the next procedure was done.

The authors concluded that extension osteotomy is a safe and effective way to treat thumb osteoarthritis in patients with Eaton grade I, II, or III. The procedure can be done early before painful symptoms even develop. Stabilizing the joint sooner than later can reduce the load and compressive forces through the joint that later lead to osteoarthritis.

The first step in treating carpometacarpal (CMC) (thumb) joint pain is usually conservative care. Nonsteroidal antiinflammatory drugs (NSAIDs) are often the first line of defense. Over-the-counter products can be tried but most doctors prefer to prescribe something a little stronger for patients who have disabling pain.

The second recommendation is to see a hand therapist. This is usually an occupational or physical therapist. The therapist can show you ways to protect your thumb and reduce the shear and compressive forces transmitted through the joint. Splinting or bracing may be appropriate to also help reduce the load.

Techniques such as manual therapy and joint mobilization can be used to reduce the pain, restore more normal alignment, and improve function. Strengthening the muscles around the joint can also help reduce the physical stress that leads to degenerative changes and the resulting pain. The therapist may also use modalities such as deep heat or electrical stimulation to help reduce the pain.

If a series of treatments over a period of three to six months does not alter your symptoms or function, then surgery is often the next step. So, if you’ve arrived at surgical options without completing this first phase, take a step back and give nonoperative care a good try.

However, if you’ve already been through therapy and surgery is the next step, then there are a couple of approaches that can help restore painfree motion and function. For example, there is the extension osteotomy, an extra-articular (outside the joint) procedure. It is done by removing a wedge- or pie-shaped piece of bone from the metacarpal above the CMC joint. A wire is used to pull the opening (made by removing the bone) closed. This procedure changes the angle of the metacarpal bone where it connects with the wrist and brings it more into a neutral position (normal alignment).

Younger patients and anyone with less advanced disease can qualify for an extension osteotomy. The main advantage of this procedure is that it doesn’t mess with the joint itself. That means patients can still have joint reconstruction or joint replacement sometime in the future should they need it.

Another possibility is the traditional operation for treating CMC joint arthritis. This is resection (excision) arthroplasty. This method has been used for many years and has withstood the test of time. Patients with severe symptoms in later stages of CMC arthritis who have failed nonsurgical treatment are good candidates for resection arthroplasty.

The purpose of resection arthroplasty is to remove the arthritic joint surfaces of the CMC joint and replace them with a cushion of material that will keep the bones separated. The trapezium bone in the wrist next to the thumb is removed in a procedure called a trapeziectomy.

A rolled up piece of tendon is placed into the space created by removing the bone. This procedure is called a resection arthroplasty with ligament reconstruction and tendon interposition (LRTI). During the healing phase after surgery, this tendon turns into tough scar tissue that forms a flexible connection between the bones, similar to a joint. Sometimes the surgeon uses a silicone-based or metal implant or disc made of costochondral tissue instead of a rolled up tendon for the interpositional material. Costochondral allografts are plugs of tissue taken from the material between the breastbone and the ribs.

Resection arthroplasty with or without LRTI can be combined with a ligament reconstruction of the joint. Tendons in the area are used to create a ligament sling between the metacarpal bone of the thumb and the carpal bone of the index finger. This helps hold the thumb in place and keeps the space between the bones from collapsing.

Fusion of the bones or joint replacement are final options to consider. But because these two operations have permanent effects, younger patients are usually steered to some of the other choices first. Talk with your surgeon about what would work best for you. There are many younger patients who benefit greatly from some of these other more conservative approaches before considering something joint replacement.