FAQ Category: Hand

A thumb joint replacement, a trapeziometacarpal implant arthroplasty is, indeed, possible. It is, however, not a popular surgery because it isn’t effective in everyone. Right now, researchers are recommending that the implants be reserved for women who are over 60 years old because in men and younger women, there is a higher rate of the implant loosening or not merging with the bones around it.

If you are interested in learning more about this, you should encourage your mother to ask her doctor about it.

Dupuytren’s contracture is a fairly common disorder of the fingers. The palmar fascia (connective tissue of the palm) contracts, or tightens. This contracture is like extra scar tissue just under the skin. Without treatment, the contracture can become so severe the finger no longer straightens. It most often affects the ring or little finger, sometimes both, and often in both hands.

No one knows exactly what causes Dupuytren’s contracture. The condition is rare in young people but becomes more common with age. When it appears at an early age, it usually progresses rapidly and is often very severe. The condition tends to progress more quickly in men than in women.

At first, when this condition is mild, careful observation is advised. If the contracture stays the same and doesn’t get worse, it may be referred to as nonDupuytren disease. It sounds like this is your situation. If hand function is not impaired, there may be no reason to treat the problem aggressively.

There’s no doubt that carpal tunnel syndrome (CTS) changes the way your hand functions. Clumsiness, loss of pinch strength, and decreased coordination are often reported. Loss of normal sensation from skin, joints, and tendons makes manual finger tasks more difficult.

Studies show that when comparing CTS patients with normal adults, people with CTS use greater force of the thumb to grip while holding objects. This appears to be the result of a combination of factors. There’s a decrease in muscle strength, impaired coordination, and numbness (when present) to consider.

Thumb-to-index finger coordination is most likely to be a problem. Without an accurate tip-to-tip thumb-finger pinch, handling objects becomes increasingly harder to do successfully (without dropping the item).

A program of strengthening and sensory input may help. Change in dexterity from severe, chronic CTS may require a more aggressive approach. Surgery may be needed to release the band of tissue over the carpal tunnel area and decompress (take pressure off) the nerve. A rehab program with a hand therapist will help you return to your former level of function.

You may have a simple case of trigger points (TrPs) of the muscles from overuse or chronic contraction without relaxation. Trigger points are tender spots in a taut band of tissue (usually in the muscles or fascia over the muscles). When these hyperirritable spots are pressed or compressed, they cause local tenderness and referred pain.

The history you present with chronic use and overuse of the hand lends some support to the idea of trigger points. Fibromyalgia is another (different) problem that can first show up as a symptom of similar muscle problems. Usually there are a wide range of other accompanying signs and symptoms such as cold intolerance, migraines, hair loss, poor sleep, and many more.

A more local problem could be something called Dupuytren’s disease. Dupuytren’s can cause a contracture of the fingers. The palmar fascia (connective tissue of the palm) contracts, or tightens. This contracture is like extra scar tissue just under the skin. Without treatment, the contracture can become so severe the finger no longer straightens. It most often affects the ring or little finger, sometimes both, and often in both hands.

If daily stretching of the fingers and muscles of the forearm don’t help, see your doctor. There could be a medical cause for the problem. This should be ruled out and an accurate diagnosis made so that proper treatment can be started.

Osteoarthritis is, as you say, more common in the back (spine), hips and knees. However, it can occur in any joint. It’s called the wear-and-tear arthritis and, if you think about it, you usually do use your thumb quite a bit. And, some people – manual laborers, for example – put a lot of pressure on their thumb and that joint.

As the tissue in the joint begins to wear away, this is what causes the pain.

In the last 10 years, a new method has been developed for the surgical treatment of carpal tunnel syndrome. The Indiana Tome Technique combines the benefits of open incision with endoscopic (minimally invasive) approaches. It allows a partial direct view inside the wrist with decreased tissue trauma.

First, a tiny incision along the palm is made to gain access to the transverse carpal ligament. Then, a special tool called a cutting tome is inserted. It looks like the flat prongs of a front-end loader. It can be pushed deep enough into the carpal tunnel to allow the surgeon to completely cut through the transverse carpal ligament without damaging the median nerve and nearby tendons.

Results of previous studies using this system report a 92 per cent success rate. Success was measured by complete pain relief or only minimal residual symptoms after surgery. Other factors used to measure success included grip, key, and three-point pinch strength. The results for these variables with the Indiana Tome technique were similar to the results with open incision surgery.

In a recent study, the charts of 1,332 carpal tunnel patients were reviewed after surgery was done. Carpal tunnel releases using the Indiana Tome system were done by two fellowship-trained hand surgeons. The researchers were particularly interested in complications and complication rate using this method. They also kept track of the time it took for patients to get back to work or to a preoperative level of function and activities.

There were very few complications (less than one per cent) with this technique. Everyone went back to their preoperative work status quickly. The few patients with numbness or hypersensitivity recovered over time. In two cases, the patients’ ability to feel two points of pressure (called two-point discrimination) was decreased permanently.

The Indiana Tome technique is safe, reliable, and effective. It must used by an experienced hand surgeon specifically trained to use this tool. In-depth knowledge of the anatomy is a must. In the hands of such an expert, there is less soft tissue damage when compared with the open method.

Doctors don’t know what causes Dupuytren disease, although they do know that it affects certain groups of people more often than others. The disease is the thickening of the skin on the palm of the hand. This can happen on one hand alone, but often develops in both at the same time. For some people, Dupuytren disease goes beyond the palm of the hand, towards the fingers. The thickened skin begins to pull on the fingers and causes them to flex, or bend, to the point that they can’t straighten out again. It’s a slow progressing disease that also can affect the soles of the feet occasionally.

Dupuytren disease is more common in people with Northern European ancestry but how many people are affected isn’t known. The reports vary from 2 percent to 42 percent. It is more common as people get older, usually in the fifties and men are diagnosed with it six times more often than women are. Other people who seem to develop Dupuytren disease more often are those with diabetes, who drink alcohol, who smoke, who have a traumatic injury to the affected hand(s), and those who do manual labor with vibrations to the hand, such as using a jack hammer.

See a surgeon and find out what are your options. There are conservative (nonoperative) ways to treat carpal tunnel. A hand therapist (physical or occupational therapist) can help you learn to modify activities to prevent compression and reduce stress on the nerve. There are tendon and nerve gliding exercises that can help decrease or eliminate symptoms. Splinting to hold the wrist and hand in a protected position is another way to approach the problem.

Sometimes a six-to-eight week course of therapy is enough to make you functional once again and restore your quality of life. Some patients even obtain complete relief from their symptoms. Most doctors suggest giving it a full three months before considering surgery.

And there are some suggested guidelines for who should have surgery. These include: 1) numbness in the hand and/or fingers for more than three months, 2) pain, numbness, and/or tingling that wakes you up at night, and 3) no change with splinting.

The surgeon also uses the results of some clinical tests in the clinical decision-making process. These tests stress the nerve and potentially reproduce your symptoms. Sometimes nerve compression tests using electrodiagnostic methods are ordered. This gives your physician an idea of just how damaged is the nerve. This information can help guide the timing of surgery.

If you’ve already tried all these things with no success, then surgery may be the next best step. Today’s minimally invasive techniques give good results and fast recovery times. Let your surgeon know of your concerns and find out more about all your options.

Rapid or immediate symptoms of carpal tunnel syndrome after a fall may be a sign of nerve compression from a bone fracture or dislocation. It would be best to have an X-ray and examination of the injury. Early recognition of the problem is needed to avoid long-term problems and complications.

When there’s enough force, ligaments are torn and the lunate (a wrist bone) is then forced into the carpal canal. With the lunate bone in the carpal canal, pressure is placed on the median nerve causing CTS. There may also be a loss of blood flow to the median nerve below the level of the injury. If this happens, the hand and fingers may become cold and pale or blue/purple in color.

The American Society for Surgery of the Hand recommends that all hand injuries should be X-rayed. More than one radiographic view may be needed. A posteroanterior (back-to-front) view will not show a lunate dislocation. It is necessary to take a lateral (from the side) view. The lateral radiograph will clearly show the extent of the injury.

The physician will check the pulses to look for any vascular (blood vessel) damage. With a bone fracture and/or dislocation, there is usually loss of normal motion. Pain and swelling limit motion. With ligament damage, dislocation, and/or fracture, the wrist is unstable. Surgery may be needed to repair and reconstruct the wrist.

With early detection, the prognosis is good for this type of injury. Missed injuries with a delayed diagnosis do not respond as well. Injuries that are not properly diagnosed until two months or more after the injury may require more extensive treatment. Restoring motion, strength, and function is often not complete or possible.

Trigger finger doesn’t seem to have a definite cause, which means doctors say it is idiopathic, or of unknown cause. It may be that people who have diabetes may be at higher risk of developing trigger finger, but that hasn’t been proven.

While it’s always best to get a doctor to confirm what the problem is so that you don’t end up doing any more damage to your finger, there are some at-home treatments that people use for relief of trigger finger. They include:

– Icing the area for up to 15 minutes at a time to relieve swelling and pain
– Over-the-counter pain medications (nonsteroidal anti-inflammatory drugs, or NSAIDs), such as ibuprofen or aspirin
– Splints at night to keep the finger in a naturally more straightened position
– Reducing actions that may aggravate the condition

The most common joint replacement or arthroplasties are for hips and knees, but other joints can be replaced. However, the prosthesis for different types of joints are different, depending on the joint. Currently, there are finger prosthesis available and patients are receiving them, but researchers are working on learning which ones are the most effective. For example, some replacements use cement to fasten them while others don’t. In a recent study, researchers found that the replacements that used cement were more effective over the long run than the uncemented ones.

Once a hand has begun to heal, it may need some strengthening or even retraining, depending on the severity and type of injury. It looks like this may be the case with your hand. Occupational therapists play a vital role in rehabilitation and helping people regain their function or independence as much as possible. Some of the things an occupational therapist may do are:

– Evaluation the injury and use his or her knowledge to determine a treatment plan in coordination with your doctor
– Look at your work or home environment to see if any adaptations need to be made.
– Evaluate your hand and make a splint or brace to help you use your hand more effectively.
– Provide exercises to strengthen and heal your hand.
– Show you how to care for your hand if it hurts or becomes swollen.
– Show you what you may do to help your hand should you feel pain.

So-called Blackberry thumb is a new repetitive stress injury that doctors are seeing, not just among business people who use the Blackberries, but in people as young as their teens because of their cell phone and text messaging use. As with any RSI, the best thing to help it is to stop the action that is causing it. You can use ice to relieve the pain, and if the pain is severe, take over-the-counter anti-inflammatories if your doctor hasn’t advised you not to.

If you feel you still must use the device, here are some tips to help reduce the risk of developing or worsening Blackberry thumb:

– Don’t use the Blackberry or any other similar device all day long. It wasn’t meant for that type of use.
– If you must send a long or several messages, do so in short periods. Write out a quick message and take a break.
– During the breaks, do something else with your hands to move the thumbs in different directions. Also stretch your hands and arms.

The scaphoid is the bone that is below the thumb. If you spread out your hand, you maybe able to see its outline. It’s one of the largest bones in the hand, but that’s not saying much because the hand bones are quite small.

The most common way to break this bone is to fall and stop your fall with your hand spread out, palm side down. At this point, the bones in the hand take the weight of the fall. The fall doesn’t have to be hard, it just needs to have enough force and be at the right angle to break the bone.

Since this is a common fracture from falls, experts are recommending that children who skateboard and do similar activities wear wrist guards to help absorb the weight of the fall, reducing the fracture risk.

You may be confusing acute versus chronic carpal tunnel syndrome (CTS). Both conditions cause compression of the median nerve in the wrist and hand. Wrist pain, numbness, and tingling are common symptoms in either condition.

Most people develop chronic CTS. This is a gradual onset of symptoms brought on by compression of the nerve for a variety of reasons. Repetitive use of the wrist and hand are often blamed for this condition. Conservative care with activity modification, splinting, and tendon and nerve gliding exercises are standard treatment modalities for chronic CTS.

Acute CTS may require immediate medical response and surgical care. Acute means the condition comes on suddenly — in a matter of minutes to hours rather than weeks to months. The cause is most likely trauma leading to bone fracture, joint dislocation, or bleeding into the carpal tunnel compartment.

In the case of acute trauma, something must be done in order to restore blood flow and preserve nerve function. That something is usually surgery. The procedure is a surgical decompression. The surgeon makes an open incision in the wrist and removes any fluid or tissue compressing the nerve.

When acute CTS occurs, early diagnosis and treatment ensure a successful outcome. The patient’s history and exam are usually enough to verify an acute cause of the syndrome. The speed with which the symptoms develop and progress is a tip-off as well. Early release of pressure on the nerve can help return complete function of the nerve.

Unless you’ve had a sudden traumatic event causing your CTS, the course of nonoperative care outlined by your doctor is standard procedure.

Cock-up splints for carpal tunnel syndrome help take the stretch and pressure off the median nerve. This gives the nerve time to rest and recuperate. Exercises to improve tendon and nerve gliding through the carpal tunnel are usually given along with the splints.

The splints are designed to modify your activities. What can’t be done in this position, shouldn’t be done. The flexed wrist position must be avoided, especially for long periods of time such as during the sleeping hours.

Sleeping with the wrists and hand curled puts pressure on the nerve and cuts off the circulation. Lack of blood supply called ischemia is a likely contributor to the problem. Studies show that ischemia is actually more detrimental to nerve function than mechanical compression from overuse of the muscles.

For the best results, wear the splints as directed. Avoid activities that can’t be done easily while wearing the splints. When it comes time to gradually wean yourself off the splints, you should be doing a progressive series of strengthening exercises. It’s important to do these in order to protect your wrist and hand from further problems.

You have described the Boxer’s knuckle perfectly. Most people with this injury also report painful swelling as well. Treatment is usually by splinting the affected finger together. A special gutter splint is used to hold the fingers in a position of partial flexion.

X-rays are taken two weeks after the injury to check the position of the bones and joints. If the placement is worse instead of better, then adjustments must be made to the splint position. The fingers are held still for four to six weeks to encourage healing.

After this period of immobilization, six weeks of hand therapy in an aggressive rehab program is advised. Flexibility and strength are eventually restored but the knuckle may not ever return to its original appearance.

Mallet injuries are so common in baseball, they are also referred to as baseball finger. The athlete reaches out to catch a ball with the fingers extended. The ball hits the tip of the finger and forces it into flexion.

The extensor tendon is torn, leaving the athlete unable to fully extend the finger. The loss of this motion is called an extensor lag. Sometimes there’s a small piece of bone still attached to the tendon where it pulled away. This is called an avulsion fracture.

If your daughter can passively straighten her finger all the way, then she may only need a splint during the healing phase. Nonoperative treatment involves placing the finger in a position of full extension and holding it there for six to eight weeks. She shouldn’t take the splint off at all (even to play her instruments) during this time.

Failure to adhere to the splint-wearing schedule may result in a prolonged period of time in the splint. As much as six more weeks may be needed before healing is complete. When she can actively straighten the finger all the way, then the splint only has to be worn at night and during sports play or practice.

Protecting the finger from further injury is important. Playing a musical instrument requires good fine motor control. Full flexion and extension of the fingers is essential. If, six months after the injury, the finger still isn’t able to bend and straighten completely, then surgery may be needed.

Requiring scientific evidence to support work-related health claims has become a central issue in the last few years. As a result, more and more studies are underway evaluating the cause of conditions such as carpal tunnel syndrome (CTS).

According to a recent investigation, genetic factors ranked the highest as possible links to CTS. The anatomic structure of the wrist and increased body mass index (BMI) are the strongest risk factors.

There isn’t enough evidence to link CTS with occupational factors such as repetitive hand use, exposure to vibration, and activities requiring high-force grip. Hand position and stressful manual work have also been investigated with similar results.

At this point in time, all evidence points to CTS as a structural, genetic, biologic problem. Environmental and occupational factors play only a minor role in this condition. Typing and computer use have not been directly linked with CTS.