FAQ Category: Hand

Your experience is typical of many patients who have basal joint osteoarthritis (OA). Basal joint refers to the joint of the thumb where it attaches to the wrist. It is also known as the carpometacarpal (CMC) joint of the thumb.

Arthritis of the CMC is fairly common, especially among post-menopausal women. In fact, it is the place in the hand most often affected by OA for both men and women. Conservative care with physical therapy, exercises, and splinting can often manage the problem.

But surgery is needed when nonoperative care fails to relieve painful symptoms or improve function. Long-term studies of the outcomes of these operations show good results. Pinch and grip strength seem to be restored early on. Pain relief isn’t always so successful.

In terms of X-ray results, many patients do have what are considered normal radiographs. No progression of disease is seen. But about 66 per cent of patients have gradually increasing symptoms between five and 15 years postop.

The reasons for this aren’t clear. Experts say that there are up to 16 ligaments that stabilize the basal joint. Some ligaments allow for motion while others hold the joint steady and keep it from moving. Anything that affects one of those ligaments could disrupt the stability of the joint leading to pain.

You may be describing the classic symptoms of osteoarthritis (OA) of the carpometacarpal (CMC) joint of the thumb. This is the most common place in the hand to be affected by arthritis.

Post-traumatic injury is a common cause of thumb arthritis. You may be able to remember some past event when you injured that thumb. But an injury isn’t needed to develop OA of the CMC. One in every three women is affected by this problem after menopause.

You may want to see an orthopedic surgeon for a definite diagnosis. An X-ray may help identify what’s going on in the thumb. Treatment for arthritis of this joint early on can prevent worsening of the symptoms.

Carpal tunnel syndrome (CTS) has been around for a long time. The first cases were reported in the mid-1800s. Today it has become a significant health problem.

Repetitive motion such as typing has been named one of the most common causes of CTS. But there are many other possible causes to consider. For example, trauma resulting in swelling, bleeding, or scar tissue can cause CTS.

Anything that changes the structure of the wrist can bring on CTS. Arthritis, pregnancy, tumors, and ganglion cysts fall into this category.
Even weight gain or obesity can be a risk factor for this condition.

And systemic problems such as thyroid disease, lupus, gout, or leukemia have been linked with CTS. It appears that increasing age can also contribute to CTS. Chronic alcohol abuse, vitamin deficiency, diabetes, and some medications are also potential causes of CTS.

It’s not likely that CTS occurs as a delayed response to your work. A medical examination is needed to find out for sure what’s causing your symptoms. Given the wide range of possibilities and the fact that it could be something more serious, a visit to your doctor may be in order.

A physical exam of your head, neck, and arms will be done. Special tests for CTS can help make the diagnosis. Sometimes more specific studies using X-rays, ultrasound, or MRIs may be needed. Blood tests don’t pinpoint CTS but can show other problems such as low thyroid or diabetes.

Puncture wounds can be very deceptive. Although the wound looks minor, there can be damage to the deeper tissues. Infection is always a concern, too.

If the tool you were using was rusty or had been in a place like the garage or barn, a tetanus shot may be required. Swelling can be a sign of internal bleeding even if no blood comes from the wound site.

Contact your physician and see if an office visit is advised. Most injuries of this type don’t really require a trip to the emergency department. Simple first aid and close observation may be all that’s required.

Antibiotics are not used to prevent infection. But if signs of an infection develop, early intervention with antibiotics may be helpful.

Carpal tunnel syndrome (CTS) has many possible causes. Only a few can be identified by a blood test. Diabetes can be a cause of numbness and tingling in the fingers.

This is called diabetic neuropathy but often gets labeled as CTS. A fasting blood glucose test shows the presence of the diabetes, which helps pinpoint the cause of the symptoms.

Low thyroid hormone causing hypothyroidism can also result in CTS. Once again a blood test showing the levels of thyroid help identify the cause of the symptoms.

Other medical conditions causing symptoms similar to CTS that can be identified with a blood test include pernicious anemia, leukemia, and vitamin deficiency.

Soft tissue causes cannot be identified with a blood test. But there are other tests the physician can perform to pinpoint the diagnosis. During the physical exam, special tests of the median nerve involved in CTS can be performed.

If necessary, electromyography (EMG) studies can be done to test the nerve conduction. Less invasive testing may include X-rays, ultrasound studies, and MRIs.

You may be experiencing a problem with local nerve compression. There are three main nerves that pass through the wrist and can be affected. The radial nerve comes down from the elbow to the thumb side of the hand. Radial nerve problems are not as common as the next two we’ll discuss.

The median nerve in the middle of the three nerves passes through the carpal tunnel. Pressure on this nerve can cause carpal tunnel syndrome. Pain, weakness of the hand, and numbness and tingling of the thumb and first two fingers are common.

The ulnar nerve passes through its own tunnel called Guyon’s canal. This space is formed by two bones and two ligaments. Pressure along the outer border of the hand can cause ulnar tunnel syndrome. Symptoms are similar to CTS but affect the ring and little finger instead.

There are two functions of each nerve in the hand. One is to provide sensation of all kinds. This is the sensory branch of the nerve. The other is to move the muscles and tendons. This is the motor nerve branch. Clawing of the fingers suggests that the motor nerve has been affected. If you have numbness and tingling or other changes in sensation, then the sensory branch may be involved.

It may be best to see a hand surgeon or orthopedic surgeon for a formal evaluation. Early diagnosis and treatment can make a difference with this type of problem. It’s important to get the pressure off the nerve and allow it to heal before permanent damage is done.

Tenderness, numbness, tingling, and decreased grip or pinch strength are common symptoms of nerve compression in the wrist and hand. More and more reports of nerve compression syndromes in the hand are being reported by bikers (racers and mountain bikers).

The area affected most often is the ulnar nerve. This is the nerve along the outside edge of the wrist and hand. Pressure on the palm of the hand from long periods on the bike (racers) and/or rough terrain (mountain bikers) can cause this problem.

This is because the area covering the ulnar nerve and the ligaments that enclose the nerve are thin. The nerve is also fairly close to the surface. That’s why many bikers wear special protective gloves. There’s usually a gel pad or foam built into the gloves along the wrist border.

The handlebars of the bike can also be padded or the angle changed to keep pressure off the palm pads. It might be a good idea to invest in some protective gear for your son. If the symptoms don’t go away with some modifications, he may have to take a break until the nerve heals.

If he already has the right gear and rest has not helped, then it may be time to see a doctor. Seek out an orthopedic doctor who has specialized as a hand surgeon if one is available in your area.

Treatment of rheumatoid arthritis (RA) has improved quite a bit since your grandmother’s time. New medications called disease-modifying antirheumatic drugs (DMARDs) have made a big difference.

DMARDs is a category of drugs used in many autoimmune disorders. They slow down disease progression (how fast and how much the joints are damaged). Joint replacements are an option for some patients. Usually pain is the deciding factor.

Patients with low demand are the best candidates for joint replacement. Results with joint implants do not provide the strength and motion needed by manual laborers, for example. Long-term studies show that the benefits of pain relief and improved motion do not always last beyond 10 years.

Your physician will be able to guide you in making any future decisions about treatment. Many RA patients are able to manage very well with medications and an exercise program. By managing the disease early, long-term complications with the need for joint replacements can be avoided.

Carpal tunnel syndrome (CTS) is a compression neuropathy. This means that pressure on the median nerve in the wrist causes nerve impairment. The most common symptoms are numbness, tingling, and pain of the wrist, palm, and first three fingers of the hand.

CTS does seem to increase in prevalence with age. The exact reason for this is still unknown. Anatomic changes in the shape and space inside the carpal tunnel from aging may be part of the answer.

The carpal tunnel is formed by the bones in the wrist. The nerves to the wrist and hand pass through this space. Anything that changes this alignment can cause CTS. Arthritis, bone spurs, wrist fracture, and obesity are just a few things that can contribute to changes in the wrist leading to CTS.

Systemic conditions can also bring on CTS. For example, vitamin B deficiency (common in older adults) has been linked with CTS. Diabetes, leukemia, multiple myeloma, and local tumors or cysts are just a few other possibilities.

CTS can be treated successfully, even in the older adult groups. This may be something to identify as a problem and work toward improving. Reducing the symptoms can improve function and quality of life for your residents.

Electrodiagnostic tests are used to help diagnose carpal tunnel syndrome (CTS). These include electromyography (EMG) and nerve conduction study (NCS). These tests show how well the nerves are working to send messages to the muscles and skin of the wrist, hand, and fingers.

These tests are done in order to avoid doing unnecessary surgery. But sometimes the tests are normal even when there is a problem. Early changes in the nerve may not show up with this type of testing. Waiting until there’s enough nerve damage to have positive electrodiagnostic tests isn’t a very good option.

As in your case, the true diagnostic test was the treatment. After surgery, your symptoms were improved. Doctors could use a simple but sensitive and reliable test to diagnose CTS. So far, this hasn’t happened.

There is a wide range of tests. The results can often be confusing or contradictory. Each patient must be evaluated individually. The doctor takes into consideration age, body weight and size, signs and symptoms, and the results of any other tests done. Ultrasound or MRI testing can be done but these are usually saved for difficult cases.

An aneurysm is a thinning and bulging of a blood vessel wall. Abdominal aortic aneurysms (AAAs) are the most common and deadly form. Ninety-five per cent of all AAAs occur in the aorta (main artery coming off the heart) right below the arteries to the kidneys.

AAAs are most common in older adults with atherosclerosis weakening the blood vessel walls. Aortic aneurysms can be congential (present at birth). Or they can develop as a result of weight-lifting or other trauma.

A false aneurysm means there is blood leaking and trapped between two layers of the blood vessel walls. Blood vessels have three layers. Trauma or injury can puncture an artery and cause the layers to separate. With every beat of the heart, blood is forced between two layers causing a mass to form.

This type of aneurysm is more common close to the surface of the body such as in the hand or foot. The injury that starts the process is usually a puncture wound of some type.

A pulsing mass in the palm of the hand sounds suspiciously like an aneurysm. An aneurysm is a blood-filled bulge caused by a weak, damaged, or injured blood vessel. There are two types of blood vessels: veins carrying blood back to the heart and arteries carrying blood from the heart to the tissues. Aneurysms affect the arteries.

The bulge in a blood vessel is like an over-inflated balloon, It can burst causing serious problems from blood loss. The larger an aneurysm gets, the more likely it is to burst. Aneurysms can be treated so it’s best to see a doctor for follow-up.

Don’t try to treat yourself until you do see a physician. The area may need to be drained and cleaned. The bleeding must be stopped so that the aneurysm can heal. Medications to stop the bleeding and improve blood clotting may be prescribed. Unless there are other health issues, healing should occur fairly quickly.

Power washers can put out a stream of water with enough force to cut open the skin and even damage underlying tissue. There has been at least one report of a tendon and nerve laceration from this very type of injury.

If the stream of water is set at a high enough pressure, the force of the spray coming in contact with any part of the body can cause considerable damage. Water forced through the opening in the skin and into the soft tissue can result in a compartment syndrome.

Compartment syndrome is caused by swelling in an area that can’t expand very much. The tight connective tissue over soft tissue can spread a little to accomodate mild to moderate inflammation or edema. But there isn’t room for a large amount of fluid. Immediate treatment to remove the fluid is needed to avoid serious damage.

Once the fluid has been taken care of, the hospital staff will probably keep your husband for an extra hour or two for observation. If necessary, the on-call surgeon can be brought in for emergency surgery. Otherwise, he will be followed up by his own personal physician.

Pressure washers are being used by more home owners, handymen, and business owners. They are very handy for quick cleaning of hard-to-reach places. And one person can clean an entire house or building in a couple of hours.

High-pressure injection of water can cause inflammation in soft tissues. But in this case, there was a substantial mechanical force from a stream of water. Those home units can put out a strean of water pressure of 2300 psi — enough to cause some serious soft tissue injuries.

Although this type of injury is rare, with the availability of industrial water guns and pressure washers for home use, we may expect to see an increase in this type of problem. It really only takes a moment of contact to sustain serious damage including nerve and tendon lacerations.

You may be referring to a new biomedical material called pyrolytic carbon or pyrocarbon. Implants coated with this substance reduce the risk of blood clots called thrombosis. Blood clots do not form easily on the surface of this material. The FDA has approved pyrocarbon implants for use in the hand to replace joints.

Early reports from the use of this implant have been favorable. Long-term results aren’t available yet. The majority of patients report improved motion with an 80 per cent decrease in pain. Pinch and grip strength improved but not always significantly.

In a small number of patients, problems develop requiring additional surgery. Deformity, contracture, dislocation, loosening, and fracture are potential complications.

Your surgeon is the best one to advise you on implant type and material. Not all surgeons are using pyrocarbon implants. Not all patients are good candidates for the surgery or for this implant.

Every hand surgeon has his or her own guidelines after each surgery performed. This is called a post operative protocol. The standard guidelines for therapy after a finger joint replacement usually starts in the first few days after the operation. Some patients have to be immobilized longer depending on the joint deformity before surgery.

You’ll probably be seeing a hand therapist, either a physical or occupational therapist. Splints to hold the finger in proper alignment and position will be made for you. You may have one for daytime wear and a separate splint for nighttime.

Over a period of weeks to months, wearing time of the splints will gradually be decreased. You may have to tape the operated finger to another finger for a while. This is called buddy tape.

As you get your motion and strength back, your activities will also increase. The surgeon may advise you to do what you can as tolerated. Let pain or discomfort be your guide. you will continue therapy with your therapist who can also help answer any questions you may have and guide you through the process.

Researchers at Vanderbilt School of Medicine may be able to help you. They spent considerable time going through all the medical literature published on the subject of treatment for trigger finger. In particular, they wanted to know how well steroid injections work.

They were able to find 56 studies on trigger finger. Four of those studies were acceptable for analysis. All the patients were adults with trigger finger caused by work trauma or diseases. For example occupational-based lifting or gripping, rheumatoid arthritis, and diabetes were most common.

Half to two-thirds of the patients got relief from their symptoms using splinting. Up to 87 per cent were helped by a single injection of corticosteroid. But a little more than one-quarter of those helped by the injection had a return of their trigger finger within a year. It appears that surgery had a much higher success rate (as high as 100 percent).

The authors of the Vanderbilt review suggest the following:

It may not be possible to separate out cause and effect. Both repeated gripping and lifting activities and diabetes mellitus have been linked to trigger finger. Both factors can cause a thickening of the synovial sheath around the finger tendon.

The result is that the tendon doesn’t glide smoothly through its own tunnel resulting in the tendon getting stuck. Usually the finger is stuck in a bent or flexed position. But sometimes it gets stuck in an extended (straight) position.

Besides a limitation in motion, many people report pain and swelling of the finger with this condition. If getting your diabetes under control doesn’t work, then local treatment may be helpful.

Sometimes splinting at night and even possibly in the day can relieve trigger finger. In other cases, a single injection of cortisone is all that’s needed. You can get back to the job right away. However, there is a recurrence rate of about 27 per cent in the first year after steroid injection.

If more conservative measures don’t work, then surgery to release the tendon may be advised. It’s not likely that the trigger finger will come back but you may develop a new trigger finger in a different finger from the same cause.

Studies of adults with carpal tunnel syndrome (CTS) and another disorder called upper limb pain disorder (ULPD) have shown some surprising results. Blood flow and blood volume appear to be normal for these two groups. And changes in vibration threshold are present on both sides even when symptoms only occur in one arm or hand.

An increased vibration threshold was found in all patients with CTS or ULPD. Increased vibratory threshold means that when compared to normal, healthy adults, it took a higher amount of vibration before the patient could feel a sense of vibration.

Scientists think these results suggest that a change in the central processing of pain is occurring. They propose that anyone with chronic pain would experience the same changes. Increased vibratory threshold is not linked with local pressure on the nerves to the arm, wrist, or hand. It is a more of a global or central nervous system problem.

It’s not clear yet how this information will change treatment. The focus must shift from local treatment of the painful areas to finding ways to affect global processing in the central nervous system.

A boutonnière deformity affects the fingers or thumb of the hand. It is the most common deformity associated with rheumatoid arthritis but it can be caused by other conditions.

This type of deformity occurs when disease or injury causes the middle joint of the finger or the base of the thumb to become flexed (bent). The end of the finger or thumb is pulled up into too much extension (hyperextension). In the thumb, the position looks like an exaggerated hitchhiker’s thumb.

Prolonged inflammation in the joints from rheumatoid arthritis damages the lining aroudn the joint called the synovium. Over time the joint capsule starts to stretch and the extensor tendon slips out of place.

Weakness and an imbalance of forces results in the deformity. If it’s not corrected, the patient may lose the ability to even passively correct the joint position. Function is affected, especially the pinch grip.

Early intervention may be able to prevent such serious deformities. But by the time a boutonnière deformity occurs, surgery is usually needed. The type of surgery depends on the condition of the ligaments, tendons, and joints.

The surgeon may be able to repair any soft tissues that are torn or ruptured. Sometimes joint fusion is required. In other cases, joint replacement is advised.