FAQ Category: Hand

Hand and finger positions when playing the piano are actually quite different from using a computer keyboard. The piano keyboard is three times as big as the computer keyboard.

Pianists actually move their arms and hands much more than typists. Computer operators use different repetitive motions and keystrokes than pianists. On the computer keyboard, you will rarely stretch the thumb and little finger apart to reach the keys. But for some people, stretching an octave plus a chord on the piano stretches the hand maximally.

It’s also true with most computer keyboards that the pressure needed to strike a key is far less than the pressure needed to depress a piano key to make a sound. The computer keyboard operator uses about the same amount of pressure on each key every time. The pianist is more likely to strike with power and force to produce the sound required by the music.

Finally, wrist motion is different between the two activities. On the piano, the player may have to tilt or rotate the wrist more and more often compared to using a computer. There’s also greater risk of injury or overuse on the piano for players with smaller hand size or hand span.

Pianists are at risk for overuse syndromes most often affecting the forearms, wrists, and hands. Some pianists also suffer with neck, shoulder, and upper arm problems. Many different conditions have been diagnosed and described in association with piano playing. It seems that music requiring fast and forceful finger movements puts musicians at the greatest risk.

Studies using computer and video systems to track hand motion have helped identify some of the problems pianists experience. Researchers have found that music with trills or arpeggios played with speed or endurance can cause many problems.

Rest is always the best treatment but most serious pianists don’t feel they have the ability to take time off from practice or performance. Choosing less difficult music for awhile may be one way to rest the soft tissues.

Without special equipment to analyze your arm and hand movements, you can still do several things on your own. Set up a video camera to record yourself playing. Ask your piano instructor to watch a short amount of the video with you. Look for anything that might help you reduce the muscular stress in the upper extremity.

A physical therapist or hand therapist (sometimes a physical therapist, sometimes an occupational therapist) may be able to help you identify a motor control problem. The muscles may be firing too soon, too late, or too long for the motion required. the therapist may be able to show you ways to change how you play without negatively affecting your playing.

Mallet finger is an injury to the tip of the finger. With a Type I injury, the extensor tendon is partially ruptured. The extensor tendon is what helps you to extend your finger fully.

The goal in treating a mallet finger is to restore full motion with equal flexion and extension to the same finger on the other hand. With an extensor tendon injury there’s a chance you won’t get your full extension back. The tip of the finger remains slightly bent making it look like the head of a mallet. The fingertip won’t straighten fully. This is called an extensor lag.

Splinting Type I injuries usually works very well. The splint is worn day and night for 10 days. Then the patient is advised to keep wearing it just at night for another two weeks. If there’s no deformity at the end of this time, then the splint can be discontinued. If extensor lag and a mallet deformity persist, then the splint is worn for another eight weeks.

There are several problems that can occur if you don’t wear the splint. For one thing, the finger won’t be straight. Some people are concerned about the way the deformity looks. Secondly, the finger can get caught when you’re trying to slip your hand into a pocket. Third, it’s harder to use the hand for some tasks with the tip of a finger slightly bent.

There are several different types of splints available. If one doesn’t work or isn’t comfortable, ask your doctor about trying a different one. For the best results, wear the splint as recommended.

Jersey finger refers to an injury to the tip of a finger (usually the ring finger). It occurs when a tackler grabs another player by the shirt (jersey). The fingers are bent holding onto the material. The other player tries to pull away. The force of the movement away from the bent fingers causes the tip of one (or more) finger(s) to hyperextend.

The ring finger is affected most often. In fact the ring finger is affected in 75 percent of the patients with Jersey finger. There are probably many reasons why this happens. The biggest factor is that the ring finger has the least amount of motion on its own. As you’ve probably noticed yourself, it’s much harder to flex and extend that finger by itself normally. It’s easier for its grip to get ripped away as the other player pulls in the opposite direction.

If the injury isn’t too severe, then splinting is the main treatment. If the tendon is pulled completely away and pulls a piece of bone with it, then surgery may be needed. You may want to contact the team athletic trainer and find out more about the extent of the injury before deciding whether or not to request an orthopedic consult.

Arthrosis is a term sometimes used in place of the word ‘joint.’ It is also used to describe degenerative changes affecting a joint. On an X-ray this may look like a narrowed joint space or bone spurs in and around the joint.

The radius or radial bone is the larger of two bones in the forearm. The smaller bone is the ulna. A displaced fracture refers to the fact that the bone has broken and moved so that the joint surfaces no longer match up.

Long-term studies of displaced radial fractures report that these changes are common. In fact more than 80% of the patients in the studies showed non-inflammatory joint changes. Patients still have good grip strength and motion so function isn’t affected even after 15 years of follow-up.

It sounds like you may have had a displaced intra-articular fracture of the distal radius. Surgery is needed to realign the joint surfaces to avoid uneven wear and tear and eventual arthritis.

According to the results of other patients in long-term studies, your chances of returning to work are very good. Patients after healing from the same kind of fracture you’re describing were examined for 17 areas of function. Tasks included lifting, lowering, and carrying. They were also tested for range of motion, strength, and endurance. Dexterity or the ability to manipulate small objects was also measured.

Hand and upper extremity function was good enough for most patients to return to their previous jobs. In some cases, the workload had to be exchanged for lighter duty. Most of these same people still had good function when retested seven and again 15 years later.

Of course some of this decision may depend on the type of work you do and the kind of final results you will get from the surgery.

Ganglion cysts of the wrist and hand are fairly common. They are benign but can still cause problems. If they get large enough, pressure on the nerve can cause wrist and finger pain, numbness, and weakness.

Most ganglia are filled with a clear fluid that comes from the synovial fluid in the nearby wrist joints. If you hold a small flashlight up against the cyst, the light will shine right through it.

The cyst itself has an outer wall made up of collagen fibers put together in a random fashion. The ganglion may have more than one lobe, all filled with the same fluid. The cyst gets larger and smaller as the fluid moves in and out of the cyst.

If the lobes get sealed off, then the cyst stays the same size. But if the cyst has an opening into the joint, fluid from the joint can move back and forth between the two spaces.

Sometimes ganglion cysts go away or resolve by themselves. In other cases, they can be drained and they don’t fill up again. Most often surgery is needed to remove the cyst and the stalk of tissue that’s connecting it to the joint.

Even without a bump on the back of the hand, whapping it with a heavy book of any kind is likely to hurt. In this case, the intended goal is to rupture the bump if it’s a fluid-filled ganglion cyst.

The traditional “Bible treatment” only works about half the time. More than 50 percent of these cysts come back again. A more successful way to treat it is with needle puncture and aspiration. The doctor inserts a needle into the sac and draws the fluid out. Cure rate is about 85 percent with this method.

Closed rupture (the Bible Treatment) or needle puncture isn’t always advised. There is a risk of injury to the arteries or nerves in that area. For some ganglion cysts, surgical removal is the best treatment. When the stalk that connects the cyst to the joint or tendon sheath is removed, the cyst doesn’t come back.

You’ll need some medical tests first to know for sure what kind of cyst is present and the best way to treat it. It’s probably best to thank the grandpa for his offer but choose a more effective, less painful method of treatment.

The base of the thumb or carpometacarpal (CMC) joint is a frequent site of pain and deformity from arthritis. The goal of surgery is to relieve pain and restore strength and stability. There are many ways to accomplish this with surgery.

Suspensionplasty uses the abductor pollicis longus (APL) tendon to hold the main bone of the thumb (metacarpal) in place after removing the painful, arthritic bone (trapezium) at the base of the thumb.

The surgeon does this by drilling a tunnel through the metacarpal bones of the thumb and the index finger. The APL is threaded through these two tunnels and stitched in place.

The main problem after this operation is called subsidence. The thumb metacarpal can sink down into the space left by the missing bone. The “suspension” doesn’t hold it in place as hoped. This may not cause problems at first but over time, pain and loss of function may require a second (revision) surgery.

A few patients who’ve had this operation report some weakness when opening jars or turning keys in locks. They also report mild discomfort or pain but most say they are much better than before the operation.

Suspensionplasty is a way of changing the pull of the abductor pollicis longus tendon (APL). The APL attaches at the base of the thumb where arthritic changes in the bone start to cause pain and weakness. By removing the bone and redirecting the tendon, pain is relieved without losing function.

The operation is easier to perform with equally good results. The other tendons of the wrist and thumb are undisturbed. Wrist stability is preserved. After surgery, rehab, and recovery you should be able to open jars, turn keys in doors, pinch, and grip without pain.

In the hand there is a flexor tendon pulley system that allows rock climbers to grip with the fingertips while keeping the hand flexed. When a bent finger is forcibly extended during a foot slip like you had, the tendon pulley system can get torn or ruptured.

With serious injury bowstringing can occur. The flexor tendon actually protrudes into the palm every time you bend it. This is a sign that surgery may be needed. Otherwise, in less serious strains conservative care is all that’s needed.

First the fingers will be immobilized. Taping or splinting is used for 10 to 14 days. Antiinflammatory drugs are also used to keep the swelling down. Early hand therapy is often advised for the rock climber who wants to get back to rock climbing. The soft tissues of the hand must be protected while you do sport-specific exercises.

Usually after two months you can start some easy climbs using tape or a soft finger cast. Full climbing activities are resumed after three months. The fingers will have to be taped for a full six months.

It’s probably best to take a deep breath and make an appointment. Find out what’s really wrong. Get a game plan going. The sooner you heal properly, the faster you’ll get back to safe rock climbing!

Splinting has been reported successful with mild cases of trigger finger. A custom-made splint is advised. It will hold the joint at the knuckle in a slight bent position. The rest of the finger is left free. Usually an occupational therapist can help you get the right splint.

You’ll have to wear the splint 24/7 for at least six weeks. For mild cases involving only one finger, splinting is a good way to go. If that doesn’t work you can always try a steroid injection or two. If all else fails, a simple surgery can be done to release the pulley mechanism of the tendon.

Steroids do have some dangerous side effects. Most of the time these occur when patients have to take oral steroids for a long period of time. When steroids are injected, the side effects are much less serious.

In the case of a bothersome trigger finger, corticosteroid injection is a very common treatment used. It works well and gives long-lasting relief from the triggering symptoms. Sometimes patients get good results after only one injection. In other cases it may take up to three injections.

There is one thing to think about. Studies show that patients who wait four to six months or more before getting injected have less success with injections. Sometimes it takes longer to work and requires more injections. The reason for this is the build up of scar tissue and fibrocartilage. Steroids can’t always reverse this.

The radial collateral ligament (RCL) of the thumb is injured much less often than the ulnar collateral ligament (UCL). The RCL is located just at the base of the thumb between the thumb and the forearm. It actually crosses the wrist line at that point. The UCL is on the other side of the wrist.

Studies of the RCL are limited. The tear is usually graded from one to three. One is a mild injury and three is a complete tear. Splinting or casting is used for grade 1 and 2 tears. Doctors disagree on the best way to treat grade 3 tears.

Some advise casting it for six to eight weeks. Others insist surgery is the only way to go. A recent study of 26 patients with grade 3 tears reported on the results of surgical treatment for grade 3 RCL tears.

Patients who had the surgery within the first three weeks of the injury had a repair. Patients who waited months to years to have the surgery had a full reconstruction. The results were excellent in both groups.

Based on this study, the authors recommended surgery in the acute stages of RCL ruptures. They predict it will reduce the risk of a painful, unstable joint and arthritis developing later.

Chronic pain and difficulty with these types of activities suggests a serious injury, perhaps a bone fracture or a torn ligament.

Patients with a torn radial collateral ligament (RCL) often describe exactly these symptoms. They also describe trauma or an injury caused by compression through the tip of the thumb. The weight of your body and force of the injury hyperextends the thumb joint tearing the ligament at the base of the thumb.

An orthopedic surgeon or hand specialist will need to make the diagnosis. History and examination are often all that’s needed. An X-ray may be taken to rule out a fracture.

Most often the decision to repair or reconstruct a torn ligament depends on the condition of the soft tissues when the area is opened surgically. The surgeon looks at the torn tissue and measures the thickness.

If the surgeon can find the ligament and pull it back to its attachment point on the bone then a repair is done. The ligament is sewn back in place. If the ligament was torn off with a little piece of bone still attached then an anchor or a suture that looks like a button is used to hold the bone in place until it heals.

If the ligament is old, fibrotic, and scarred, then the surgeon must start over. This is called reconstruction. The old tissue is removed. Holes are made in the bone. A tendon graft is harvested from some other place on the body and threaded through the holes. The graft is stitched in place. Sometimes a wire is used to hold the joint stable.

Whether repaired or reconstructed the patient is put in a cast for five or six weeks. Hand therapy follows cast removal to help you regain strength and motion.

It could be but a doctor would need to examine you to confirm it. Dupuytren’s is a connective tissue disorder. Thick, scar-like tissue develops in the palm of the hand. It can affect one or more fingers, pulling them into a flexed position.

When changes occur from Dupuytren’s along the backs of the hands it’s called Garrod’s nodes. At first this can look like bumps or nodules. The same problem can affect the penis, called Peyonie’s disease. If the bottom of the feet start to tighten up with fibrous scarring, it’s called Ledderhose’s disease. Each of these problems can be disabling.

These three conditions are all part of the same disease process. No one knows yet why it happens or how to cure it. Treatment is most often surgical. There’s no known drug to treat or cure this problem whether it affects the hands, feet, or penis.

Dupuytren’s disease isn’t a contagious condition. It’s the overproduction of fibrous tissue that causes a thick cord or band of fascia in the hand. Sometimes the feet are affected too.

Scientists aren’t sure what causes it. They think there’s a genetic link. People with a family history of Dupuytren’s are more likely to have it than someone with no family history.

It’s actually fairly common in people of Celtic (Scottish) origin. Adults over age 60 with this background seem to be targeted. In the past, a history of smoking, diabetes, and high cholesterol have been linked with Dupuytren’s.

If you do have a family history it’s not clear if you are more likely to develop the disease if you smoke or have any of these other factors.

It’s always helpful to know what causes a disease. Scientists can work to find ways to prevent it. If there’s a known genetic link then anyone with a family history of Dupuytren’s can watch for early tell tale signs of it. Earlier treatment may be able to prevent serious complications.

According to a recent study from Finland a positive family history of Dupuytren’s increases your risk of getting the disease. Not only that but the condition develops at an earlier age. It tends to be more severe and affect more fingers in those with a positive family history.

In cases like this, instead of taking a wait-and-see approach, surgery may be advised. For more futuristic thinkers…if you knew you had a family history of Dupuytren’s and scientists knew which gene transfers the problem, then to avoid this potentially disabling condition a person could have a gene transfer. The defective gene would be removed and a normal gene put in its place. This could prevent the problem from ever occurring in the first place.

Dupuytren’s disease (DD) is the overgrowth of cells in tissue around the tendons of the palm. Sometimes it affects tendons in the feet in a similar way. The tissue forms tight cords that pull the fingers (or toes) into flexion.

There isn’t much known about what causes DD. Scientists are trying to find a genetic link. It seems to affect men around age 50 and older. Men of northern European background are targeted most often. Older men from Scotland, Norway, and Iceland have the highest incidence of DD.

Risk factors associated with DD include: alcoholism, diabetes, epilepsy, and smoking. Just what is the link remains unknown.

Genetic studies have been able to isolate one gene that may be responsible for the tissue overgrowth. The MafB gene appears to be present four times as much in tissue removed from hands affected by DD. MafB is known to cause tissue to grow but how or why it gets turned on or turned up in DD remains a mystery.