FAQ Category: Hand

Osteoarthritis (OA) is a common problem for many adults as we get older. Thumb OA is especially common. Severe pain and disability from OA at the base of the thumb only affects a small number of people.

Thumb OA rarely causes disability. Treatment is possible with drugs, splinting, and exercises. Surgery may be needed in severe cases. Even if you had an operation, return to work is likely after rehab.

Hand symptoms caused by cancer can look just like one of several forms of arthritis. This is common when there are no other symptoms of any kind to suggest a more serious problem.

Sometimes the tumor gives off hormones and other chemicals that affect the body far from the site of the tumor. When this happens the patient might get a skin rash, joint pain and stiffness, fever, or other vague symptoms. This is part of a syndrome called a
paraneoplastic syndrome.

Diagnosis can be delayed months to years. It isn’t until the treatment fails to improve the patient’s symptoms or the cancer gets much worse that a correct diagnosis can be made. Paraneoplastic syndromes are rare and unusual so the medical staff can be fooled easily.

Yes, in a small number of cases cancer can present like arthritis. This is true for quite a few different kinds of cancer. The condition is called a paraneoplastic syndrome. Para means like. Neoplastic is another word for cancer. Syndrome refers to a group of symptoms.

In a recent study, the Mayo clinic in Jacksonville, Florida, reported four cases of hand and arm symptoms that later turned out to be from ovarian cancer. There was a wide range
of symptoms from pain and stiffness to actual contractures. Contractures are fixed positions of the joints so the patient can’t fully flex or extend.

Most cases are finally diagnosed properly when the symptoms don’t clear up as expected with treatment. Sometimes the cancer gets worse and the patient develops other symptoms to guide the doctor.

Your experience is not uncommon. A study of Canadian workers’ compensation patients with carpal tunnel syndrome reported a long time on the same job before having symptoms. In a
group of 964 patients, there was a range of eight to 11 years between start of work and onset of symptoms.

Doctors think it takes this long for the tissue to build up inside the wrist. Once the tissue size gets larger than the space for the nerve, pressure on the median nerve causes pain, numbness, and tingling.

It’s likely that a long period of damaging work activity must occur before symptoms start. In fact symptoms may not begin, even when the tissues have changed. It may be another couple years before the worker feels anything. Many workers wait up to two years before reporting their symptoms. By that time even more changes have likely occurred inside the wrist.

A recent study of Canadian workers reports a high number of people with both tendonitis and carpal tunnel syndrome (CTS). They aren’t sure what the link is between these two conditions.

Maybe it’s the type of work you’re doing that is affecting both areas of the arm. Perhaps there’s a certain body type that’s at greater risk for soft tissue injuries. Repeated motions while working can irritate more than one area of the arm. Yet not everyone doing that job gets CTS. So there must be some other factors at work.

Since CTS is so common in the workplace scientists are working hard to find some answers to these questions.

It’s possible, but more likely you have something called a tendon slip. There is a main tendon and some separate fibers alongside the main tendon. They are usually inside
the same tendon lining or sheath. Since you can see them move separately, they may each have a separate covering.

From studies of anatomy we know about three percent of the population has some
differences from the norm. Sometimes this is a missing tendon or muscle. Sometimes it’s a fused bone or missing bone. Small variations in placement of tendons is very possible.

Sudden, unexplained tears are not uncommon in the extensor pollicis longus (EPL) tendon of the thumb. This tendon extends the thumb when you give a “thumbs up” signal. You can see it under the skin when you make this motion.

Doctors aren’t sure why this tendon ruptures so easily. It’s a common injury when the lower arm is broken. There’s a band of tissue that holds the tendon tightly in place. When a fracture occurs, the tendon can rub against the broken bone and tear.

Overuse can explain some EPL ruptures. Friction when the tendon glides over a bump in the bone can build up during repeated motions. Of course, actual trauma or injury to the
thumb from a fall or sports activity can help explain some EPL ruptures.

In the rest of the unknown cases there may be a mixture of vascular and mechanical
causes. Vascular refers to a loss of blood supply. Maybe the tendon is okay, but the lining around the tendon is too tight. This can cut off circulation. With reduced blood flow, there’s a possibility that friction builds up. Without proper lubrication, high
friction scrapes the tendon.

Grip strength varies based on age, sex, and hand dominance. The presence of conditions such as arthritis, trigger fingers, or carpal tunnel syndrome can reduce grip strength. The position of your hand can also change the strength during testing.

Grip strength is usually measured using a special tool called a dynamometer. This test is often given by a physical or occupational therapist. Pinch strength can also be
measured with a smaller, similar tool.

Results from a 1984 study of normal grip strength done at the University of Wisconsin (Milwaukee) Occupational Therapy program can be found at http://www.bleng.com/pdf/grip1.pdf. There is some question whether the newer dynamometers would give different normal values if tested in adults today.

No one knows for sure why tendonitis occurs at just a certain moment. We don’t know why one person gets it while another doing the same job doesn’t have any problems. It’s likely that the repeated motions are part of the problem. But since not everyone gets
into trouble, there must be other factors.

Researchers think some people have a slower blood supply and less lubrication to that area. The result is high friction. The tendon gets abraded and ruptures. In some people the shape of the bone under the tendon might have something to do with it. If the tendon
moves back and forth over the same spot, it might rub and begin to fray.

Any of these problems can cause tendon surface damage over time. Inflammation starts. Enzymes destroy the natural lubricating fluid around the tendons. This increases friction
and damage and sets up a vicious cycle of more inflammation, more friction, and less lubrication.

Be sure and take a look at your hand position as you work. Make sure your workstation is set up to give you optimal position and use of your hands and arms. Also, you may wish to look at these two web sites for more information:

You may not need surgery just yet. If your arthritis is at an early stage you may be able to use nonsurgical therapy. This consists of antiinflammatory drugs, steroid injections, splinting, and/or exercise.

Many times the doctor will send the patient who doesn’t want surgery to a physical or
occupational therapist. The therapist can teach you how to reduce your pain, protect your joint, and improve your motion.

If an operation is needed to fuse the joint or move or repair a tendon, it’s better to have it done before the arthritis gets really bad. Stay in touch with your doctor as you go through treatment to find the best way to treat your problem and in the best timing.

The RICE formula (Rest, Ice, Compression, and Elevation) still applies for all acute injuries. This means ice is best and should be used during the first 24 to 48 hours after
injury. During the early phase of injury the body overreacts and sends too many cells to help out with the inflammation. Ice helps slow down the amount of blood (and inflammatory cells) to the area.

Once the initial healing response is launched then heat can be helpful, too. This isn’t until at least 48 hours (or more) after the injury has occurred. Heat can increase the blood flow to the area, bringing pain relief and reduced muscle and joint stiffness.

The new heat wraps give continuous heat for up to eight hours at a time. Early studies show this works well with common wrist problems such as sprains, strains, or carpal tunnel syndrome.

Pressure on the median nerve in the wrist can cause carpal tunnel syndrome (CTS). Pregnancy can cause CTS for two reasons. The hormonal changes can affect the nerve directly. Increased fluid volume from pregnancy can put greater pressure on the nerve. There isn’t a lot of room in the carpal tunnel area of the wrist where the tendons and nerves pass through to the fingers and hand. The added fluid may be just enough to trigger CTS in some women.

The condition often goes away after the baby is born. For this reason, most pregnant women don’t want to have surgery. There are some other options that work well for many people. The wrist can be splinted in a neutral position. Pressure on the nerve is reduced this way. The splint can be worn at night for patients who can’t get their job tasks done with splints on during the day.

Heat wraps and nerve and tendon gliding exercises have also been found effective. The patient should avoid strong, gripping and pinching motions. Such activities can increase pressure in the carpal tunnel.

Finally, you may want to consider a steroid injection into the wrist. This reduces the swelling without affecting the fetus.

If you aren’t a touch-typist, you may have to keep it up for a while. Your grandchildren are right, though. It’s better for your wrists if the keyboard is flat or even angled slightly downward. This puts the wrists in a more neutral position and takes the pressure
off the carpal tunnel.

Try to lower the board once you learn the keyboard and can type without looking. You may want to do this gradually if there are several positions possible. That way the change in
tension on your wrists and hands won’t be as much as if you did it all at once.

The regular, everyday typewriter and standard computer keyboard is called QWERTY. It refers to the layout of the keys placing the six keys (QWERTY) in the upper left corner.

Believe it or not, this layout goes all the way back to 1873 when the first commercial typewriter was used. Many people have tried to change this design, but no one has succeeded.

Your friend may have been suggesting you look for a tilted or slanted keyboard. The keys are still in the same order on the keyboard. The board itself is tilted or angled to put the forearms, wrists, and hands in a more neutral position.

Some designs even split the board in half so the arms remain at shoulder distance apart. This puts less stress on the neck, shoulders, and upper arms. Researchers haven’t been able to find the ideal slope, angle, or tilt for the keyboard yet. It may even be different for each person and based on how much time is spent on the computer.

It is clear that the slope of the keyboard can make a difference. Instead of tilting upward, we now know a flat (or even slightly downward sloping) keyboard is best. There is less stress on the nerves and tendons going through the carpal tunnel when the wrist is close to neutral.

Dupuytren’s disease is an abnormal thickening of tissue beneath the skin in the palm of the hand. The tissue between the skin and the tendons called the fascia is affected the most. A small lump of fibrous tissue forms and starts pulling the finger or toe into a flexed or bent position.

The disease often occurs in both hands. In fact, it seems to “spread” from finger to finger, hand to hand, and hand to foot. It can affect the soles of the feet. It’s usually milder in the feet compared to the hands and may not even need treatment.

You may not be doing anything wrong. New research shows there may be a genetic factor. Some people are more likely to get carpal tunnel syndrome than others when doing the same kind and same amount of activity.

The exact reason for this isn’t clear. It could be the shape of your bones that form the tunnel at the wrist where the nerve passes through. It could be the way the nerves and tendons slide and glide through the tunnel.

On the other hand, it is possible that the way you have your work station set up is part of the problem. Since you are at a hospital, ask a physical or occupational therapist to take a look at your set up. The therapist can evaluate your posture, hand placement, and angle of work and let you know if any of these need to be changed.

A few studies have been done using magnets for carpal tunnel syndrome (CTS). The magnets may increase blood flow and offer pain relief. This hasn’t been proven yet. When patients are divided into two groups (treatment for 45 minutes with real magnets, treatment with placebo magnets), there’s no difference in the results afterwards.

Magnets worn with wrist support wraps 24 hours per day have better results. Patients have less numbness and tingling. Nerve tests show better results after eight weeks of this treatment.

If using magnets, The side of the magnet with negative polarity is held against the skin, either with tape, or as part of a splint or wrap. Refrigerator magnets are too weak to be used for CTS. The magnets must be at least 550 to 850 gauss. Gauss is a unit of measurement of magnetic strength.

Remember to avoid having magnets near computers or any other electronic equipment. The data can be erased by the magnetic force.

Studies show that surgery is a good option for restoring hand motion and function for patients with Dupuytren’s. In fact, the earlier the better for good results. A recent study measured hand function before and after the operation.

Patients improved more when the middle joints of the fingers (PIPs) were operated on. The thickened chord that develops with Dupuytren’s was cut and released. Patients were able to do many functions with greater ease such as picking up small items, writing with a pen or pencil, and pouring water from a cup or jug. Putting on gloves or washing hands are common problems with severe Dupuytren’s, but these were not reported on in this study.

See a surgeon who specializes in hand surgery and find out what other treatment might be suggested for you.

A certified hand therapist (CHT) has special training with specific hand problems. This health care specialist is usually a physical or occupational therapist who has taken extra training. They must pass a special test called a certification exam. This
shows their knowledge of all topics related to hand therapy.

With more information about each hand problem, the CHT can perform accurate assessments and offer effective treatment. The end result is reduced treatment time and financial
savings for the patient. Often the patient can get back to work sooner, too for an even greater savings.

For more information, try checking out the American Society of Hand Therapists at:
http://www.asht.org. Click on “Patient Information” to
find out more about hand therapists including a directory of registered hand specialists.

According to a recent study from the University of Cincinnati 12 percent of patients experience disease regression. The nodules reduce in size and slowly go away.

The disease is more likely to get worse if you are: 1) under age 50 at the time of diagnosis, 2) of Northern European ethnicity, and 3) there’s someone else in your family with this disease.