FAQ Category: Hand

Dupuytren’s disease is a condition affecting the palm of the hand. Extra connective tissue forms into bumps or nodules at the base of the fingers. The ring and index fingers are affected most often.

The exact cause is unknown. There are certain risk factors that increase a person’s chances of developing this problem. Family history is one. European ethnicity is another. Smoking, liver disease, diabetes, and alcohol use also increase a person’s chances of Dupuytren’s.

Nodules associated with Dupuytren’s disease can progress to become cords of thick, tight palmar fascia. The joints can get contracted or “stuck” in one position. The patient is unable to fully straighten the finger.

Some people decide to have elective surgery to remove the nodules. Others wait until contractures cause pain, loss of motion, and loss of function. It’s not clear yet if it makes a difference in outcomes as to when the surgery is done.

The nodules return in about 60 percent of patients who have surgery to remove them. There doesn’t seem to be any way yet to predict which patients will have a good outcome and who will have disease recurrence.

Studies dating back to the early 1950s show a link between grip strength and overall arm strength. For most people handgrip strength shows a moderate correlation with the total
strength of many other muscles of the body. If the grip is strong, the shoulders are also strong.

Handgrip strength is used as a measure of overall strength for several other reasons. It’s safe and easy to measure using a handheld device called a dynamometer. This device is readily available in many health care, school, and gym settings. This makes strength testing using a grip test convenient.

There is a joint at the base of the thumb called the basal joint or CMC (carpometacarpal) joint. This joint allows the thumb to swivel and pivot in order to touch the fingers, pinch, and pick up objects.

Osteoarthritis is fairly common in this joint because it gets used so much in daily activities. People get arthritis in this joint when they don’t have arthritis anywhere else. Injuring the thumb puts the joint at increased risk for arthritis later.

Pain at the base of the thumb during pinching and gripping is common. Loss of motion can also occur. Many people have a weak pinch grip.

Thumb pain from arthritis may not be dangerous but it can be crippling. It’s not likely that the arthritis will spread to the rest of your hand, wrist, arm, or body.

Your quality of life may be the biggest issue. Pain, loss of motion, and weakness of the joint decreases your pinch strength. This may become a real problem for you since as humans, we all use our ability to pinch and grip in so many daily activities.

For some people with this type of thumb pain, it goes away after a few years. Some doctors say the arthritis and irritation in this joint “burn out.”

There’s probably a small window of opportunity during which surgery can give the best result. After too many years, the thumb weakness and the loss of motion of the thumb may not be turned around or changed even with the operation.

The main reason to do surgery is for pain relief. Preventing weakness and deformity are important goals, too. You may have a mild problem that gets worse from time to time. If you haven’t already, you can ignore it and see if it goes away or treat it with antiinflammatories, rest, and/or a brace.

If the problem is severe and keeps you from doing things with your hand, surgery may be your best option.

Shoulder pain after a hand injury is common. Weakness can occur when there is pain but this usually means hand pain leads to hand and wrist weakness, not shoulder weakness.

A study was done at a large medical facility in Texas to find out how many patients with wrist or hand pain have weak shoulder muscles. Grip strength was measured. Separate tests were given for each muscle around the shoulder.

The study showed rotator cuff weakness in patients with hand and/or wrist injuries. It’s not clear if the hand injury leads to disuse of the limb and deconditioning as the cause
of the weakness. More studies are needed to see if the shoulder pain is caused by injury to the hand or wrist.

It’s widely accepted that the dominant hand is stronger than the other (nondominant) side. Studies from the 1950s suggest a 10 percent difference in grip strength between right and left hands.

Later studies supported a 12 to 13 percent difference for right-handed adults. Left-handed adults were more even from side to side. There was less than one percentdifference in grip strength from side to side in this group.

Shoulder strength appears to be about the same from one side to the other. Studies have not shown a significant difference in rotator cuff strength (muscles around the shoulder) from side to side.

Treatment may depend on where the problem is and how severe the symptoms are. The bone in the thumb that attaches to the wrist is called the thumb metacarpal. The metacarpal attaches to a bone in the wrist called the trapezium.

When the cartilage between these two bones is damaged or worn out, bone rubs on bone causing pain and arthritic changes. Early treatment can help reduce swelling and sometimes restore the cartilage. If the disease gets worse instead of better, surgery may be needed.

The surgeon has several options to choose from. Sometimes the surgeon just removes the trapezium. A ligament or bone graft may be used to hold the rest of the joint together. In other cases, the joint is removed and replaced with an artificial implant. This is called a joint arthroplasty.

Carpal tunnel syndrome (CTS) is a common problem, especially in the work place. Numbness and tingling along with wrist and hand pain can be disabling. Many studies show a high cost for CTS as an industrial illness. There’s lost time and lost productivity.

Treatment varies quite a bit in the United States and even in Europe. Most doctors start with conservative care. This can include splints, anti-inflammatory drugs, vitamins, and steroid injections.

A recent study among auto workers in Michigan showed nighttime use of splints is a good option. Workers got better even when there was nerve damage that didn’t get better. The splint wearers had less discomfort in the wrist and hand AND in the forearm and elbow.

Talk with your doctor about this decision. Treatment is sometimes directed based on the underlying cause of the problem. Sometimes just changing the way you do things is all that’s
needed.

Using splints for carpal tunnel syndrome (CTS) is known to be effective in reducing pain and discomfort. It’s not clear just what kind of splints are best or how and when to where them.

Two recent studies using splints as the only treatment show symptoms are better when the splints are only worn at night. Symptoms and nerve function both improve when the splints are worn day and night.

There are a few things to consider with splint wearing as a treatment option. It is known that the discomfort of CTS is less likely to respond when the symptoms have been present a long time. Second, wearing splints helps reduce pain and discomfort in other muscles and joints. Third, most patients who wear splints think they wear them more than they do.

If you’re trying splints for the first time, take some notes along the way. Record the date and time when you put the splints on and take them off. Note any symptoms that are present before, during, and after using the splints. Make a special note if you use the splints with any other form of treatment such as heat, medicine, or injections.

Review your results every five to seven days. If your symptoms get worse instead of better, see a doctor. Early treatment usually has better results.

Some studies show that patients with carpal tunnel syndrome (CTS) who wake up at night are less likely to improve over time with treatment. Nighttime symptoms may be a sign of a more severe case of CTS.

Treating any painful musculoskeletal problem early on usually brings about better results than waiting until it becomes a severe problem. Most patients with CTS first notice numbness and tingling in the thumb and first two fingers of the hand. Later they may have
hand and wrist pain, too.

t first symptoms at night go away by changing position or by shaking the hands. The patient with symptoms night and day may start to get muscle atrophy and weakness. Nighttime symptoms may be a sign that the condition has progressed to the point of irreversible nerve damage.

There’s good news though. Several studies have shown that wearing splints on the wrists and forearms can reduce symptoms and help restore nerve function. These can be worn at
night to prevent the symptoms. Day and nighttime use may give better results in the long-run.

Some hand surgeons have found that primary care doctors are less likely to refer older patients for carpal tunnel surgery. This may occur because some studies show older patients have a poorer recovery after nerve injury and repair compared to younger
patients. The dividing line in terms of age is usually younger than 65 versus 65 and older.

Older adults tend to have slower nerve conduction compared to younger adults. There may be a link between the speed that messages move along nerves and the ability to recover
after an operation.

A recent study may have put this theory to rest. It showed an 83 percent satisfaction
rate after carpal tunnel release surgery in a group of adults 65 years and older. Painful symptoms were much improved. Grip and pinch strength and overall hand function were also much better.

There may be some specific health-related reasons for your doctor’s judgment about your case. Ask for a more detailed explanation. If you’re still wondering, you may want to get a second opinion.

Grip and pinch strength can improve with exercise. You may need a specific rehab program to help you out with hand function. A physical or occupational therapist can offer you some help in this area. Most often, one or two visits with a follow-up home program are
all that’s needed.

Most muscle training takes about four to six weeks to show improvements. Don’t get discouraged if you don’t see a change right away. Commit to your exercises for at least a month before quitting or trying something else. If you don’t see any improvement after giving it your best, see your doctor for follow-up.

There’s been some debate about how old is “too old” for carpal tunnel surgery (CTS). It’s true that younger patients recover better and faster, but folks over age 65 can have good
results too.

A recent study was done comparing symptoms and function before and after CTS. The results showed an overall satisfaction rate of 83 percent among older patients. Those who didn’t get better had more muscle wasting before the operation. They may have just waited too long before having the surgery.

Many older adults are affected by carpal tunnel syndrome. When nonsurgical therapy fails or when the symptoms are severe and affecting a person’s livelihood, then surgery should
be considered as a possible treatment option.

You may be observing signs of osteoarthritis of the hands called Heberden’s nodes. They are named for the doctor who first described them in the 1800s. The hands may feel painful or stiff or the person may not be aware of any symptoms. Sometimes the joints make crackling sounds with movement. There may be some swelling of the joints. Many people don’t notice it at first.

X-rays show joint osteoarthritis in a third of people aged 25 to 75. Hand symptoms are seen most often starting around age 45. Women are affected more often than men.

Any kind of skin changes must be examined and diagnosed by a physician. Finding the cause of the problem early may help prevent further problems later.

The trapeziometacarpal (TMC) joint at the base of the thumb is a common place for osteoarthritis. Efforts have been made in the past to replace the joint with silicon implants. The implants didn’t wear well and many patients had a reaction to the material.

A Swedish company with previous success designing implants for the spine designed the biodegradable TMC joint spacer. The FDA approved the new thumb joint spacer for use in the Uunited States in September of 2004.

The material used in the spacer can be broken down by a process called hydrolysis. This means water is used to split the chemical bonds holding the implant together. Hydrolysis of this kind in the body is done by the body’s own natural enzymes.

It takes about six years for this process to occur. Only about half the implant is actually degraded. The rest remains part of the tissue implantation.

Taking the trapezium (bone at the base of the thumb) out without doing anything else will result in shortening of the thumb. The hand will be disfigured and your pinch strength will be greatly affected.

In fact there are actually two types of pinch: key pinch and tripod pinch. Key pinch is the finger hold you use to insert a key and turn it in a lock. Tripod or three-point pinch is the opposition of the index and middle finger against the thumb. You use the tripod pinch anytime you pull a tape measure out of its casing or pick up a bag of fast food.

You may not think much about losing your pinch strength but just try turning a key in the door, picking up a dime, or carrying a plate of cookies to the table without using some kind of pinch. And that’s just a short list of all the things we use our strong, opposable thumbs for.

There are several different surgical ways to treat osteoarthritis (OA) of the trapeziometacarpal (TMC) joint. The two most common operations are tendon arthroplasty and TMC arthrodesis.

In a tendon arthroplasty the trapezium bone at the base of the thumb is taken out. A nearby tendon is split and used to stabilize the joint and fill in the gap. During an arthrodesis the TMC joint is fused together. There are some problems with both of these operations.

For example, studies show the thumb pinch remains weak years after the tendon arthroplasty. Arthrodesis gives a good pinch but many patients have trouble with pain and they can’t flatten the palm down.

A newer treatment option is the use of a joint spacer. The trapezium is removed and a special biodegradable T-shaped insert is placed in the hole. The spacer gives a scaffold for the healing tissue to cling to while forming new joint cartilage. After a few years most of the implant breaks down. A recent study in Sweden showed this treatment option gave long-term pain relief while restoring motion and strength.

Thumb pain is quite common among video game players. Back in the 1980s it was associated with Nintendo and called nintendonitis. Besides pain, the thumb can be unstable because of lax ligaments. Thumb pinch strength is greatly reduced.

There are many types of keyboards designed to reduce the risk of muscular pain. Some are split in half to make it easier to reach the keys. Others have rearranged the keys or put a soft bar between you and the keyboard to support the wrists.

You can even buy software that reminds your son to take regular breaks. The program gives on-screen examples of the exercises that can be done to stretch and protect against repetitive motion injuries.

However, just changing a keyboard is not going to solve the whole problem. The thumb wasn’t really made for so many hours of pounding and overuse. Limiting computer time is also suggested though not very popular among video gamers.

In a recent study of men and women with carpal tunnel syndrome (CTS) pain level was not able to diagnose or predict a CTS problem. The same measuring tool used with you was used in this study. It’s called the visual analogue scale (VAS). Three ratings were given: