FAQ Category: Hand

A procedure to weave sections of nearby tendons through and around the bones of the thumb shows promise in delaying, and possibly preventing, thumb joint arthritis.

This form of surgery is best used when the trapeziometacarpal (TM) joint of the thumb is mildly loose–but not arthritic. When arthritis is present other surgical procedures may be recommended. When these guidelines are used, ligament reconstruction surgery appears to keep the joint from eventually becoming arthritic. In a recent study, follow up X-rays taken as many as 17 years after this type of surgery showed no signs of thumb arthritis.

The traditional surgery for trigger digits is the “open” method. This involves making an incision through the skin over the swollen nodule. By opening the skin, the doctor is able to see inside and cut the tendon pulley.

A newer way to release the tendon pulley is to use a percutaneous (across the skin) method. The doctor simply inserts a needle through the skin, just under the tendon pulley. By twisting the needle, the tendon pulley is cut, and the nodule is free to move. The challenge with this surgery is the surgeon is unable to see the tendon pulley.

Patients seem to do well with both types of surgery. However, the open method takes longer, and people have less pain and get back to activities faster after the percutaneous method. Your doctor will know which method is best for your particular condition.

Studies have repeatedly shown that early passive range of motion (using the other hand to move the finger) speeds healing. It is not exactly known why this works. New information is available that shows applying a force to a newly repaired tendon is not any better than the passive movements the doctor recommended. And actively moving the tendon too soon after the operation can harm the tendon. Your mother should follow her surgeon’s advice closely.

University and teaching hospitals often have advanced technology that allows them to use the most up to date methods. However, new methods for surgery are tried out first on animals and then on cadavers (a human body preserved for study).

When the operation is perfected and ready for use on humans, doctors use what are called “clinical trials.” In clinical trials people are offered the choice between the standard method or the new method. Full information is provided, and the patient must agree to the use of the operation. Don’t hesitate to ask your doctor more about how the planned operation will be done.

Regular use of power tools such as small electric drills is considered safe. But exposure to the vibration of pneumatic drills or other vibrating hand tools can cause osteoarthritis of the wrist, shoulder, and hand. Usually this doesn’t develop for several years.

There are special gloves designed to help absorb the vibration and impact of these tools. These gloves are available through a physical or occupational therapist. The therapist will review the forces generated by the tools you use and help you get the best type of glove or wrist support.

The tendon is like a rope on a pulley. In order for tendons to move the fingers, they must be able to move or glide easily inside the lining that covers them. Once a tendon has been cut it can’t repair itself enough to put pressure on the pulley system and move the finger. It will fill in with scar tissue, and you will lose finger motion. Early repair and return to movement is advised.

There is a way surgeons can fuse the two bones of the forearm together. The operation places the hand in a handshake position or with the palm facing down slightly. So far, this surgery has been used to help children whose hands are open but who can’t turn the palm down. With a condition like cerebral palsy often there are other problems, such as tight muscles and joints. This type of fusion is probably not recommended for your daughter, but she may be helped with the use of special feeding equipment.

Anything that puts pressure on the median nerve in the wrist can lead to symptoms of carpal tunnel syndrome. Repeated hand and wrist actions can irritate the median nerve where it passes through the carpal tunnel of the wrist. And simple actions, such as cutting with scissors, can cause the median nerve to become enlarged within the carpal tunnel. This in itself is not a signal you have carpal tunnel syndrome. In fact, this increase in nerve size is a normal occurrence. However, as the nerve enlarges as you cut with scissors, the increased size of the nerve may be producing just enough pressure to cause your symtpoms. Be sure to talk with your doctor if these symptoms continue.

The first step is to find out what is causing these symptoms. Your doctor will take your history and carry out an examination before deciding further tests to do. Sometimes an X-ray is enough to show what is causing the problem. Other more advanced scanning technology is also available. Once your problem is identified, your doctor will outline treatment choices that can help.

It does, though perhaps less often. Dupuytren’s disease is characterized by the fingers curling into the palm of the hand, due to a shortening of tissues in the palm. This condition is mostly seen in people of northern European descent. It is rarely seen in Asians and blacks. And the disease is practically unknown in India.

Researchers recently looked at cases of Dupuytren’s disease in two ethnic groups in northern Norway. The first group was ethnic Norwegians. The second was an aboriginal group called the Sami. Doctors from the region could not recall a single case of Dupuytren’s disease among Sami people.

These researchers did find some cases of Dupuytren’s disease among Sami. The disease showed up in about eight percent of Sami men. Even so, the disease was more common among ethnic Norwegians (16 percent of Norwegian men). Researchers think the genetic nature of the disease could be causing these patterns.

Researchers think this condition (characterized by fingers curling into the palm of the hand) has a strong genetic component. This idea is supported by the fact that Dupuytren’s disease is more common in people of northern European descent than in people from southern Europe and elsewhere. These patterns have led researchers to believe that genetics plays a role in Dupuytren’s disease.

Researchers recently compared numbers of people with Dupuytren’s disease in northern Norway. They found that the disease was more common in ethnic Norwegians than in Sami, an aboriginal people who are ethnically distinct from Norwegians. This seems to confirm the importance of genetics in the disease.

Both the disease and the contracture refer to the same condition. The disease affects the hand, causing the tissues in the palm of the hand become shorter and thicker. As a result, the fingers begin to curl into the palm. This tightening of the tissues is called a contracture. Dupuytren’s usually shows up in men over the age of 50. It is more common in whites than in other racial groups.

The cause of this condition is unknown. Researchers suspect it has a strong genetic component. Work and other factors may also contribute.

It depends. If your problem is from doing too much with the hand in the first place, doing extra exercises right now could actually make things worse. Doing exercises that cause the wrist to bend can put more pressure around the median nerve inside the carpal tunnel. If symptoms are coming from extra pressure, you might need to wear a splint to help rest your wrist and fingers. When symptoms calm down, exercises can be done to improve movement and strength.

Addressed in early stages of the problem, exercises are one strategy to help prevent the problem from getting worse. However, it is not clear whether exercise alone can prevent or reverse problems of CTS. When symptoms have been going on long enough to cause the muscles on the thumb-side of the palm to atrophy (shrink in size), it’s likely that exercises will not correct the problem.

After surgery, your hand will be bandaged with a well-padded dressing and a splint for support. Physical or occupational therapy sessions may be needed after surgery for up to six weeks. Visits will include heat treatments, soft tissue massage, and vigorous stretching. Therapy treatments after surgery can make the difference in a successful result after surgery.

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.

People who smoke have a greater risk of having Dupuytren’s contracture. Heavy smokers who abuse alcohol are even more at risk. Recently, scientists have found a connection with the disease among people who have diabetes. But there hasn’t been a connection made whether work tasks can put a person at risk or speed the progression of the disease.

When the ligaments around a joint are damaged by a sprain, it can change the way the joint moves and may increase the forces on the articular cartilage surfaces. This is similar to any mechanical device or machinery. If the mechanism is out of balance, it tends to wear out faster. A bad thumb sprain early in life can help explain why your X-ray shows arthritis in your thumb joint.

As the disorder progresses, bending of the finger becomes more and more severe, limiting the motion of the finger. Without treatment, the contracture can become so severe that you cannot straighten your finger, and eventually you may not be able to use your hand effectively. Because our fingers are slightly bent when our hand is relaxed, many people put up with the contracture for a long time. Patients with this condition usually seek medical advice for cosmetic reasons or the loss of use of their hand. At times, the nodules can be very painful.

The aim is to remove the diseased fascia, allowing the finger to straighten out again. By removing the tight cords and fascia, the tension on the finger is released. Grafting extra skin near the incision gives the finger more flexibility to straighten.

Dupuytren’s contracture is a fairly common disorder of the fingers. It most often affects the ring or little finger, sometimes both, and often in both hands. Although the exact cause is unknown, it occurs most often in middle-aged, white men and is genetic in nature, meaning it runs in families. This condition is seven times more common in men than women. It is more common in men of Scandinavian, Irish, or Eastern European ancestry. Interestingly, the spread of the disease seems to follow the same pattern as the spread of Viking culture in ancient times. The disorder may occur suddenly but more commonly progresses slowly over a period of years. The disease usually doesn’t cause symptoms until after the age of forty.

Your doctor may inject painful nodules with cortisone. Cortisone can be very effective at temporarily easing pain and inflammation. Heat and stretching treatments given by a physical or occupational therapist may also be prescribed to control pain and to try to  slow the progression of the contracture. Treatment also consists of wearing a splint that keeps the finger straight. This splint is usually worn at night.

Dupuytren’s contracture is known to progress, so surgery may be needed at some point to release the contracture and to prevent disability in your hand. Surgery is usually recommended when the joint at the knuckle of the finger reaches thirty degrees of flexion.