News Category: Hand

New understanding of the biochemical basis of Dupuytren disease may help explain complications that often occur after surgery for this condition. In this report, surgeons from Georgetown University Hospital in Washington, D.C. bring us up-to-date on the recent research findings related to Dupuytrens.

Dupuytren’s contracture is a fairly common disorder of the fingers. The condition usually shows up as a thick nodule (knob) or a short cord in the palm of the hand, just below the ring finger. More nodules form, and the tissues thicken and shorten until the finger cannot be fully straightened. Dupuytren’s contracture usually affects only the ring and little finger. The contracture spreads to the joints of the finger, which can become permanently immobilized.

One or both hands can be affected. Although the exact cause is unknown, it occurs most often in middle-aged, white men. It is genetic in nature, meaning it runs in families. Dupuytren disease is seven times more common in men than women. It is more common in men of Scandinavian, Irish, or Eastern European ancestry. The disorder may occur suddenly. More often, it progresses slowly over a period of years. The disease usually doesn’t cause symptoms until after the age of 40.

There are some other known risk factors for this disease. These include diabetes, alcohol abuse, and tobacco use. Trauma from injury or vibration during manual labor can also increase the chances of developing Dupuytrens. The natural course of the disease is unpredictable. Some people have a mild case that doesn’t cause problems. Others progress to severe contracture preventing proper use of the hand.

Surgery to release the soft tissues (fasciectomy) and/or remove the contracted fascia (connective tissue) (fasciotomy) is the main treatment approach. The procedure is done through the skin and is called percutaneous needle fasciectomy/fasciotomy (PNF).

But because the problem is genetic, it’s likely to recur despite treatment. In fact, up to 65 per cent of the time, the fingers start to stiffen up again soon after the operation. Sometimes the trauma of the surgery makes the problem worse instead of better.

The younger the patient is when the disease occurs, the more likely the problem will repeat itself over time. Results from surgery aren’t always perfect. Complications such as stiffness, infections, and delayed healing with loss of hand function can occur. There can be permanent problems if the nerves or blood vessels are damaged during surgery.

New information about the molecular basis of Dupuytrens has caused scientists to take a second look at this condition. The goal is to improve treatment results and reduce the incidence and severity of complications. So what are the latest biomolecular discoveries associated with Dupuytrens?

Labratory examination of tissue has shown that fibroblast growth factor (FGF), interleukin-1 (IL-1), and epidermal growth factor(EGF) are increased in the affected tissue. At the same time, transforming growth factor-alpha (TGF-alpha) and platelet derived growth factor are found more often in these same tissues.

With increased collagen deposits in the tissue, it’s likely that enzymes that get collagen tissue growing and collagen inhibitors that keep collagen from overgrowing are part of the picture. Genes for the regulation of collagen are not in balance in this condition. Gene products such as metalloproteinases (MMPs) seem to have a role in the abnormal formation, remodeling, and shortenng of the collagen matrix in the tendons.

Once scientists figure out which gene products are involved, they may be able to target the affected genes that are dysregulated. Treatment will be directed to stop the formation of excess collagen in Dupuytren disease. Investigations are underway now injecting collagenase into the affected tissue. Collagenases are enzymes that break the peptide bonds in collagen. The injected collagenase breaks down the cords that are causing the tendon contractures in Dupuytren disease.

There are a few studies done so far using collagenase injections for this condition. The short-term results (up to two years) have been very favorable with a low rate of complications or recurrence. The number of patients studied so far using this approach has been fairly limited. But the results are encouraging enough to continue trying this nonsurgical treatment. The major problems have been reactions to the injections such as pain, swelling, and brusing. But these responses were mild and went away after 10 to 14 days.

The authors conclude by saying that the current surgical approach to Dupuytrens is being reviewed and reevaluated. The results with percutaneous release or removal of the fascia are less than satisfactory with high rates of disease recurrrence. Newer, less invasive gene-specific targeted therapy may be the gold standard of the future. Studies to understand the underlying biochemical and molecular processes behind Dupuytrens will help pave the way for more effective treatment with long lasting results (if not cure).

The carpal tunnel is the spot in your wrist that allows a nerve, the median nerve to pass from your forearm into your hand. When the carpal tunnel becomes inflamed or if there is something that causes the area to get smaller, it puts pressure on this nerve and this causes pain and numbness in the hand, particularly around the thumb area. This is called carpal tunnel syndrome.

Carpal tunnel syndrome is usually a repetitive stress injury that is caused by making the same motions again and again with the wrist. It has gotten much more news since the explosion of computer and mouse use, but carpal tunnel syndrome has affected many types of workers for many years. They include pastry chefs who use icing bags continuously or construction workers who using heavy vibrating machinery, like jackhammers.

If conservative treatment for carpal tunnel syndrome (non-surgical) doesn’t work for a patient, the next step is usually surgery, carpal tunnel release. However, it’s always better if a surgeon can determine a prognosis ahead of time, how well a patient will do after surgery. However, although many reports have been written, there haven’t been any definite findings.

The authors of this article wanted to see what factors may influence a patient’s prognosis, using their own assessments and comparing these with the patients’ symptoms and test findings. Researchers evaluated 102 hands of 64 patients, the majority of whom were women. There were only five men in the group. The patients were between 32 and 77 years old and their carpal tunnel syndrome symptoms were present from eight months to 25 years. The follow-up on the patients ranged from 12 to 23 months.

The researchers tested the patients for sensation in the affected hands and if there is pain at night (nocturnal pain). They also performed the Phalen test, which involves pushing back the patient’s hand for 60 seconds, perhaps triggering the pain, and the Tinel sign, which involves tapping along the median nerve on the wrist to see if this worsens the tingling or pain. They also checked for weakening of the muscles. The patients were then asked to complete the Boston carpal tunnel questionnaire, which asks about the severity and frequency of symptoms, as well as how it affects function of the hand. The answers ranged from one, meaning no pain or difficulty, to five, meaning severe pain or difficulty.

After the tests and questionnaires were completed, the patients underwent surgery to release the carpal tunnel and the patients wore a short-arm splint for one week after surgery.

The researchers found that the results of the Boston scores improved in all patients after one year and all patients had improvement in their wrist and hand after three months. When the researchers looked at the questionnaires completed before the surgery, they found that the average duration of symptoms was five years and 77 of the 102 cases caused nocturnal pain. These patients, as well as those who didn’t feel their hands were weak and those who did not have cold intolerance all had better outcomes after surgery than all the other patients.

The authors of this article, when discussing the study’s findings, pointed out that pain at night is caused by swelling of the soft tissues at night, putting pressure on the nerve. Therefore, by releasing the nerve, there should be no more pressure on the nerve, reducing the nocturnal pain. With this, the researchers predict that patients who have nocturnal pain have a better prognosis after surgery. The researchers couldn’t identify a specific reason why cold intolerance would be a factor to determine if surgery would be successful, however.

Trigger finger is a catching or popping of the tendons as they move the fingers. Usually this problem occurs as the finger is moved toward the palm of the hand. This movement is called flexion. But in this article, five cases of extensor tendon triggering are reported.

The tendons that move the fingers are held in place on the bones by a series of ligaments called pulleys. These ligaments form an arch on the surface of the bone that creates a sort of tunnel for the tendon to run in along the bone.

To keep the tendons moving smoothly under the ligaments, the tendons are wrapped in a slippery coating called tenosynovium. The tenosynovium reduces the friction and allows the tendons to glide through the tunnel formed by the pulleys as the hand is opened to release objects.

Triggering is usually the result of a thickening in the tendon. Constant irritation from the tendon repeatedly sliding through the pulley causes the tendon to swell in this area. A nodule or knob forms. The pulley ligament may thicken as well. The nodule catches on the pulley causing the popping or catching sensation.

Sometimes, a thickening in the band of connective tissue across the back of the wrist is the cause of the problem. This area is called the extensor retinaculum. Even minor changes in the tendon can cause catching of tendon as it tries to glide under the retinaculum.

The authors present each of the five cases in detail. History, clinical presentation, diagnosis, treatment, and outcomes are reviewed and discussed. Each patient had an extensor tendon trigger of either the index or small finger. These two fingers are referred to as the border digits. Each one is along the outer border (outside edge) of the extensor retinaculum.

There was no single reason for the impingement causing the triggering. In one case, there was a lump in the index finger extensor tendon. The retinaculum was also thickened. In the second case, the patient had a ganglion in the tendon. Each time the tendon tried to slide and glide under the retinaculum, the ganglion would get caught on the edge of the retinaculum.

Another patient had a tightening of the sheath around the tendon. Two others demonstrated thickening of the extensor retinaculum but no other visible cause and no apparent reason for the thickening. The reported findings were observed during surgery that was done in order to identify and correct the problem.

In one patient, the area of tendon thickening was so small, the surgeons were surprised that releasing the retinaculum took care of the problem completely. This same patient presented again six months later with the same problem in the other hand three years later. After surgery, the five patients recovered fully. They had full function, no symptoms, and no complications.

The authors conclude that a mismatch between the size of the tendon and the area through which it must move can result in catching of the tendon called trigger tendon as described. Patients’ reports of pain, popping, and clicking are relieved when surgery is done to correct the problem.

Most of the time, trigger finger affects fingers on the palmar side of the hand. In these rare cases, the same problem occurred along the extensor (back side) surface of the hand. Extra slips of tendon, thickening within the tendon or retinaculum, or inflammation of the lining of the tendon can all contribute to the development of extensor tendon triggering.

There probably isn’t a single factor leading to this problem. With so many tendons and other soft tissues passing through such a small space, it’s more likely there are many reasons for this condition. Surgery is usually successful both in identifying more specifically what’s causing the problem and in fixing it.

What’s the benefit of steroid injections for carpal tunnel syndrome? Is a single injection enough? If one works, would the patient benefit by another one? Does the injection improve the function of the nerve? These are the questions Dr. M. I. Boyer of the Washington University in St. Louis researched and reported on in this study.

Carpal tunnel syndrome is a common problem affecting the hand and wrist. Symptoms begin when the median nerve gets squeezed inside the carpal tunnel of the wrist, a medical condition known as nerve entrapment. Any condition that decreases the size of the carpal tunnel or enlarges the tissues inside the tunnel can produce the symptoms of CTS.

Symptoms can include gradual tingling and numbness in the areas supplied by the median nerve. This is typically followed by dull, vague pain where the nerve gives sensation in the hand. The hand may begin to feel like it’s asleep. Patients often report waking up at night and shaking the hands to wake them up.

Studies so far have not shown a benefit to the nerve after steroid injection treatment in terms of improved function. Although the injection may give the patient relief from the symptoms, it doesn’t affect nerve function any more or any better than other treatment approaches.

And more is not necessarily better. In other words, increasing the dose (amount of steroid used or number of injections given) doesn’t reduce the pain, numbness, or tingling any faster or better than a single dose. Likewise, injecting a specific area (above or below the wrist crease) doesn’t provide different results.

Whether or not a particular type of steroid works best (e.g., methylprednisolone acetate, betamethasone, triamcinolone acetonide, dexamethasone) remains under investigation. The biggest predictor of results with steroid injection is the outcome of electrodiagnostic tests. Electrical impulses through the nerve are evaluated. Slow or absent messages from the nerve to the muscles are an indication of damage to the median nerve.

Electrodiagnostic tests showing that the median nerve is damaged are an indicator that surgery is advised. When there are positive objective findings on testing, steroid injection may provide symptom relief, but it’s only temporary. On the other hand, patients who have normal electrodiagnostic tests are actually more likely to benefit from a steroid injection.

Patients with altered sensation and slow nerve impulses have the poorest response to injection. And they are more likely to have a relapse with return of symptoms. Once the electrodiagnostic tests show nerve impairment, chances are that conservative care with steroid injection won’t help.

For now, it looks like a single steroid injection is safe and offers fast relief from symptoms. Results are short-term and the symptoms may come back if there is damage to the nerve. Steroid injection is one option for patients who want to avoid having surgery for as long as possible or for those who need immediate symptom relief.

There are still many factors around carpal tunnel syndrome left to study. The author points out that some studies show that symptoms go away naturally (without treatment) in one out of every three patients. Scientists need to find out how to predict which patients will get better on their own, which patients will benefit from conservative care, and who should just go ahead and have the surgery right away.

For now, anyone with normal electrodiagnostic test results should start with antiinflammatory drugs, splinting, and/or physical therapy. A steroid injection is advised if these conservative measures don’t help, or if the patient needs fast relief of symptoms.

The American Association of Orthopaedic Surgeons (AAOS) put together a special committee to develop a clinical practice guideline on the treatment of carpal tunnel syndrome (CTS). The Guideline Workgroup worked together reviewing the most up-to-date evidence collected from clinicians and researchers to guide them.

Carpal tunnel syndrome is a common problem affecting the hand and wrist. Symptoms begin when the median nerve gets squeezed inside the carpal tunnel of the wrist, a medical condition known as nerve entrapment. Any condition that decreases the size of the carpal tunnel or enlarges the tissues inside the tunnel can produce the symptoms of CTS.

This syndrome has received a lot of attention in recent years. Many people thought it might be linked with occupations that require repeated use of the hands. The number of patients with CTS seemed to be increasing as more people were spending time typing on a computer keyboard or doing assembly work. Actually, many people develop this condition regardless of the type of work they do.

So, finding a way to treat CTS in all patients has become important. In the past, the AAOS published clinical practice guidelines for the diagnosis of CTS. Turning their focus to the treatment of this condition was the next step.

A work group was selected and the process began in December 2007. Once the review was completed, the process was opened to public comments. Several special committees reviewed the results before presenting the final recommendations to the AAOS Board of Directors in September 2008. There are nine basic recommendations. Here is a summary of the main points:

There are many potential causes of carpal tunnel syndrome (CTS). Most people are familiar with CTS from repetitive motions, especially from activity in the work place. But CTS can also occur as a result of a wrist fracture. Specifically, fracture of the distal radius is the focus of this study.

Symptoms of CTS begin when the median nerve gets squeezed inside the carpal tunnel of the wrist, a medical condition known as nerve entrapment. The carpal tunnel is a canal formed by the wrist bones arranged in a circle. Nerves and blood vessels pass through the tunnel going from the wrist to the hand. Anything that causes pressure inside the carpal tunnel can compress the median nerve leading to CTS.

There are two bones in the forearm: the ulna and the radius. The radial bone is the larger of the two forearm bones. It’s on the thumb side of the forearm. The authors showed how the risk of CTS after a distal radial fracture increases if the two ends of the bone are displaced (separated). Distal refers to the end of the bones in the forearm that’s closest to the wrist.

They found that increased pressures within the carpal tunnel following fracture was the main cause of the acute CTS. They studied a group of 50 patients who had acute CTS after surgery for a distal radius fracture. The purpose of the study was to find predictive factors that would help surgeons prevent this complication.

Each patient was treated for the displaced fracture with an open reduction and internal fixation (ORIF). Open reduction means an incision was made to open the area for the surgeon to make the repair. Reduction means the two ends of the bone were moved back together and lined up again. Internal fixation refers to the use of a metal plate and/or screws to hold the ends of the bones together until healing occurs.

These 50 patients were identified because later, after the surgery was done, they developed CTS. Then they needed a second surgery to release the band of connective tissue across the carpal tunnel area. This area is called the retinaculum. The procedure is called a carpal tunnel release.

With a fracture, there can be contusion, deformity, or swelling from elevated pressure within the tunnel. Any of these problems can cause median nerve dysfunction and lead to permanent damage of the median nerve. Early recognition and treatment of any of these factors can prevent long-term problems.

But is it possible to tell ahead of time who might develop acute CTS after distal radial fracture? The goal would be to prevent carpal tunnel syndrome. The surgeon could do prophylactic (preventive) surgery for CTS at the time of the open reduction and internal fixation surgery.

These 50 patients who did develop CTS were compared with another group of 50 patients with the same type of radial fracture. The second group were matched with the first group by age, gender, and injury mechanism (how the injury occurred). But the difference was that the second group didn’t have CTS.

Various factors were considered as being possibly significant. These included injury mechanism, other arm injuries present at the same time, low versus high energy injury, open or closed fracture, and presence of a crush injury. The authors were able to isolate fracture translation or displacement as the main difference between the two groups. Fracture translation is what would be called a predictive factor.

They found that if the two bones moved 35 per cent or more, the risk of acute CTS increased measurably. In general, studies show that displaced radial fractures are more common among men. The same was true in this study. But acute CTS after distal radial fracture was more likely to occur among women less than 48 years old.

The authors weren’t sure if that was a fluke in their findings or a truly significant result. They also noted that because they were more likely to see higher-energy injuries at their clinic, they couldn’t be sure their findings would be true for all displaced distal radial fractures. Before making specific recommendations, future studies will be done to sort out these two variables (age and high energy injury) further.

According to studies from the 1970s, every year in the United States, there are between 600,000 and 1.2 million injuries in high school and college football. About 30 percent of these injuries affect the hands or arm of the player. Unfortunately, there have been no large studies done since the 1970s, so the current number of injuries was unknown. Because professional football players have better access to training facilities, are more experienced, and are stronger and faster, it would make sense that they would experience fewer injuries. However, because of the lack of studies there is no way to keep track of such injuries. A database of football injuries is in place, though. As a whole, databases usually focus on career-threatening injuries, such as concussions and knee injuries. Because hand and arm injuries usually only sideline athletes instead of ending their careers, these injuries tend to get overlooked.

The authors of this article reviewed the background and causes of hand injuries that were reported over a 10-year period in the National Football League (NFL). To do this, researchers reviewed the NFL Sports Injury Monitoring System, where injuries are entered if they cause an athlete to leave a game or practice session early, or it causes a missed game or practice. The researchers were interested in any injuries that affected the finger joints, as well as the bones, ligaments and muscles in the hand. They also looked at the wrist and joints in the wrist. The types of injuries included contusions (bruises), lacerations (cuts), inflammatory disorders like bursitis and tendonitis, strains and sprains, and fractures.

Out of 24,432 injuries that were recorded in the database, 1,385 involved the hand, wrist, or fingers. Three hundred seven of the injuries involved the hand itself, 414 involved the first ray (wrist joint and the finger joints, skin and ligaments and muscles in and between the thumb and the first finger), and 664 to the fingers. Of the total number of injuries to the hand, fingers, or thumb, 522 happened during practice sessions, 338 during games. Of 338 injuries of the hand, 118 occurred during practice, the rest in games. Games were also the major setting for first ray injuries (292) compared with practices (105), while fingers alone were injured in games 351 times compared with practices at 299 times.

The most common hand injury was the metacarpal fracture, or broken finger. These occurred in 236 of the hand injuries, followed by contusions, which made up 55 of the hand injuries. When the researchers looked at injuries of the first ray, they found 200 fractures, which made up 48 percent of all first ray injuries. There were also 148 sprains and 37 joint dislocations. Finger injuries included dislocations or overbending (326) and fractures (196).

Looking at days lost due to these injuries, the database showed that fractures of the fingers and thumb caused 73 percent of days lost. This was followed, in order of number of days lost from most to least, by bursitis of the hand, overbending of the finger, thumb sprains, lacerations of the tendon, and Bennett fractures of the thumb (a break at the base of the thumb).

The most common cause of fractures was tackling an opposing player (1174 injuries), while blocking was the second most common (324 injuries). Being on the receiving end of tackling wasn’t as dangerous for the players. Being tackled caused 121 injuries while being blocked caused 105. Defensive players were at highest risk of these injuries than any other player. These include safeties and cornerbacks, as secondary positions. The fewest injuries occurred among tight ends and quarterbacks.

The authors felt that the emphasis on the seemingly more severe injuries increased safety on the field, but that this safety needed to be applied to the lesser known injuries, such as those to the hands and fingers. By being aware of which players are at highest risk and what adds to the risks, more awareness and prevention can be put into place to reducing the rate of injury. For example, the database showed that most of the hand injuries were the result of a direct trauma, often because the players are catching or deflecting the ball. Tackling also caused many finger and hand injuries. With information like this, it may be possible to design better safety equipment to protect the players.

Nonoperative treatment of Dupuytren’s disease just isn’t a reliable way to treat Dupuytren’s disease. Dr. G. M. Rayan from the INTEGRIS Baptist Medical Center in Oklahoma City, Oklahoma reviews the main options available in conservative care for this problem. Best available evidence was used to show that surgery is still the most effective way to treat Dupuytren’s.

Dupuytren’s contracture is a fairly common disorder of the fingers. The palmar fascia (connective tissue of the palm) contracts, or tightens. This contracture is like extra scar tissue just under the skin. Without treatment, the contracture can become so severe the finger no longer straightens. It most often affects the ring or little finger, sometimes both, and often in both hands.

At first, when this condition is mild, careful observation is advised. If the contracture stays the same and doesn’t get worse, it may be referred to as nonDupuytren disease. If hand function is not impaired, there may be no reason to treat the problem aggressively.

Other nonoperative treatment options include physical therapy, radiation therapy, vitamin E, and injection therapy. Each of these modalities is discussed briefly in this article.

Stretching with the application of ultrasound may be helpful in the early stages of Dupuytren contracture. Ultrasound can break the disulfide bonds that hold collagen tissue together. Stretching the tissue during the heat treatment is needed to lengthen and realign the structure.

Range-of-motion exercises should be done several times a day to maintain this new tissue placement. The physical therapist may also recommend that the patient wear a custom splint or brace at night. This will keep the fingers straight and stretch them. All of these physical therapy techniques are designed to slow the progression of the contracture. Studies to prove the effectiveness of this approach have not been done yet.

Radiation therapy and vitamin E treatment were tried and abandoned in the 1950s. There was no evidence to support their continued use. Cortisone injected into the painful nodules can ease pain and inflammation. But this is only a temporary solution. And it can lead to skin color changes and tendon rupture.

Other chemicals can be injected into the lesion as well. Scientists have studied the effects of pharmaceutical agents used this way in both early- and advanced-stage disease. The hope is to find a way to stop the collagen from overproducing. Suppressing the disease without adding extra complications may be possible in the future.

Enzymes have also been used in an attempt to dissolve the collagen. Then forcible stretching of the affected finger is used to manually rupture the diseased cord thereby releasing the contracture. This type of enzyme treatment is still considered investigational by the FDA.

With any kind of injection therapy, there are possible complications. There can be local pain and swelling or the formation of a hematoma (pocket of pooled blood). Damage to the nearby nerves can cause numbness and possible motor involvement with additional weakness of the tendons and muscles of the hand.

All nonoperative treatments of this condition have a high rate of recurrence. In rare cases, a surgeon may inject the area with a numbing agent and use a surgical blade to cut the cord in half. This procedure is called a percutaneous and needle fasciotomy. Percutaneous refers to making a small incision and passing the blade under the skin.

Recurrence of the contracture is common after fasciotomy. It is a technique used most often with older patients, people in poor health, or as a first step to fasciectomy (removal of the tissue).

Studies so far indicate the best success when using fasciectomy. Surgery doesn’t cure the problem, but it can control it. Reducing the contracture’s pull on the joints may also help prevent damage to the articular cartilage but this hasn’t been proven yet either.

Loss of strength, coordination, and movement of the fingers from carpal tunnel syndrome (CTS) make it difficult to pick up and hold objects. In this study, scientists measure the effect of CTS on precision pinch movements between the thumb and index finger.

Two groups of people were included in the study. The control group was normal adults with no evidence of CTS. They were matched by age and gender with the second group (subjects with CTS). Everyone in both groups was right handed.

Patients with CTS reported numbness, pain, and night awakening. Clinical and electrodiagnostic tests were all positive for CTS. Severity of symptoms was determined using several special tests. These included the Levine-Katz questionnaire, Semmes-Weinstein monofilament tests, and two-point discrimination. According to the combined results of these tests, the CTS group had mild-to-moderately severe CTS.

A special video-based motion analysis system was used to measure precise pinch movements. The equipment used surface markers to help trace the movement without interfering with normal movement. The arm was put in a special holder to stabilize the elbow, forearm, and wrist.

Each person completed two sets of 15-pinch cycles. One cycle was from a position of fingers opened to contact of the tips and return to an open hand position. Each cycle took approximately three seconds to complete. Using a grid of coordinates, the researchers measured the variability of pinch closures. They looked at joint angles, placement of pinch positions, and joint motion of the thumb.

They found there was a difference between the two groups. Patients with CTS had much more variability in joint angles and tip position of the thumb and index finger at the point of pinch closure.

These differences show how finger coordination is affected by CTS. Precise pinch movements are more difficult when nerve impairment from CTS causes numbness of the fingertips and loss of muscle strength in the thumb and fingers.

Certain movements of the thumb were more impaired than others. For example, thumb abduction (moving the thumb toward the other hand) was affected more than flexion or extension. This is most likely because the median nerve affected by CTS is the main nerve to supply the thumb abductor muscles.

Nerve damage means less input to the hand from the skin, joints, and tendons. The result is a loss of accuracy when trying to put the thumb and finger together for pinching. During everyday activities this means grasping, picking up, and holding of objects can be difficult. Precise finger manual tasks are important to keep from dropping things.

Other studies have shown a change in the angle of the tips of the index finger and thumb during pinch for patients with CTS. Change in joint posture was not evident between the two groups in this study. The authors suggest this may be because patients with CTS did not have severe, chronic CTS.

The authors conclude that using measures of variability in repetitive movements like pinch is a good way to measure or quantify hand dysfunction. This information can be used to establish a baseline of function.

The baseline can be used to identify if and when the condition is getting better or worse. And measurable results of treatment can be determined. Improvement in precision pinch movements might be a good way to tell which intervention(s) work best.

One of the many conditions that can affect your hand is Dupuytren disease. It was first written about in 1614 but it was only in 1831 that the disease was defined and described in detail to medical students. The disease is the thickening of the skin on the palm of the hand. This can happen on one hand alone, but often develops in both at the same time. For some people, Dupuytren disease goes beyond the palm of the hand, towards the fingers. The thickened skin begins to pull on the fingers and causes them to flex, or bend, to the point that they can’t straighten out again. It’s a slow progressing disease that also can affect the soles of the feet occasionally.

Dupuytren disease is more common in people with Northern European ancestry but how many people are affected isn’t known. The reports vary from 2 percent to 42 percent. It is more common as people get older, usually in the fifties and men are diagnosed with it six times more often than women are. Other people who seem to develop Dupuytren disease more often are those with diabetes, who drink alcohol, who smoke, who have a traumatic injury to the affected hand(s), and those who do manual labor with vibrations to the hand, such as using a jack hammer.

While many patients with Dupuytren disease don’t need treatment, those whose disease affects their fingers can end up losing the ability to use their hand. In that case, surgery is the usual treatment. Unfortunately, because the disease is progressive, the surgery does have its limitations. The disease will continue to progress and continue to cause contractions, keeping the fingers flexed. This is particularly important if the patient is young. Also, research into surgery for Dupuytren disease has found that complications occur after surgery in about 17 percent to as much as 50 percent of the time. Some of these complications include stiffness in the fingers, infections, and injuries to the tendons, the thick fibrous tissue that controls your finger movements.

To try to overcome the problems with surgery, researchers have been looking into other methods of treatment. One such treatment, percutaneous needle fasciotomy was the standard treatment for 150 years, beginning in the 18th century. It fell out of popularity because of its high rate of complications, but the technique was brought forward again in the 1970s, with a finer technique and fewer complications. At this point, the treatment has become fairly popular because of the patient’s quick recovery and the lower risk of serious complications. The problem is, though, that the fasciotomy doesn’t cure the disease, only the finger problem over the short term. There is also a school of thought that believes that the trauma caused by surgery may “awaken” the disease and cause it to spread faster along the hand and fingers.

Another approach to treatment is called the collagenase injection. This approach was tried because researchers felt that the therapy may work on the disease process itself. Collagen is a protein that helps bind together connective tissue. Collagenase is an enzyme that breaks down collagen. Researchers felt that by injecting a substance that would break down the collagen would release the fingers. Results of some small studies are finding that collagenase injections may be helpful. Complications to the injections are related to the injection itself, such as pain where the injection was given and swelling.

In conclusion, the authors wrote that there have been advances in the treatment of Dupuytren’s disease but that the disease itself is still not understood.

Osteoarthritis is often called the wear-and-tear arthritis and most often hits the weight-bearing joints like the hips and knees. However, osteoarthritis of the trapeziometacarpal joint, the joint at the base of the thumb, is quite common, particularly among women who are past menopause. Treatment of osteoarthritis of the base of the thumb is almost always first non-surgical. This means trying anti-inflammatory medications, steroid injections, and maybe splinting the thumb. Exercises may also be recommended. It is only if there is no improvement or if the conditions worsen, that surgery should be considered. At that point, the surgeon must decide which is the best type of surgery for each particular patient. For example, if someone is a manual worker and depends on the strength of his or her hands and fingers, then the surgery that favors strength of mobility will likely be chosen.

The trapezuinetacarpal arthroscopy is an arthroscopic surgery, which means it is done with tiny incisions and the surgeon uses small narrow instruments to see inside the joint and make the repairs. This surgery is often preferred because, unlike an open incision, it is minimally invasive and has a lower chance of complications like injuring the nerves around the joint. At the same time, the doctor can have a good look around and sometimes diagnose problems in the cartilage before they could be picked up by x-rays or other tests.

With arthroscopic surgery, surgeons can debride the area, remove any tissue that has broken away or become damaged. According to several studies, arthroscopic surgery has a success rate similar to the open surgery procedures.

Another type of surgery is the metacarpal osteotomy, where the surgeon tightens the ligament, the tissue that connects the muscle to bone. If this is done in the early stages of osteoarthritis, in Stage 1, the results are promising. Ligament reconstruction is another option available to the surgeons. This is, as the name says, a reconstruction of the ligament but it is only successful in the early stages, Stage 1 and 2. The doctors feel that this surgery can help slow down the disease progression.

A trapeziectomy is done to relieve pain, but it can result in a weaker thumb. The surgeon must shorten the bone somewhat, which can also cause instability of the joint and further deterioration in the joint. This may be solved with the trapezietomy and ligament reconstruction, which is often done for stages 2 to 4 of the disease. By reconstructing the ligament, the thumb shouldn’t weaken, but there aren’t any studies that have backed this up as yet.

Two other procedures are called the trapeziometacarpal arthodesis and the trapeziometacarpal implant arthroplasty. The first, the arthrodesis, is a fusion of the thumb at the joint. This can help make the thumb strong, but limits the movement available. Studies have yet to come up with solid proof that this is an effective treatment. The second, the arthroplasty, is a joint replacement of the thumb joint. While this does help relieve pain, there are some problems associated with the replacement, such as loosening of the implant. The loosening has been a concern, particularly among men and younger women. Some researchers say that it should be done only in women who are over 60 years old, to avoid this problem.

In conclusion, the authors of this article wrote that it is agreed that non-surgical management of osteoarthritis of the base of the thumb should be the first choice. Surgery is only to be done if the non-surgical management doesn’t work. However, more studies are needed to be able to adequately compare the different types of surgical procedures to come up with recommendations as to which are better than others.

Classic open surgery for carpal tunnel syndrome (CTS) comes with a list of possible complications. The incision can become scarred down and very sensitive. A cut is made across the wrist crease and through the interthenar fascia. This fascia is a band of connective tissue between the muscle of the thumb and the muscle on the other (little finger) side of the palm. Cutting through this tissue contributes to hand weakness.

Surgeons have worked hard to develop less invasive surgical techniques. Now, a tiny incision can be made and an endoscope can be slipped under the skin into the carpal tunnel. The transverse or carpal tunnel ligament can be released without damaging the other nearby soft tissues.

Problems can still occur even with the endoscopic approach. The median nerve (or one of its tiny branches) just under the ligament can be nicked by mistake. In some people, the ulnar nerve (which also goes through the carpal tunnel) is closer to the median nerve than expected. It can be unkowingly damaged during the procedure.

Studies on cadavers (bodies preserved after death for study) show a 50 per cent rate of incomplete ligament transection with endoscopy. Without an open incision and clear visualization of the ligament, it isn’t always easy to tell if the ligament has been completely cut through. Using the endoscope takes time and practice. Some surgeons consider this a major drawback of the technique.

In the last 10 years, a new method has been developed for the surgical treatment of carpal tunnel syndrome. The Indiana Tome Technique combines the benefits of open incision and endoscopic (minimally invasive) approaches. It allows a partial direct view with decreased tissue trauma.

First, a tiny incision along the palm is made to gain access to the transverse carpal ligament. Then, a special tool called a cutting tome is inserted. It looks like the flat prongs of a front-end loader. It can be pushed deep enough into the carpal tunnel to allow the surgeon to completely cut the transverse carpal ligament without damaging the median nerve and nearby tendons.

Results of previous studies using this system report a 92 per cent success rate. Success was measured by complete pain relief or only minimal residual symptoms after surgery. Other measures used to measure success included grip, key, and three-point pinch strength. The results for these variables with the Indiana Tome technique was similar to open incision surgery.

In this study, the charts of 1,332 carpal tunnel patients were reviewed after surgery was done. Carpal tunnel releases using the Indiana Tome system were done by two fellowship-trained hand surgeons. The researchers were particularly interested in complications and complication rate using this method. They also kept track of the time it took for patients to get back to work or to a preoperative level of function and activities.

There were very few complications (less than one per cent) with this technique. Everyone went back to their preoperative work status quickly. The few patients with numbness or hypersensitivity recovered over time. In two cases, the patients’ ability to feel two points of pressure (called two-point discrimination) was decreased permanently.

The authors conclude that the Indiana Tome technique is safe, reliable, and effective. It must used by an experienced hand surgeon specifically trained to use this tool. In-depth knowledge of the anatomy is a must. In the hands of such an expert, there is less soft tissue damage when compared with the open method.

There is no need for extra equipment and set-up of the endoscopic equipment. If the need arises to switch to an open approach, it can be done easily. This doesn’t happen very often, which is another advantage of the system.

Trigger finger, medically termed stenosing tenosynovitis, is fairly common among adults. It results in a person’s hand taking on the position of getting ready to pull a gun trigger. Unfortunately, treatment for trigger finger doesn’t guarantee that it won’t come back and many people find themselves with the problem again later on.

Researchers performed a study to see if they could predict which patients may end up having the problem recur, or come back. To do this, the researchers enrolled 130 patients (119 patients completed the study) who had trigger finger for the first time and who had been treated with corticosteroid injections. This treatment is usually the first invasive treatment tried if splinting and/or using anti-inflammatory medications doesn’t work.

In order to gather information, the patients completed a questionnaire about how long they had their problem, the severity of the problem, and their medical history. All patients received the same medication (corticosteroid) and amount injected into the affected finger. The patients were then followed for six weeks to watch for improvement.

The researchers used a Visual Analog scale to rate the severity of the patients’ symptoms. If it was determined that the patients’ symptoms were relieved by more than 50 percent using the scale, they were offered a second corticosteroid injection. If the patients had less than a 50 percent improvement and those with more than 50 percent but refused a second injection were referred for surgery to help relieve the trigger finger.

A year after treatment, researchers contacted the patients to see if they had any recurrence of the symptoms. If they did have symptoms, they were asked how long they had been symptom free and if they had any other treatments. The researchers also asked if any other fingers became affected since the treatment.

Following treatment, all patients reported that they had some relief from the trigger finger. At an average of 5.6 months, an average of 56 percent of fingers had a recurrence after one injection. The researchers noticed that the longer the patients had the symptoms, the slightly higher a risk they had of having a recurrence.

When looking at how long the patients were symptom free, the researchers found that freedom from symptoms was about 70 percent at six months and 45 percent at 12 months.

For the patients who chose to have a second injection, 21 percent ended up having to have surgery, compared with 23 percent who did not have a second injection. Other issues were also examined. People who were younger and/or who had more than one finger affected tended to need a repeat injection. Those who had type 1 diabetes, underactive thyroid hypothyroidism, or overactive thyroid hyperthyroidism, tended to require surgery most often.

In conclusion, the researchers wrote that their study did have some limitations. They included the arbitrarily chosen corticosteroid dosage and the telephone consultation after one year, rather than a face-to-face examination. Otherwise, the researchers say that their findings show that although corticosteroids should continue to be used as one of the first-line treatments, patients who are younger, who have more than one finger affected, and/or who have type 1 diabetes, will have a higher chance of needing additional treatment.

Occupational hand injuries in Hong Kong are high, estimated to represent about 40 percent of visits to emergency departments. In contrast, in Denmark, the rate is only about 26 percent. The issue of hand injuries is an important one because such injuries affect no only the social aspects of life, but the ability to work and earn an income, as well.

The length of time a patient remains off work due to a hand injury varies quite a bit. Deciding factors as to whether to stay home or go to work include issues like what type of job the patient does, the severity of the injury and the rehabilitation, if the patient receives compensation, and even the social and economic environment. The author of this study wanted to evaluate the average time of work lost due to hand injuries, as based on an injury severity score, as well as other factors.

Researchers recruited 124 subjects with hand injuries and they were followed for two weeks. Over half of the subjects worked in non-skilled labor. According to law in Hong Kong, if a person is injured on the job, he or she is entitled to compensation for up to two years, during which the patients undergo rehabilitation in preparation for the return to work. In a previous study, researchers found that those subjects who were off for long periods had a lower chance of returning to work. In other words, the longer people were off, the less likely they were to return to their job. They also found that women came back in higher numbers than did men.

In defining “time off work,” researchers used the length of time between the initial hand injury and the return to work. The researchers then assessed the severity of the injuries by using the Hand Injury Severity Scale, HISS, which looks at the integument, skeletal, motor, and neural for each hand. This means if the hand was intact (integument), the condition of the hand’s bones (skeletal), how the hand moved (motor), and if the nerves were affected (neural).

To assess the work the subjects did, their jobs were classified from one to five, according to their physical demand, from sedentary to very heavy. The researchers also looked to see if the injured hand was the dominant hand. The main injuries were: finger fracture (34 patients), tendon injury (28), simple laceration (tear or cut in the skin) (19), hand fracture (16), and crushing injury to the hand (7).

When analyzing the findings, the researchers found that of the 124 subjects, 109 returned to work, 10 were no longer working, two had changed jobs, and three were lost to follow-up. What made this group particularly interesting is that not all patients were compliant (went along with) treatment. In fact, 43 patients did not follow the complete treatment. They also found that half of the subjects performed sedentary jobs, making return to work easier. This was in comparison with those in the very heavy jobs, among whom only nine returned to work and four were unemployed after the treatment ended.

Among the subjects who returned to work, the average length of time off work was about eight weeks and the average length of rehabilitation was nine weeks. The severity of the injury and presence of complications did affect the length of time a subject would be off work. There did not seem to be any differences between subjects who did or did not go to work in terms of age, gender, or if the injured hand was dominant. There also did not appear to be any differences between the subjects regarding if the injury occurred while at work, if there was posttraumatic stress, or if there was adequate social support. There was, however, a difference between those who had complications and those who had physically demanding jobs. Those who were unemployed after the injury had a higher rate of complications and were more likely to have a demanding job. Education also appeared to play a role; those who had less education were more likely to be unemployed.

The author concluded that the severity of injury, number of operations, and whether a subject received compensation while off work all played a role in how long they stayed off work. She wrote that these findings should help physicians understand the effects of the injury on work.

Although hip and knee arthroplasty (replacement) are quite common now, finger joint replacements – particularly the proximal interphangeal (PIP) joint – are not done as often. This is the joint closest to the tip of the finger. The replacements that have been done vary in how successful they have been.

The authors of this study wanted to compare how the uncemented procedure compared with the cemented procedure in the PIP joint, to see if this could be one of the reasons why the success of the surgery was so varied, particularly among younger patients who need to use their fingers more and for a longer period of time than would older patients. The researchers compared the findings on 18 patients who had a total of 27 PIP joints replaced with the cemented prosthesis (replacement) and 18 patients who had 21 prosthesis with the uncemented technique.

The researchers pointed out that the success of the surgery depends on a combination of factors, not just the cemented versus uncemented issue. These include the implant design, differences between the patients themselves, surgical technique and after surgery care.

When assessing the patients, the researchers assessed the patients’ pain with a Visual analog score (VAS) of 0 to 10, with 0 being no pain and 10 being the most severe the patient experienced. The researchers also checked for the patients’ range of motion, and x-rays.

After surgery, the patients used a splint and exercises began on the first day after surgery. The strength of the exercises increased according to the patients’ ability and healing. The patients were followed for more than two years.

After the surgery, the results were only available for 28 patients, 24 with cemented implants and 19 uncemented implants. The researchers found that the average pain score dropped by 5.5 from before surgery and the range of motion increased by an average of 13 degrees. When looking at pain and range of motion in relation to the type of prosthesis, no differences were found between the cemented and uncemented replacement. When assessing joint failures, there were two failures in the cemented group. Follow-up showed no loosening or failure for several years. In the uncemented group, however, there were 5 joint failures. There were also eight other instances of implants loosening or difficulty with movement over the follow-up period.

In conclusion, the authors wrote that there were no differences in the pain scores before and after surgery between uncemented and cemented replacements but there was a significant difference between the two groups in loosening and failure of the replacements.

People who have diabetes run the risk of developing several long-term complications resulting from the disease. Among those are conditions of the hands that are often seen among this population.

As early as 1957, it was noticed that many people with diabetes complained of stiffness in the hands or stiff joints. This was eventually called limited joint mobility (LJM). It was found most often in people with what was called then, juvenile diabetes, just called Type 1 diabetes now. On examination, the hands of people with this complaint couldn’t stretch out as much as they should. For example, if placing the hands palms down on a table top, normally the fingers spread out. In patients with this stiffness, the fingers and palm of the hand will not lie flat. The authors of this article caution, however, that this sign could also be of another disorder called Dupuytren’s contracture or from a previous injury, so this shouldn’t be relied on alone for final diagnosis.

When doing research on the causes of LJM, researchers have tried to find the connection between LJM and diabetes. What most have found is that it is most common in older patients who have had diabetes for a long time. Studies showed that anywhere from 7 percent to 76 percent of older patients with diabetes have LJM, but the most common figure is 30 percent. In one study, researchers looked at patients who had type 2 diabetes (what used to be called adult onset) for 10 years or less and none of the patients showed signs of LJM.

Similar to LJM is another disease called Dupuytren’s disease and it, too, is more common among those of have diabetes than those who do not. Researchers have a better understanding of DD than LJM though. People with DD have nodules and cords on their fingers and palms of the hands, and the problem seems to occur most often in the ring fingers and middle fingers rather than all of them as in LJM. How old a patient is and how long he or she has had diabetes also is a factor in if they develop DD.

Carpal tunnel syndrome is one that many people are familiar with, however it is worse in people with diabetes than those without. As well, if people with diabetes have the surgery to release the carpal tunnel, they have worse outcomes than those without.

Studies have estimated that between 11 percent and 21 percent of patients with diabetes also have CTS. One theory is that the connective tissue is more vulnerable to injury in those with diabetes.

Trigger finger, or stenosing tensynovitis is not as well known in the diabetic population but it is more common than in the non-diabetic population. The signs of trigger finger are stiffness of the finger and locking in position. This seems to happen more among females, in both hands, and not often in the index fingers or smaller fingers. Studies estimate that about 20 percent of the diabetic population may experience trigger finger, compared wit 2 percent in the general population.

Infections can happen to anyone, with diabetes or without, but the low blood sugar (hypoglycemia) makes is easier for infection to settle in. Therefore, infections of the hand are more common among those with diabetes. As well, weakness in the hand seems to be more common among those with diabetes.

Another issue noticed by the authors of this study are lesions on the hands and fingers, as well as other parts of the body. Diabetic blisters, called bullosis diabeticorum can occur in patients with severe diabetes. They usually appear and last for anywhere between two to four weeks. Small papules called granuloma annulare seem to occur more often in those with diabetes as well. These do not go away on their own but often are left untreated.

A third type of skin problem is called Huntley’s papules, which look like little skin pebbles. They are often found on the top of the hands or in the joints. Finally, painless, scaly papules, called necrobiosis lipoidica diabeticorum, can appear on the hands, although they are more likely to form on the legs. The complication that occurs with this problem is that they can ulcerate, or split open, causing an open wound.

Different types of sports place different forces on the hand and can cause significant injury to an athlete. Ball sports, such as basketball or football, can result in a “jammed finger,” which can range from damage to the ligament to a fracture. Contact sports can result in fractures from falls or the contact itself; gymnastics places a strong burden on the wrists; rock climbers exert unusual force on the flexor system of the hands; and combat sports often can result in fractures.

Treatment of these injuries vary and the right choice is vital not only for proper healing, but for the athlete to be able to return to his or her sport.In the case of “jammed fingers,” treatment options range from surgery to plate implantation. The “mallet finger,” a common baseball or basketball injury, has seen various techniques used for treatment, with none apparently being better than another. Although surgery may be an option, splinting the displaced fracture to the neighboring finger remains a common treatment.

In contact sports, the “jersey finger” usually requires surgery within seven to ten days of the injury, This time frame is vital to prevent tendon damage. The scaphoid fracture is usually treated with a long-arm cast, with good results. Traction may be used if needed. Another injury, the scapholunate ligament rupture is difficult to treat. The goal is to repair the ligament as much as is possible, but this doesn’t have a high success rate. In one study, the findings showed that only one out of eight athletes who use their wrists extensively were able to return to their preinjury function. The issue becomes even more difficult to treat if the injury is a chronic one.

Gymnastics poses another problem for the hands and wrists because of the repetitive loads placed on the wrist. Diagnosis is also not easy as the gymnast may have complaints of vague wrist pain when tumbling or vaulting, but the x-rays may appear normal. This should be further investigated because non-treatment of this injury can result in a total physical shut down of the wrist, along with angular deformity and shortening of the wrist.

Rock climbers face a different type of hand injury because of the strain in their flexor system, due to the sustained and sudden pull force while climbing. Called a pulley disruption, this injury is associated with the “crimp-grip” hand position that the climber needs to use to grab on to small ledges.

In combat sports, the injuries can be more obvious. In boxing, for example, the “boxer’s knuckle” is an injury in the third metacarpal head, sometimes from a single punch, but most often from repetitive punching.

The authors of this article conclude that if athletic injuries of the hand are not well assessed and treated, the function of the hand can compromise not only the patient’s athletic career, but also the normal activities of daily living.

Many people are familiar with carpal tunnel syndrome (CTS). Most often the condition is chronic with a gradual onset of pain, numbness, and tingling of the fingers, palm, and/or wrist. But sudden CTS can occur as a result of bone fracture, infection, snake bite, or other trauma.

Sudden, severe symptoms of CTS that develop over the course of a few hours (rather than weeks to months) is referred to as acute CTS. A rapid rise in pressure occurs inside the carpal tunnel.

Symptoms develop as a result of compression of the nerve from blood (hemorrhage), snake venom, tumor, or other fluid inside the compartment. Blood clots, bone fractures and/or dislocation, and burn or thermal injuries can also lead to acute CTS.

In this review study, Dr. K. A. Schnetzler, an orthopedic surgeon reports that most cases of acute CTS are caused by uncommon disorders and injuries. Immediate medical attention is required. Surgery to relieve pressure on the median nerve restores blood flow to the area needed to preserve normal nerve function. This procedure is called surgical decompression.

A careful diagnosis is needed to distinguish between nerve contusion versus acute nerve compression. Nerve contusion (bruising) may only require rest and close follow-up. Urgent surgical treatment is more likely for rapid elevation of pressure from acute CTS.

Dr. Schnetzler describes the desired treatment protocol for acute CTS. Early nonoperative emergency measures such as elevation and support of the hand, wrist, and forearm are discussed. Measuring carpal tunnel pressures can help direct the timing of surgical intervention. Length and placement of the surgical incision is suggested but left up to the surgeon’s preference.

Results are best when surgery is done within the first few hours of trauma. Complete return of function is more likely when release occurs in the first 12 hours. Delayed diagnosis and intervention leads to delayed return of function.

Trigger finger can be successfully treated with a steroid injection. Hand surgeons differ in which type of steroid should be used. This is the first study to provide evidence that one type may be better than another.

Trigger finger (or thumb) occurs when swelling of the lining around a tendon causes narrowing of the tunnel through which the tendon moves. The person with a trigger finger is unable to extend the affected finger. When attempting to straighten the finger, pain and cracking occurs. If the finger can unlock, it pops back suddenly, as if releasing a trigger on a gun.

Steroid combined with a numbing agent such as lidocaine can be injected into and around the flexor sheath. The goal is to reduce inflammation and resolve the symptoms of trigger finger. Two types of steroid are commonly used: dexamethasone and triamcinolone.

Dexamethasone is much stronger than triamcinolone and the effects last twice as long. Triamcinolone may leave a deposit in the flexor tendon sheath that can prevent smooth tendon gliding.

In this study, patients with trigger finger received a single injection of either dexamethasone or triamcinolone. They were evaluated at six weeks and three months after the injection. Measures used to assess the outcome included function, patient satisfaction, and improvement of the trigger finger.

Improvement was measured using the Quinnell system of grading the finger. The Quinnell system grades trigger fingers as:

Injuries of the hand and finger are common in ball sports. They could be prevented with protective gear but such equipment isn’t used because it limits dexterity. The most common finger injuries are the topic of this article. Mallet finger, Jersey finger, Boutonnière deformity, Boxer’s fracture, and Gamekeeper’s thumb are presented. Ligament and fractures of the fingers as well as finger dislocations are also discussed.

History, clinical exam, and test procedures for each type of injury are provided. Conservative (nonoperative) care may be okay for some injuries. Others require immediate surgery for the best result. When to order X-rays and what to look for in each type of injury is outlined.

Traumatic injuries of the fingers are usually fairly easy to identify. For example, mallet finger (also known as baseball finger) results in the tip of the finger remaining in a permanently flexed position without treatment. A splint may be all that’s needed but surgery is advised if loss of movement persists after six months.

For more difficult to diagnose injuries, such as Jersey finger, special tests and X-rays help the physician rule out fractures and identify the true problem. Jersey finger is named as such because it occurs when a player (usually a football player) grabs another player’s jersey. The bent finger gets pulled into extension. In the process, one of the flexor tendons to the finger is torn.

A Boutonnière deformity occurs from the same mechanism as the mallet finger but affects the middle joint of the finger (instead of the tip). The finger was extended at the time of the injury and gets forced into flexion. Painful swelling and an inability to straighten the finger are typical signs of a Boutonnière deformity. Splinting and hand therapy are usually prescribed.

Some injuries, such as the Gamekeeper’s thumb can occur with any sport. The athlete falls onto the hand with enough force to tear the ulnar collateral ligament (UCL). X-rays provide information needed to guide the treatment plan. For instance, a splint to immobilize the thumb may be all that’s required. This is true if the UCL is torn but there’s no fracture. A rehab program starts about six to eight weeks after immobilization.

Punching someone or something with enough force to fracture the knuckle is called a Boxer’s fracture. Splinting is required for four to six weeks followed by an aggressive rehab program. Flexibility and strength may be regained but the knuckle may not ever look normal again.

Many of these types of hand and finger injuries are misdiagnosed at first. Delay (or wrong) treatment applied can affect a ball player’s abilities. Early diagnosis and treatment is always advised.

Regaining motion and strength are important in the dexterity needed for ball sports. Healing of the soft tissues or bone usually takes six to eight weeks. An equal amount of time may be required to complete the rehab program and return to full participation in sports.