- Orthopaedic & Neurosurgery Specialists PC (ONS)

Common Hand Problems

Our hands are integral to nearly all daily life activities. An injury to the hand, wrist or fingers can greatly impact the ability to function normally at home, at work or playing sports. Some of the most common hand and wrist problems are described here.

Ganglion cysts

A ganglion cyst is a non-cancerous mass or lump the usually occurs in the back of the hand. It is a fluid-filled capsule that arises from joint linings or tendon sheaths. Many do not require treatment. However, if the cyst is painful or interferes with normal function, it may be made smaller by removing the fluid with a needle (aspiration), or by surgery.

Carpal tunnel syndrome

Carpal tunnel syndrome is caused by compression of the median nerve at the base of the palm, where it passes near the wrist joint. This nerve provides sensation to the thumb and most parts of the fingers. It also affects the strength of the muscles at the base of the thumb. If compressed, the nerve may sustain serious damage.

Common symptoms of carpal tunnel syndrome include numbness and tingling in the hand, especially at night; pain while gripping or holding; and clumsiness in handling objects. The pain may even extend from the hand, up into the shoulder.

Carpal tunnel syndrome in the early stages may be treated with a splint or brace to allow the wrist to rest. Steroids injected into the carpal canal may also help decrease swelling. Cases that do not respond to non-surgical methods, or are diagnosed late, may eventually require surgery. This is usually done in an outpatient setting under local anesthesia.

Osteoarthritis of the hand

The hand and wrist are comprised of multiple small joints that work together to produce many intricate motions, from threading a needle to turning a key in a door. When joints become affected with arthritis, the activities of daily living can be very difficult. When a joint becomes arthritic, the cartilage has worn away and the joint can no longer function smoothly with the bones gliding easily over each other. Movement is painful and the range of motion is reduced.
The most common form of arthritis is osteoarthritis or wear and tear arthritis, which generally affects people over 45. Rheumatoid arthritis is a form of the disease that causes significant joint inflammation.

Traumatic arthritis can affect people of any age and may occur as a result of an injury or trauma to the joint. A joint that has sustained an injury is more likely to become arthritic, even if the injury has been properly treated. Fractures that damage the cartilage or joint surface and dislocations are the most common injuries that lead to arthritis.

Arthritis symptoms

Common symptoms of hand or wrist arthritis include:

• Joint pain
• Pain after strenuous hand or wrist activity such as gripping or grasping
• Morning pain and stiffness in the hands
• Pain that disrupts sleep
• Swelling in fingers or wrist

Heberden nodes are "bumps" which occur at the last joint of the finger or thumb due to wear and tear arthritis. As the joints deteriorate, small bone spurs form over the back of the joints and make them appear "lumpy." Since most Heberden nodes are not painful and seldom interfere with function, no specific treatment is usually required.

Treatment for arthritis

Medications are used to treat arthritis symptoms but cannot restore joint cartilage or reverse damage. Anti-inflammatory medications are commonly used to reduce pain and swelling.

If anti-inflammatory medications do not control pain, steroidal injections into the joint may be used.

Splinting to help support the joint is often done in combination with injections. It should be small enough to allow functional use of the hand and should only be used during periods when the joint is painful. Wearing a splint for too long can actually lead to further joint and muscle stiffening.

Arthritis surgery

If non-operative treatments fails and the joint surfaces no longer work, surgery may be an option. A joint fusion (arthrodesis) provides long-term pain relief but the joint will no longer move. Since the damaged joint surfaces are gone, the symptoms disappear.

For wrist arthritis, surgical options include partially or completely removing the arthritic joint surfaces and fusing the joint to make it solid.

Joint replacement surgery can help with certain types of hand and wrist arthritis.

Tendonitis of the wrist

DeQuervain's tendonitis is characterized by pain and swelling of the thumb-side of the wrist. Recurrent irritation of the tendon and its sheath make it difficult and painful for the tendons to function normally.

Pain that occurs when grasping or pinching and tenderness over the wrist, are the most common symptoms of tendonitis. Sometimes a lump can be felt in this area.

Wrist tendonitis (inflammation of the tendons) may be caused by overuse and also can be seen in association with pregnancy or rheumatoid arthritis.

Treatment for tendonitis

Tendonitis symptoms may improve with short periods of rest in a splint and by stretching exercises designed to get the tendons gliding again. By resting the tendon, the inflammation should decrease. Avoiding the activities that led to the onset of symptoms may be necessary.

Icing wrist tendonitis can help decrease inflammation and also stimulate blood flow to the area of tendonitis.

Nonsteroidal anti-inflammatory medications can help control symptoms of pain, and also decrease inflammation and swelling of the soft-tissues.

A steroid injection can frequently cure the condition.

More severe cases may require surgery. The operation entails opens the covering that surrounds the tendons to create more room for the irritated tendons. Afterward, physical therapy may be prescribed to restore normal use of the hand.

Dupuytren's contracture

Dupuytren's contracture is a condition that causes a thickening of the tissue that is just below the skin of the palm. This condition produces small and elongated lumps and cords that may eventually cause the fingers to be drawn into the palm.

The disease is hereditary and is also linked with cigarette smoking, vascular disease, epilepsy, and diabetes.

If nodules or lumps are small, surgery is not needed. However if a cord forms the affected fingers will develop a contraction effect that can interfere with hand function. Even after a successful surgery, bands may reappear or occur in other fingers.

Trigger finger

The tendon that bends the finger passes through a tube-like tendon sheath. If the tendon and sheath become irritated and enlarged from repetitive gripping action, inflammation may occur making it difficult for the tendon to pass through the sheath. The condition is called trigger finger because the tendon catches and then suddenly releases, as if clicking a "trigger."

Discomfort and swelling can be treated with rest, activity modification, anti-inflammatory medication, or steroid injections. If the tendon does not return to its normal, pain-free condition, a minor surgery may be necessary.

Sports-related hand injuries

Injuries to the hand are common in athletes because the hands frequently absorb impact during sports activity. Sports-related injuries may involve the supporting ligaments, tendons or bones.

Skiers are susceptible to an injury known as skier’s thumb, a tear of the ulnar collateral ligament in the large joint of the thumb. This can happen when the skier falls and the ski pole handle forces the thumb to bend away from the fingers. The same injury can occur in other sports players whose hands are often used to break a fall.

Treatment for sports-related tears

Many common ligament injuries are treated non-surgically, A few will require surgery to restore stable ligament function.
If the thumb ligament is completely torn, surgery may be necessary. Sometimes, as the ligament tears, it pulls a bone fragment away from the base of the bone. The fragment may need to be removed or replaced to its correct position. Patients commonly need to wear a short-arm cast or a splint to protect the thumb ligament for a period of time following surgery.

Fractures

The most common fracture to the wrist occurs to the distal radius, the end of the larger of the two arm bones at the thumb-side of the wrist. Distal radius fractures usually happen about one inch from the end of the radius and most often occur in people over 60. The injury causes pain, swelling, bruising and can create a deformed appearance to the wrist.

Initial treatment usually includes icing, elevating the arm and anti-inflammatory medications to control pain and swelling. If the bone is properly aligned, a splint may be used for the first few days. A cast may be added a few days later, after the swelling has gone down. It may need to be changed after a couple of weeks once the swelling has diminished further.

For more serious fractures, surgery may be required to correct the alignment of the bone. Sometimes a cast alone can be used, or it may be necessary to insert metal pins, a plate and screws.

 

 

 

A fracture may also occur to the scaphoid bone, a small bone in the thumb-side of the wrist. It can occur in people of all ages including children. A fracture of the scaphoid is a common sports injury and is usually a result of a fall toward an outstretched arm.

Treatment depends on the location of the break. Fractures at the end of the bone, close to the thumb, usually heal in a few weeks when placed in a cast. If the scaphoid is broken in the middle of the bone or closer to the forearm, healing can be more difficult requiring a long-arm cast or surgery.

When the scaphoid is broken at the waist or proximal pole, surgery may also be recommended. A screw may be used to stabilize the bone while it heals. After surgery, the wrist may be put into a cast, however even with surgery, these fractures can be difficult to heal.

For more information on hand and wrist injuries, visit the American Association of Orthopaedic Surgeons website at http://orthoinfo.aaos.org/category.cfm?topcategory=Hand.