Hand and Wrist

Arthritis

There are many different types of arthritis that can affect the hand and wrist. The most common type of arthritis in the US involves osteoarthritis(wear and tear or degenerative arthritis) at the base of the thumb. Pain and swelling are the most common symptoms involved with loss of motion of the affected joint. Late stages may involve deformities of the joints and loss of use.  There are many treatments that includes heat or ice therapy, analgesic creams, arthritis creams, braces, medications such as NSAIDS like Advil or Aleve, pain medications such as Tylenol and others, range of motion exercises and physical therapy, injections of steroids such as cortisone, and possibly surgery to relieve pressure on the joint or replace the joint or fuse the joint. For more information, contact your Orthopaedic   Surgeon.

Carpal Tunnel Syndrome

This is a very common condition in which one of the nerves that goes to the hand called the median nerve does not work properly usually due to pressure. People who use their hands a lot especially in repetitive motions such as assembly line workers, carpenters, mechanics, and typists are more susceptible to this condition. A family history of carpal tunnel syndrome is a major risk factor as is pregnancy, low thyroid, and diabetes.  Symptoms include pain in the wrist and hand, numbness, tingling, burning, dropping things, weakness especially with grip, difficulty with small objects like hooking jewelry or buttoning buttons, loss of dexterity especially with repetitive motions or small objects, cramping of the hand especially the thumb, pain at night that wakes you up, sensitivity to cold, and waking up shaking your hand and wrist due to the hand being numb.  This is diagnosed by an Orthopaedic Surgeon or Neurologist with a history and physical exam and several physical exam tests.  Sometimes a nerve study called a Nerve Conduction Study and EMG may be done to check how severe this is.  This is treated with changing your activity, wearing wrist splints called Carpal Tunnel Splints, doing exercises, taking anti-inflammatory medications such as Advil or Aleve, performing ice massages, and taking B Vitamins.  Sometimes an injection of steroids such as cortisone will help with the symptoms and slow down the process.  Sometimes surgery may be necessary to stop the process and help with symptoms before permanent nerve damage and permanent weakness develops.  This is a quick surgery that can be done as an outpatient through a small incision with rapid return to normal activities.  For more information, contact your Orthopaedic   Surgeon.

Dupuytren’s Contracture

This is a condition of the hand and fingers caused by a thickening of the fibrous tissue under the skin that causes the fingers to often bend or curl into the palm. This is often painless and is more common in men and usually occurs in your 50’s or 60’s.  The cause of this condition is unknown and there is no known cure.  This does not occur from trauma/injury or heavy lifting or repetitive use.  This occurs more commonly in people of Northern European Descent (English, Irish, Danish, Scottish and French) and Scandinavian Descent (Swedish, Swiss, Norwegian, and Finnish) and has a strong tendency to be hereditary and run in families.  Other risk factors include heavy alcohol use, smoking, diabetes, and seizure disorders.  The bending of the fingers (contractures) is usually painless and occurs gradually. The frequency of this condition increases as you get older. Symptoms include painful or painless bands, cords and nodules in the palm and fingers that gradual tighten and pull the finger into the palm. Sometimes puckering of the skin is seen in the palm.  The little finger and ring finger are most commonly affected.  The contractures usually get worse with time and can become permanent. Treatment is with stretching the fingers, splinting the fingers, possibly injecting the nodules and bands with steroids, and sometimes performing surgical releases of the fingers.  A new injection called Xiaflex has recently been approved by the FDA to release tight cords without surgery. Unfortunately there is no known cure and sometimes multiple surgeries are performed during a patient’s lifetime.  For more information, contact your Orthopaedic Surgeon.

Ganglion Cyst

Ganglion Cyst is a small sac of fluid that develops under the skin on the front or back of the wrist and sometimes near any of the small joints of the hand and wrist.  This is the most common mass of the hand and wrist.  The cyst contains fluid from the joint or tendon sheath that is normal fluid that has escaped the tendon sheath or joint.  This is not a tumor or cancer. These develop commonly after trauma such as a wrist sprain or from arthritis.  Some people are born with this cyst.  Repetitive motion often makes the cyst get bigger and rest often makes the cyst get smaller.  Treatment involves rest and ice/ ice massages to the cyst if it hurts. Sometimes a splint or a brace will help. Often no treatment is necessary if there is no pain.  Anti-inflammatory medications often help such as Advil or Aleve (NSAIDS).  These used to be called “Bible Bumps” because people would often hit the cyst with the biggest book in the house to burst the cyst and the only book in some houses was the Bible.  Now the cysts are often popped with a small needle or aspirated to remove the fluid. Sometimes a steroid is also injected. If this is unsuccessful and the cyst continues to come back (recurrence) then surgery is often necessary.  Sometimes the cyst returns even with surgery.  For more information, contact your Orthopaedic  Surgeon.

Mallet Finger

This is an injury to the fingertip caused by a direct blow to the end of the finger such as jamming the finger.  This is also sometimes called “Baseball Finger”.  The tip of the finger can no longer be fully straightened out and the finger looks like it sags.  Pain and swelling usually occur with the inability to straighten out the finger.  An x-ray is often needed to see if the tendon was injured or the tendon and bone injured.  Medical care is necessary to prevent permanent deformity and to regain full function of the tip of the finger. Treatment involves ice and elevation, splinting, medications such as Advil or Aleve (NSAIDS), and some- times surgical fixation.  For more information, contact your Orthopaedic Surgeon.

Tendonitis

A tendon connects muscle to bone.  A ligament connects bone to bone. The hand and wrist have many tendons on the back of the arm and many tendons on the front of the arm that helps move the hand and wrist in many directions. Any of these can get inflamed and cause pain which is called tendonitis.  The most common cause of tendonitis is from overuse or repetitive use. Trauma and generalized swelling of the hand or wrist can also cause tendonitis.  Common activities include throwing, catching, hammering/screwing/painting, typing, sewing, feeding newborns, playing sports, and writing. Symptoms include pain and swelling with occasional loss of motion. This is best treated with rest, bracing, ice or ice massages, stretching and strengthening, medication such as Advil or Aleve (NSAIDS), Tylenol, and avoiding repetitive motions.  Sometimes an injection of a steroid will help as will physical therapy. Rarely is surgery necessary. One specific type of tendonitis is De Quervain’s  Tenosynovitis which involves the tendon at the base of the thumb. This is common in new mothers who are bottle or breast feeding their newborn babies. Repetitive motions such as hammering and twisting the wrist can also cause this condition. For more information, contact your Orthopaedic Surgeon.

Trigger Finger

This is a specific type of tendonitis of the fingers also called Stenosing Tenosynovitis.  This causes the finger to often lock-up or catch and is often very painful. Some people can’t straighten out the finger once it is bent. This is especially true first thing in the morning when waking up and finding it difficult to straighten out one or more fingers.  This is caused by swelling and inflammation around the tendon sheath causing the tendon to get stuck.  Pain is usually noted when unlocking the finger or straightening out the finger especially on the palm side at the base of the finger.  Treatment usually involves stretching exercises, ice massages, anti-inflammatory medication such as Advil or Aleve (NSAIDS), and avoiding tight gripping of objects.  Sometimes an injection of a steroid will fix the problem.  If a single finger continues to get inflamed, surgery may be necessary to prevent any recurrence.  For more information, contact your Orthopaedic Surgeon.