Hand treatments & procedures
Peripheral nerve entrapment
Patients report a dull aching pain in the wrist traveling up the forearm to the elbow. Often, it is accompanied by severe tingling and / or numbness (severe 'pins and needles) in the thumb and index finger, particularly after sleep.
Often, patients rub their wrists or shake their hands in an attempt to "get the blood circulating."
Pain is often worse at night and can also disturb sleep. As the symptoms worsen, numbness may be increase in the fingers.
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This is the result of compression of the median nerve as it passes through the wrist and carpal tunnel. Surgical treatment is often very successful - however reocurrence of symptoms is not uncommon.
Dupuytren's disease
A condition affecting the hands and fingers. It causes one or more of the fingers (on one or both hands) to bend inwards - towards the palm of the hand.
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The condition occurs when nodules (small growths or lumps of tissue) develop in the tissue of the palm, under the skin. These can lead to cords of contracted tissue. As this tissue contracts, it becomes hard to fully extend affected fingers. Eventually these can be permanently fixed in a bent 'claw' position.
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Surgery can release the contracted finger. The affected tissue can be cut to relieve the tension in the finger, or the tissue can be removed completely.
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In some cases, the chance of the condition reoccurring after successful surgery can be as much as 50%. More extensive surgery may be necessary if the condition returns. In cases when diagnosed at an early stage this condition can be treated with Ultrasound and manipulation of the hand.
Trigger finger
Caused by a problem in the 'tunnel' that protects the tendon in your finger. If the tendon cannot glide smoothly through the tunnel, this can cause acute pain and stiffness - referred to as 'trigger finger'.
If the tendon is impeded, the condition can worsen in one of three ways:
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1. Constant friction can cause the tendon to swell in the tunnel.
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2. The tunnel is lined with a slick coating called tenosynovium. Irritation from the tendon may cause the lining to become inflamed, narrowing the tunnel.
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3. Irritation from the tendon can cause a small growth or lump of tissue to form in the sheath, impeding the movement of the tendon.
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If a cycle of irritation and inflammation occurs, the tendon will become stuck and the finger will lock in a bent 'claw' position. Sometimes, the tendon will free itself without treatment and your finger will be able to move again, or it can become locked in a permanently bent position.
Arthritis of the hand and thumb
Osteoarthritis can affect three major areas of the hand:
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1. The base of the thumb
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2. The joints closest to the fingertips
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3. The middle joints of the fingers
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Fingers often become stiff, painful and swollen and you may experience lumps on the joints of the fingers. Over time the pain in your fingers may subside and even disappear altogether, whilst lumps and swelling may continue to be present.
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Affected fingers may bend sideways at the joints and can be accompanied by painful cysts (fluid-filled lumps) on the the fingers.
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In some cases, you may also develop a lump at the base of the thumb where it meets the wrist. This can be painful and you may find it is difficult to perform many simple tasks, such as writing, typing, opening screw tops or using keys.
Fractures of the hand and fingers
A fracture occurs when one of the small bones of the hand or finger is broken. Most hand fractures occur when an object falls on the hand or the hand strikes an object. Symptoms include pain, swelling, a visible deformity and difficulty moving the affected fingers.
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If a hand fracture is suspected, your doctor will obtain x-ray studies to determine if the bone is broken. If a fracture is seen in one of the bones of the hand a decision will be made to determine appropriate treatment for the injury.
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Possible treatments of hand fractures include a cast and splints. If the fracture is not displaced a cast or splint will often be sufficient for treatment.
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Some hand fractures do not need to be in perfect position in order to heal well. These fractures may also be casted or splinted. Other options include:
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Small metal pins - these may be inserted through the skin in order to hold the bones in a better position. This procedure is usually performed under general anesthesia, but may also be done with a local anesthetic. The metal pins remain in place for several weeks while the fracture heals, whereupon pins are removed.
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The two most common problems patients who sustain a hand fracture will face are stiffness of the fingers or a bump. The bump is caused by the extra bone the body forms as part of the healing process.
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While the bump does decrease in size over time it may never completely go away. Finger stiffness is prevented by beginning motion as soon as possible. It is sometimes beneficial to see a specialized hand therapist in order to help regain correct finger motion.
Ganglion and other lump removal
Ganglion cysts are harmless and do not require treatment. Some disappear on their own when left untreated. However, if a ganglion is unsightly or causes pain or discomfort, it can be removed.
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Treatments include draining the fluid with a syringe, or a surgical procedure. Surgery removes the ganglion cyst itself rather than removing the fluid contents.During the operation an incision is made into the skin that is at least as wide as the lump.
The ganglion is then removed. Even after surgery some ganglions can reappear, but they do not always need to be removed again.