Arthritis is the wearing away of the cartilage in joints caused by normal wear and tear, injury, or inflammation which can lead to deformities that are painful and unresponsive to medical management.
- You may experience pain, swelling, stiffness, weakness, and deformity of the affected joints.
- Arthritis can usually be diagnosed by interview and physical examination alone, but an x-ray should be obtained to confirm the diagnosis before beginning treatment.
- Most arthritis can be managed by a medical doctor with medications, therapy, and activity modification. This would be considered first line treatment.
- If you continue to have symptoms after trying medications and therapy, or develop worsening symptoms, you may benefit from temporary immobilization with splinting or possibly steroid injections.
- If the pain is debilitating and does not respond to these treatments, surgery may be able to improve function and relieve pain.
Carpal Tunnel Syndrome
Carpal tunnel syndrome is one of the most common chronic afflications, and affects people through a strain injury brought on by overuse of hands, repetitive motion, or fluid retention. Nerves of the carpal tunnel in the wrist become compressed due to inflammation or excess fluid in the canal and may result in discomfort ranging from mild to crippling and can render the individual essentially nonfunctional.
- May range from mild tingling or burning sensations to numbness, aching, pain with range of motion, and impaired function, affecting your ability to perform normal daily activities.
- Most cases can be diagnosed by an interview and physical examination alone including two specific tests called Tinnels and Phalens. Tinnels is performed by tapping directly over the median nerve at the carpal tunnel and assessing for a shooting sensation which travels to the fingertips. Phalens is performed by having the individual place the backs of their hands together and bending their wrist at a 90* angle. This should result in an increase in tingling/burning sensations and discomfort.
- Even with positive findings using Tinnels and Phalens, nerve conduction tests are frequently performed to confirm the diagnosis prior to proceeding with treatment.
- Most patients with carpal tunnel syndrome are initially treated with splinting and ant-inflammatory medication.
- If symptoms persist after a trial of splinting and NSAIDs, you may benefit from a steroid injection to reduce the inflammation in the area.
- Many people respond well to a steroid injection, but if symptoms recur or are not adequately relieved, a carpal tunnel release surgery may be necessary for longterm relief.
Dupuytren's Contracture is an abnormal thickening of the fibrous tissue in the palm, extending into the fingers. It starts as a firm nodule in the palm and can progress to a thick band causing bending or contractures of the fingers which make using the hand difficult.
- Although the nodules may be tender initially, the pain typically dissipates and the condition progresses painlessly. However, as the cords form and tighten, they can prevent the fingers from straightening and can cause functional problems.
- The diagnosis is usually obvious on examination which may show firm, tender nodules on the palm, painless cords, or joint contractures at the MCP and/or PIP joints.
- Advanced Dupuytren’s Contracture that prevents the fingers from straightening completely is treated by surgery to remove the diseased fascia. Skin grafting and local flaps are sometimes needed in severe cases.
- Medication and splinting are ineffective, although splinting may be used initially after surgery. Additionally, hand therapy is an important part of postoperative management.
- Steroid injections may offer some benefit, but a series of injections is usually required to have any effect.
- An enzyme injection may also be used as an alternative to surgery, which dissolves the cords and can allow the finger to be straightened within several hours of the treatment. Occasionally a repeat injection is required to be effective. This injection is also associated with possible complications such as tendon ruptures or nerve damage.
A ganglion cyst is a sac filled with fluid and is often located over the wrist or fingers. It has a firm rubbery consistency, and may be tethered to tendons, nerves, or bony prominences such as bone spurs.
- It is benign and can fluctuate in size, but may be painful or cause functional problems depending on the specific location.
- Most ganglion cysts can be diagnosed by physical examination, although x-rays may be used to rule out other causes for pain and swelling and can assess for bone spurs that would need to be removed to prevent recurrence.
- Small ganglion cysts that are not painful may easily be left alone. Some may rupture or disappear spontaneously.
- Cysts that are large, painful, interfere with function, or are bothersome in general can be aspirated with a needle or surgically excised. If possible, surgical removal is typically recommended so the cyst itself can be evaluated by pathology. Additionally, surgical removal is associated with a decreased rate of recurrence, coming back in approximately 1/3 of cases. Recurrence rates are substantially greater if they are not removed but are instead aspirated or left alone and rupture.
Although ganglion cysts are typically benign and a relatively common occurrence, any mass, including those which may resemble a ganglion, should be evaluated by a specialist to rule out other potentially harmful growths.
Tendonitis is inflammation of a tendon and frequently associated with overuse or repetitive use. De Quervain’s tenosynovitis is a common form of tendonitis that causes pain on the thumb side of the wrist.
- May be painful to touch or with motion and can cause weakness and swelling.
- Tendonitis can usually be diagnosed by interview and physical examination alone, however x-rays or a CT might be used to rule out other causes of pain and swelling, especially if there is a recent history of trauma such as falling or hitting your wrist or hand.
- Most cases of tendinitis can respond to rest and splinting alone or in conjuction with anti-inflammatory medications.
- If simple immobilization does not aid in reducing your pain, steroid injections may be helpful to reduce the inflammation that is causing discomfort. In some, this may be enough to treat your discomfort long term.
- Some tendonitis, especially if chronic or severe, is poorly responsive to steroids. In these cases, surgery is recommended for resolution.
Infections of the hand can involve the skin (cellulitis), deeper soft tissues (abscess), tendons (tenosynovitis), joints (septic arthritis), or bone (osteomyelitis).
- May or may not be associated with trauma or injury to the affected area and may involve pain, swelling, redness, drainage of pus, red streaks up the arm, and fever. Medical attention should be sought immediately on presentation of any of these symptoms. If you develop streaking up the arm or fever, proceeding straight to the emergency room is recommended.
- The diagnosis is usually clear based on your symptoms and physical examination. Additional tests such as x-ray, CT or MRI are sometimes helpful. A culture is usually performed to aid in identifying the cause of the infection and the best antibiotic to treat it.
- Infections of the hand can become severe quite rapidly. They should be treated as emergencies with prompt medical attention and initiation of appropriate antibiotics. Surgery may also be necessary to drain and wash out the infected area depending on the type of infection and severity at the time of presentation.
Trigger finger is a specific form of tendinitis which affects the tendons of the fingers along the palm side of the hand. These tendons, called flexors, are held tight to the bone by tendon sheaths. As the tendons become irritated and swell, they can get stuck by the sheaths which then prevent sliding down the hand.
- You may experience clicking or locking of the finger when you try to straighten it from a bent position. You may also have pain or feel a pop when you straighten the finger due to a difference in size between the tendon and its protective sheath.
- Trigger finger can usually be diagnosed by physical examination with the affected finger locked in a flexed position and a snap or trigger when moved forcefully beyond the restriction. This is easily felt by the practitioner performing the exam.
- Steroid injection into the tendon sheath is the first line treatment. However, there is nearly a 50% likelihood that the symptoms will recur.
- If triggering is not resolved with steroid injection or returns within 1 year from the initial injection, surgery may be necessary and is considered a permanent solution except in rare cases where significant scarring can reproduce symptoms.