Our hands allow us to do so much: we use them to touch and feel. Our hands enable us to type an email, send a birthday card and if you’re musically inclined, you may use them to play the guitar or piano. The hand allows us to play sports: throwing a baseball, dribbling a basketball or swinging a golf club. We use our hands to drive our cars, wash the dishes and do the yard work. Our hands make possible the most common greeting in Western culture, the handshake. And our hands allow us to hold a baby or pet a dog. Most of us take these things for granted. But if our hands are injured, our ability to do everyday tasks is at risk.
There are a number of common injuries that can dramatically limit one’s use of the hands. In many cases, however, early diagnosis and treatment can help restore the hand’s function. Here’s a look at some of the most common conditions that affect the hands:
Carpal Tunnel Syndrome
The carpal tunnel is literally a tunnel that runs through our wrist. This tunnel is formed by the carpal bones on the bottom and sides, with the “roof” of the tunnel formed by the transverse carpal ligament, a very strong band of connective tissue. Because of the composition of the tunnel, it is very rigid.
The median nerve, which controls feeling in the thumb, middle, index and ring fingers, as well as the muscles near the base of the thumb, passes through the carpal tunnel from the forearm into the hand. The carpal tunnel also serves as the passageway for the flexor tendons, the nine tendons that allow us to bend our fingers and thumb.
“If the carpal tunnel narrows – or the tissues surrounding the flexor tendons swell – this creates pressure on the median nerve that in turn can create pain, pressure, numbness, tingling or weakness in the hand,” says orthopedic surgeon and hand specialist Dr. Nathan Lesley. “This condition is known as carpal tunnel syndrome.”
Anyone can develop carpal tunnel syndrome, but there are some known risk factors:
Women and older people are at greater risk.
Heredity plays some role; the carpal tunnel is smaller in some people and this trait may be genetic.
Repetitive hand use: repetition of the same hand and wrist motions can lead to carpal tunnel syndrome.
Certain health conditions, such as rheumatoid arthritis, diabetes and thyroid gland imbalance have all been associated with carpal tunnel syndrome.
Diagnosis and Treatment
Anyone experiencing numbness, tingling, weakness or pain in the hands should see an orthopedic hand doctor for an examination. “Sometimes, people ignore these early symptoms and don’t come in until the carpal tunnel syndrome has progressed to a point at which the patient is having difficulty with routine tasks, such as gripping an object or buttoning a shirt,” says Dr. Eric Wroten, a hand specialist and orthopedic surgeon. “The sooner we can see you and find out what’s going on, the better chance we will have of a successful treatment.”
The physician will conduct a physical examination of your hands, which will then likely be followed by an imaging exam, such as an x-ray, MRI or ultrasound. The doctor may also order an electrophysiological test, which can measure how effectively the nerves are carrying signals, as well as measure electrical activity in the muscles.
If carpal tunnel syndrome is diagnosed at an early stage, non-surgical treatment may help to alleviate the symptoms. Wearing a wrist brace can help to relieve pressure on the median nerve by keeping the wrist straight, while taking ibuprofen or naproxen can help to reduce inflammation in the wrist. Additionally, reducing repetitive physical activity that may have led to the onset of the carpal tunnel syndrome can help to reduce symptoms.
Some patients receive cortisone injections as a way to relieve pain – the cortisone is injected directly into the carpal tunnel and will help to reduce inflammation. However, the benefits of these injections are only temporary and the swelling and pain will return over time.
If these treatments do not work or decrease in efficacy over time, your physician may recommend surgery if your carpal tunnel syndrome is causing severe pain or limiting your mobility and lifestyle. Carpal tunnel surgery is known as a “carpal tunnel release,” the goal of which is to relieve pressure on the median nerve by cutting the ligament that forms the roof of the tunnel. This has the effect of widening the tunnel and reducing pressure on the nerve.
This surgery is usually performed on an outpatient basis, under either local or general anesthesia. Recovery from this surgery may take some time, as it can be a few months before complete grip and pinch strength return to the hand.
Arthritis, a disease affecting the joints, is one of the most common chronic conditions in the United States. More than one out of five American adults has been diagnosed with arthritis by a physician. The most common type of arthritis is osteoarthritis. Especially prevalent in older people, osteoarthritis occurs when the cartilage in between joints wears down. Cartilage is a hard and slippery tissue that enables our bones to glide over one another when we bend our joints, such as the fingers, knees, elbows, toes and hips. Over time, the cartilage can deteriorate, causing bone to rub against bone and leading to pain, swelling and stiffness.
The wrist is a complex joint, meaning it is actually comprised of several smaller joints. When the cartilage wears down on one or more of these smaller joints, arthritis of the wrist develops. If you are experiencing pain, swelling, stiffness or weakness in the wrist, your doctor will conduct a physical examination and may also order an x-ray to help diagnose the cause of the symptoms.
“While there is no cure for arthritis, there are a number of treatments that can help to alleviate the pain and other symptoms,” says Dr. Ryan Reardon, an orthopedic surgeon specializing in hand surgery.
Modification of activity and use of anti-inflammatory drugs, such as ibuprofen; exercise and steroid injections can all help to alleviate the symptoms of wrist arthritis.
If these treatments do not help reduce the effects of the arthritis, your physician may recommend surgery. The goal of the surgery is reduce or eliminate the bone-on-bone contact that causes the pain. This can be accomplished through one of these procedures:
Proximal row carpectomy: In this procedure, the three carpal bones closest to the forearm are removed, which will help to reduce pain while preserving some motion in the wrist.
Fusion: If the movement of the bones in the wrist is the source of the pain, your surgeon may fuse the bones together, essentially creating one bone. This can eliminate the pain but also immobilizes the wrist. In some cases, a partial fusion is performed in order to preserve partial motion.
Total wrist replacement: In this procedure, the surgeon removes the damaged cartilage and bone in the wrist and inserts an artificial joint; this procedure removes the source of the pain and provides for movement in the wrist.
Trigger finger is a condition in which a finger does not extend all the way out and “catches” before it pops out straight with the other fingers. Trigger finger is caused when the flexor tendon that controls finger movement becomes irritated, causing the finger to get “stuck” before it pops out.
The cause of trigger finger is unknown. It is more common in women and is most prevalent in people between the ages of 40-60.
Trigger finger can be treated through non-surgical options, including anti-inflammatories and cortisone injections. In cases where a finger is permanently stuck, your doctor may recommend surgery. Surgery for trigger finger involves widening the opening of the tunnel that the tendon slides through so it can move more easily and not get stuck.
Skip the Fireworks
We may not be able to prevent the onset of hand conditions such as carpal tunnel syndrome, wrist arthritis and trigger finger. However, there is an unfortunately-all-too-common hand injury that’s entirely preventable, and it tends to happen around the Fourth of July.
As we prepare to celebrate Independence Day, it’s a good time to remind everyone: leave the fireworks to the professionals. “I’ve seen far too many people come in with a hand injury – including loss of a finger – because they were shooting off fireworks,” says Dr. Lesley. “People think it won’t happen to them, until it does.” Just ask Jason Pierre-Paul, the New York Giants defensive end who lost his index finger and parts of others when he lit a firework and it exploded in his hand in 2015.
“Fireworks can easily cause injury to the hands, face and eyes, not to mention you can start a fire and burn down a house,” warns Dr. Wroten. “Go watch a professional fireworks show this Fourth of July and forget using them yourself – your hands will thank you for it.”
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