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Hand & Wrist Conditions



De Quervain Tendinitis

De Quervain tendinitis is caused when the two tendons that run from the back of your thumb and down the side of your wrist are swollen and irritated. It can be caused by playing sports such as tennis, gold or rowing.

Symptoms of De Quervain tendinitis may include:

  • Pain on the back of your thumb when you make a fist, grab something or turn your wrist
  • Numbness in the thumb and index finger
  • Swelling of the wrist
  • Stiffness when moving your thumb or wrist

Treatment:

De Quervain tendinitis is typically treated with conservative methods, including rest, splints, medicine, and recommended changes in activity and exercise. Your doctor may give you a shot of cortisone to help decrease pain and swelling. In severe, chronic cases that do not improve after conservative care, you may need surgery to give the tendon more room to slide without rubbing on the tendon wall.

  • Rest your wrist. Keep your wrist from moving for at least 1 week. You can do this with a wrist splint.
  • Wear a wrist splint during any sports or activities that could put stress on your wrist.
  • Once you can move your wrist without pain, you can start light stretching to increase strength and movement.
  • Your doctor may recommend physical therapy so that you can return to normal activity as soon as possible.
  • Ask your doctor about exercises to help you increase strength and flexibility

The best way for the tendons to heal is to stick to a care plan. The more you rest and do the exercises, the quicker your wrist will heal.




Thumb Arthritis

Cartilage is the firm, rubbery tissue that cushions your bones at the joints. It allows bones to glide over one another. Osteoarthritis causes the cartilage breaks down and wears away, the bones rub together, often causing pain, swelling, and stiffness. In the hand, the base of the thumb is one of the most common joints to develop osteoarthritis. It is commonly seen in women over the age of 40. While the cause is unknown, genetics and previous injuries may predispose you to arthritis of the thumb.

Symptoms:

  • Pain at the base of the thumb
  • Pain in activities that require pinching, such as opening doors, writing, or opening jars
  • In severe cases, mal-alignment of the joint
  • Limited motion and weakness

Treatment:

In less severe cases, conservative methods such as splinting, cortisone injections and arthritis medication may help relieve pain. Patients with severe arthritis that does not respond to treatment may be candidates for surgery. A consultation with your hand surgeon can help decide the best option for you.


Cubital Tunnel Syndrome

Cubital tunnel syndrome is a condition in which the nerve that travels from the shoulder to the hand, called the ulnar nerve, is stretched or compressed. This causes numbness or tingling in the ring and small fingers, pain in the forearm or weakness in the hand.




Mallet Finger

Mallet finger occurs when you cannot straighten the tip of your finger. When you do try to straighten it, the tip of your finger remains bent toward your palm. Mallet finger occurs when the tendon that attaches to the tip of your finger on the back side is stretched, torn or has pulled a piece of bone away from the rest of the finger. It most often occurs when something hits the tip of your straightened finger and bends it down with force. Sports injuries, particularly from catching a ball, are the most common cause of mallet finger.

Treatment:

Wearing a splint on your finger to keep it straight is the most common treatment for mallet finger. You may need to wear a splint for different lengths of time.

  • If your tendon is only stretched or torn it should heal in 6 to 8 weeks if you wear a splint all the time.
  • After that, you will need to wear your splint for another 3 to 4 weeks, at night only.

When it is time for your splint to come off, your health care provider will examine how well your finger has healed. Swelling in your finger when you are no longer wearing the splint may be a sign that the tendon has not healed yet. You may need another X-ray of your finger.

If your finger has not healed at the end of treatment, your provider may recommend another 4 weeks of wearing the splint or discuss surgical intervention with you.




Dupuytren Contracture

Dupuytren contracture is a painless thickening and tightening (contracture) of tissue beneath the skin on the palm of the hand and fingers. A family history of Dupuytren contracture makes you more likely to develop this condition. The condition is more common after the age of 40, and men are more likely to be affected than women. Risk factors include alcohol use, diabetes, trauma, and smoking.

Symptoms:

  • One or both hands may be affected. The ring finger is affected most often, followed by the little, middle, and index fingers.
  • A small, nodule or lump develops in the tissue below the skin on the palm side of the hand. Over time, it thickens into a cord-like band. Usually, there is no pain. In rare cases, the tendons or joints become inflamed and painful. Other possible symptoms are itching, pressure, burning, or tension.
  • As time passes, it becomes difficult to extend or straighten the fingers. In severe cases, straightening them is impossible.

Treatment:

If the condition is not severe, your doctor may utilize conservative treatment, including exercises, warm water baths, stretching, or splints. Your doctor may also recommend treatment that involves injecting medicine or a substance into the scarred or fibrous tissue:

  • Corticosteroid medicine relieves inflammation and pain. It also works by not allowing thickening of the tissue to get worse. In some cases, it heals the tissue completely. Several treatments are usually needed.
  • Collagenase is a substance known as an enzyme. It is injected into the thickened tissue to break it down. This treatment may be just as effective as surgery in some patients.

Surgery is usually recommended in severe cases when the finger can no longer be extended, or stuck in a bent position. Physical therapy exercises after surgery help the hand recover normal movement.

Talk to your doctor about the risks and benefits of the different kinds of treatments.



Trigger Finger

Trigger finger occurs when a finger or thumb gets stuck in a bent position, as if you were squeezing a trigger. Once it gets unstuck, the finger pops straight out, like a trigger being released.

The tendons that move your finger slide through a tendon sheath (tunnel) as you bend your finger, and if the tunnel swells, or the tendon has a bump on it, the tendon cannot slide smoothly through the tunnel. When it cannot slide smoothly, the tendon may become stuck when you try to straighten your finger.

Trigger finger can occur in both children and adults. It is more common in people who:

  • Are over 45 years old
  • Are female
  • Have diabetes, rheumatoid arthritis, or gout
  • Do work or activities that require repeated gripping of their hands

Symptoms:

  • Your finger is stiff or it locks in a bent position.
  • You have painful snapping or popping when you bend and straighten your finger.
  • Your symptoms are worse in the morning.
  • You have a tender bump on the palm side of your hand at the base of your finger.

Treatments:

In mild cases, the goal is to decrease swelling in the tunnel.

Self-care management mainly includes:

  • Allowing the tendon to rest. Applying heat and ice and stretching may also be helpful.

Your provider may also give you a shot of a medicine called cortisone. The shot goes into the tunnel that the tendon goes through. This can help reduce swelling. Your provider may try a second shot if the first one does not work.

You may need surgery if your finger is locked in a bent position or does not get better with conservative treatment.



Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is a condition caused by repetitive motion of the wrist and hand that creates pressure on the median nerve. The median nerve allows for the feeling and movement of the rest of the hand, predominately the area surrounding the thumb. Pressure on this nerve causes a mixture of symptoms from loss of feeling to numbness. Typing on a keyboard, painting, driving, and writing are the most common causes of the syndrome.

  • Weakness in gripping objects
  • Tingling or loss of feeling in hand
  • Pain in hand or wrist extending up to the elbow
  • Issues with finger coordination

Treatment:

Wearing a splint on the wrist, and using hot or cold compresses can help control pain and inflammation. Anti-inflammatory medicine like ibuprofen or naproxen may also help. Using special devices that assist the arm with typing or writing, as well as altering wrist and arm posture during repetitive activities also will help. Corticosteroid injections are often helpful in relieving the inflammation in the carpal tunnel. Surgery may be necessary in severe and persisting cases of median nerve impingement, in order to prevent long term nerve and muscle damage.



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