We do everything with our hands — from the functional like carrying groceries to the expressive like gesturing or giving a hug.
Hands are one of the smaller, yet most important, parts of your body. However, despite their small size, there’s a variety of conditions that may afflict them.
Hand conditions come in several forms, from an obvious injury after a trauma to carpal tunnel syndrome and arthritis-related pain. If your hand hurts and you’re unsure why, here’s what you need to know:
Types of Hand Conditions
If someone has fallen or has had an identifiable trauma, then the cause of their hand injury is clearer. Depending on the amount of energy involved in the injury, there may be a risk for a broken bone or sprained ligament. For these types of injuries, we often will perform an X-ray in the office to supplement our physical exam in making a diagnosis and recommending a treatment approach.
Outside of obvious injury, arthritis and degenerative changes are one main reason people have pain in the hand. Arthritis simply refers to degeneration of the protective cartilage surfaces of the joint, regardless of the cause and may be due to previous injuries (post-traumatic arthritis), age- related degeneration or specific systemic medical conditions such as rheumatoid arthritis or gout. Within the hand, the CMC-joint, which is the joint on your hand at the very base of the thumb, is the most common joint to develop symptomatic arthritis — although you also can have arthritis pain in the other small joints of your fingers and the wrist.
We also see a lot of nerve compression syndromes, like carpal tunnel syndrome and cubital tunnel syndrome, where there’s pressure on a nerve that can restrict blood flow and cause painful tingling and altered sensation in the hand and fingers. In advanced cases, muscle function may be impaired. While carpal tunnel at the wrist and the cubital tunnel (funny bone area) behind the elbow are common sites of nerve entrapment, compression anywhere along the course of the nerve, including the neck, may cause tingling in the fingers. For this reason, it’s important to undergo a thorough physical exam to help identify the source of the compression.
Trigger finger, a condition where a finger will “catch” or “lock,” is another reason for hand pain. In the same way that a fishing pole has rings on it to hold the fishing line to it, our bones have rings of tissues on them called “pulleys” to hold the tendons to them. Normally, the tendons will glide through these rings, but if they get swollen they can begin to lock or “trigger,” leading to painful friction with the pulleys. Though the highest incidence of carpal tunnel and trigger finger are seen in middle-aged patients, they can occur at any age (although generally quite infrequently in patients less than 18 years old). Treatment will depend on several factors, but in general, non-surgical options including immobilization, anti-inflammatory treatment and corticosteroid injection are the initial treatments administered.
Treatment for Hand Conditions
For arthritis-related hand pain, over-the-counter relievers like Ibuprofen can help. Immobilization can support the joint and keep it in a comfortable range of motion. With some patients, anti-inflammatory medications like steroids — for example, a “cortisone shot” — injected directly into the joint can relieve pain.
With nerve compression syndrome, the main goal is to get pressure off the nerve. For example, in people who have carpal tunnel syndrome, positional changes of the hand can provoke symptoms by increasing pressure on the median nerve (the nerve affected in carpal tunnel syndrome) at the wrist. It’s common for people to sleep with their elbows flexed and their wrist curled at night, which increases pressure on the nerve. For this reason, we often have patients wear wrist splints at night to prevent them from flexing their wrists, which reduces excess pressure on the nerve and can improve patients’ symptoms.
For trigger fingers, a corticosteroid injection into the tendon sheath is really effective at treating the problem. In up to 80 percent of patients, symptoms of a trigger finger will resolve with a single injection.
However, despite appropriate non-surgical treatment, some patients may have persistent symptoms. In these instances, surgical options may be the best treatment approach for relieving symptoms. In carpal tunnel syndrome or cubital tunnel syndrome, we may perform an operation in which we decompress the affected nerve. This generally involves making an incision and then dissecting or releasing the tissue surrounding the nerve to create more room for the nerve and to decrease the pressure on it. Similarly, surgery for a trigger finger involves release of the pulley, thus removing the barrier to gliding for the tendon. Surgical treatment for arthritis of the hand depends on which joint is affected, but generally involves removing the portion of the joint where the bones are rubbing together and either replacing them (arthroplasty) or fusing them together so that the degenerated bony surfaces no longer move in relation to one another. These surgeries are generally straightforward, relatively low-risk outpatient procedures where patients will go home the same day. Some, particularly carpal tunnel release and trigger finger release, even can be completed under local anesthesia with the patient wide-awake. The benefit of this is that the patient avoids the “hangover” effect that sometimes occurs after receiving anesthesia. It also shortens the amount of time the patient needs to be at the surgery center and can also be less costly to the patient.
We follow a patient-centered approach, with a goal of doing what’s best for each person who walks into our clinic. We generally take a more conservative approach first and reserve surgery for those patients who are not improving despite appropriate non-surgical care. However, treatment is influenced by how advanced a patient’s condition is and a patient’s previous treatments. For instance, a patient with a long history of symptoms who has already tried several non-surgical interventions may be an appropriate candidate for surgery after an initial evaluation. Likewise, if symptoms are advanced, it may be appropriate to proceed directly to surgery to prevent further damage. In advanced carpal tunnel syndrome for example, the nerve signal to the muscle may be blocked. If the nerve signal is not restored in an adequate amount of time, the loss of muscle function may be permanent so surgery after the initial evaluation may be appropriate.
Our hands are a critical part of how we experience the world, so when their function is compromised, we understand the importance of getting them back in working order. If you have symptoms of one of the previously mentioned conditions or other hand symptoms that concern you, visit a doctor and get checked out. We’ll work to diagnose the problem, and make sure that you understand what is going on. Our team will provide individualized treatment for you to address the pain and to help you get better.
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