COMMON HAND PROBLEMS
Ganglion Cysts |
Carpal Tunnel Syndrome |
Tendonitis of the Wrist |
Arthritis of the Hand |
Dupuytren's Contracture |
Trigger Finger
Ganglion Cysts
Ganglion cysts are the most common mass or lump in the hand. They
are most common on the back of the wrist. These non-cancerous,
fluid-filled cysts arise from the ligaments, joint linings, or
tendon sheaths when they are irritated or inflamed. They may
disappear or change size quickly.
Many ganglion cysts do not require treatment. However, if the cyst
is painful, interferes with function or the patient does not like
the appearance, your orthopaedic surgeon can remove the fluid with a
needle (aspiration) or remove it surgically.
Carpal Tunnel Syndrome
Common symptoms of carpal tunnel syndrome are numbness and tingling
in the hand, especially at night; pain with prolonged gripping such
as holding a steering wheel; or clumsiness in handling objects.
Sometimes the pain can go all the way up to the shoulder.
These symptoms are caused by pressure on the median nerve as it
enters the hand through a tunnel in the wrist. The tendons that bend
your fingers and thumb also travel in this tunnel.
Mild cases can be treated with a splint or brace to rest the wrist.
Steroid injections into the carpal canal to decrease swelling may be
used in addition to splinting. Those cases that do not respond to
non-surgical treatment and those that are diagnosed late often
require surgery. This is generally done in an outpatient setting
under local anesthesia.
Tendonitis of the Wrist
DeQuervain's stenosing tenosynovitis is an irritation and swelling
of the sheath or tunnel which surrounds the thumb tendons as they
pass from the wrist to the thumb. Pain when grasping or pinching and
tenderness over the tunnel are the most common symptoms. Sometimes a
lump or thickening can be felt in this area. If the hand is made
into a fist with the thumb "tucked in" and bent towards the little
finger, the pain gets worse (Finkelstein test).
Tendonitis may be caused by overuse and also can be seen in
association with pregnancy or inflammatory arthritis such as
rheumatoid disease.
If treated early, many cases improve with short periods of rest in a
splint, followed by stretching exercises designed to get the tendons
gliding. Injection with steroids and/or taking anti-inflammatory
medications. More severe cases or those that do not respond to other
treatment may require surgery. Modification of the activities which
caused the symptoms initially also may be required.
Arthritis of the Hand
Wear and tear arthritis is very common at the base of the thumb.
Pain localized to the base of the thumb, particularly with use, is a
very common early symptom. Early disease can be treated with
anti-inflammatory medication, steroid injections into the joint, or
splinting.
As the wear and deformity progress, surgery is frequently required.
There are many procedures to relieve pain and improve function.
Heberden nodes are "bumps" which occur at the last joint of the
finger or thumb due to wear and tear arthritis (osteoarthritis). As
the joints deteriorate, small bone spurs form over the back of the
joints and make them appear "lumpy."
Since most Heberden nodes are not painful and seldom interfere with
function, no specific treatment is usually required. Patients with
pain can be treated with anti-inflammatory medications. All patients
should continue moving their hands; disuse frequently results in
stiffness.
Dupuytren's Contracture
Dupuytren's contracture is a hereditary thickening of the tough
tissue called fascia that lies just below the skin of your palm.
This condition may vary from small lumps or bands to very thick
bands which may eventually pull the fingers into the palm.
Dupuytren's disease is familial, and may be associated with
cigarette smoking, vascular disease, epilepsy, and diabetes.
The mainstay of treatment is surgical and is recommended if there
is progressive contracture drawing the fingers into the hand.
Sometimes a steroid injection will be used in a painful nodule.
Small nodules or lumps in the palm do not need treatment until they
are very large and interfere with hand function. Even with
successful surgical removal, the bands may reappear or occur in
other fingers.
Trigger Finger
Trigger finger is an irritation of the digital sheath which
surrounds the flexor tendons. When the tendon sheath becomes
thickened or swollen it pinches the tendon and prevents it from
gliding smoothly. In some cases the tendon catches and then suddenly
releases as though a "trigger" were released.
Sometimes the swelling can be treated with rest, activity
modification, oral anti-inflammatories, or steroid injections. The
tendon sheath will then return to its normal, pain-free condition.
More severe cases may require surgery to release the tendon. This
can be done as an outpatient procedure. Normal activity can be
resumed as pain allows. More information:
American Association for Hand Surgery
20 North Michigan Avenue, Suite 700
Chicago, IL 60602
Phone:
312-236-3307
Fax: 312-782-0553
Website:
www.handsurgery.org
American Academy of
Orthopaedic Surgeons
6300 North River Road
Rosemont, IL 60018
Phone:
847-823-7186 | 1-800-346-AAOS
Fax: 847-823-8125
Website: www.aaos.org
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