Surgical & Non-Surgical Treatments for the Hand -- August 15, 20 - | Nashville News, Weather & Sports

Surgical & Non-Surgical Treatments for the Hand -- August 15, 2011 -- Dr. Tom Dovan

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TOPIC: Surgical & Non-Surgical Treatments for the Hand
Tom Dovan, MD: orthopaedic hand surgeon


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Everyone has had a minor problem with a finger, hand, or wrist. Most of the time our body movements do not cause problems, but it's not surprising that symptoms occur from everyday wear and tear, or overuse. Finger, hand, or wrist problems can also be caused by injuries or the natural process of aging.

Your fingers, hands, or wrists may burn, sting, or hurt, or feel tired, sore, stiff, numb, tingly , hot, or cold. Maybe you can't move them as well as usual, or they are swollen. Perhaps your hands have turned a different color, such as red, pale, or blue. A lump or bump might have appeared on your wrist, palm, or fingers. Home treatment is often all that is needed to relieve your symptoms.

Finger, hand, or wrist problems may be caused by an injury. If you think an injury caused your problem, see the topic Finger, Hand, and Wrist Injuries. But there are many other causes of finger, hand, or wrist problems.

Overuse problems

  • Carpal tunnel syndrome is caused by pressure on a nerve (median nerve ) in the wrist. The symptoms include tingling, numbness, weakness, or pain of the fingers and hand.
  • Tendon pain is actually a symptom of tendinosis, a series of very small tears (microtears) in the tissue in or around the tendon. In addition to pain and tenderness, common symptoms of tendon injury include decreased strength and movement in the affected area.
  • De Quervain's disease can occur in the hand and wrist when tendons and the tendon covering (sheath) on the thumb side of the wrist swell and become inflamed.
  • Repetitive motion syndrome is a term used to describe symptoms such as pain, swelling, or tenderness that occur from repeating the same motion over and over.
  • Writer's cramps develop with repeated hand or finger motion, such as writing or typing.
  • Trigger finger or trigger thumb is a tendon problem

Bone, muscle, or joint problems

  • Dupuytren's disease is an abnormal thickening of tissue beneath the skin in the palm of the hand or hands and occasionally the soles of the feet. The thickened skin and tendons (palmar fascia) may eventually limit movement or cause the fingers to bend so that they can't be straightened.
  • Trigger finger or trigger thumb occurs when the flexor tendon and its sheath in a finger or thumb thicken or swell.
  • Ganglion cysts are small sacs (cysts) filled with clear, jellylike fluid that often appear as bumps on the hands and wrists but can also develop on feet, ankles, knees, or shoulders.

Problems from medical conditions

  • Tingling or pain in the fingers or hand (especially the left hand) may be signs of a heart attack.
  • Diabetes may change how the hands normally feel or sense touch. Decreased feeling in the hands is common because of decreased blood flow to the hands or damage to nerves of the hand .
  • Pregnancy may cause redness, itching, swelling, numbness, or tingling that often goes away after delivery.
  • Osteoarthritis is the progressive breakdown of the tissue that protects and cushions joints (cartilage). It may cause stiffness and pain with movement.
  • Rheumatoid arthritis may cause stiffness and pain with movement. Over time, deformity of the fingers may occur.
  • Lupus is a long-lasting autoimmune disease in which the immune system attacks normal body tissues as though they were foreign substances. It may cause joint pain.
  • Gout is an inflammatory joint disease that causes acute pain and swelling. It is a form of arthritis that develops when uric acid crystals form in and around the joints, commonly affecting the big toe joint.
  • Raynaud's phenomenon is a condition in which some areas of the body, usually the fingers or toes, have an extreme response to cold temperature or emotional stress. During an attack of Raynaud's, the blood vessels in the affected areas tighten, severely limiting the flow of blood to the skin, causing numbness, tingling, swelling, pain, and pale color.
  • Infection can cause pain, redness, and swelling that occur with red streaking, heat, fever, or the drainage of pus. An infection often causes tenderness to the touch or pain with movement at the site of the infection.

Further Reading:

What is carpal tunnel syndrome?

Carpal tunnel syndrome is the term used to describe a combination of tingling, numbness, weakness, or pain in the fingers, thumb, or palm, and sometimes in the forearm. These symptoms occur when there is pressure on a nerve (median nerve) at the wrist (carpal tunnel). .

Carpal tunnel syndrome can often be linked to repetitive hand and wrist motion. Swelling in the wrist area, as during pregnancy or caused by a medical condition, can also cause or contribute to carpal tunnel symptoms. Chronic and severe carpal tunnel syndrome can lead to permanent nerve damage, pain, and muscle weakness and wasting (atrophy).

What are the risks of chronic, severe carpal tunnel syndrome?

Long-standing carpal tunnel syndrome can cause:

  • A loss of feeling and coordination in the fingers and hand. The thumb muscles can become weak and waste away (atrophy), making it difficult to grip or hold objects.
  • Permanent damage to the median nerve that results in difficulty using the hand. A damaged nerve may require surgery, which may not completely restore the feeling and coordination to the fingers and hand.

What kind of surgery is done for carpal tunnel syndrome?

The goal of surgery is to reduce the pressure on the median nerve in the wrist. The surgery used to relieve carpal tunnel symptoms is called carpal tunnel release . This procedure involves cutting the transverse carpal ligament to relieve pressure on the median nerve in the wrist.

Two approaches for this surgery are open and endoscopic. Each has advantages and disadvantages. When done by an experienced surgeon, endoscopic carpal tunnel release heals more quickly and does not leave the larger and potentially painful scar that open surgery produces.


How does surgical treatment success compare with wrist splint therapy?

Research suggests that for people with severe symptoms, open carpal tunnel release surgery provides more relief to more people than wearing a wrist splint at night for 6 weeks. In one study:2

  • At 3 months after treatment, 80% of surgery recipients and 54% of splint therapy recipients reported successful relief of severe symptoms.
  • At 18 months after treatment, 90% of surgery recipients and 75% of splint therapy recipients reported treatment success.
  • At 18 months after treatment, 41% of splint therapy recipients had since chosen surgery.


Arthritis and Trigger Finger

Trigger finger and thumb are painful conditions that cause the fingers or thumb to catch or lock in a bent position. The problems often stem from inflammation of tendons that are located within a protective covering called the tendon sheath.

The affected tendons are tough, fibrous bands of tissue that connect the muscles of the forearm to your finger and thumb bones. Together, the tendons and muscles allow you to bend and extend your fingers and thumb, for example, as in making a fist.

A tendon usually glides quite easily through the tissue that covers it (also called a sheath) because of a lubricating membrane surrounding the joint called the synovium. Occasionally a tendon may become inflamed and swollen. When this happens, bending the finger or thumb may pull the inflamed portion through a narrowed tendon sheath, making it snap or pop.


What Causes Trigger Finger?

Trigger finger may be caused by highly repetitive or forceful use of the finger and thumb. Medical conditions that cause changes in tissues -- such as rheumatoid arthritis, gout, or diabetes -- also may result in trigger finger. Prolonged, strenuous grasping, such as with power tools, also may aggravate the condition.

Who Gets Trigger Finger?

Farmers, industrial workers, and musicians are frequently affected by trigger finger since they rely on their fingers or thumbs for multiple repetitive movements. Trigger finger is more common in women than in men and tends to occur most frequently in people who are between 40 and 60 years of age.

What Are the Symptoms of Trigger Finger?

One of the first symptoms may be soreness at the base of the finger or thumb. The most common symptom is a painful clicking or snapping when attempting to flex or extend the affected finger. This catching sensation tends to worsen after periods of inactivity and loosen up with movement.

In some cases, the finger or thumb that is affected locks in a flexed position or in an extended position as the condition becomes more severe, and must be gently straightened with the other hand. Joint contraction or stiffening may eventually occur.

How Is Trigger Finger Diagnosed?

No X-rays or lab tests are used to diagnose trigger finger. It is generally diagnosed following a physical exam of the hand and fingers. In some cases, the affected finger may be swollen and there may be a nodule, or bump, over the joint in the palm of the hand. The finger also may be locked in a flexed (bent) position, or it may be stiff and painful.

How Is Trigger Finger Treated?

The first step to recovery is to limit activities that aggravate trigger finger. Occasionally, your doctor may put a splint on the affected hand to restrict the joint movement. If symptoms continue, anti-inflammatory medications, such as ibuprofen or naproxen, may be prescribed. Your doctor may also recommend an injection of a steroid medication into the tendon sheath. If the condition does not respond to conservative measures or consistently recurs, surgery may be recommended to release the tendon sheath and restore movement.

How Long Does Recovery From Trigger Finger Take?

The time it takes to recover from trigger finger depends on the severity of the condition, which varies from person to person. The choice of treatment also impacts recovery time. For example, splinting may be necessary for six weeks. However, most patients with trigger finger recover within a few weeks by resting and limiting the use of the affected finger and/or using anti-inflammatory medications.

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