Hand Injuries & Treatments -- April 14, 2008 -- Dr. Tom Dovan - NewsChannel5.com | Nashville News, Weather & Sports

MEDICAL MONDAYS NEWS NOTES
Tom Dovan, MD orthopaedic surgeon
BAPTIST HOSPITAL
TOPIC: Surgical & Non-Surgical Treatments of the Hand
April 14, 2008  

What is a Hand Surgeon?

Our hands serve many purposes. Hands help us eat, dress, write, earn a living, create art, and do many other activities. To do these activities, our hands require sensation and movement, such as joint motion, tendon gliding, and muscle contraction. When a problem takes place in the hand, care must be given to all the different types of tissues that make function of the hand possible.

What do hand surgeons do?

Hand surgery is the field of medicine that deals with problems of the hand, wrist, and forearm. Hand surgeons care for these problems with and without surgery. They are specially trained to operate when necessary. Many hand surgeons are also experts in diagnosing and caring for shoulder and elbow problems.

Hand surgeons are orthopaedic, plastic, or general surgeons who have additional training in surgery of the hand. To become members of the American Society for Surgery of the Hand, hand surgeons must take a full year of additional training and must pass a rigorous certifying examination.

Some hand surgeons treat only children, some treat only adults, and some treat both. Because many hand surgeons devote most of their time to examining, treating and studying the hand, they are specialists in hand care.

Why visit a hand surgeon?

When a problem takes place in the hand, care must be given to all the different types of tissues that make function of the hand possible.

Not every visit to a hand surgeon results in hand surgery.

Hand surgeons often recommend non-surgical treatment options to assist you. Sometimes, they may refer you to a hand therapist for more treatment.

Hand surgeons are specialists in hand care.

If you have pain in your fingers, hand, wrist or arm, or have other upper-extremity related concerns, you may want to consult a hand surgeon.

Examples of conditions treated by a hand surgeon are:

• Carpal tunnel syndrome
• Wrist pain
• Cuts on the fingers and hand
• Sports injuries to the hand and wrist
• Creating fingers from toes and other joints

Topic Overview

At one time or another, everyone has had a minor injury to a finger, hand, or wrist that caused pain or swelling. Most of the time our body movements do not cause problems, but it's not surprising that symptoms develop from everyday wear and tear, overuse, or an injury.

Finger, hand, or wrist injuries most commonly occur during:

• Sports or recreational activities.
• Work-related tasks.
• Work or projects around the home, especially if using machinery such as lawn mowers, snow blowers, or hand tools.
• Accidental falls.
• Fistfights.

The risk of finger, hand, or wrist injury is higher in contact sports, such as wrestling, football, or soccer, and in high-speed sports, such as biking, in-line skating, skiing, snowboarding, and skateboarding. Sports that require weight-bearing on the hands and arms, such as gymnastics, can increase the risk for injury. Sports that use hand equipment such as ski poles, hockey or lacrosse sticks, or racquets also increase the risk of injury.

In children, most finger, hand, or wrist injuries occur during sports or play or from accidental falls. Any injury occurring at the end of a long bone near a joint may injure the growth plate (physis) and needs to be evaluated.

Older adults are at higher risk for injuries and fractures because they lose muscle mass and bone strength (osteopenia) as they age. They also have more problems with vision and balance, which increases their risk of accidental injury.

Most minor injuries will heal on their own, and home treatment is usually all that is needed to relieve symptoms and promote healing.

Sudden (acute) injury

An acute injury may occur from a direct blow, a penetrating injury, a fall, or from twisting, jerking, jamming, or bending a limb abnormally. Pain may be sudden and severe. Bruising and swelling may develop soon after the injury. Acute injuries include:

• Bruises. After a wrist or hand injury, bruising may extend to the fingers from the effects of gravity. See an illustration of a bruise (contusion) .
• Injuries to ligaments. See an illustration of a torn thumb ligament as in skier's thumb.
• Injuries to tendons, such as mallet finger.
• Injuries to joints (sprains).
• Pulled muscles (strains).
• Broken bones (fractures), such as a wrist fracture .
• Dislocations.
• Crushing injury, which can lead to compartment syndrome.

Overuse injuries

Overuse injuries occur when too much stress is placed on a joint or other tissue, often by "overdoing" an activity or repeating the same activity. Overuse injuries include the following:

• 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. See an illustration of carpal tunnel syndrome .
• 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. See an illustration of de Quervain's disease .

Treatment

For a finger, hand, or wrist injury may include first aid measures; medication; "buddy-taping" for support; application of a brace, splint, or cast, physical therapy; and in some cases, surgery. Treatment depends on:

• The location, type, and severity of the injury.
• How long ago the injury occurred.
• Your age, health condition, and activities (such as work, sports, or hobbies).

Dupuytren's Disease - Surgery

Surgery is the main treatment option for severe cases of Dupuytren's disease. The goal of surgery is to restore the use of your fingers and hand. In most cases, surgery removes the diseased soft-tissue bands that connect your finger joints to the palm, and may involve a skin graft. Total hand function may not be completely restored by surgery. Even with successful surgery, thickened palm tissue may develop again in the same place or in a new area of the hands. Reoperation is often necessary to maintain hand function.

You may improve the outcome if you do postsurgical rehabilitation with finger exercises and splints, as directed by your health professional.

Should I have surgery for Dupuytren's disease?

Surgery Choices

Depending on your condition, your surgeon will choose one of the following surgical procedures:⁶

• Fasciectomy. Removal of the affected tissue (fascia) is the most common procedure.
• Fasciotomy. The cords of fiber in the palm are divided through small incisions. This procedure is reserved for people who cannot have more extensive surgery or general anesthesia.
• Amputation. Removal of one or more fingers is rarely needed but may be done if earlier procedures have resulted in nerve or vessel damage or the disease has recurred repeatedly and severe contracture exists.

What To Think About

Your decision whether to have surgery should consider:

• Presence of any other health conditions or diseases, such as diabetes.
• Willingness to undergo postsurgery rehabilitation, which is necessary in order to restore hand function.
• The severity of the loss of function and how you are affected in your daily activities.
• Age. The risk of complications and treatment failure are greater with advanced age.

Needle aponeurotomy is a form of fasciotomy that is done as an outpatient procedure with local anesthesia. While it has been done for several years in France, it is just being introduced in the United States. This procedure only partially corrects pulling or contracture between the fingers and the palm. Also there is chance of damaging nerves of the adjacent fingers and there is a high chance the contracture will come back.