Thumb Arthritis & Injury

handsurgerypc_hand_care_thumb_arthritis_injuryThe most common form of arthritis in the thumb is osteoarthritis. It often begins with pain and swelling at the base of the thumb. The joint where the thumb meets the wrist is called the basal joint, or carpometacarpal joint of the thumb. This joint is very important for moving the thumb out of the palm. It allows a person to be prehensile which means placing the thumb in a position to oppose the tips of the digits.

The pain is aggravated when the person pinches: as in pulling up pants, turning a key in the door, taking a pot off the stove, and driving. In evaluating and planning treatment, one must distinguish between arthritis in the thumb, a trigger thumb, and arthritis in the wrist.

There is a classification of severity Stage 1 to Stage 4 based on the x-rays of the thumb. Much can be done to diminish the pain and improve function for patients with arthritis in their thumb. At Boston Hand to Shoulder, in Newton, MA, our doctors will evaluate your case and determine the right arthritis treatment to diminish the pain and improve function for you.

Dupuytren's Contracture

Dupuytren’s contracture (or disease) is an abnormal thickening of the fascia. The involved fascia is a tissue that under the skin lines the palms of the hands and soles of the feet. While it often starts as painless lumps or nodules in the palm, it can develop into cords in the palm that bend the fingers and prevent straightening. The lumps can occur on the back of the hand in the middle knuckles of the fingers. In this location they are called dorsal knuckle pads.

Most people with a few nodules and no contractures, are evaluated regularly looking for cords and contractures to develop. Treatment is usually reserved for patients who develop bent fingers which interfere with function. Traditional treatment for many years has been open surgery (fasciectomy) to remove the cords and help the fingers straighten. While some patients still require surgery, newer minimally invasive methods are now available.

In 2008, Boston Hand to Shoulder participated in the published multicenter national study the introduced collagenase (Xiaflex) in the treatment of Dupuytren’s Cords, Since 2010, we have been using collagenase injections to rupture the cords and improve motion and function.

Arthritis of the Hand

Arthritis literally means "inflamed joint." A normal joint consists of two bones that are hinged together covered with a specialized cushioning cartilage that creates a smooth surface. Arthritis makes the surfaces irregular and at times like "sandpaper rubbing sandpaper." Arthritis can affect any joint in the body.

handsurgerypc_hand_care_arthritis_of_the_handTreatment is directed to relieve pain and improve function. Medical management includes anti-inflammatory medications such as ibuprofen and nutritional supplements including glucosamine and chondroitin sulfate. Hand therapists offer a range of modalities to comfort the patient. Splinting the joints offers rest and supplemented with heat (hot wax and hot shower) often diminishes the discomfort of arthritis. Finding a balance between rest and exercise is critical for patient comfort. On occasion injections with cortisone or supplements such as hyaluronic acid relieve the pain temporarily. What is new is the use of PRP, platelet rich plasma, for arthritis. This modality is still evolving and not covered by insurance.

Surgery is indicated if other treatments have failed to adequately relieve pain. For the DIP joints, fusion is recommended. This procedure eliminates pain while making the joint permanently stiff. The degenerated joint surfaces are removed and the raw bone ends internally fixed with wires or a screw.

For severe arthritis at the base of the thumb joint, reconstruction is done to relieve pain and restore motion and function. The new joint, an arthroplasty, does not require implants but the use of the patient’s own tissues. The remarkable relief patients experience justifies the role of surgery for this disabling form of arthritis.

» To learn more about Arthritis, click here.

Carpal Tunnel

Carpal tunnel syndrome is a common condition that causes numbness and tingling in the thumb, index, middle and half the ring fingers. Symptoms usually start at night, awakening with painful tingling in the hand. Driving, computing, holding a book or newspaper, and other repetitive tasks can aggravate the condition. The problem is entrapment of the median nerve in the carpal tunnel. The nerve compression results usually from the swelling of the lining of the nine tendons that pass along with the median nerve through the carpal tunnel.

Trigger Finger

Trigger finger is a condition that involves one of the fingers becoming stuck in a bent position and then rapidly straightened like the trigger of a gun. This condition is caused by a narrowing of the sheath that surrounds the tendons in the finger, and is common in people who perform repetitive gripping actions. It is also more common in women and people with diabetes. Trigger finger causes stiffness, pain and may eventually lead to an inability to completely straighten the finger.

Mild cases of trigger finger can often be treated through conservative home methods such as rest, finger exercises and avoiding repetitive movements. More severe cases may need anti-inflammatory medication, steroids or surgery. One of our doctors will help you decide which treatment is best for you depending on your individual case.

Arthritis of the Finger Joints

The large knuckles in the hand are called the metacarpophalageal (MP) joints. They are important in making a fist, gripping things, and opening the hand. Osteoarthritis (OA) and more commonly rheumatoid arthritis (RA) can damage the joint surface of these joints.

Arthritis of the MP joints causes pain and weakness of grip. The joints can swell and appear larger. The diagnosis is made by history, physical examination, and careful x-rays of the joints. Laboratory studies are used to assess for rheumatoid arthritis.

Nail Bed Injuries

handsurgerypc_hand_care_nail_bed_injuriesInjuries to the hardened nail plate and the underlying nail bed (soft nail matrix) often occur secondary to crush injuries of the fingertip. There may associated fractures of the bone (distal phalanx) on which the nail rests, lacerations of the skin of the fingertip (pulp, nail folds, and cuticle), and the nerves and tendons to the fingertip.

These injuries are common in children and result when the fingertip gets caught in a door. Car door injuries occur in adults.

 

The severity of the injury varies. Simple crushes of the fingertip may create a painful collection of blood (hematoma) under the nail. More severe injuries cause complex injuries to the underlying nail bed and bone.

Treatment is based on the extent of injury. X-rays are obtained in our office to look for associated fractures. Often administering local anesthetic to the finger in the office is performed to help the patient be comfortable while the extent of injury is evaluated.

Fractures

The hand is a complex structure made up of 27 different bones. A hand fracture can occur as a result of a direct blow to the hand or a fall onto outstretched hands. The most common hand fractures include injury to the pinkie side of the palm or the thumb.

Patients with a hand fracture often experience:

  • Pain
  • Swelling
  • Tenderness
  • Physical deformity

  • Inability to move the fingers
  • Shortened fingers
  • Depressed knuckle

These symptoms can vary depending on which bone in the hand is broken.

It is important for patients to seek medical attention for a hand injury, even if it appears to be minor. Function of the hand relies on the proper alignment of the bones within it, so it is important to determine whether or not those bones have been moved as a result of your injury. Your doctor can diagnose a hand fracture physically examining the motion of the hand and position of the fingers, and also by performing an x-ray exam to confirm this diagnosis.

Treatment for a hand fracture can usually be performed through nonsurgical methods that include immobilizing the broken bones in a brace or cast. Patients will be required to wear this for three to six weeks as the bones heal, and may perform hand exercises once it is removed to restore function to the hand. Surgery may be required for severe fractures in order to realign the bones, which may require the use of wires, screws or plates.

Hand Tumors

handsurgerypc_hand_care_hand_tumorsAn abnormal lump or bump, or “mass," is considered a tumor. Tumors can occur on the skin, such as a mole or a wart, or can occur underneath the skin in the soft tissue or even the bone. Because there are so many tissue types in the hand (e.g. skin, fat, ligaments, tendons, nerves, blood vessels, bone, etc) there are many types of tumors that can occur. Some are more common than others.

Often, surgery is done under a local or regional anesthesia (numbing the extremity or area) and on an outpatient basis. Some patients may choose to do nothing and simply live with the tumor once they learn that it is probably benign. However, if the tumor changes (i.e., skin discoloration, pain, increased size) or if it causes problems with nearby structures (for example, numbness or pain from pressure on a nearby nerve) treatment is recommended. We will provide you information and advice to allow you to make the best decision regarding treatment.

Tendons & Nerve Injuries

The tendons and nerves within your hands and wrists are sensitive structures that may be susceptible to several different types of conditions when they are irritated or impinged by certain factors. Pressure on these structures caused by obesity, stress, injury or overuse can cause painful symptoms that are further aggravated by the constant use of our hands and wrists, and may interfere with performing simple tasks in your everyday life.

These conditions, such as tendonitis, carpal tunnel syndrome or DeQuervain's disease, can cause pain, swelling, stiffness, weakness, numbness and tingling in the wrist, hand and fingers, and sometimes radiating through the arm as well. Tendonitis of the wrist involves irritation and swelling of the tissues surrounding the tendons of the wrist and thumb. This usually causes pain in the front of the wrist and when bending or extending it.

Damaged tendons and nerves can usually be effectively treated through conservative methods that may include rest, immobilization, physical therapy or over-the-counter medications. More severe cases may require surgery to repair damage that does not respond to other treatments. Most nerve and tendon damage can be repaired, so it is important to seek thorough medical treatment in order to prevent permanent damage.

You can prevent many tendon and nerve issues by taking regular breaks from working, exercising your hands to promote strength and mobility, and practicing correct posture and form while working. Talk to your doctor to learn more about how to prevent these conditions.