Common Hand Problems

No matter what your age or occupation your hands are always working. Since your hands are so important any abnormality can be a cause for concern. Many common hand problems that interfere with your daily activities can be diagnosed and treated by your orthopaedic surgeon.

Ganglion Cysts
Ganglion cysts 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. If the cyst is painful, however, or is considered by the patient to be unattractive in appearance, your orthopaedic surgeon can remove the fluid with a needle or remove the sac surgically.

Tendonitis of the wrist
DeQuervain's stenosing tenosynovitis is an irritation and swelling of the sheath or tunnel that 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 toward the little finger, the pain gets worse (Finkelstein test).

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 runs in families 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 steriod 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-inflammatory medications 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.