Getting a grip on common hand conditions

Unnoticed and unsung, healthy hands perform countless small tasks, from pouring your morning coffee to brushing your teeth at night. But aching hands transform even a simple task into a painful ordeal. Beneath the skin, your hands are an intricate architecture of tendons, joints, ligaments, nerves, and bones. Each of these structures is vulnerable to damage from illness or injury. Arthritis can make it difficult to carry a shopping bag. Carpal tunnel syndrome can interfere with your work and hobbies. Hand or finger deformities can make basic self-care routines such as getting dressed difficult.

Besides helping you with work and play, hands are also a tool of communication, expression, and emotion. Your hands are the only part of your body that is nearly visible to you and others. People tend to be very conscious about the appearance of their hands, and hand pain or deformity can cause embarrassment and inhibition, triggering feelings of poor self-esteem. And your hands may hurt for a variety of reasons, from the mechanical to neurological. Today’s column describes some of these common hand conditions that produce pain and discomfort — and how to recognize and successfully manage them. The goal is to keep your hands healthy and strong so you can enjoy the pleasures of work, play, communication, and expression for years to come.

Thumb Arthritis

Thumb arthritis occurs when the joint at your wrist and the base of the thumb — the basal or carpometacarpal (CMC) joint — develops osteoarthritis. It usually occurs after age 40 and is more common in women than in men. The shape of these bones allows your thumb to move up and down, bend across the palm, and pinch with each of the fingers. This is the second most common joint to develop osteoarthritis. The last joint of the finger before the nail, the distal interphalangeal (DIP) joint, is the most common site for osteoarthritis of the hands.

Cause: In a normal basal joint, cartilage covers the end of the bones, acting as a cushion and allowing bones to glide smoothly against each other. With thumb, or CMC, arthritis, the cartilage that covers the ends of the bones deteriorates and its smooth surface roughens. The bones then rub against each other, resulting in friction and joint damage. It’s suspected that a combination of factors, including the aging process, previous joint injury, or stress, and heredity, may lead to thumb arthritis. There’s some recent evidence that the female hormone estrogen and the relaxation of the joint ligaments may play a role.

Treatment: Treatment focuses on helping to reduce pain, improve joint movement, and minimize disability. It often includes a combination of self-care measures, such as applying heat to the joint, as well as activity modification, splints, and physical therapy, including exercise. Your doctor may recommend non-steroidal anti-inflammatory drugs (NSAIDs) to decrease inflammation in the joint and relieve pain. Cortisone injections may relieve symptoms. In severe cases, surgery may be necessary.

Trigger Finger

The term trigger finger may conjure up visions of sharpshooters and hunters. Actually, this common condition is so named because of the trigger-like snap that occurs when the finger briefly locks and then suddenly releases as you try to bend or straighten it. In severe cases, your finger may become locked in a bent or straight position.

Cause: A thickening of the liner, or sheath, which surrounds the tendon in the affected finger. A nodule may also form (see illustration). More women than men are affected. Trigger finger also tends to be more common in people whose work or hobbies require repetitive gripping motions or who have certain conditions, such as rheumatoid arthritis, diabetes, and hypothyroidism.

Treatment: For mild cases, treatment may include rest, splinting, finger exercises, modified activities, warm water soaks, and stretching. Persistent cases may call for NSAIDs or the injection of cortisone to relieve inflammation and swelling that’s constricting the tendon sheath. If the locking doesn’t respond to other treatments, surgery can release the affected tendon.

Ganglion Cyst

Ganglion cysts usually appear as raised lumps near your wrists or finger joints. These non-cancerous, fluid-filled lumps, which typically develop along the tendons or joints of your wrists or hands, are often painless. However, ganglion cysts can cause pain, weakness or numbness in your hand if they put pressure on nerves near a joint. They may wax and wane in size.

Cause: The cause isn’t clear. But the cysts are more common in women than men. You may also be at greater risk if you have osteoarthritis or have injured the joints or tendons in your hands.

Treatment: An old-time treatment for these cysts was to hit them with a heavy book, which is why they’re also known as “bible cysts.” Don’t try this, however — it’s not effective, and you could fracture your wrist! Often, no treatment is required. Sometimes, just changing how you use your hand will cause a cyst to shrink. However, if a cyst is causing pain or interfering with a joint movement, your doctor may puncture the cyst with a needle and remove the fluid with a syringe. In some cases, surgery to remove the cyst may be recommended.

De Quervain’s Tendinitis Or Tenosynovitis

The most common signs and symptoms of wrist tendonitis, called de Quervain’s tenosynovitis, are pain and swelling about a half-inch back from the base of the thumb. The main symptom is pain over the thumb side of the wrist, which can appear gradually or suddenly and may move up to the forearm. Without treatment, the pain worsens when you pinch or grasp things or twist your wrist. You may notice swelling over the affected tendon.

Cause: This form of tendonitis is caused by the irritation and swelling of the sheath that surrounds the major tendons connecting your wrist and lower thumb. This problem can be the result of overusing your wrist and thumb together. In fact, de Quervain’s is sometimes called “new mother’s” disease because it’s often seen in mothers (and fathers) who pick up infants with their thumbs out and wrists bent forward.

Treatment: Initial treatments include resting the thumb and wrist by wearing a splint. Your doctor may also recommend anti-inflammatory medicines to curb pain and swelling. Steroid injections into the tendon compartment may help. If all these measures fail to improve your symptoms, surgery (which releases the tendon sheath) is often successful.

Mallet Finger

The extensor tendons, which allow you to straighten your fingers and thumb, are just under the skin on the back of your hand and fingers. Because of their location, they can easily be injured, even by a minor cut. If the tip of your finger is hit with enough force that it bends down toward the palm, the tendon can tear (see illustration).

Cause: One common cause is a fast-moving baseball, which is why the injury (at least in the US) is known as baseball finger. In the Philippines, basketball is probably a more common cause. Also called a mallet finger, this tendon injury can leave the top of your finger, near the fingernail, tender, painful, and slightly swollen. If the tendon is fully detached from the bone, you won’t be able to straighten your finger, which may hang down in an abnormal position.

Treatment: The treatment of an extensor tendon tear involves wearing a splint to keep the end joint stable for six to eight weeks. Cut or torn tendons need to be repaired. You will need to wear a splint for up to two months and you will need physical and occupational therapy treatments later, including special exercises to aid healing and maintain motion.

Seeing A Doctor

It’s important to talk with your doctor about any new pain, swelling or other abnormality that’s affecting your hands. Depending on the hand condition, you may need a rheumatologist, orthopedic surgeon, physiatrist (a specialist in physical medicine and rehabilitation), or plastic (hand) surgeon, to consult with. Also a good hand therapist can teach you how to care for a disabled hand, improve your ability to use it and, in some instances, recover quickly from surgery.