COMMON HAND CONDITIONS
A SELECTION OF TYPICAL HAND CONDITIONS
Carpal tunnel syndrome
This condition is most common in women in their 50s and men with heavy physical jobs. It is also common in pregnancy. Characterised by numbness in the hand and occasionally pain radiating from the forearm to the shoulder, it is fortunately a very treatable condition.
This condition is characterised by nodules in the palm which progress to pull the fingers down into a contracted position. There is a strong genetic predisposition to this condition and it is most common in northern Europeans. It is a very slowly progressive condition and there is never any urgency to treat it. Interference with daily function would be an indication for treatment. Common functional impairments would include an inability to get clothes on, awkwardness when shaking hands or face washing.
This is one of the commonest condition seen by hand surgeons. The finger may lock in flexion, most commonly in the morning. During the day there maybe an annoying and painful click as the finger flexes and extends. Steroid injection is a very effective primary treatment and may be curative in 70 to 80% of cases. Occasionally a 2nd injection is required, and if the condition persists a surgical release under local anaesthetic is a day case will usually cure the condition. Some patients are unfortunately afflicted by this condition in more than one digit.
Patients who are stressing their wrists were often get inflammation around the tendons of the rest. Lifting small babies will often cause pain at the base of the thumb which is known as DeQuervain’s tendinitis. Sports which stress the wrist will often cause inflammation in the sense trawled dorsal part of the wrist or towards the little finger (ulnar) side of the wrist.
The central pain is usually caused by impingement, which is essentially entrapment of soft tissue. The pain on the ulnar side of the wrist is usually caused by inflammation of the extensor carpi ulnaris (ECU) tendon. An MRI scan will often shared more light on this diagnosis. Both of these conditions can be treated by steroid injection.
NUMBNESS IN THE HAND
TYPICAL CAUSES OF NUMBNESS IN THE HAND
Carpal tunnel syndrome
Patients commonly present with numbness and tingling in the thumb, index and middle finger. There is sometimes a pain in the forearm which can radiate to the shoulder. The symptoms come on commonly at night, or when holding a book or telephone or steering wheel. The underlying cause is inflammation in the flexor tendons that share the same tunnel with the median nerve. This is another condition which is common in patients with busy hands. The diagnosis is proven by clinical examination, electrical tests, and occasionally ultrasound. Treatments include splinting, physiotherapy, acupuncture, steroid injections, and surgical decompression.
Cubital tunnel syndrome
This condition commonly presents with numbness in the little finger and weakness in the small muscles other hand. It is caused by entrapment of the ulnar nerve at the elbow, on the inner side, commonly referred to as the ‘funnybone’. The diagnosis is proven by nerve conduction studies. Treatment is usually by surgical decompression.
Cervical nerve root entrapment
This is the commonest differential diagnosis for the two conditions above. If the symptoms do not quite fit with the diagnoses above or the nerve conduction studies are negative, it is usual to perform an MRI scan of the neck to exclude a protruding disc pressing one of the nerve roots to the hand. This can usually be treated by physiotherapy.
COMMON WRIST-RELATED SYMPTOMS & CAUSES
Pain in the wrist
Acute pain in the wrist is most commonly caused by a fall onto the outstretched hand. As this is, unfortunately, a fairly common experience for most of us, minor sprains of the wrist a well known to settle uneventfully after a few days. Most patients correctly identify when the pain is a little worse than this and identify when they may have sustained a fracture. Bruising and swelling are frequent features of a wrist fracture, but fractures can occur without these signs being present.
There are no wrist injuries that need to be treated within 48 hour is apart from open fractures, dislocations, and injuries where there is altered circulation or sensation. Fortunately most of these more severe injuries are obvious and patients direct themselves immediately to an emergency department or minor injuries unit. If the pain has settled promptly in 48 hours then no further action needs to be taken. If doubt remains then a clinical examination and possibly further investigations are indicated.
The commonest causes of wrist pain after a fall that feels more like a sprain than a fracture, but that fails to settle in 48 hours, are:
scapholunate ligament injury
triangular fibro cartilage complex (TFCC) injury
extrinsic ligament injury
All of the above can be identified by a combination of clinical examination and xrays and scans were necessary.
Chronic pain in the wrist
This may occur as a result of a previous injury. Undiagnosed fractures or injuries to the scapholunate ligament or TF CC are the common causes of persistent pain. If pain persists for longer than 3 months after an injury and the cause is not clear then a wrist arthroscopy may be indicated.
If there is no history of injury then the common causes are:
In addition to physical examination, further imaging in the form of scans and xrays will help to establish the cause in these cases and occasionally blood tests will be required.
STIFFNESS IN THE HAND
CAUSES OF STIFFNESS IN THE HAND
What is stiffness in the hand?
The commonest cause of stiffness in the hand is inflammation in the flexor tendons. This is often called flexor tendinitis. This is surprisingly common in patients with diabetes. It is also common in patients who have jobs where their hands are particularly busy. They can be generalised inability to fully extend the fingers or perhaps just one finger. It is commonly worse in the morning when the swelling has had a chance to develop overnight. Patients sometimes experience triggering whether tendon flicks into extension. If this does not settle then steroid injections can be very effective. If particularly refractory surgical intervention is sometimes required.
A progressive inability to fully extended finger may also be due to Dupuytren’s contracture. There is a genetic element to this condition. Again it is more common in patients with busy hands. Minor trauma seems to accelerate its progression. This is generally a very benign condition and treatments range from injection with an enzyme and rupture 1 to 2 days later, cutting the cord with a needle, or open surgery. An inability to place the hand flat on the table with good palm contact is often stated as an indication for intervention.
Isolated stiffness of finger joints may be due to wear and tear change. If the stiffness follows an injury to the joint then a soft tissue contracture of the joint can sometimes be improved by surgical release.
Specialised physiotherapy, or hand therapy, is often required after interventions for stiff fingers, and sometimes prior to intervention.