The hands and arms are the body’s workhorses. Some conditions that affect the hand include:
- Dupuytren’s contracture
- Fractures of the hand and wrist
Dupuytren’s contracture is a fairly common condition that occurs when the connective tissue or fascia under the skin begins to thicken and shorten. As the tissue tightens, it may pull the fingers down towards the palm of the hand. In some individuals, the condition may progress until the involved fingers become disabled.
The first sign is a thickening or nodule in the palm of the hand that most frequently develops near the base of the ring or little finger. The nodule, which can resemble a callus, may be tender to the touch. Gradually, other nodules may develop and extend a contracture across the first joint into the finger. The overlying skin begins to pucker, and rough cords of tissue extend into the finger. As the process continues, these cords tighten and pull the finger in toward the palm.
The ring finger is usually affected first, followed by the little, long and index fingers. The problem is not pain, but the restriction of motion and the deformity it causes.
Incidence increases after the age of 40. At this age men are affected more often than women. After the age of 80 men and women are affected equally.
Dupuytren’s disease primarily affects:
- People of Scandinavian or Northern European ancestry
- Men rather than women (men are ten times as likely to develop the condition)
- People over the age of 40
- People with a family history
- People with liver cirrhosis
Often no treatment for Dupuytren’s contracture is necessary, but even with treatment there is no permanent way to stop or cure the condition. Amputation of fingers may be required for severe or recurrent disease, or as a complication of surgical treatment.
Hand and Wrist Fractures
The bones in a normal hand line up precisely, letting you perform many specialized functions like grasping a pen or manipulating small objects in your palm. When you fracture a finger bone, it can put your whole hand out of alignment. Without treatment, your broken finger may stay stiff and painful.
Sometimes a bone can break without you realizing it. That’s usually what happens to the scaphoid bone in your wrist, a boat-shaped bone located on the outermost side of the thumb side of the hand. Many people with a fractured scaphoid think they have a sprained wrist instead of a broken bone because there is no obvious deformity and very little swelling.
Signs and symptoms of a fracture in the bones of your hand or wrist include pain and tenderness and swelling. If you have a finger fracture, you may be unable to move your finger. Other indications of a finger fracture are a shortened finger, a depressed knuckle or if your finger crosses over an adjacent finger when you make a partial fist.
If you have a wrist fracture, you may be unable to hold a grip. Other signs of a wrist fracture are pain that may subside, then return as a deep, dull aching and marked tenderness when pressure is applied on the side of the hand between two tendons that lead to the thumb.
To treat the fracture, your doctor will put your broken bone back into place, usually without surgery. You’ll get a splint or cast to hold your finger or wrist straight and protect it from further injury while it heals.
Some bones – such as the scaphoid in the wrist – do not readily heal without surgery. Others – such as the distal radius in the outermost part of forearm – commonly require bone alignment with arthroscopic imaging using a flexible viewing tube inserted in the joint or radiographic imaging, and stabilizing with special bone screws, plates, pins or other devices.
Osteoarthritis of the Hand
Osteoarthritis is a degenerative joint disease in which the cushioning cartilage that covers the bone surfaces at joints begins to wear out. It may be caused by simple “wear and tear” on joints, or it may develop after an injury. Arthritis of the hand can be both painful and disabling.
Symptoms include stiffness, swelling, loss of motion and pain. Bony nodules, which are small knots or swellings, may develop. When at the middle joint of one or more fingers, these swellings are called Bouchard’s nodes. When located at the fingertip, they are called Heberden’s nodes. The joints become enlarged and the fingers crooked.
Osteoarthritis (of all types) affects nearly 27 million people in North America. It is estimated that 80% of the population have radiographic evidence of OA by age 65, although only 60% of those will have symptoms.
Treatment is designed to relieve pain and restore function. Anti-inflammatory medications such as aspirin or ibuprofen may help reduce swelling and relieve pain. Prescription medications or steroid (cortisone) injections may be recommended.
Your physician may refer you to a physical or occupational therapist, as changing the way you do things with your hands may help relieve pain and pressure. If conservative measures fail, surgery may be necessary. Several surgical options are available:
- Surgery may be used to drain or remove the cysts associated with the nodes and to remove excess bone growth.
- Joint fusion, a way of stiffening the problem joint, may be used to correct deformities that interfere with function or that are cosmetically unacceptable.
- A joint replacement may be advised.