HAND
* What should I do if my hand is hurting? [back to the top]
There are a variety of causes of hand pain if you have not had a severe injury. These can include pressure o nerves and/or tendons. These problems can lead to loss of function. Dr. Hawkins – Rivers our new associate can assist in the evaluation of hand pain; he has just completed a fellowship in hand surgery at Baylor University in Houston, TX.
If you have any questions about this topic, please contact your family
physician or call our office for further information. We accept all major
insurances.
F. Andrew Morfesis, M.D., F.A.C.S.
Owen Drive Surgical Clinic of Fayetteville
513 Owen Drive, Fayetteville, NC 28304
(910) 323-0101
* What is repetitive motion injury? [back to the top]
Repeated movements over years can lead to pain in the hand, injured nerves (carpal tunnel syndrome), locking of fingers (trigger finger), loss of movement or pain especially affecting the thumb. Many of these conditions can be improved with simple treatment. Treatments including injections, medications and/or surgery can reduce pain and improve function.
* What is Carpal Tunnel Syndrome? [back to the top]
Carpal Tunnel Syndrome is a compression of the median nerve usually caused by the carpal canal. The symptoms of carpal tunnel vary from mild numbness and tingling in the fingertips to pain and muscle wasting of the thumb area. The thumb, index, and middle finger are usually affected. Repeated use of the hands can lead to thickening of the main wrist ligaments. These ligaments can press on the main hand nerve (median nerve) and cause numbness and weakness in the hand. Generally this occurs when the hand is in use.
Over time, this pressure on the nerve can lead to nerve damage. The initial treatment for carpal tunnel is anti-inflammatory drugs (Motrin) and splinting. If this is not effective, surgery may be another option. A test can be done that will determine if the nerve is under pressure. If this is the case, the pressure can be permanently relieved with a small operation to release the ligament: “Release of transverse carpal ligament”.
* What is trigger finger? (Stenosing tenosynovitis)
[back to the top]
Trigger finger is a tendonitis or tendenosis of the flexor tendons in the
hand. Symptomatically the patient with this condition may experience a
clicking, catching, or locking of any one of the five fingers. Trigger finger is more common in patients with rheumatoid arthritis, diabetes, and other connective tissues disorders. Treatment of trigger finger includes anti-inflammatory drug, steroid injections into the tendon sheath and surgical release of the tendon.
* What is deQuervains Tendonitis? (thumb pain) [back to the top]
deQuervains Tendonitis is an inflammation of the first dorsal extensor tendon
compartment of the thumb. Symptoms include pain over the wrist at the base of
the thumb. (First extensor compartment). The disease is thought to arise from repetitive movements. New mothers are especially prone to deQuervains. Treatment options include anti-inflammatory drugs, steroid injections into the tendon and surgical release of the first dorsal compartment of the hand. Cessation of the offending motion can also be effective.
* What is Cubital Tunnel ? [back to the top]
Cubital Tunnel Syndrome is a compression injury of the ulnar nerve (funny
bone nerve) usually at the elbow. Symptoms of ulnar nerve compression include
numbness, tingling, and pain in the ring and small finger usually most
pronounced after prolonged bending of the elbow (after sleeping) Treatment
involves cessation of the offending motion that causes pressure on the nerve.
An elbow splint may help. Surgical decompression may be warranted if behavior
modification fails to solve the problem.
* What is Dupuytren’s Contracture? (inability to straighten fingers) [back to the top]
Dupuytren’s Contracture is a thickening of the palmar fascia (palm) of the hand. It is known to be hereditary particularly in persons of northern European
descent. Symptoms of dupuytrens contracture are nodules in the hand. The cause of this illness is unknown and there is no cure. Options for treatment include
surgical removal of the palmar fascia of the hand (fasciectomy). However, this
is only indicated once a contracture (bending of the finger) occurs.
* What is cellulitis of the hand? [back to the top]
Cellulitis is a diffuse inflammatory disorder caused by leukocyte infiltration into infected soft tissues. The areas are usually red, tender, and inflamed. There is no abscess cavity. However, cellulitis may be caused secondarily to an abscess. Treatment for cellulitis is rest elevation of the limb and usually a course of antibiotics. There is no need for surgical treatment of this disease entity (problem).
* What is a felon? [back to the top]
A felon is a subcutaneous abscess (pus) of the distal fingertip. These lesions typically occur after injury to the finger, such as a puncture wound or in response to a retained foreign body in the finger. Patients with Diabetes or autoimmune disorders are more susceptible to this type of infection. Symptoms include pain, swelling, and possibly discharge (pus) from the wound. Treatment options for a felon, or any abscess, include surgical drainage of the abscess, antibiotics and elevation of the extremity.
* What is a paronychia? [back to the top]
Paronychia is an infection of beneath the eponychial fold of the finger (fingernail area). It usually occurs when there is a disruption between the fold of skin adjacent to the fingernail, and the nail itself. It presents as a painful draining mass on the side of the finger exactly adjacent to the nail. Conservation treatment of paronychia includes warm soaks and oral antibiotics. Surgical treatment is reserved for those refractory cases. This includes removal of part of the fingernail and drainage of the abscess cavity.
* What is septic flexor tenosynovitis ? [back to the top]
Pus or infection of the tendons responsible for closing the hand. Probably the most dreaded of all hand infections. If left untreated, this process can affect the gliding surface of the tendon, and potentially cause tendon rupture. Symptoms include 4 cardinal signs: finger resting in flexed position, tenderness over the flexor tendon, a sausage like swelling of the finger, pain with passive extension. Treatment is almost always surgical, and it involves opening the tendon sheath for drainage of the area, along with antibiotic therapy.
* What is gangrene of the finger tip ? [back to the top]
Gangrene of the fingertip occurs most commonly in patients with Diabetes. However it is not limited to this patient population. These infections are quite devastating. Treatment involves surgical debridement with strong antibiotics. Amputation is usually required to eliminate the infection because the remaining dead tissue does not allow for a functional digit. Symptoms include a painful usually discolored fingertip, with a foul odor. Immediate medical treatment is warranted.
* What is Carpal-metacarpal arthritis of the thumb ?
CMC arthritis of the thumb is a unique entity of osteoarthritis that affects the joint at the wrist and base of the thumb. This condition is usually associated with middle aged women causing exquisite pain at the base of the thumb. Symptoms include decreased grip strength in the thumb as well as localized pain at the base of the thumb. Treatment options include rest and anti-inflammatory drugs. Second line treatment includes injecting the joint with steroids. Surgery can be helpful and is often the only cure for the pain. It involves removing the bone at the wrist that connects to the thumb.
If you have any questions about this topic, please contact your family physician or call our office for further information. We accept all major insurances.
Owen Drive Surgical Clinic of Fayetteville
513 Owen Drive, Fayetteville, NC 28304
(910) 323-0101 [back to the top]
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