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Conditions of the Hand

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Injury Information

Metacarpal Bone Fracture

The metacarpal bones join the wrist to the fingers. This injury most commonly occurs in the metacarpal bone of the thumb or the little finger. The fracture will occur as a result of punching a hard object and is therefore common in contact sports such as rugby union or ice hockey.

Deep sharp pain will be felt in the hand immediately and swelling will follow soon after. It is important to treat swelling as soon as possible and seek medical advice.

Median Nerve compression (Carpal Tunnel Syndrome)

The median nerve crosses through the wrist into the hand via a small tunnel in the wrist called the carpal tunnel. Bones and stiff connective tissue form the boundaries of the carpal tunnel. Narrowing of this tunnel can be caused by tendon inflammation, fractures or swelling in the hand can put pressure on the median nerve causing a constant, dull ache radiating to the thumb, index and middle finger as well as pins and needles and numbness and in the extreme weakness of the thumb musculature. The pain will tend to worsen at night. Tapping over the wrist on the palm side may reproduce symptoms in the hand where Carpal Tunnel Syndrome is present. Rest and anti-inflammatory measures may decrease pain; surgery may be indicated in chronic cases.

Pressure on the Ulnar Nerve (Ulnar Neuritis)

The ulnar nerve may be compressed in the wrist at the inner side of the hand. This problem is usually caused by compression and friction from altered hand postures such as during cycling. Symptoms include pain, pins and needles radiating to the little and ring finger as well as muscle weakness when trying to spread the fingers. Rest and anti-inflammatory measures may decrease pain; surgery may be needed in chronic cases.

Nerve Ganglion

The ganglion is an inflammation and proliferation of nerve tissue over the site of a nerve. Ganglions are common over the nerves in the wrist and may appear over the front or back of the wrist. The ganglion will appear as a bump in the wrist and may or may not be accompanied by symptoms in the wrist. Symptoms may include local pain and swelling. The ganglion may not need to be treated if it is unsymptomatic. If symptoms persist a doctor should be consulted.

Dupuytren’s Disease

Dupuytren’s disease is a genetically inherited disorder which primarily involves the palmar aponeourosis (located under the skin on the palm of the hand, and its digital propogations (extensions into the fingers).

The primary pathological change is in the fascial tissues of the palm which results in thickening, cord-like formation of contractile bands, and then eventual contractures at the level of the interphalangeal joints. These contractures cause the palm of the hand to start to contract causing an inability to open the hand out flat effectively.

Certain contributing factors increase the likelihood of significant progression. These include a strong family history, early onset of disease, rather extensive bilateral involvement, and the presence of disease in other areas such as the plantar regions of the feet. These contributing factors may lead to a more aggressive course of the disease and possibly even an operation at an earlier age.

The disease is seen much more frequently in men than in women and has a tendency to usually appear between the ages of 40 and 60.

Dupuytren’s disease has over a 65% chance of being bilateral, and can involve other areas such as the foot, the dorsum of the hand, and other fibrous tissues. It is a slowly progressive disorder which may have periods of temporary arrest, or even a rapid progression. After the nodules have formed, the tendency is for these to coalesce into a cord, which will lead to a flexion contracture at the MCP joints and the PIP joints. The skin itself can be infiltrated by the disease.

Initial treatment is always non-surgical. This would consist of continued observation for progression of the problem. As the disease does not involve any pain, there is no reason for the excision of the nodules or cords until contractures in digits have occurred. If a contracture becomes bothersome or a nodule becomes painful, or if the contracture in the MCPJ exceeds 30 degrees or any involvement at the PIP joint occurs, we would recommend surgical excision. This would consist of a palmar and digital fasciectomy utilizing an axillary block anesthetic. A skin graft taken from the forearm is almost always used. Long term results are usually quite good. If contractures have developed at the MCPJ and PIP joint, they can usually be corrected to within half of the preoperative level. Recurrence of the disease is possible, but this is usually not associated with further contracture necessitating surgery.

Early Injury Management

For approximately the first 72 hours following an injury, the RICE regime should be followed to ensure control of inflammation and pain relief.

R - Rest

I – Ice

C - Compression

E – Elevation

Rest from aggravating activity.

Ice should be applied in the first 72 hours or when inflammation persists. Ice should be applied for 15 to 20 minutes at a time. Ice should not be applied directly to the skin, but through a wet towel or cloth.

Compression can be achieved with an elastic bandage.

Elevation is used to help swelling to return to the heart through the blood stream.

The injured area should be elevated above the level of the heart.

Exercises

Strengthening programs should only be commenced when:

Exercises should be 3 sets of 8-12 repetitions.