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Arthritis in the hand occurs when joints are inflamed and may occur at the base of the thumb (the trapeziometacarpal joint), the middle joint of a finger, (the PIP joint) or in the metacarpophalangeal (MP) joint. The most common forms include osteoarthritis, post-traumatic arthritis and rheumatoid arthritis.

To diagnose Arthritis, the Hand Center must conduct a physical exam and depending on your findings perform imaging tests. 

Symptoms of arthritis include stiffness, swelling and pain.

Treatment of arthritis may include anti-inflammatory medications, cortisone injections and individualized hand therapy involving a combination of exercises and splints. Surgery is indicated when these more conservative treatments fail and the patient has too much pain or cannot function well. Surgery can involve joint fusion or joint reconstruction. Your hand surgeon will help determine the best course of treatment for you.

 

In children, the most common brachial plexus injuries occur at birth, when the brachial plexus is damaged in a baby’s shoulder during delivery. About one or two babies out of 1,000 will have a brachial plexus injury when born, and about 10 percent of these babies will need surgery. In adults, the most common causes of trauma to the brachial plexus include motor vehicle crashes, sports injuries, industrial accidents, falls and severe over-extension of the arm.

Brachial plexus injuries are diagnosed by a thorough examination of muscle function and sensation. It takes a physician experienced in treating many brachial plexus injuries to notice subtle changes in muscle function. In addition, electrical testing of the muscles and nerves is done to determine the severity and location of the injury. This testing is done with an electromyogram (EMG) to test the muscles along with nerve conduction velocity (NCV) and evoked potential to test the nerves. Imaging of the neck and shoulder using X-rays, computed tomography (CT) and magnetic resonance imaging (MRI) may be done as well.

The symptoms of brachial plexus resulting from an injury may produce numbness or tingling, pain, weakness, limited movement and paralysis in the shoulder, arm and hand. Left untreated, muscles associated with the damaged nerves will atrophy (waste away). If a person waits too long for treatment, the muscle will become permanently dysfunctional.

Following diagnosis, patients are monitored over a period of time to see if the function has returned in their hand, arm and shoulder. During this time, the patient may undergo occupational therapy. If it is determined that there is insufficient improvement, surgery may be needed. The best results for surgical repair are obtained within one year of the injury.

Burns are caused by prolonged exposure to heat. Causes can be fire, chemical, or electrical. Severe burns to the skin cause wounds and high risk of infection. Severe hand burns may result in poor function, loss of the hand, and even death.

To diagnose burns, the Hand Center team will perform a visual inspection. 

The symptoms and severity of a burn are dependent on the temperature of the heat source, the type of skin that was burned, and how long the skin was exposed to the heat. Symptoms of burns may include swelling, blisters, and changes sensation or tingling in the burned areas. The appearance and symptoms of a burn depends on how deeply the burn injures our tissues.

Superficial or first degree burns involve the top layer of skin (epidermis) only. They are red, painful, and dry. There is no blistering. Healing occurs on its own. Mild sunburns are superficial burns.

Second degree burns are more accurately described as superficial or deep partial thickness burns. Superficial partial thickness burns involve up to half of the skin depth. Blisters are present. The wound is pink or red, and blanches (turns white) with pressure. These burns are painful and wet appearing. These generally heal on their own in 1-2weeks. Deep partial thickness burns destroy most of the skin depth. These burns are red or white and appear dry. Pain is variable.

Full thickness, third degree, burns destroy all of the skin layer. These burns are black or white, dry, and leathery. These are usually not painful, because the nerves are damaged.

Fourth degree burns destroy all of the skin and even the deeper structures including muscle, tendon, and bone.

The immediate treatment of burns involves removing the heat, gently washing the burned area, and applying dressings.

If a burned hand is not getting enough blood to the fingertips, emergent surgery may be needed to open the tight burned tissue and allow blood to get to the fingers. This should be assessed by a medical professional as soon as possible.

Rehabilitation with a hand therapist is recommended early on in the treatment of the person with burns. The initial focus in rehabilitation includes wound care, maintaining range of motion, and management of swelling. Splints are often used to help prevent stiffness. Hand therapist will also work with you on scar management, pain reduction, and strengthening after the wounds are healed.

Burns that are deep partial thickness or deeper will require reconstructive surgery, which moves healthy tissue to the burned area. The depth, size and location of the wound will influence what kind of surgery is needed. Your surgeon will review all available reconstructive options with you and help you decide the type of reconstruction needed for your burn.

The cause is unknown. There are several factors that contribute to CTS: joint dislocations, fractures, and arthritis can narrow the tunnel in which the median nerve travels through; and awkward wrist postures such as keeping the wrist bent for long periods of time. Fluid retention during pregnancy can also cause swelling in the carpal tunnel which lead to CTS symptoms that usually go away after delivery. Thyroid conditions, rheumatoid arthritis, and diabetes can also be associated with CTS.

To diagnose carpal tunnel syndrome, we will use a combination of your medial history, a physical examination, and tests.  

Symptoms from carpal tunnel syndrome include tingling, numbness, and pain are the most common symptoms. Typically the numbness or tingling occur in the thumb, index, middle, and ring fingers. It can progress to hand weakness and eventually limit hand function.

The first step for treatment of carpal tunnel syndrome is an evaluation by your doctor where they will perform an exam to learn more about your symptoms and gather a detailed history including medical conditions and how the hands are being used. X-ray may be taken to check for other causes of the symptoms such as fracture or arthritis. EMG test may be performed to confirm the diagnosis of carpal tunnel syndrome and to check out other nerve related problems.

Symptoms may be treated without surgery by changing the patterns of hand use or keeping the wrist in neutral position in a splint to reduce nerve pressure. A steroid injection into the carpal tunnel may also help with reducing the swelling around the nerve.

If symptoms do not improve then surgery may be needed to make more room for the nerve. Pressure on the nerve is decreased by cutting the ligament that forms a roof over the tunnel. Symptoms may not go away quickly after surgery.

Download Carpal Tunnel Syndrome Brochure (PDF)

Complex hand injuries may be caused by machinery, farm equipment, or motor vehicle accidents.

Diagnosing complex hand injuries is usually straightforward. 

Symptoms of complex hand injuries include pain and swelling in the hand. 

Treatment for complex hand injuries following a significant traumatic injury requires special surgical expertise.  Microscopic surgery is required to repair the small nerves and blood vessels in the hand. Fixation of bones may be completed through the use of plates, screws, wire, pins or external fixators. Injured tendons may be directly repaired, or if injured more seriously may require a tendon graft (spare piece of tendon sewed into the gap caused by injury), or may require tendon transfer (nearby tendon is redirected to perform function similar to injured tendon. Missing skin tissue may be replaced using various types of skin grafts (layers of skin donated from other area on body), or may be temporarily covered by manufactured tissue. Restoration of appropriate circulation to the hand may require significant medical interventions, and close monitoring by medical staff.

Hand Therapy for Complex Hand Injuries

An appropriate and timely hand rehabilitation program is critical to restoration of functional use of the hand. Skilled hand therapists make customized splints or “orthoses” to position and protect the hand during the healing period. Early Hand Therapy interventions may also include wound care, edema control, and initiation of motion exercises very specific to your type of hand injury. Therapy in the later phases of healing may incorporate scar management, active motion exercises, functional use and strengthening of the hand.

Long-Term Outcomes following Complex Hand Injury

Severe traumatic injuries can be very difficult to treat, and in most cases full normal motion and sensibility does not return following the injury. Extensive scarring on the inside of the hand may cause the tendons to lose their ability to bend and straighten the joints, or may cause the joints to be stiff and less mobile. Sometimes additional surgery may be required to improve motion, sensation, or functional use of the hand.

Cubital tunnel syndrome occurs when there is significant pressure placed over the nerve. Since the ulnar nerve is positioned right next to the bone and has very little padding over it, pressure on the elbow will put pressure on the nerve. Bending the elbow will also irritate the nerve by compressing it inside the tunnel thus creating inflammation which leads to pain or numbness. Pressure at the elbow can develop in several ways:

• Keeping the elbow in a bent position for a long time (i.e. holding the phone)
• Leaning on the elbow for a long time
• Sleeping with arms tightly bent
• Sudden elbow injury
• Previous elbow fracture

Cubital tunnel syndrome symptoms usually include:

• Numbness/tingling into the ring and little fingers
• Weakness while gripping and pinching with a tendency to drop things
• Inability to straighten the fingers
• Tenderness with sharp pain with touch to the elbow

Nonsurgical treatment: can include rest, medication, and activity modification. You can also try the following:

• Take medication to reduce swelling
• Incorporate rest breaks during activities
• Wear elbow pad
• Wear an elbow splint at night to avoid keeping the elbow bent
• Switch to a headset phone

Surgical treatment includes shifting the ulnar nerve to the front of the elbow, which relieves pressure and tension on the nerve. The nerve may be placed under a layer of fat, under the muscle, or within the muscle. Surgery may also involve removing part of the bone.

Download Cubital Tunnel Syndrome Brochure (PDF)

Cysts are caused by a bulge of the lining of joints and tendon sheaths. It is suspected that cysts form at a point of focal weakness in this lining. Normal joint or sheath fluid then fills the bulge, creating a mass or balloon appearance.

To diagnose a cyst in your hand, the Hand Center will have to conduct a physical examination as well as an X-Ray. 

Symptoms of cysts are usually painless, soft lumps just under the skin of the hand. If the mass grows large enough to press on surrounding nerves or tendons, you may develop pain, numbness, or limited range of motion.

Treatment options for cysts are are not dangerous and therefore can be observed. However, in some patients the cyst causes pain when they press on the surrounding structures. In these cases, the cyst can be treated with aspiration or surgical excision.

Following surgical removal of a ganglion cyst, a therapist will educate the patient on wound care, safe range of motion exercises, and edema control.

Download Ganglion Cysts Brochure (PDF)

The cause of DeQuervain’s Tenosynovitis is unknown but there are factors that may contribute to it such as: repetitive motions of unscrewing jar lids, forceful grasping or twisting, or picking up a child under the arms.