Hands are vitally important for us to explore and manipulate our world. Their position at the end of a long mobile arm makes it easier for us to get them into a position to use them effectively. There are not many jobs that exist that do not require at least some use of our hands. Unfortunately, this is why any disease of the hand can be quite disabling. The hands are also commonly involved with accidents.
Common Hand Conditions
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Carpal tunnel disease is very common. It is compression of the median nerve in the wrist (carpus) tunnel which is made of bones and strong ligaments. This results initially in pins and needles in the thumb, index, middle and ring fingers in a variable pattern. Eventually, the pins and needles can become numbness and also there is a weakness of the thumb muscles. Pain at night preventing good sleep is common and represents the median nerve getting starved of blood supply. This can go on to cause permanent damage to the nerve. Initially, carpal tunnel can be managed non-operatively by treating associated causes eg. diabetes, hypothyroidism rheumatoid disease or pregnancy, and splintage or avoidance of aggravating activities.
Sometimes relief can be achieved with a steroid injection into the tunnel. If people are getting night waking however, it is better to have surgery to treat the condition. This is a safe, relatively painless day procedure that is usually just done under local anaesthesia with sedation. The hand is only bandaged for two days and then the 4-5cm wound is covered with a dressing and the patient is encouraged to use the hand for light general tasks not involving heavy gripping. It takes 2-3 weeks for the wound to heal. If the condition is treated before nerve damage is significant, full recovery with normal hand function can be expected. If the condition has been left too long the nerve can be permanently damaged and have residual weakness and numbness.
Trigger finger is a disease where inflammation of the sheath surrounding the flexor (palmar) tendons of the hand causes a painful nodule to form and this then gets caught in one of many tunnels that we have in the hand to direct tendons where to go. It often can start off as a stiff, swollen painful finger that then goes on to frankly ‘triggering’ (getting caught down into the palm with flexion and suddenly then letting go as it releases) which can be painful. Early disease is often treated successfully with steroid injections and hand therapy, but advanced disease will need surgery. This is a safe, relatively painless day procedure that is usually just done under local anaesthesia with sedation. The hand is usually better and can be used almost immediately and the condition will not recur after surgery.
Dupuytren’s disease is a very common condition known in layman’s terms as ‘Vikings Curse’. It is a genetic disease passed on by people who have had Viking descent. It initially starts with firm nodules on the palmar surface of the hand that are sometimes tender. They can coalesce into bands which may eventually cause the finger to curl over into the palm. In more advanced disease the finger can become very stiff and difficult to use and even dangerous as it can get caught on things. Multiple fingers can be involved at once in both hands. There is no treatment needed for early disease. Once the finger starts to curl such that the hand can no longer be laid flat enough on a table to prevent a pen from being able to pushed underneath it, surgery is indicated. This involves dissecting out important structures the full length of the disease and then excising the disease. Depending on the initial deformity, splintage and hand therapy are often required afterward. The result of surgery for early disease is an essentially normal hand. Leaving the condition too long will result in a poorer outcome.
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Hand trauma is common. It can involve bones and soft tissues including tendons, nerves and arteries. Early assessment is important to decide appropriate management for the best outcomes. This management can range from simple functional splinting and exercises to quite detailed, intricate surgery. Having a surgeon experienced with dealing with these injuries is vital for a functional outcome and the best outcomes are achieved when the surgery is accompanied by good hand therapy.
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