Information about Hand related conditions
The most common cause of Arthritis of the base of the thumb is Osteoarthritis.
The most common cause for Arthritis of the fingers is Rheumatoid Arthritis. The second most common is osteoarthritis.
Arthritis of the Base of the Thumb
This is a very common problem, predominantly seen in women. It is also seen in men who are workers and are involved in a lot of gripping and pinching motions. The base of the thumb gets worn out which in turn leads to a lot of pain. Simple activities, for example holding a key, pinching, gripping, twisting, trying to open a cap off a bottle etc, becomes difficult.
The diagnosis for this is made following an x-ray. Base of thumb arthritis is not uncommon in both the thumbs.
The treatment for this is commonly initiated with physiotherapy and also an injection to help settle the pain and symptoms. However if the arthritis of the base of the thumb is fairly advanced then surgical intervention will need to occur.
The common surgery performed for the THUMB is:
1. Excision of base of thumb bone (trapeziectomy) with or without ligament reconstruction and tendon interposition.
This operation, i.e. trapeziectomy, is the most robust and has excellent long term results. T The decision of what is best for the patient is entirely dependent on the kind of activity the person does and what sort of function one is willing to achieve.
2. Thumb Joint Replacement.
The base of thumb joint replacement is relatively new. This is and excellent operation if the physical demands of the person is low. This operation may not be suitable for a person involved with manual work or exercise. This has a higher complication rate in the form of dislocations and has a limited life span of approximately 10 years
By and large both the operations are successful and allow reasonably good hand function and full activities of daily living. The correct procedure is chosen for the person seeking this treatment following a detailed consultation and analysis.
Arthritis of the fingers and hand
When one gets rheumatoid arthritis the fingers do get affected with a persistence of swelling, pain and ligament deformity as a result. This deformity, once the rheumatoid arthritis settles down, becomes virtually permanent as the joints do get worn out and destroyed to a certain extent.
There are two forms of treatment. The first is to correct the soft tissues in the form of re-arranging the ligament and the guiders to improve the hand function. However the second option is to replace the joints of the fingers. These replacements are usually made of silicon and help to straighten the fingers out to allow an improvement in hand function.
Carpal tunnel syndrome is a mixture of symptoms predominantly causing tingling, numbness and pain in the thumb, index, middle and part of the ring finger. The most common symptom present is night waking due to a numb hand which usually improves slightly after shaking the hand around.
This syndrome is caused when the median nerve, the nerve supplying sensation to the fingers of the hand, thumb and some muscles aswell, gets pressed in the base of the thumb. This is usually caused by either overusing the hand, infection and even mere inflammation which can be chronic. If left untreated this can lead to significant discomfort and weakness of the hand, thus affecting function. The most common function affected is grip strength which leads to an individual dropping simple objects for example pens, cups etc. It also affects simple activities for example writing, holding the steering wheel whilst driving, holding the telephone whilst talking which also cause discomfort and hence making tasks difficult.
The most common treatment is to initially provide a wrist splint which helps to settle the symptoms and helps to improve the function to a certain extent. However, if you have chronic and disabling presentations you will usually require a small operation. This operation is called a carpal tunnel release.
The operation can be done under either a local or general anaesthetic. It involves a small cut into the base of the thumb which releases the ligament from on top of the nerve. This allows the nerve to relax out and start healing.
The ultimate recovery period following a carpal tunnel release can be anywhere between 4-6 weeks. However the instant relief from the procedure is the disappearance of pain and night waking symptoms.
Grip strength and general hand function will return between 6-8 weeks. Those patients who have a desk based role can return to work within the week. However those involved with manual work, engineering, physical activity, sports including racket sports etc can take slightly longer at approximately 3-4 weeks to return to work.
Dupuytren’s contracture is a genetic linked disease of the hand which leads to a contraction of the fingers and sometimes also in the palm.
This is predominantly seen in men and sometimes in women. It is found to be more of a nuisance value when the fingers start to bend and are unable to straighten out because the tissue in the palm forms cords which bend the finger down. Contrary to the previous belief this does not involve the tendons (guiders) in the hand.
Treatment for this is essentially when the hand becomes a nuisance and the fingers do not straighten out and it affects function and activities of daily living. Treatment is essentially surgical. The procedure involves the removal of the cord which will be followed by local flaps of the skin which in turn allow it to stretch when the hand and the fingers straighten out. This is performed under a general anaesthetic.
There are significant complications which may arise with this procedure. These may include infection and digital nerve injury. However the likelihood of this occurring is less than 1%. However sometimes the Dupuytren’s contracture can recur and become quite aggressive. If this occurs it will be treated by further intervention, either physiotherapy or a repeat surgical intervention.
The return to work and activities of daily living is swift. The wounds usually heal in the palm to a useable extent in approximately 2 weeks and the skin becomes firm enough for normal use in about 3-4 weeks.
It is better to intervene earlier when the symptoms are present as it reduces the extent of surgical correction, hence providing better function. It is up to the surgeon and the patient to come to an arrangement as to what the best time is to intervene.