State-of-the-Art Care for Injured Hands

By, Dr. George Zanaros

X-ray of a hand

State-of-the-art care for hand injuries has brought relief to many enabling them to experience life without pain. Hand sensation and movement are essential to almost every tasks performed throughout the day, including eating, dressing, and writing, typing, driving, and working. Although often taken for granted, the hand can be considered just as important to functioning as eyesight.

Motion of joints, gliding of tendons and contraction of muscles are all part of hand operation. When injury takes of place, care is given to the various tissues that facilitate functioning of the hand. In addition, millions of people suffer from such problems as arthritis and inflammatory conditions. Impairment of the – especially when deformities are involved – can create a socioeconomic and psychological burden. To provide relief to suffers, hand surgery has become a medical specialty in its own right.

The focus on the hand as a specialized field of study began in the era of World War II. Before that time, one physician would be needed to treat the broken bones, another to repair the damaged nerves and still another for skin reconstruction. It was soon realized that one specialist for the entire hand in all of its functions would be beneficial. Thus, the era of the hand surgeon was born. Today, some hand surgeons specialize in the treatment of children, while others treat both children and adults.

Many hand surgeons are general surgeons or orthopedic surgeons with additional training to care for problems of the hand, wrist and forearm. Much of their time is spent outside the operating room, treating these problems without surgery. A number of problems including cuts, wrist pain, sports injuries, tennis elbow, burns, ganglion cysts, tumors, arthritis, congenital abnormalities and carpal tunnel syndrome are now routinely treated by hand surgeons.

Trigger finger

One form of chronic tendinitis, called trigger finger poses a particular challenge to the hand specialists. Tendons that bend the fingers and thumb passed through the opening of a snug tunnel. When the tunnel becomes too snug – or when the tendon becomes too thick – the tendon becomes stuck at the opening of the tunnel. A popping sound or sensation may result when the tendon finally gives way. In severe cases, the finger may remain stuck in a bent condition.

No x-rays are needed for diagnosis of “trigger finger;” a hand specialist can detect the problem simply by interviewing the patient and examining the hand. Medications can be used to treat the pain. A splint may be all that is needed to rest the finger. If the problem is severe, outpatient surgery may be recommended.

The decision for surgery is a personal one, as trigger finger is neither life threatening nor dangerous. The goal of surgery is to widen the opening of the tunnel so that the tendons will not be blocked or obstructed. A small incision is made in patient’s palm, after which the tunnel is opened with the needle. Usually, movement of the finger is improved immediately after surgery, although it may be several weeks before recovery is complete area meanwhile, swelling and pain can be controlled by elevating the hand.

Hand Injuries

Injuries to the hand are common, affecting as much as a third of all accident victims. Hand injuries usually involve either fractures of the bone or joint, damage to the fingernail bed, or fingertip injuries. Fingertip injuries are the most common injury to the hand and may involve loss of skin or damage to the fingertip had. Fingertip injuries are not minor. Without treatment, swelling loss of sensation and infection may occur and lead to disability of the entire hand. Thus, seemingly minor injuries can have major consequences.

Deep cuts to the wrist, palm or finger can result in nerve and tendon injuries. Each finger contains two flexor tendons, one extensor tendon, and two nerves. Hence even when one tendon or one nerve is cut, some movement or feeling may be present. Damaged nerves can be repaired, often through microsurgery, although these may not heal completely.

Flexor tendons can also be repaired through microsurgery. One complication however, involves scar tissue, which can bind the tendon and prevent movement. To address this, a program of post-operative hand therapy is important. Specific exercises can help the patient break up scar tissue and restore function to the tendon.

Diabetes is often an underlying factor in hand pain. For example, trigger finger, discussed earlier, is more common in diabetic patients. In addition, a side effect of diabetes is a peripheral neuropathy, which results in tingling of all fingers. It can be difficult to distinguish this condition from carpal tunnel syndrome, but the telltale factor is one of distribution: a peripheral neuropathy often involves both hands and both feet, starting at the ends of the fingers or toes and moving toward the center of the body.

Dupuytren’s contracture

Another hand problem that frequently requires surgery is Dupuytren’s contracture, which most often affects the fourth and fifth fingers. Not to be confused with trigger finger (which also results in bent fingers), Dupuytren’s contracture is a disease of the palmar fascia that causes the fibrous bands of the hands, the layer of flesh just under the skin of the palm, to thicken and short. Lumps or dimples in the skin of the Palm a result. Small nodules develop in a cord like band, preventing the hand to straighten and giving it a clawlike appearance. Although he usually has its onset in adulthood, some say the Dupuytren’s contracture is inherited.

It is best to seek help for Dupuytren’s contracture before the condition deteriorates to the point that the fingers are bent into a fist. In severe cases where deformities are present, surgery will usually be recommended for Dupuytren’s contracture. The goal of the surgeon is the excision of the fascia and releasing of the ligaments to restore the strengthening of the hand.

The field of hand surgery continues to provide renewed hope to millions. State of art care is helping many who suffer from disease or injury today and, helping them to experience something they may have thought impossible, a life without pain.