Hand
Finger Fracture
Description
Fractures of the finger are not minor injuries. More often than not a fractured finger is caused by an injury to the hand often causing it to be out of alignment. If the finger is not treated, it can result in it becoming stiff and painful. The cause of finger fractures can vary, whether it be from slamming your fingers in a door, jamming your fingers when catching a ball or putting your hand out to break a fall.
Symptoms
The symptoms of a fractured finger can be swelling, tenderness and bruising around the fracture site. The finger can become stiff and unable to move completely. There also may be some deformity of the injured finger.
Treatment
Non-surgical: Dr Marchant can put the fractured bone back into place without surgery. In some cases the fractured bone is in a good position or can be put back into place without surgery.
Surgical: Surgery may be required depending on the type and extent of the fracture. The aim of any surgery would be to put the bones back into alignment, generally through the use of pins, screws and/or wires.
Recovery
Rehabilitation exercises daily will help in the recovery process and to reduce the swelling and stiffness. A hand therapist might be suggested to help you with these exercises. It can take six to eight weeks for the fracture to unite with therapy prescribed following this to regain movement and strength.
Thumb Fracture
Description
There are different types of thumb fractures. Bennett and Rolando fractures occur at the base of the thumb. They involve the joint between the thumb metacarpal and a specific wrist bone and are more difficult to treat. Thumb fractures can be caused by direct impact such as a fall or when a ball catches and pulls the thumb backwards. Sometimes a fracture can be caused indirectly, from twisting or muscle contractions as happens occasionally in sports such as football, hockey or skiing.
Symptoms
Thumb fractures can often be severely painful, swollen and extremely tender. The ability to move the thumb can be limited or sometimes impossible. Numbness and coldness can also be a symptom.
Treatment
Non-surgical: if the fracture isn’t displaced or located in the middle shaft of the bone a specially designed cast may be used to hold the fragments in place. This may need to be worn for up to six weeks. X rays will be required to monitor the alignment of the fracture.
Surgical: Depending on the location of the fracture and the movement of the bone fragments surgery may be needed. Fixation of the fragments is used to realign the bones and hold them in place while the fracture heals. Internal fixation of the bone requires the use of wire, pins, plate and screws. For up to six weeks post surgery a cast or splint will be required as well as hand therapy to help restore movement in the thumb.
Recovery
It generally takes six weeks for the bone to heal and unite following a fracture, with therapy exercises prescribed following this to regain strength and movement.
Fingertip Injuries/Amputation
Description
Fingertip injuries can be crushing, tearing or amputating injuries to the tips of fingers and thumbs. The injuries can include damage to skin and soft tissue, bone or to the nail and nailbed.
Treatment
Non-surgical: if the fingertip is not deep enough to expose bone it may heal on its own. A dressing to cover the wound may be applied or a splint made to protect the area.
Surgical: if the fingertip wound is open and large, surgery is often required. A skin graft is taken from another site and used to cover the injury. If a large part of your finger has been cut off in this injury, Dr Marchant may consider reattaching the tip. This is called replantation.
Recovery
The recovery time from a fingertip injury may take several months. Mild to severe pain and sensitivity may continue for a year and sometimes may even remain a permanent outcome. Physiotherapy exercises may be recommended to help with movement and strength and sometimes splinting, traction and special wrappings may be encouraged to help with the healing process.
Mallet Finger
Description
A mallet injury occurs when an object hits the tip of the finger or thumb and the force of the impact tears the extensor tendon. A result of this might be the rupturing of the tendon or pull the tendon away from its attachment to the finger bone. In some cases, a small piece of bone is pulled away along with the tendon. This is called an avulsion injury.
Symptoms
The finger as a result of this injury may be painful, swollen and bruised. The fingertip usually will drop noticeably and only straightens if you physically push it up.
Treatment
Non-Surgical: If mallet finger injuries are not treated it can result in stiffness and deformity in the injured fingertip. Mallet fingers can be treated non-surgical most of the time. A non-surgical option is treatment using splinting. The splint will hold the fingertip straight until it heals. This may need to be used for up to eight weeks.
Surgical: Surgery may be considered if there is a large fracture fragment or the joint is out of line. Surgically the fracture is repaired using pins to hold the pieces of bones together while the finger heals.
Recovery
If treatment measures are adhered to, healing should occur around eight to twelve weeks, which is then followed by a course of rehabilitation therapy to assist in regaining full movement and strength.
Carpal Tunnel Syndrome
Description
Carpal tunnel syndrome occurs when the tissue surrounding the tendons in the wrist swell and put pressure on the median nerve
Symptoms
Numbness, tingling and pain in thumb, index finger, middle finger and edge of the ring finger are common symptoms, with altered sensations and pain travelling up the arm also experienced in some cases. Common complaints include weakness, clumsiness and frequently dropping things. If the condition is severe the muscles at the base of the thumb may become wasted.
Treatment
Tests: Physical tests and electrical or nerve conduction tests are often done to confirm the diagnosis.
Non-surgical: If symptoms are mild to moderate the condition may be treated with bracing or splinting to prevent irritation. Alternatively anti-inflammatory medications or steroid injections may provide relief as will avoiding positions or activities that aggravate the symptoms.
Surgical: If non-surgical treatments do not provide relief or the condition is severe then surgery is considered. Surgical management involves a small incision and release of the ligament using an endoscopic surgical technique (small surgical camera). As the ligament heals across the division it allows more space for the nerve and tendons. This surgery is typically done as a day surgery procedure.
Recovery
Carpal Tunnel Surgery is typically an simple procedure and you will be able to go home after the procedure on the same day in most cases. There may be some tenderness, discomfort and swelling following surgery. Normal activities are usually resumed two to six weeks following surgery.
Arthritis of the Thumb
Description
Osteoarthritis is the type of arthritis that affects the joint at the base of the thumb and it occurs when the usually smooth cartilage of the joint begins to wear away causing friction and damage to the bones and joint.
Symptoms
Common symptoms include swelling and tenderness at the base of the thumb with development of a bony bump over the joint. Loss of strength or increase in pain with activities that involve gripping or pinching such as turning a key or opening a door can also be signs associated with this condition.
Treatment
Non-surgical: Ice on the joint, anti-inflammatory medication or wearing a supportive splint may help symptoms in the early stages but it is a progressive, degenerative condition and will likely get worse over time. A steroid injection into the joint may provide relief for several months but cannot be repeated indefinitely.
Surgical: There are surgical options that can be which include fusing of the bones which will alleviate symptoms but will limit movement. Alternatively joint replacement may be recommended by Dr Marchant.
Recovery
Following surgery a cast will be applied for four to eight weeks depending on the procedure. Followed by rehabilitation with a physiotherapist to regain movement and strength in the hand. There may be some discomfort in the initial stages of rehabilitation but this will diminish with full recovery taking several months.
Arthritis of the Hand
Description
Arthritis in the joints of the hand can be as a result of osteoarthritis which is wear and tear to the cartilage or rheumatoid arthritis which is an inflammatory response by the body which results in cartilage damage. Joints that have had previous trauma or injury are more susceptible to arthritis.
Symptoms
Early symptoms include joint pain particularly after periods of increased joint use. The pain may be delayed and show up later in the day or the following day. Morning pain and stiffness is typical. There may be swelling around the joint, in an attempt to cushion it from further damage, as well as warmth. There may be a grinding sensation in the joint or looseness to the joint if the surrounding ligaments have been damaged.
Treatment
Non-surgical: Initial treatment options include anti-inflammatory medications, steroid injections into the joint and/or splinting to support the affected joint.
Surgical: If non-surgical management fails to provide relief surgery may be offered by Dr Marchant. This consists of fusion of the joint or joint replacement if the damage is extensive.
Recovery
Recovery time varies widely depending on the extent of the surgery performed. Rehabilitation will usually include referral to a hand therapist, use of a splint or cast and pain medication. Most people can return to normal daily activities approximately three months after even extensive joint reconstruction.
Dupuytren’s Contracture
Description
Thickening of the fibrous tissue layer underneath the skin of the palm and fingers including nodules/bumps.
Symptoms
Initial symptoms include itching, aching in the palm as one or more tender nodules form in the palm. Over time the tenderness subsides as the nodules thicken and contract forming tough bands under the skin. This fibrous bands cause the fingers to curl. Most commonly affected are the ring finger and little finger. The contracture is not dangerous and usually progresses very slowly and may not become troublesome for years.
Treatment
Surgical: Surgery to divide or remove the thickened bands may be indicated if function is limited in order to restore finger motion.
Recovery
Some swelling and soreness is expected after surgery. After surgery a specialised intensive course of hand therapy is required to assist in improving function and range of motion in the hand. This may need to be continued for up to six months with improvements out to nine months post-surgery.
Boutonniere Deformity
Description
Deformity that most often results from an injury to the tendons in back of the finger that are responsible for straightening the middle joint of the finger. May also be caused by Rheumatoid Arthritis.
Symptoms
Commonly sees finger swelling with the middle joint of the injured finger not able to straighten and the fingertip bending back. Deformity may develop immediately or may develop up to three weeks later. Unless promptly treated the deformity may progress resulting in permanent deformity and impaired function.
Treatment
Deformity must be treated early to help retain full range of motion in the finger.
Nonsurgical: Preferred treatment includes splint for up to six weeks to straighten middle finger and allow the fingertip to bend. In the longer term exercises to improve strength and flexibility in the fingers and a protective splint for participation in sports to prevent re-injury are advised. If the deformity is caused by arthritis then medications and steroid injections are used along with splinting.
Surgery: Surgery is an option in certain cases where the tendon is severed, there is bone displacement or the condition does not improve with splinting. Surgery may not fully correct the condition but will reduce pain and improve functioning.
Recovery
A splint is applied during recovery in conjunction with rehabilitation therapy which can take four to six months.
Trigger Finger
Description
Condition of the tendons of the fingers or thumb causing movement of the finger to be limited such as locking or catching in a bent position when attempting to straighten it. It can be caused by an irritation of the tendon, or thickening of the tendon sheath, reducing the opening through which the tendon runs.
Symptoms
Symptoms may follow periods of heavy hand use. Symptoms include a tender lump in the palm, swelling, catching or popping sensation in finger/thumb joints or pain and stiffness when bending or straightening your finger. These symptoms tend to be worse after inactivity and will loosen up as you move your finger.
Treatment
Non-surgical: In mild cases, resting the finger may resolve the problem and this may include using a splint. Medications such as anti-inflammatories can be used to relieve pain. Corticosteroid injections into the tendon sheath may also improve the problem temporarily.
Surgical: Surgical management for finger trigger release involves a small incision in the palm cutting the tendon sheath to allow more room for the tendon to track through. As the tendon heals across the division it allows more space for the tendon.
Recovery
Trigger finger release is typically an uncomplicated surgery and you will be able to go home after the procedure on the same day in most cases. There may be some tenderness, discomfort and swelling following surgery. Normal activities are usually resumed two to six weeks following surgery.