No matter what your age or occupation your hands are always working. Since your hands are so important any abnormality can be a cause for concern. Many common hand problems that interfere with your daily activities can be diagnosed and treated by your orthopedic surgeon.
Many ganglion cysts do not require treatment. However, if the cyst is painful, interferes with function or the patient does not like the appearance, your orthopedic surgeon can remove the fluid with a needle (aspiration) or remove it surgically.
These symptoms are caused by pressure on the median nerve as it enters the hand through a tunnel in the wrist. The tendons that bend your fingers and thumb also travel in this tunnel.
Mild cases can be treated with a splint or brace to rest the wrist. Steroid injections into the carpal canal to decrease swelling may be used in addition to splinting. Those cases that do not respond to nonsurgical treatment and those that are diagnosed late often require surgery. This is generally done in an outpatient setting under local anesthesia.
Tendonitis may be caused by overuse and also can be seen in association with pregnancy or inflammatory arthritis such as rheumatoid disease.
If treated early, many cases improve with short periods of rest in a splint, followed by stretching exercises designed to get the tendons gliding. Injection with steroids and/or taking anti-inflammatory medications. More severe cases or those that do not respond to other treatment may require surgery. Modification of the activities which caused the symptoms initially also may be required.
As the wear and deformity progress, surgery is frequently required. There are many procedures to relieve pain and improve function.
Heberden nodes are "bumps" which occur at the last joint of the finger or thumb due to wear and tear arthritis (osteoarthritis). As the joints deteriorate, small bone spurs form over the back of the joints and make them appear "lumpy."
Since most Heberden nodes are not painful and seldom interfere with function, no specific treatment is usually required. Patients with pain can be treated with anti-inflammatory medications. All patients should continue moving their hands; disuse frequently results in stiffness.
Dupuytren's disease is familial, and may be associated with cigarette smoking, vascular disease, epilepsy, and diabetes.
The mainstay of treatment is surgical and is recommended if there is progressive contracture drawing the fingers into the hand. Sometimes a steriod injection will be used in a painful nodule. Small nodules or lumps in the palm do not need treatment until they are very large and interfere with hand function. Even with successful surgical removal, the bands may reappear or occur in other fingers.
Sometimes the swelling can be treated with rest, activity modification, oral anti-inflammatories, or steroid injections. The tendon sheath will then return to its normal, pain-free condition. More severe cases may require surgery to release the tendon. This can be done as an outpatient procedure. Normal activity can be resumed as pain allows.
Your orthopedist is a medical doctor with extensive training in the diagnosis and nonsurgical and surgical treatment of the musculoskeletal system, including bones, joints, ligaments, tendons, muscles, and nerves.
This brochure has been prepared by the American Academy of Orthopedic Surgeons and is intended to contain current information on the subject from recognized authorities. However, it does not represent official policy of the Academy and its text should not be construed as excluding other acceptable viewpoints.
Dr. Ashberg is a board certified Orthopaedic Surgeon
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