A fracture or break as it is commonly referred to can occur when a significant force is applied to a bone. There are many different types of fractures and not all of them require surgery. Treatment can vary depending on the severity of the fracture and it’s location. While some fractures are very obvious to see there can be smaller fractures that are representative of an associated ligament injury. This is why it is important to see a hand surgeon for evaluation. Treatment and results can vary depending on how old an injury is. Generally the longer one waits for treatment the less optimal the result may be. I encourage you to seek evaluation as soon as possible after an injury.
Tendons are flat noodle like structures that connect to muscle and allow your bones to move. Tendons can be either cut by sharp items such as a knife or they can be pulled out of the bone ( called an avulsion) by blunt force. They can be either partially torn or completely severed in two. If there is a significant injury to a tendon and it is not repaired it can lead to a functional problem with the use of the hand. Like many injuries to the hand early repair is essential to optimizing the result.
One specific example of a tendon rupture is that of a mallet injury. This is where the tendon that allows the distal joint (the one by the nail) to extend is pulled out of the bone. Sometimes a piece of bone is attached to the tendon as it is pulled away. You may notice that the tip of the finger is drooping downwards and you cannot lift it up. Treatment involves constant splinting or immobilization of this joint for a period of time, generally 6 to 7 weeks. A surgical option is available to internally splint the joint so that an external splint does not have to be worn at all times. This allows you to perform hygiene activities more easily. After the splinting period formal therapy is necessary.
Carpal Tunnel Syndrome
This is a group of symptoms that occurs when a nerve (median nerve) is compressed at the level of the wrist. Generally these symptoms include numbness and tingling in the fingers (usually the thumb, index, middle and a portion of the ring finger), pain that can extend to the shoulder and loss of hand strength. These symptoms can also wake you from sleep. Treatment is based upon how badly the nerve has been compressed and ranges from splinting and hand therapy to surgery.
Injuries to the tips of fingers are extremely common both in adults and children alike. Every injury is different and requires a unique approach for every patient. One thing that they have in common is the psychological trauma that may be associated with seeing the tip of a finger damaged or amputated. This is especially true for parents of a child that have sustained this type of injury. There are many options available to reconstruct the tip of a digit including using surrounding skin from the same digit or using skin from the palm. In fact, there may be more than one way to repair the same injury. Treatment options can be tailored to suit the patient’s own lifestyle and how soon they wish to return to this lifestyle. I’m happy to discuss these options along with diagrams and photographs to help make the decision. While not all injuries can be repaired to look as they were before the injury the great majority of them can be repaired to be functional and aesthetically pleasing.
These are fluid filled bumps that may develop near a tendon or a joint. They are very common at the tips of the digits near the nail and at the level of the wrist. They may be associated with arthritis especially at the tip of the finger or as a result of an injury. They are not a cancer. They can change in size by themselves or even disappear completely. Treatment may involve aspiration (using a needle to remove the fluid) or surgery. Keep in mind that even with treatment the cysts can recur. Surgery offers the greatest chance of the cyst not returning.
A joint is where two bones connect. Either through genetics or an injury the joint can wear out. The cartilage that was protecting the joint surface can be lost causing rubbing of bone on bone. While it is not always the case this can be quite painful and limit activities with the use of the hand. A very common place for this to occur is at the base of the thumb. This is more common in woman than men. Treatment options include nonsteroidal anti-inflammatory’s, splinting, corticosteroid injection and possible surgery. The treatment is tailored to each patient’s symptoms and needs.
This refers to inflammation of a tendon or group of tendons. It can be caused either from repetitive activities or an injury. Generally you may experience pain as a result of motion in the region of the involved tendon or tendons. Treatment involves anti-inflammatory medication, hand therapy, splinting and on occasion surgery is necessary.
This is a specific type of tendinitis that occurs at the level of the wrist on the thumb side. You might see swelling in this area and it can be tender to touch. Twisting and grasping motions of the hand can be quite painful as a result. Treatment includes anti-inflammatory medication, hand therapy, splinting, corticosteroid injection, and surgery for those that do not gain sustained relief from the above.
This is a condition whereby in it’s mildest case you may experience pain in the palm of the hand at the base of a finger or thumb. This may progress to where you feel a clicking or popping (triggering) of the digit. Some people feel like a joint is dislocating. This is not the case however. It is the result of thickened tissue in the palm that does not allow for smooth gliding of the tendons that control motion of the finger. In more severe cases the finger may get locked in the palm and you have to use your other fingers to unlock it. The majority of cases that I see are from repetitive grip type activities. They occur more commonly in patients with diabetes or rheumatoid arthritis. It may seem quite concerning but the treatment is actually quite simple. One or two corticosteroid injections will resolve most cases however surgery may be necessary for those that do not resolve. It is not uncommon for this to be the case with diabetics.
Dupytren’s Contracture (Disease)
This is a condition where the tissue beneath the skin (fascia) becomes thickened. In the early stages all you may see are lumps or pits in the palm. However this may progress to where you feel thickened bands that extend from the palm to the fingers. You may be able to make a fist without a problem but cannot fully extend the fingers or lay the hand flat on a table. It is generally not a painful problem. However it can interfere with activities of daily living as a result of the inability to fully open the fingers from the palm. Several causes have been identified but the most common is that of a genetic predisposition. It occurs mostly in males over 40 of Northern European descent. It can occur in women as well but less commonly. Not all people with this problem require treatment. It is only those that have contractures and functional problems with the hand that treatment is recommended. Unlike many hand related problems treatment can be very successful even after having this condition for many years. There are several options available for treatment including injections or surgery. Treatment is tailored for the individual. While not all people will regain full range of motion treatment for this condition is generally very successful. A course of hand therapy is generally necessary as a part of their treatment.
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FINGER TIP INJURY
Amputation to tip of finger