Arthritis

There are many types of Arthritis. It is a degenerative condition that happens as the cartilage lining the joint surfaces begins to wear out. This can lead to direct bone on bone contact at the joint level and over time becomes painful, swollen, and stiff. There are many options, both surgical  and non surgical that are out there to treat these types of conditions.
You may have arthritis if:

• Your hand, finger or wrist when you wake up in the morning
• The affected areas need time to loosen up before functioning properly
• Pain or soreness after routine tasks
• Swelling at the joint sites
• Lose mobility

Basal Joint Arthritis

The Basal Joint is one of the most common joints found in the hand that develops arthritis. This joint is located at the base of the thumb where it meets the wrist. Diagnosis of this condition is confirmed after evaluation by a hand surgeon and X-rays show demonstrate degenerative changes at the level of the basal joint. Treatment can include hand therapy, splints, cortisone (steroid) injections or surgery.

Tendonitis

Tendonitis is the inflammation of the structure that connects muscles to bones, or the tendons. This can be as a result of injury, overuse, or other medical conditions. Tendonitis can typically be treated without surgery in an medical office. You may have some form of tendonitis if you are experiencing pain with motion of your fingers or swelling in the hand, wrist or finger or even pain when gripping objects.

Trigger Finger

Triggering of the digits can be a result of tendon swelling in the area that the finders flex. This can manifest itself as a result of overuse, from an injury, or simply a general medical condition. If the tendon swells, it catches on the structures that it normally slides right through. The effect is a painful symptom, sometimes triggering or locking. After a thorough evaluation, this can often be treated non-surgically with a minimally invasive procedure. In those instances that require surgery, the procedure can be accomplished under local anesthesia as an in office procedure. This allows for a more convenient procedure, scheduled around your availability.

Raynaud’s disease and phenomenon

The physical manifestations of Raynaud’s disease and phenomenon fall across a very wide spectrum. The most severe case can threaten the viability of the fingers, especially the finger tips. In patients with Raynaud’s Disease and phenomenon, cold temperatures can cause a painful decrease in blood flow to the hand and finger tips. Depending of the severity of a patients symptoms this can occur from exposure to cold temperatures during inclement weather (9 months of the year in Chicago!), holding cold objects or even reaching into the freezer at home.

Dupuytren’s Disease

The disease is a thickening of the palm and often presents in men and women who are over the age of 40. This is a progressive disease which starts with firm lumps in the palm. In some patients these lumps will extend into the fingers in cord like structures. There are several treatment options ranging from minimally invasive procedures to injection of medication (Xiaflex) to surgery. Treatment options and timing of procedures can be discussed with your hand surgeon.

Ganglion Cysts

These cysts are extremely common and appear on the body as fluid filled masses. These can occur in the fingers, hand, and wrist. They can originate from both joints and tendons. These fluid filled cysts typically connect to the underlying joint with a one-way valve that allows joint fluid to progressively enter and remain in the cyst. When these occur in the last small joint in the fingers they can affect the appearance of the adjacent finger nails. Often referred to as a Mucous Cyst, it is common to see deformities in the nail near these cysts. It is recommended to avoid puncturing these readily accessible cysts as this can lead to severe infections of the joint.

In the wrist, ganglion cysts can occur on either side of the hand/wrist. While the cyst itself is not typically painful it is not uncommon for patients to experience some dull or sharp pain just prior to the clinical appearance of the mass. While aspiration can help deflate the cyst cavity, surgical excision is a small procedure that produces the lowest recurrence rate.

Mucous Cyst

These types of cysts are very common today and often present as fluid filled masses in the fingers. They can originate from both the joints and tendons. These fluid filled cysts typically connect to the underlying joint with a one-way valve that allows joint fluid to progressively enter and remain in the cyst. When these occur in the last small joint in the fingers (DIP joint) they can affect the appearance of the adjacent finger nails. Referred to as a Mucous Cyst, it is common to see grooving or other deformities in the nail near these cysts. It is recommended to avoid puncturing these readily accessible cysts as this can lead to severe infections of the joint. While aspiration can help deflate the cyst cavity, surgical excision is a small procedure that produces the lowest recurrence rate.

Rheumatoid arthritis

Rheumatoid arthritis is a disease that can affect the whole body. It causes inflammation and swelling in the cells that line the joints. This swelling erodes the cartilage and bone and may also stretch the surrounding ligaments, which are the connective tissues that hold the bones together, resulting in deformity and instability. The inflammation may also spread to the tendons, which are the rope-like structures that link muscles to bones. This can result in stretching out of and ruptures of the tendons. Rheumatoid arthritis of the hand is most common in the wrist and the finger knuckles.

If you have rheumatoid arthritis in your hands, a rheumatologist will often prescribe and manage medications that can help decrease inflammation, relieve pain and slow the progression of the disease. Several disease-modifying treatments are now available that help suppress the body’s immune system to reduce the inflammation and pain.

Surgery to treat the arthritic joints includes removal of inflamed joint linings, joint replacements, joint fusions, and in some cases, removal of damaged bone. Your hand surgeon can help you decide on the most appropriate treatment for you. Unfortunately, there is no cure for rheumatoid arthritis. However, surgical procedures can often help correct deformities, relieve pain, and improve function.

Congenital hand defects

Babies can be born with a number of hand conditions ranging from relatively minor to major. While some can be treated as a newborn, most conditions are treated when the child is a few years old. Some of the more common hand defects are webbed Fingers, extra digits, missing digits or small digits and hand conditions related to other more severe medical conditions.

Infection

Hand infections can be quite serious and debilitating. Our hand surgeons understand the urgent nature of these conditions and will accommodate patients on a same day basis for evaluation. Please seek consultation if you experience signs of infection: pain, redness, swelling, warmth or drainage in the upper extremity. Common sites for infection include:

Fractures

A fracture is another term for a broken bone. This can occur as a result of many types of trauma such as falls, sports and work related injuries. The small narrow bones of the fingers, hand (metacarpal bones) and wrist (carpal bones, radius and ulna) are all very susceptible to fractures even with minor injuries. While all fractures do not require surgery to heal properly, treatment by a trained hand surgeon can optimize the outcome. You should seek consultation if you have pain and or swelling in your forearm, wrist, hand, or fingers after an injury or if there are any noticeable deformities affecting the same areas.

Dislocations

Dislocations are injuries that occur when one of the two bones that make up a joint is forced from its natural (anatomic) position. The severity of these injuries can vary, some effect the soft tissue that hold the joint in place while others can be associated with fractures. Certain patterns of dislocations can require surgery to heal properly. However dislocations that cannot be properly aligned (reduced) require urgent medical attention. You may have suffered a dislocation if:

• Any noticeable deformity of finger, hand or wrist after an injury
• An incident in which the joint had to be ‘popped’ back into place (reduced)

 

Sprain

Traumatic injuries may not be severe enough to cause fractures or dislocations. A sprain occurs when the structures that hold the bones into place are stretched or strained. Sprains can be associated with nagging symptoms that last for weeks to months. Without proper attention certain types of sprains can lead to loss of motion or stability at the level of a finger, hand or wrist joint. Seek consultation with a hand specialist if after an injury you continue to have:

• Swelling
• Pain with motion
• Joints that feel unstable
• Point tenderness or isolated pain at the injury site

Ligament Injuries

A ligament is the soft tissue that connects bones to bones. It provides much needed stability to resist the forces that we place on the hand, fingers and wrist in our daily activities. Injuries to these structure occur through trauma, such as injury to the thumb ligaments from a ski pole bending the thumb backwards. This can lead to pain, swelling, instability of the joint and even a dislocation. Injuries to ligaments can remain painful for 6-8 weeks and may not be evident to a lay person or non-hand specialist. These injuries may require surgery to repair but some select case can be treated with casting and immobilization.