Hand Care & Treatment

Pain or discomfort in your hands can interrupt your whole life, from work to tasks at home to leisure activities. At Reading Hospital's Joint Care Center, we take hand issues seriously.

Common Hand Conditions

Arthritis

Arthritis is inflammation of one or more joints, which results in pain, swelling, stiffness, and limited movement. There are over 100 different types of arthritis.

Arthritis involves the breakdown of cartilage. Cartilage normally protects the joint, allowing for smooth movement. Cartilage also absorbs shock when pressure is placed on the joint, like when you walk. Without the usual amount of cartilage, the bones rub together, causing pain, swelling (inflammation), and stiffness.

You may have joint inflammation for a variety of reasons, including:

  • An autoimmune disease (the body attacks itself because the immune system believes a body part is foreign)
  • Broken bone
  • General "wear and tear" on joints
  • Infection (usually caused by bacteria or viruses)

Carpal Tunnel Syndrome

Carpal tunnel syndrome is caused by pressure on the median nerve at the point where it passes through the wrist. The median nerve supplies sensation to the thumb side of the palm, and to the thumb, index finger, middle finger, and the thumb side of the ring finger. It also helps with movement to part of the hand.

The area where the nerve enters the hand is called the carpal tunnel. Since the passageway is stiff, any swelling in this area can put pressure on the nerve. This may also be called entrapment of the nerve.

Some of the conditions associated with carpal tunnel syndrome include:

  • Acromegaly
  • Diabetes
  • High blood pressure
  • Hypothyroidism
  • Kidney failure
  • Menopause
  • Multiple myeloma
  • Obesity
  • Pregnancy
  • Premenstrual syndrome (PMS)
  • Recent fungal infection
  • Recent tuberculosis
  • Rheumatoid arthritis

Tenosynovitis

Tenosynovitis is inflammation of the lining of the sheath that surrounds a tendon (the cord that joins muscle to bone).

The synovium is a lining of the protective sheath that covers tendons. Tenosynovitis is inflammation of this sheath. The cause of the inflammation may be unknown, or it may result from:

  • Infection
  • Injury
  • Overuse
  • Strain

The wrists, hands, and feet are commonly affected. However, the condition may occur with any tendon sheath.

Note: An infected cut to the hands or wrists that causes tenosynovitis may be an emergency requiring surgery.

Diagnosing Hand Conditions

During a physical examination, the doctor may identify numbness in the palm, thumb, index finger, middle finger, and thumb side of the ring finger. Hand grip may be weak.

Electromyography and nerve conduction velocity will show decreased conduction across the wrist. Wrist x-rays should be done to rule other problems (such as wrist arthritis).

Treatment Options

There are many ergonomic devices that can be used in the workplace to reduce the stress placed on the wrist. These include special keyboards, cushioned mouse pads, and keyboard drawers.

Make sure the keyboard is low enough so that the wrists aren't bent upward during typing. You may also need to make changes in your work duties or recreational activities.

Some of the jobs associated with carpal tunnel syndrome include those that involve typing and vibrating tools. Carpal tunnel syndrome has also been linked to professional musicians.

Hand Surgery

Carpal tunnel release is a surgical procedure that cuts into the ligament that is pressing on the nerve. Surgery is successful most of the time, but depends on severity and duration of nerve compression.

After surgery, the damaged nerve must heal for the symptoms to improve. This can take months. In severe cases, the nerve may not be able to fully heal. Certain types of damage (such as muscular atrophy) may not be reversible.

In severe cases, electromyography or nerve conduction studies may be used to check how well the nerve is recovering.

Surgery Recovery

Patients with symptoms of carpal tunnel syndrome usually have non-surgical treatments first. These include:

  • Anti-inflammatory medications
  • Occupational therapy
  • Workplace modification
  • Wrist splints

A splint may be used to reduce wrist motion for the first few days after surgery. Don't delay moving the wrist for too long, though, because it can become stiff.

The longer the symptoms lasted before surgery, and the more severely damaged the nerve appears at surgery, the longer the recovery time.