Got Pain?

Tying a shoe, typing an email, opening a jar, texting on a Blackberry. The mobility of our fingers and wrists can often be taken for granted. That is until the throbbing pain begins, and interferes with simple, everyday tasks. According to new research presented at the 2009 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), there are new alternatives other than surgery for hand and wrist pain.

"Outside of the brain, the hand is the most versatile part of the body," stated A. Lee Osterman, MD and professor of orthopedic and hand surgery at Thomas Jefferson University Hospital. "When the 27 bones, cartilage, joints, tendons and nerves in the hand do not work as they should, deformity, motion loss and disability become a painful reality for many people."

According to the latest numbers available, in 2006 -
• More than 3 million people visited their physician due to wrist pain and more than 7 million for hand and finger pain.

Common hand and finger problems can include arthritis in the base of the thumb, Dupuytren's Disease (the tissue just beneath the skin of the palm) and nerve pain, explains Dr. Osterman. But new treatments, like arthroscopy, collagenase injections, nerve wraps, desensitization techniques, therapeutic techniques and neuroleptic medications – both oral and injectable – (examples include Vitamin C and Botulinum injections) have aided a hand surgeon's ability to combat these problems and get patients back to full function.

Arthritis of the Base of the Thumb and Finger

• The second most common joint in the hand to develop arthritis. More common in women over 40.
• Past injuries to the joint, such as a fracture or sprain, increase likelihood of arthritis.
• Previous treatment options included - surgical and non-surgical care, splinting and/or pain medication.

"Arthroscopic treatment is a viable, newer option for people with thumb and finger arthritis," said Scott P. Steinmann, MD, professor of orthopaedics at Mayo Clinic in Rochester, Minnesota. His recent study in the Journal of Hand Surgery showed that 94 percent of patients undergoing arthroscopic debridement procedures were partially or completely satisfied.

Figure 1: Dupuytrens disease may present as a small lump, pit, or thickened cord in the palm of the hand

Dupuytren's Disease

• Often starts with lumps in the palm. Firm cords begin to develop underneath the skin, stretching from the palm to the finger. Gradually, the cords cause the fingers to bend into the palm.
• Dupuytren's contracture is more common in men over the age of 40.
• Previous treatment included observation and surgery.