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Arthritis of the Thumb

Basal Thumb Arthritis: Causes, Symptoms, and Treatment

In a normal joint, cartilage covers the ends of bones, acting as a shock absorber to allow smooth and pain-free movement. However, in osteoarthritis (OA), the cartilage layer wears away, leading to direct bone contact. This results in pain, deformity, and limited range of motion. The base of the thumb is often affected by OA, particularly the carpometacarpal (CMC) joint, which is formed by the trapezium bone in the wrist and the metacarpal bone in the thumb. The specialized saddle-shaped structure of the CMC joint allows a wide range of motion, but OA can restrict this motion and cause significant pain.

Who Gets Basal Thumb Arthritis?

Basal thumb arthritis is more commonly seen in women over the age of 40. While the exact cause is unknown, several factors may increase the risk, including:

Genetics: A family history may increase the likelihood of developing OA.
Previous injuries: Past fractures or dislocations can predispose individuals to arthritis in the CMC joint.
Joint laxity: Generalized looseness of the joints can make the thumb more susceptible to arthritis.

What Are the Signs and Symptoms?

The most common symptom of basal thumb arthritis is pain at the base of the thumb, which can be aggravated by activities that require pinching, such as:

Opening jars
Turning door knobs or keys
Writing or gripping objects

As the condition progresses, pain may occur at rest or at night. In severe cases, the joint may deteriorate, causing misalignment and a bump at the base of the thumb. This misalignment can limit motion, cause weakness, and make pinching difficult. The joint above the CMC may compensate by hyperextending (bending backward).

How is the Diagnosis Made?

Your doctor will diagnose basal thumb arthritis based on a physical evaluation and your medical history. Common signs include pain with pressure, twisting, or movement of the joint, often accompanied by a grinding sensation. While X-rays are used to confirm the diagnosis, the severity of symptoms does not always correlate with the X-ray findings.

What Are the Treatment Options?

In less severe cases, thumb arthritis can often be managed with non-surgical treatments, including:

Arthritis medication: To help manage pain and inflammation.
Splinting: Rigid or non-rigid splints can be worn while sleeping or during activities to support the joint.
Cortisone injections: To provide temporary relief from pain and inflammation.

If non-surgical treatments fail or if the arthritis is advanced, surgical reconstruction may be necessary. Surgical options include:

Removal of arthritic bone and joint reconstruction: To restore joint function and reduce pain.
Joint fusion: Fusing the bones of the joint to eliminate pain, though it can limit motion.
Bone realignment: To correct deformities and improve function.

If you’re experiencing thumb joint pain, make an appointment with South Florida Hand and Orthopaedic Center to explore your treatment options and find relief.

Trigger Finger

Trigger Finger (Stenosing Tenosynovitis): Causes, Symptoms, and Treatment

Stenosing tenosynovitis, commonly known as trigger finger or trigger thumb, occurs when a finger or thumb gets stuck in a bent position and then “pops” out when released, much like releasing a trigger. This condition involves the tendons in the hand that bend the finger. The tendons act like a pulley system, with “ropes” connecting the forearm muscles to the bones of the fingers and thumb. If the pulley at the base of the finger becomes too thick or constricted, it can prevent the tendon from moving freely, causing the finger to get stuck and snap back when it is freed. This cycle can lead to inflammation, pain, and difficulty in straightening or bending the finger.

What Causes Trigger Finger?

The exact cause of trigger finger is not fully understood, but several factors can contribute to its development. These include:

Rheumatoid arthritis: A condition that can cause inflammation of the joints, including the tendons in the fingers.
Gout: A form of arthritis that may affect the tendons and joints in the fingers.
Diabetes: People with diabetes may be more prone to developing trigger finger.
Local trauma: Injury or repetitive stress to the area may also trigger the onset of this condition.

Symptoms of Trigger Finger

Common symptoms of trigger finger include:

Discomfort at the base of the finger or thumb
Tenderness upon localized pressure
Inflammation of the affected finger or thumb
Stiffness, making movement difficult
A nodule (lump) may appear on the middle finger or tip knuckle of the thumb

Treatment for Trigger Finger

The goal of treatment is to alleviate the catching of the finger and allow for full movement without discomfort. Treatment options may include:

Splinting: Wearing a splint to immobilize the affected finger or thumb.
Anti-inflammatory medication: To reduce inflammation in the area.
Activity modification: Changing activities to reduce further swelling and irritation.
Surgery: If non-invasive treatments do not relieve symptoms, surgery may be recommended to release the constricted tendon.

If you suspect that you have trigger finger, it is important to seek treatment from a specialist at South Florida Hand and Orthopaedic Center as soon as possible to prevent further pain or injury.

Metacarpophalangeal Joint Arthritis

Elderly woman with Arthritis in her hands

Metacarpophalangeal (MP) Joint Arthritis: Causes, Diagnosis, and Treatment

The metacarpophalangeal (MP or MCP) joints are large joints at the base of each finger. These complex hinge joints play an important role in both power grip and pinch activities.

Causes of Metacarpophalangeal Joint Arthritis

The MP joints are less commonly affected by arthritis than smaller hand joints or the joints where the thumb meets the wrist (CMC). However, several conditions can affect the MP joints, including:

Rheumatoid arthritis: The most common arthritic condition affecting the MP joints. It causes inflammation of the joint lining (synovium), leading to cartilage and soft tissue destruction, resulting in ulnar drift of the fingers toward the little finger.
Post-traumatic arthritis: Occurs after injury, leading to gradual loss of cartilage and progressive pain and stiffness.
Osteoarthritis: A form of arthritis that affects the MP joints, causing pain and stiffness, particularly in the thumb, index, and middle fingers.
Gout, psoriasis, and infection: Less common causes of MP joint arthritis.

Diagnosis of Metacarpophalangeal Joint Arthritis

The symptoms of MP joint arthritis vary based on the underlying cause:

Rheumatoid arthritis: Characterized by pain, swelling, and deformity in multiple joints, with an ulnar drift of the fingers and loss of motion, especially in extending (straightening) the fingers.
Osteoarthritis and post-traumatic arthritis: Involves deep, aching joint pain, particularly with grip and pinch activities. Swelling, especially between large knuckles, may also be present.

The doctor can confirm the presence of MP arthritis through x-rays, and special x-rays may be necessary to assess the metacarpal head in milder cases.

Treatment Options for MP Arthritis

There are various treatment options depending on the severity of joint destruction and the symptoms experienced:

Rheumatoid arthritis: Medications to combat the inflammatory process are typically the first line of treatment. If medications are ineffective, synovectomy (removal of the inflamed synovium) may be considered to slow the destructive process and preserve cartilage.
Post-traumatic arthritis: Anti-inflammatory medications, activity modification, and splints may offer relief. If symptoms worsen, surgical treatment may be necessary.

MP Joint Fusion or Replacement

For severe joint destruction, patients may benefit from joint fusion or replacement. Key options include:

Joint fusion: While effective for the thumb, joint fusion can result in a loss of motion in the fingers.
Joint replacement: Typically preferred over fusion, especially in younger or more active patients.
Salastic hinged implants: Provide reasonable pain relief and are often used in older, less active patients.
Advanced implants: Newer implants that replicate joint surfaces may offer improved outcomes for younger, more active individuals.

If you’re suffering from metacarpophalangeal joint arthritis, make an appointment with South Florida Hand and Orthopaedic Center.

Nail Bed Injuries

Nail Bed Injuries: Causes, Symptoms, and Treatment

Nail bed injuries are often linked to damage to surrounding structures, including:

Bone fractures: Typically involving the distal phalanx.
Nail bed or fingertip skin (pulp) cuts.
Tendons: Those responsible for straightening or bending the fingertip.
Nerve endings.

These injuries often result from crushing incidents, such as getting the fingertip caught in a door. Any type of pinching, crushing, or sharp cut to the fingertip can lead to a nail bed injury.

Identifying a Nail Bed Injury

A simple fingertip crush can cause a painful collection of blood (hematoma) under the nail. More severe injuries may cause the nail to crack into pieces or result in the nail and/or fingertip tearing off, potentially injuring nearby structures.

Diagnosis of Nail Bed Injuries

The doctor will begin by asking for details about the injury’s cause. X-rays may be recommended to check for associated fractures that may need treatment. The full extent of the injury may not be apparent until the nail bed is examined with magnification.

Nail Bed Injury Treatment

Treatment aims to restore the anatomy of the nail and surrounding structures. Treatment options may include:

Hematoma drainage: A small hole is made in the nail to relieve pressure and reduce pain.
Repairs for cuts: The affected areas are realigned to their proper position.
Bone alignment: If bone fragments are present, alignment and restoration of the fingertip fractures may be required. Larger bone fragments may need pins or splints to heal.
Nail bed grafts: Missing nail bed areas may be grafted from the same finger or other digits.
Tendon injuries: Tendon damage may require splinting or pinning.
Skin flaps: Local skin flaps can replace missing skin, or the area may heal naturally or with a skin graft.

The final appearance and function of the nail and fingertip depend on the restoration of the anatomy. If the injury is sharp and can be repaired, the nail can be restored to normal. However, severe crushing of the nail bed can result in scarring and deformity. Damage to the germinal matrix (the crescent-shaped area at the base of the nail) may lead to deformed nail growth. It generally takes three to six months for the nail to grow from the cuticle to the fingertip.

Flexor Tendon Injuries

Flexor Tendon Injuries: Causes, Symptoms, and Treatment

Flexor tendons are cord-like structures that connect the flexor muscles to the bones, enabling the bending or flexing of the fingers. These tendons run from the elbow and forearm, pass through the wrist, and attach to the bones of the fingers. They move through fibrous rings, known as pulleys, which guide and keep the tendons close to the bones for efficient movement of the joints.

Flexor Tendon Injuries

Deep cuts to the palm side of the wrist, hand, or fingers can damage the flexor tendons, as well as the surrounding nerves and blood vessels. While the external injury may appear minor, it can be quite complex internally. When a tendon is cut, its ends act like a rubber band, pulling apart. If a tendon is not fully severed, the finger may still bend but may cause pain, catching, or eventually tear completely. If the tendon is entirely cut, the finger joint will be unable to bend on its own.

Treating Flexor Tendon Injuries

Since the tendon ends typically separate after a cut, they will not heal properly without surgical intervention. Your doctor will guide you on the urgency of the surgery based on the severity of the injury. Various repair techniques may be used, depending on the type of tendon injury, and special attention is required to preserve the pulleys of the finger.

Post-surgery care: After surgery, the injured area may be protected from movement or placed on a controlled limited-movement regimen for several weeks, based on the nature of the injury.
Hand therapy: Your surgeon may recommend hand therapy after surgery to assist in recovery.
Rehabilitation: After four to six weeks, you may begin to move your finger slowly, without resistance, to regain mobility.

It is crucial to follow your surgeon’s guidance closely to ensure the best possible recovery and preserve the functionality of your finger.

Fingertip Injuries

Fingertip Injuries: Causes, Evaluation, and Treatment

Fingertip injuries encompass a wide range of damage to the skin, bone, nail, nail bed, tendon, or the pulp of the fingertip. These injuries can affect both the functionality and appearance of the finger, often requiring immediate care to prevent complications.

Evaluating a Fingertip Injury

The way in which the injury occurred and any pre-existing medical conditions are crucial factors in determining the most effective treatment. Your hand doctor will:

Examine the extent and size of the tissue injury.
Assess the sensation and circulation in the fingertip.
Check the mobility of the fingertip, as tendon injuries can affect the ability to bend or straighten the finger.
Possibly perform an X-ray to determine if the bone has been injured.

Fingertip Injury Treatment

For fingertip injuries, treatment will depend on the severity of the damage.

Minor injuries: If only the skin is affected and the defect is less than a centimeter in diameter, treatment may involve simple dressing changes.
Exposure of bone: If the injury exposes bone, your doctor may trim the bone back slightly and treat it with a dressing.
Larger skin defects: In cases where more significant skin loss occurs, skin grafting may be necessary. Smaller grafts can be taken from the little finger side of the hand, while larger grafts may be harvested from the forearm or groin.

Due to the fingertip’s highly sensitive and specialized skin, restoring full function and sensation can be a complex process, but with the proper treatment, many injuries can heal successfully.

Fingertip Infections

Fingertip Infections: Causes, Symptoms, and Common Types

Fingertip infections are a common health issue due to the frequent use of our hands in everyday activities. Any opening in the skin around the fingertip can allow harmful bacteria, viruses, or fungi to enter, leading to infection. If left untreated, fingertip infections can result in permanent damage or even the loss of a finger.

Common Causes of Fingertip Infections

Fingertip infections can result from numerous factors, including:

Biting nails
Picking cuticles
Working with sharp or rough objects
Handling animals

Any of these activities can lead to cuts or breaks in the skin, creating an entry point for infections. Below are some of the most common types of fingertip infections:

Types of Fingertip Infections

Felon: A bacterial infection located in the fingertip pad, often caused by staphylococcal or streptococcal bacteria. It typically enters through a puncture wound, leading to swelling and pain in the fingertip. The infection is localized, forming a pocket of pus.
Herpetic Whitlow: A herpes simplex virus infection commonly seen in healthcare professionals or individuals who have herpes. This infection causes redness, tenderness, and a burning or itching sensation in the fingertip.
Cellulitis: The most common fingertip infection, cellulitis is a staphylococcal or streptococcal infection that occurs due to an open wound. The infected area becomes red, warm, swollen, and tender, and can spread to surrounding tissues or enter the bloodstream if untreated.
Infectious Flexor Tenosynovitis: Caused by deep, penetrating trauma, this infection affects the tendon sheaths in the fingertip. It causes swelling, tenderness in the underside of the finger, and pain when trying to bend the finger. The infection can spread easily along the tendon sheath.
Paronychia: A bacterial or fungal infection near the fingernail, often caused by biting hangnails. The affected area becomes red, swollen, and may develop pus.

Preventing Fingertip Infections

To prevent fingertip infections, it is important to avoid activities that break the skin on your fingers, such as nail biting and cuticle picking. Always clean wounds promptly and avoid putting your hands in potentially contaminated areas. If an infection does occur, seek treatment to prevent complications.

Extensor Tendon Injuries

Understanding Extensor Tendon Injuries: Causes, Types, and Treatment

Located on the back of the hand and fingers, the extensor tendons are responsible for allowing you to straighten your fingers and thumb. These tendons are attached to muscles in your forearm and become flat and thin as they extend into the fingers. Smaller tendons from the hand muscles contribute to delicate finger motions and coordination.

Common Types of Extensor Tendon Injuries

Extensor tendons are located just beneath the skin, directly on the bone, making them highly vulnerable to injury, even from minor cuts. A jamming injury can tear these tendons away from the bone, resulting in difficulty straightening one or more joints. Common types of extensor tendon injuries include:

Mallet Finger: This occurs when the tendon at the end joint is cut or separated from the bone, causing the fingertip to droop.
Boutonniere Deformity: This condition results in a bent-down (flexed) middle joint of the finger due to a tear or cut of the extensor tendon.
Lacerations: Cuts on the back of the hand can damage the extensor tendons.

Treatment for Extensor Tendon Injuries

The treatment for extensor tendon injuries depends on the type and severity of the injury. Here’s what you can expect:

Cuts or Lacerations: A tendon cut may require stitches to repair the injury.
Jamming Injuries: Tears caused by jamming injuries are typically treated with splints that prevent the healing tendon from pulling apart.
Splinting: The doctor will apply the splint to the correct area and provide instructions on how long it should be worn. In some cases, a pin may be inserted through the bone to serve as an internal splint.

It is essential to follow the doctor’s instructions and wear the splint as prescribed to ensure proper healing and restore the functionality of the tendon. In severe cases, further intervention may be necessary to ensure full recovery.

Stiffness In Hands

Understanding Hand Stiffness: Causes, Diagnosis, and Treatment

The joints in your hand are covered by a smooth layer of articular cartilage and held together by tough ligaments. These structures facilitate motion and provide stability, preventing hyper-extension and side-to-side stress on the fingers. However, when your hands begin to stiffen, it could indicate various underlying conditions that affect the normal function of these structures.

Common Causes of Hand Stiffness

Several conditions can lead to stiffness and pain in the hand:

Arthritis: A common cause of joint stiffness, where inflammation and cartilage wear down over time.
Fractures: Broken bones or damage to the joint or ligament can lead to limited motion.
Scar Tissue: Post-injury healing can result in the formation of thickened tissue, which restricts movement.
Dislocations: Displaced joints can result in structural changes that affect joint function.
Bad Sprains: Severe sprains can lead to instability and stiffness due to ligament damage.
Tendon and Muscle Injuries: Injuries to the soft tissues can lead to stiffness and reduced range of motion.

When these structures change, it can result in thicker, less elastic ligaments, causing a loss of mobility and joint flexibility. This can lead to the stiffness you feel in your hands.

Diagnosis and Treatment of Hand Stiffness

At South Florida Hand and Orthopaedic Center, our doctors will conduct a comprehensive evaluation to understand the root cause of your hand stiffness. Here’s what to expect:

Full Evaluation: Your doctor will ask about your medical history, previous injuries, and the extent of your stiffness.
Physical Examination: The doctor will assess your range of motion, joint mobility, swelling, and tenderness in the affected hand.
X-rays: Imaging may be used to check for fractures, arthritis, or other structural issues.

Treatment will vary depending on the severity of the condition, ranging from minor interventions to more extensive options:

Stretching Exercises: These may be recommended for less severe cases to improve mobility.
Splinting: The hand or fingers may need to be splinted to stretch tightened joints and promote healing.
Surgery: In more severe cases, surgical intervention may be necessary to restore function and reduce stiffness.

It is important to seek care from a specialized hand surgeon, like the experienced doctors at South Florida Hand and Orthopaedic Center, to receive the most effective treatment tailored to your specific needs.

Skin Cancer of the Hand

Papilloma on the finger, common wart Verruca vulgaris a flat wart on a hand, human papillomavirus HPV

Skin Cancer of the Hand: Types, Risk Factors, Diagnosis, and Treatment

The skin is the most common area of the body where cancer develops. In the hand, the most frequent types of skin cancer are Squamous Cell Carcinoma (SCC), followed by Basal Cell Carcinoma (BCC) and Melanoma. Rare forms such as Kaposi’s sarcoma, dermatofibrosarcoma protuberans, sweat gland tumors, and Merkel cell carcinoma can also affect the hands.

Risk Factors for Skin Cancer

Several factors increase the likelihood of developing skin cancer in the hand:

Sun Exposure: Prolonged and unprotected exposure to UV rays.
Light or Fair Complexion: Individuals with lighter skin are at higher risk.
Immune Suppression: Weakened immune systems can increase vulnerability to skin cancer.
Radiation Exposure: Past radiation treatments increase risk.
Chemical Exposure: Arsenic and certain chemicals are associated with a higher risk of skin cancer.
Genetic Conditions: Conditions like xeroderma pigmentosum and Gorlin syndrome predispose individuals to skin cancer.
Pre-malignant Lesions: Actinic keratosis, cutaneous horns, and Bowen’s disease may develop into squamous carcinoma.
Family History: A family history of skin cancer or certain types of moles can indicate a predisposition to melanoma.

What Does Skin Cancer Look Like?

Each type of skin cancer has distinct features:

Squamous Cell Carcinoma (SCC): SCC typically forms small, firm nodules that are brown or tan. These may show scaling, ulceration, bleeding, or crusting. In some cases, a cutaneous horn may form on the lesion. SCC can also appear as a non-healing wound or infection.
Basal Cell Carcinoma (BCC): BCC appears as a small, well-defined nodule with a translucent, pearly border and visible abnormal blood vessels (telangiectasias). These lesions may ulcerate over time, looking like chronic sores, but they tend to grow slowly and rarely metastasize.
Melanomas: Melanomas typically resemble moles or birthmarks. Suspicious signs include increased growth, variations in color or shape, irregular borders, or a size greater than 6 mm (1/4 inch). Melanomas have a high potential to metastasize.

How is Skin Cancer Diagnosed?

To diagnose skin cancer, your doctor will:

Inspect the Suspicious Lesion: A physical examination and a detailed review of your medical history will be conducted.
Perform a Biopsy: A biopsy is necessary to confirm malignancy. This can involve removing a small part of the lesion or excising the lesion entirely.
Examine Lymph Nodes: Since melanoma and SCC can spread to the lymph nodes, your doctor will examine them for potential metastasis.
Additional Evaluations: In some cases, further tests such as sentinel lymph node biopsy, CT scans, or PET scans may be required to check for metastasis.

Treatment Options for Skin Cancer

The primary treatment for skin cancer is surgical removal of the tumor with clear margins to ensure no cancer cells remain at the edge of the excised tissue. Additional treatments may include:

Skin Grafting or Tissue Flap Coverage: To cover the wound after surgery.
Local Amputation: In more severe cases, amputation of the affected part of the hand may be required.
Radiation or Chemotherapy: For more aggressive forms of skin cancer, radiation or chemotherapy may be necessary.

Prevention is the best approach for skin cancer. Protective measures include:

Wearing protective clothing and sunscreen.
Avoiding high-risk exposures, such as excessive sun exposure and certain chemicals.