Hand Surgery at Middlesex Hospital
Sprains, fractures and general traumatic injuries to the hand can result from falls, athletic and work-related activities, bites, repetitive motion, and accidents from improper use of lawnmowers, snow blowers and other machinery and tools. Arthritis also is a major cause of hand pain and limited motion.
Broken thumbs and fingers
Fractures of the hand can occur in either the small bones of the fingers (phalanges) or the long bones (metacarpals). They can result from a twisting injury, a fall, a crush injury, or direct contact in sports. Although a break can occur in any of these bones, the most serious breaks happen near the joints. This is particularly true when the fracture occurs at the base of the thumb near the wrist.
Thumb fractures are usually caused by direct stress, such as from a fall. A thumb fracture may happen when a ball catches and pulls the thumb back. Some fractures may be caused indirectly, from twisting or muscle contractions, as in contact sports such as wrestling, hockey, football, and skiing. People with a history of bone disease or calcium deficiency are especially at risk.
Surgery may be needed, depending on the location of the fracture and the amount of movement between the broken fragments of bone. There are several operative techniques to realign the bone fragments.
These techniques include devices that hold the bone fragments in place either inside the body (internal fixation) or outside the body (external fixation) while they heal. Internal fixation techniques include the use of wire, pins, plates, and screws. External fixation techniques include the use of pins in bone that are held in place through their attachment to an external fixation device.
Dealing with hand pain and inflammation
It is estimated that one out of every five people living in the United States has at least one joint with signs or symptoms of arthritis. About half of arthritis sufferers are under age 50, and arthritis is the leading cause of disability.
Arthritis is inflammation of one or more of your joints. A joint is where the ends of bones meet -- inflammation causes swelling, pain, and stiffness. Fractures, particularly those that damage the joint surface, and dislocations, are the most common injuries that lead to arthritis. An injured joint is about seven times more likely to become arthritic, even if the injury is properly treated.
Although there are hundreds of kinds of arthritis, most hand pain is caused by osteoarthritis (OA) and rheumatoid arthritis (RA). Osteoarthritis wears away cartilage, which helps keep bones moving easily. When the bare bones rub against each other, it results in pain, stiffness, and weakness.
Osteoarthritis can develop due to normal "wear-and-tear" in the hand, particularly in people who have a family history of arthritis. It may also develop as a result of a traumatic injury, such as a broken bone or a sprain. OA causes swelling, pain, limited motion, and weakness.
Rheumatoid arthritis is a chronic disease that attacks multiple joints throughout the body. Rheumatoid arthritis often starts in smaller joints, like those found in the hand and wrist. It is symmetrical, meaning that it usually affects the same joint on both sides of the body.
RA often affects the joint between the two bones of the forearm, softening and eroding them, which can cause tearing of the tendons that straighten your fingers. This can result in joint deformity, such as bent wrists and gnarled fingers. RA of the wrist joint also causes swelling, pain, limited motion, and weakness. However, in contrast to OA, wrist symptoms will usually be accompanied by pain, swelling and stiffness in the knuckle joints of the hand.
In general, early treatment is non-surgical and designed to help relieve pain and swelling.
Surgical treatment for your hands
When non-surgical treatments are no longer effective, resulting in progressive loss of hand function, surgery is an option to relieve pain and to preserve use.
If there is any way the joint can be preserved or reconstructed, this option is usually chosen. When the damage has progressed to a point that the surfaces will no longer work, a joint replacement or a fusion is performed. Joint fusions provide pain relief but stop joint motion. The fused joint no longer moves; the damaged joint surfaces are gone, so they cannot cause symptoms.
Joint replacement is performed to provide pain relief and functional joint motion. There have been significant improvements in joint replacements in the hand and wrist. The replacement joints are made of materials similar to those used in weight-bearing joints, such as ceramics or long-wearing metal and plastic parts. The goal is to improve the function and longevity of the replaced joint. Most of the major joints of the hand and wrist can be replaced.
At Middlesex Hospital, our orthopedic surgery department specializes in a variety of diagnostic procedures designed to carefully analyze your hand injury or condition and determine the best course of action. We then help you navigate surgical and non-surgical recommendations and follow-up requirements. If your hand requires surgery, our Board-certified surgeons and highly experienced orthopedic surgical team perform a variety of advanced surgeries, using the most sophisticated tools, customized materials and technologies.
Regardless of which form of surgery you and your surgeon choose, rehabilitation plays a vital role in getting you back to your daily activities. At Middlesex Hospital, we customize your physical therapy program to help you regain hand strength and motion and to promote healthy healing and a faster recovery. [For more information on rehabilitation after hand surgery, click here.] And our nurse navigator [ADD LINK] assists you, every step of the way, providing pre- and post-surgical support and assistance during your recovery.