Research Articles


Should I seek treatment for my finger that will not straighten?

I jammed my finger playing basketball a few weeks ago. I’ve rested my finger since then but still am unable to straighten my fingertip all the way. Should I seek medical treatment or is it just going to stay this way? Recent review of the literature suggests that you should go ahead and seek medical treatment. Even though it has been awhile since your injury you are still within the successful treatment time-frame. Your physician will more than likely refer you to a physical therapist …Read more

Soft Tissue Mallet Finger Injuries With Delayed Treatment

Delayed Treatment of Mallet Finger InjuriesMallet finger typically occurs with jamming your finger, like hitting a basketball with a straight finger, forcing it to bend when not expected. If the tendon that attaches near the base of your fingernail is unable to withstand this sudden force, it avulses or rips off of the bone creating a droopy fingertip. Unless this tendon is reattached somehow, you will never be able to straighten the tip of your finger again. Typically, this does not interfere…Read more

Avoiding complications after finger dislocations

Three hand surgeons from well-known centers for reconstructive hand surgery presented a lecture on complications following dislocations of the proximal interphalangeal (PIP) joint. The lecture was given at the 2013 annual meeting of the American Academy of Orthopaedic Surgeons. This article is a written record of that instructional lecture.The proximal interphalangeal (PIP) joint is the middle joint of the finger. Dislocations of this joint can be very problematic. Every effort is made to preven…Read more

Alternative Treatment for Hand Arthritis

If you are one of the many people who suffer from painful, degenerative arthritis of the hands, you may find the information in this article helpful. Two physicians from the Raleigh Hand Center (North Carolina) bring us up-to-date information on alternative treatment for this condition. Their focus is on recent evidence concerning the use of osteoarthritis-knee” class=”alinks-link” title=”Glucosamine and Chondroitin Sulfate”>glucosamine and chondroitin sulfate in the treatment of hand osteoar…Read more

Results From Around the World Treating Dupuytren’s Contracture

Thirty-seven hand surgeons from around the world worked together over a period of years to gather data on the long-term results of using collagenase (Xiaflex) injection for Dupuytren’s contracture. This report is a summary of their findings using recurrence rate as the main measuring stick for success/failure.Dupuytren’s contracture is a fairly common disorder of the fingers. The condition usually shows up as a thick nodule (knob) or a short cord in the palm of the hand, just below the ring fing…Read more

Surgeons More Conservative in Treatment of Carpal Tunnel Syndrome Compared to 25 Years Ago

According to a new survey of hand surgeons, the treatment of carpal tunnel syndrome has changed quite a bit from 25 years ago. This new study was done by the American Society for the Surgery of the Hand (ASSH). They sent email questionnaires to all of their members (a total of 1,463) and compared the answers to the same questions sent out 25 years ago.The goal of the study was to see how clinical practice has changed in the last 25 years. No attempt was made to assess results from then to now wi…Read more

Review of Treatment of Metacarpal (Finger) Fractures

Fractures of the long bones of the fingers (called metacarpals usually only require casting and immobilization for a short time to promote healing. But if the fracture is separated (called displacement), unstable, or incongruent (broken ends don’t line up correctly), then surgical fixation may be required.Fixation refers to the use of Kirschner wires, condylar plates, or interfragmentary screws to hold broken bones together until healing takes place. The surgery may be done as an open or closed …Read more

Surgeon Reports on Rare Fistula of the Hand

In this report, a hand surgeon from the Southern Illinois Hand Center recaps his experience treating a rare fistula in the palm of 15 patients. All had either an injury to the palm or surgery with incision for trigger finger and steroid injections as the reason(s) or cause(s) allowing the problem to develop.A fistula is an abnormal channel or passageway between two places that normally do not connect. In the case of these patients, the tract was from the lining around a tendon out through an ope…Read more

Treating Finger Fractures Without Immobilizing the Wrist

Fractures of the fingers that don’t involve the joint are called extraarticular phalangeal fractures. The term phalanges refers to the finger bones. Of the three bones in each of the fingers, the phalanges closest to the hand is the proximal phalange. Extraarticular fractures of the proximal phalanges are the topic of this article.Treatment for nondisplaced phalangeal fractures is usually with cast immobilization. The cast places the large knuckles (metacarpal phalangeal joints) in a bent positi…Read more

Management of Thumb Deformity Caused By Arthritis

The base of the thumb (where it joins the wrist) is a common spot for arthritis that can be very disabling. This joint is called the thumb basilar or carpometacarpal joint. Arthritis of the thumb makes it difficult to pick up objects, open doors, turn a key in a lock, get dressed, and many other daily activities we often take for granted.More than half of all women in their 70s and older will experience this type of problem. Collapse of the basilar thumb joint will cause a zigzag shift throughou…Read more

When Carpal Tunnel Surgery Doesn’t Work: Predicting Results of a Second Surgery

Imagine you have carpal tunnel syndrome that has not responded well to conservative (nonoperative) treatment. After having surgery to release the carpal tunnel but you didn’t get the results you had hope for. Instead, the pain remains in your wrist and hand. The numbness and tingling in your thumb and first two fingers is enough to drive you crazy some days. You ask yourself: is it worth it to have a second surgery? If it didn’t work the first time, how can you be sure the procedure will be succ…Read more

Comparing Finger Splints for Trigger Finger

There is nothing more annoying than having your finger lock up on you and not being able to open your hand. Your hand gets stuck inside pants pockets. You can’t reach into your pocket and pull out your wallet. Even taking care of business in the bathroom can become a challenge.Trigger finger is a condition affecting the movement of the tendons as they move the finger(s) toward or away from the palm of the hand. In the early stages of this condition, there is pain, swelling, and a clicking sensat…Read more

Hand Surgeons Surveyed About Treatment for Thumb Arthritis

n this study, outcomes of various treatments for basal thumb arthritis are investigated and compared with current trends in the treatment of this condition. Basal thumb arthritis refers to pain, stiffness, and decreased pinch strength associated with degenerative changes of the trapeziometacarpal (TM) joint.The trapeziometacarpal (TM) joint is at the base of the thumb where the metacarpal bone of the thumb connects to the trapezium of the wrist. This joint is also referred to as the CMC joint (a…Read more

Getting Back to Work After Carpal Tunnel Surgery

The results of this study from the Hand and Upper Extremity Department at Massachusetts General Hospital in Boston may be of interest to anyone with carpal tunnel syndrome. They took a look at type of work (desk versus manual labor) and its relation to return-to-work.The patients in the study had a small open incision surgery under local anesthesia to release pressure on the median nerve (the usual cause of carpal tunnel syndrome). Desk workers were able to return-to-work sooner than manual labo…Read more

Successful Treatment of Thumb Arthritis

When you stop to think about how much you use your thumbs, it’s easy to see why the joint where the thumb attaches to the hand can suffer from wear and tear. This joint is called the carpometacarpal or CMC joint. The CMC is the joint that allows you to move your thumb into your palm, a motion called opposition. The CMC joint is sometimes referred to as a “universal joint” because of the wide range of movements possible.The place where the CMC joint of the thumb attaches to the wrist is at the tr…Read more

What Do We Need to Improve Treatment for Dupuytren Contracture

Two orthopedic hand surgeons from the University of Rochester Medical Center in Rochester, New York use the example of a 66-year-old man with Dupuytren contracture to look at directions for future research. By asking what is the best treatment for this patient, the authors identified areas where more study is needed. They take a look at the disease itself, the current treatment, and point out where more information could help provide better outcomes.Dupuytren’s contracture is a fairly common dis…Read more

Treatment for Dupuytren Disease is Changing

New understanding of Dupuytren disease is changing the way the condition is treated. Surgery is less common now. Injections to dissolve the cords formed by this condition are becoming a preferred treatment. In this article, two hand surgeons from the Boston area review the causes, treatment, complications of treatment, and prognosis for this problem.Dupuytren disease is a fairly common disorder of the fingers. It occurs most often in middle-aged, white men. This condition is seven times more com…Read more

Do You Really Need Those Preventive Antibiotics For Surgery

Studies show that taking antibiotics in preparation for hip replacement, surgery for hip fracture fixation, and breast reconstruction really does help reduce the risk of infection. But if you are having elective hand surgery to remove a tumor, cyst, or ganglion; to treat carpal tunnel syndrome, or to transfer a nerve — do you really need those preventive antibiotics? Especially now that we know the overuse of antibiotics has caused some equally serious problems.That’s the topic of this retrospe…Read more

Comparing Costs and Effectiveness of Treatment for Dupuytren’s Contracture

Patients who have a hand condition called Dupuytren’s contracture have three basic treatment choices. They can have an open partial fasciotomy (removal of the tissue), needle aponeurotomy (destruction of the connective tissue), or collagenase injection (needle injection of enzymes that break down the tissue.Along with those three choices come some disappointing results — recurrence of the problem. Let’s take a look at what the problem is and then come back to this point. Dupuytren’s contracture…Read more

News For Orthopedic Surgeons, Plastic Surgeons, and Hand Surgeons

Every surgeon must know the details of the anatomy in the area being operated on. But sometimes the body throws a ringer that can surprise even the most experienced surgeons. That’s the case in this report of a 70-year-old woman with carpal tunnel syndrome.Carpal tunnel syndrome (CTS) is a common problem affecting the hand and wrist. Symptoms begin when the median nerve gets squeezed inside the carpal tunnel of the wrist, a medical condition known as nerve entrapment or compressive neuropathy. A…Read more

Treatment Decisions and Options for Boutonniere Finger

People who have rheumatoid arthritis of the hands often develop a finger deformity referred to as a Boutonniere deformity. The name comes from a French word for “button hole”. We will explain that further after we describe the deformity.When the affected finger is viewed from the side, it has a zig-zag appearance. That’s because the joint of the middle knuckle of the finger (called the proximal interphalangeal or PIP joint) is permanently bent toward the palm while the tip of the finger (as the …Read more

Long Term Results of Finger Joint Replacements

You never really know or appreciate just what one little finger joint can do for you — until you lose the ability to move it. But patients with osteoarthritis of the interphalangeal (IP) joint can testify that pain limits function and even movement of the other finger joints.It is possible to replace damaged joints these days — even finger joints like the interphalangeal (IP) joint. That’s the middle finger joint between the large knuckle and the tip of the finger. But does replacing the degen…Read more

New Drug Treatment for Dupuytrens Disease

New Drug Treatment for Dupuytrens Disease May Replace Surgery Almost 400 years have passed by since Dupuytrens disease of the hand was first described by a Swiss physician. Since that time, surgery has been the only successful treatment. That may all change with the recent FDA approval of Xiaflex, an injectable drug designed to weaken the diseased tissue.Dupuytrens disease is a fairly common disorder of the fingers. It most often affects the ring or little finger, sometimes both, and often in b…Read more

Age Is Not a Factor in Finger Replantation

Fears that older age (65 or older) increases the risk of complications (including death) from finger replantation can be set aside. According to this study from Stanford University, the risk of serious blood clots leading to death after surgery to reattach a thumb or finger in the older age group is no different than in the younger crowd.They determined this by reviewing the medical records of 616 patients across the U.S. who had this surgery done over a 10-year period of time. The data was take…Read more

The Role of Surgery in Treating Rheumatoid Arthritis of the Hand

There’s no doubt that improved medical treatment has reduced the number (and severity) of hand, finger, and thumb deformities caused by rheumatoid arthritis. But these and other problems still do crop up and may require surgical intervention.In this article, the role of surgery in the management of rheumatoid arthritis affecting the hand is reviewed. Each area of the hand from the wrist to the finger tips is discussed. Treatment of specific deformities such as boutonniere or swan-neck of the fin…Read more

What’s the Best Surgery for Thumb Arthritis?

Pain, swelling, and loss of motion at the base of the thumb describe symptoms of carpometacarpal osteoarthritis (CMC OA) otherwise known as thumb arthritis. Just try and get along on a single day without being able to use your thumb. Everything from picking up a carton of milk to taking the handbrake off in the car can become impossible.Over time, the thumb becomes weaker and weaker. With loss of normal strength, the thumb loses its anatomic alignment. Deformity and disability develop. Pretty so…Read more

Is the Mystery of Anterior Interosseous Palsy Solved?

Sometimes orthopedic surgeons have to be like Sherlock Holmes, the fictional detective written about by Sir Arthur Conan Doyle back in the 1800s. Patients come in with all types of pain and symptoms. The diagnosis isn’t always obvious at first.Take the patient featured in this article for example. She was a 36-year-old woman without significant pain or discomfort. But suddenly her handwriting started to get worse and worse. She didn’t have any numbness or tingling to suggest a nerve problem. The…Read more

A New Test to Assess Severity of Complex Regional Pain Syndrome

Some of the best minds in the world of rehabilitation have come together to formulate a scoring system for complex regional pain syndrome (CRPS). Until now, patients were diagnosed with this condition as either “yes you have CRPS” or “no, you don’t have CRPS”. [That’s what is called a dichotomous diagnosis]. Until now, there has been no way to give it a description such as mild, moderate, or severe that conveyed to everyone just what the condition looked like.Like its name, complex regional pain…Read more

Successful Treatment of Tenosynovitis

Trigger fingers, De Quervain syndrome, and intersection syndrome are the topic of this review article. These three conditions have one thing in common: they all cause painful forearm, wrist, and/or hand symptoms. Although these problems all fall under the category of tenosynovitis (inflammation of the synovial lining around the tendons), they aren’t all really inflammatory conditions.How do we know this? Scientists have examined cells taken from painful tendons, tendon sheaths, the synovial lini…Read more

A Useful Technique for Treating Mallet Finger Fractures

You wouldn’t think a fracture of the tip of a finger would be a big deal. But without proper treatment, the affected tip can end up in a bent position called mallet finger. That fixed position can be annoying, painful, and limit function. Mallet finger injuries are common among sports athletes but they can also occur at work and during activities at home.An injury of this kind affects the distal interphalangeal (DIP) joint. That’s the anatomical term for the joint that moves the tip of the finge…Read more

Less Invasive Treatment of Dupuytren’s Disease

Promising Results with Less Invasive Treatment of Dupuytren’s Disease Dupuytren’s disease is a condition where the tissue just under the skin in the palm of your hand becomes thick and shrinks, pulling very tight. In some cases, this causes lumping or unevenness of the palm of the hand and in others, it can cause a significant flexion contracture, making the hand look as if it is permanently holding on to something.The regularly accepted treatment for Dupuytren’s has been surgery. But there is …Read more

What’s New for Hand Surgeons Regarding Peripheral Nerve Injuries

In this article, hand surgeons from the Upper Extremity Center of Atlanta Georgia offer a detailed review and update on peripheral nerve injuries of the arm. Their specific focus is tendon transfer treatment for muscles that lose power as a result of the injury. Although age was not specifically stated in the discussion, the patient photos were all of children.There are three major nerves to the muscles of the arm: the radial nerve, ulnar nerve, and median nerve. There can be a high nerve injury…Read more

Combined Wrist Injury Requires Combined Surgical Approach

As a result of this study, hand surgeons from Duke University (North Carolina) are suggesting the use of both arthroscopic and open incision surgery for one kind of painful wrist fracture that doesn’t heal. Bone fractures that don’t heal are called nonunion fractures. The nonunion fracture in this study was of the ulnar styloid.A little bit of wrist anatomy will help us understand what they found and why they make this recommendation. At the end of the forearm, two bones meet the first row of bo…Read more

First Study to Compare Hand Therapy After Finger Flexor Tendon Repair

Since that time, research has continued in the area of hand therapy. Hand rehab programs have expanded to include all kinds of different ideas for post-op positioning, motion, and exercise. In this study, the use of a passive motion program was compared with early active motion therapy. The authors believe this is the first study published comparing these two hand therapy techniques.Passive motion refers to the fact that someone else other than the patient (in this case, a hand therapist) is mov…Read more

Review of Tendon Disorders of the Hand and Wrist

It is quite likely that the most common injuries to the hand and wrist are those affecting the tendons. And, although they are common and have been known about for a long time, there are still disagreements and uncertainty as to how to treat some of them. In earlier days, it was thought that tendon injuries were caused by inflammation and this is why they were given their names: tendonitis, tenosynovitis, and tendovaginitis – with itis meaning inflammation. However, this isn’t always the case. T…Read more

Chronic Nerve Compression: What’s Going On?

Ever felt nervous, jittery, or just plain irritable? You might think those are all emotional responses but in fact, that’s your nervous system responding to whatever is happening in your life. The central nervous system (CNS) is made up of the brain and spinal cord. But there’s another part of the nervous system called the peripheral nervous system (PNS). It’s made up of all the nerves coming from the spinal cord and going out to the rest of your body. The peripheral nerves can be sensory only, …Read more

Carpal Tunnel Release Effectiveness Appears to Be Maintained in Seniors

Are you over 65 years and suffering from carpal tunnel symptoms? This article reviews the post-operative outcome for clients who had surgery for carpal tunnel release and the outcome was 70-89% favourable at six months post-surgery for resolving their symptoms. Discuss your symptoms of pain, numbness and tingling with your Physical Therapist at Synergy Therapeutic Group for further advice.Read more

Thanks to a Skiing Injury, Mallet Finger Injuries Get a Review

Mallet finger treatment is reviewed in this article. Although further research is indicated for this condition, Synergy Therapeutic Group have been advised to date that splinting appears to be the treatment of choice, in all but the worst injuries; therefore splinting compliance is linked with favourable outcome.Read more

New Findings About Trigger Finger and How to Treat It

Little by little, researchers are coming to understand what’s behind the problem of trigger finger. Trigger finger (and trigger thumb) are conditions affecting the movement of the tendons as they bend the fingers or thumb toward the palm of the hand. This movement is called flexion. The tendons that move the fingers are held in place on the bones by a series of ligaments called pulleys. These ligaments form an arch on the surface of the bone that creates a sort of tunnel for the tendon to follow…Read more

Little and Ring Fingers May Do Better with Silicone Arthroplasty Than Index and Middle Fingers

Arthroplasty (joint replacement) can be done on many joints now, including the fingers. Metacarpophalangeal joints, or the knuckles at the base of the fingers, that have been damaged by rheumatoid arthritis can be replaced using silicone arthroplasty, but some studies have shown that this may not be as effective in some fingers than in others. The authors of this study wanted to see if different fingers reacted differently to the silicone arthroplasty in how they were able to move, extend, and m…Read more

Acupuncture Works for Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is a common problem affecting the thumb, hand, and wrist. Symptoms begin when the median nerve gets squeezed inside the carpal tunnel of the wrist. The result is a medical condition known as nerve entrapment or compressive neuropathy. Any condition that decreases the size of the carpal tunnel or enlarges the tissues inside the tunnel can produce the symptoms of CTS. This includes diabetes, kidney failure, rheumatoid arthritis, pregnancy, thyroid disease, and many oth…Read more

Surgical and Non-Surgical Treatment of Basal Joint Arthritis of the Thumb

Osteoarthritis is often called the wear-and-tear arthritis and most often hits the weight-bearing joints like the hips and knees. However, osteoarthritis of the trapeziometacarpal joint, the joint at the base of the thumb, is quite common, particularly among women who are past menopause. Treatment of osteoarthritis of the base of the thumb is almost always first non-surgical. This means trying anti-inflammatory medications, steroid injections, and maybe splinting the thumb. Exercises may also be…Read more

Trigger Thumb in Children

A trigger finger is a condition where a finger is stuck in a bent position as if pulling a trigger. The tendon in the finger, the tough fibrous tissue that controls the finger’s motion, becomes irritated and may swell up in the opening of the passage through the finger. As it becomes inflamed, the tendon can thicken and then get caught in the opening. When the situation isn’t severe, it is possible to straighten the finger and you may even feel a popping sensation as the tendon is released from …Read more

Review of Dupuytren Disease Management

One of the many conditions that can affect your hand is Dupuytren disease. It was first written about in 1614 but it was only in 1831 that the disease was defined and described in detail to medical students. The disease is the thickening of the skin on the palm of the hand. This can happen on one hand alone, but often develops in both at the same time. For some people, Dupuytren disease goes beyond the palm of the hand, towards the fingers. The thickened skin begins to pull on the fingers.