4 common hand conditions and how to spot them

Mr Ewan Bigsby Mr Ewan Bigsby Consultant Orthopaedic Surgeon, Cheltenham Hospital
Mr Ewan Bigsby, Consultant Orthopaedic surgeon at Nuffield Health Cheltenham Hospital, guides you through the most common hand conditions, how to spot the signs and your treatment options.

Whether it’s trouble gardening, washing your face or even putting your hands in your pocket, it can be overwhelming to discover there’s something wrong with your hands.

In the hands, 4 of the commonest conditions are: trigger finger/thumb, carpal tunnel syndrome, base of thumb arthritis, and Dupuytren's disease.

1.Trigger finger or thumb

There are tendons that run along the front of the hand that slide to bend the fingers and thumbs.

They run under a series of hoops. But when the tendon thickens it can catch on these hoops and cause a trigger. In more advanced cases, the finger or thumb may actually lock, getting stuck in a bent position, and the other hand may be required to straighten it.

What are the symptoms?

In the early stages it fan feel a bit uncomfortable at the base of the finger and you might feel a clicking. Sometimes the condition may resolve itself and not require much intervention.

Because it may be painful to make a tight grip, picking up a saucepan, or wringing out a cloth may be difficult.

How is trigger finger treated?

If the triggering is troublesome, a cortisone injection can prove helpful, but in more resistant cases, surgery provides a good long-term solution. Surgery is usually performed under local anaesthetic.

2.Carpal tunnel syndrome

While we’ve all experienced pins and needles at some point, those associated with carpal tunnel syndrome (CTS ) can be very intrusive. They can be particularly troublesome at night and wake people from sleep.

What are the symptoms?

CTS comprises a collection of symptoms which arise from irritation of the median nerve at the wrist. There are a number of risk factors for the development of CTS that have been identified, including diabetes, hypothyroidism, pregnancy, some injuries to the wrist, and certain professions.

With reduced feeling in the tips of the fingers, some people report fine needle work difficult, or even doing up buttons on their clothes.

As the condition progresses, constant numbness of the fingers and a weakness in the hand may develop and in severe cases wasting of some of the hand muscles may be seen, particularly at the base of the thumb.

How is carpal tunnel syndrome treated?

Treatment usually starts with wrist splints that are worn at night. The splints keep the wrist straight, which is the position where the nerve has the least pressure on it. In some instances, an injection into the wrist may be advised.

Another option is surgery. The role of surgery is to take the pressure off the median nerve and prevent ongoing damage to it. Surgery usually provides a rapid improvement for some symptoms but it can take several years for the nerve to fully recover and for symptoms to resolve.

In severe cases the nerve may already be too damaged and people are left with the permanent numbness or weakness that they had before the surgery.

3.Base of thumb (CMCJ) arthritis

Arthritis can occur in any joint in the body, and commonly affects the base of the thumb at the carpometacarpal joint (CMCJ).

What are the symptoms?

Symptoms can have a significant impact on everyday activities such as opening jars, turning door handles or picking up a cup of tea. How significant the impact on activities is will depend both on the severity of the arthritis but also on the demands an individual places on their hands.

Pain and stiffness of the thumb are commonly reported, as are a weakness of grip and swelling. Sometimes a subtle change in the shape of the thumb can happen.

How is CMCJ treated?

Various surgical and non-surgical treatment options are available.

In the early stages, simply modifying how tasks are performed to take pressure off the thumb may be sufficient to manage the pain, together with some simple painkillers when needed.

Splints which protect the arthritic joint can also be very helpful.

Cortisone injections are often used both to help confirm the diagnosis but also to provide some pain relief, although this is usually not a long-term solution.

There are a number of surgical treatment options. The commonest is excision arthroplasty, which is removing one of the wrist bones that the thumb grinds against. Other options include joint fusion or joint replacement. Most people gain good pain relief and improvement in function following surgery.

4.Dupuytren's disease

Dupuytren's disease is a thickening of the tissue in the palm, fingers or thumbs. This leads to lumps, or cords of tight tissue which cause the fingers to flex up.

What are the symptoms?

In the early stages, day-to-day tasks may not be affected. But as the restriction in movement progresses, it can become difficult to put gloves on, hold coins in your palm, or put your hands in your pockets. Patients have also reported a flexed finger that is troublesome when washing the face as it can poke into the eye.

A number of risk factors have been identified, and include other family members having Dupuytren's, smoking, high alcohol intake, previous trauma to the hand, previous heavy manual work, certain medications, and diabetes.

How is Dupuytren's treated?

Treatment in the early stages may be just to monitor the condition but once the finger or thumb flexion becomes problematic, there are a number of treatment options.

In some people, needle fasciotomy may be advised. This is a procedure to simply release the tether to the finger or thumb by using a needle through the skin to perforate the tether. While this is a straightforward procedure, it has a high rate of recurrence.

The most established treatment is to remove the diseased tissue through surgery, involving a cut on the palm and/or the affected finger/thumb.

More recently a special injection which digests a component of the diseased tissue, has been used, although there are ongoing studies to determine how effective this is.

Key takeaway

Hand problems don’t need to get in the way of enjoying your day-to-day life. If you’re concerned about pain or other symptoms in your hands, speak to your GP about a diagnosis.

Last updated Wednesday 27 November 2019