Latest Articles

by ANDREA LUEKEN, OTR/L, CHT

As the weather gets better, many of us are spending more time outside. Gardening is great hobby and way to stay active. Unfortunately, for those with  hand arthritis, this hobby can be painful.  When activities you love cause pain, it’s time to think about what you can do to minimize pain and further damage to your joints.  The following tips can help you enjoy gardening for many years to come!

1. Plan ahead. Think about what activities may require help. If you are handling heavy plants or maneuvering pots, ask for assistance. You’ve heard the saying, “Two hands are better than one”. Well, for those with pain, four hands are better than two! If you use less effort on the heavier tasks, you can do more enjoyable activities like planting flowers and tending to your vegetables.

Planning ahead may also mean organizing your time. Trying to finish the whole garden in one shot may not be good for your joints! Make sure you take breaks and spread the project over several days to avoid unnecessary pain.

2. Finds tools to help your body work more efficient. For those with arthritis in the hands, there are a variety ofgardening tools to decrease strain on your joints. Typically, tools with wider grips and curved handles are better. These can help place joints in better positions for less pain, but also allow you to use larger muscles groups to do the work.

3.  Know your limits. If your are performing a task and it is painful, you probably shouldn’t be doing it! Is there a different way to complete that task that doesn’t cause pain (i.e. reposition hands/body, use different tool)? There is almost always more than one way to finish a project. And your joints with thank you when you find that way!

Arthritis can be painful and debilitating. But with the right tools and knowledge, gardening is one activity that you can enjoy for a long time! The following websites may be helpful in completing your goals.

www.arthritistoday.org

www.arthritissupplies.com

You can also speak with one of our hand therapists to help you determine the best way to enjoy these activities for years to come!

A hand surgeon is a physician who is proficient in both the non-surgical and surgical treatment of most hand and upper extremity conditions. After completing a residency in general, plastic, or orthopaedic surgery, hand surgeons complete an additional year of training in the injuries, diseases, and conditions unique to the hand and arm. The complete care of the hand and upper extremity involves specialized techniques in orthopaedic, plastic, neurologic, arthroscopic, and microvascular surgery — combining features from multiple surgical specialites. Over the last several decades, there have been enormous strides in the understanding and treatment of hand and upper extremity conditions. RHC physicians and therapists stay informed of the latest developments in upper extremity care though weekly conferences and national meetings. National board certification is available in both orthopaedic surgery and hand surgery. All Raleigh Hand Center physicians are board certified or eligible.

What is a metacarpal fracture?

Metacarpal fractures are common hand injuries. They can occur from a variety of injuries such as a fall, a motor vehicle collision, or striking the fist against a hard surface. There are five metacarpals, one for each finger and the thumb. The metacarpals contribute to the bony architecture of the hand. Satisfactory healing of this fracture is important to restoring hand function. A fracture of the metacarpal neck of the small finger is sometimes called a “boxer’s fracture,” as they can be seen in punching injuries.

What are the treatment options?

The treatment plan will depend on the severity of the fracture and the patient’s medical condition and activity level. Most people have fractures which are well-aligned, and, therefore, do not require surgery and are treated in a splint or cast. Follow-up x-rays are obtained to evaluate how the fracture is healing. Hand therapy is sometimes necessary to improve strength and range of motion.

Some patients with displaced fractures can be treated with manual realignment of the fracture. This is performed in the office or emergency room with local anesthesia (numbing medicine). Once the bones are “set,” a splint is placed to maintain the alignment. Surgery may be recommended to patients with more severe fractures, such as those with unsatisfactory alignment or an open fracture which breaks the skin.

What is involved with surgery?

The surgery is performed as an outpatient using either regional anesthesia or general anesthesia. During surgery, the bones are realigned and stabilized. In some cases, a low-profile plate and/or screws are used to fix the bones internally. This is called “open reduction and internal fixation” and requires an incision on the back of the hand. In other cases, temporary pins are placed through the skin to stabilize the bones while they heal. This is called “closed reduction and percutaneous pinning.” The pins can be removed in clinic after a few weeks. Other options which are less commonly used include intramedullary nail fixation and external fixation. Which technique is used depends on the fracture pattern and is often determined in the operating room. The bone healing process takes about 6 weeks, but full recovery can take a few months.

What can I expect after surgery?

Rest and elevation of the hand above the level of the heart is very import for the first few days after surgery to reduce swelling. Shoulder and elbow range of motion exercises are important to help prevent stiffness in these joints. The first few days after surgery can be painful, and medications will be prescribed to help. These medications should be weaned as the pain subsides.

Your wrist and fingers will be protected in a plaster splint after the surgery. The splint will be removed in clinic after a few days and a removable splint will be provided. At that point, most patients can begin gentle wrist and finger range of motion with the oversight of a hand therapist. However, some patients need an additional few weeks of splinting to protect the repair, depending on the severity of the fracture. Avoid heavy lifting or use of the hand until the fracture heals.

Pain, swelling, and stiffness gradually improve over time. Most patients can return to more normal function at about 2 months post-operatively, but maximum improvement can take 3-6 months. Recovery time varies among patients.

What are the complications from surgery?

Possible complications include pain, bleeding, infection, stiffness, nonunion, malunion, hardware failure, and damage to the surrounding nerves and blood vessels. A fracture which fails to unite is known as a nonunion. A fracture which heals with deformity is known as a malunion. Other complications are also possible but are uncommon.

What can I do to improve my results?

Obtaining prompt diagnosis and treatment are important. Adequate nutritional intake is important during the healing and recovery process. If you smoke, reducing or eliminating tobacco use will decrease your risk of complications. Complying with the therapist’s recommendations is very important to maximize your result. The natural tendency of the hand after trauma is to become “stiff” and swollen. Dedication to a hand therapy program can be valuable in reducing the chance of complications and restoring function.

If you have an injury to your finger, hand, wrist or arm and live near the North Carolina Triangle area, please call the Raleigh Hand Center promptly at 919-872-3171 to be evaluated by an orthopaedic hand specialist.

The material provided on this site is intended for general information only and does not constitute medical advice. This does not replace direct evaluation by a physician.