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Treatment of Hand Arthritis

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Many patients say: “my doctor said there is nothing we can do for arthritis.” It is true that doctors cannot cure arthritis, but treatment of hand arthritis is available.

What is arthritis? Arthritis is a common source of hand pain in patients older than 40 years of age. Osteoarthritis is the most common type of arthritis. This is also known as degenerative joint disease. Osteoarthritis is caused from normal “wear and tear” occurring gradually over time. The small joints in the fingers and the large joint at the base of the thumb are commonly affected areas in the hand. Rheumatoid arthritis, psoriatic arthritis, and gout arthritis are other specific types of arthritis, which are less common.

What are the signs of arthritis? Patients often describe a gradual onset of “dull ache” pain in the joints and morning stiffness in the fingers. In some patients, the stiffness in the fingers gets worse and the patient notices decreased range of motion in the hand. Some of the knuckles can develop prominent bumps, which are seen as bone spurs or “osteophytes” on x-rays. These bumps are called Heberden’s nodes. In more severe cases, the fingers can develop deformity and appear crooked. Not everyone with arthritis develops deformity or much pain, however.

treatment of hand osteoarthritis
Hand Osteoarthritis

What causes arthritis? There are many factors which contribute to osteoarthritis including family history, injuries, inflammation, and age. The joints in our bodies are made up of cartilage, which cushions and protects the end of the bones. The cartilage allows for full range of motion. Over time, this protective cartilage becomes thin and wears away. In some patients, the cartilage surface is worn out and there is “bone-on-bone” grinding at the joint, which can be painful. This “wear and tear” process can be increased after an injury.

Osteophyte bone spur

What is a treatment of hand arthritis? Although there is no cure for arthritis, there are several treatments which can help reduce the symptoms. Simple things patients often try at home are warm water soaks in the morning, range of motion exercises with the fingers, and warm paraffin wax dips. There are many over-the-counter products which may help such as oral medications, dietary supplements, and topical ointments. Use of oral anti-inflammatory pills (Tylenol, Ibuprofen, Naproxen, etc.) can reduce pain temporarily. NSAIDs should be used sparingly due to side-effects.  Anti-inflammatory creams can be purchased over-the-counter and applied to the skin over a painful joint. Additionally, doctors can prescribe hand therapy and various types of braces to help support arthritic joints. Corticosteroid injections (cortisone shots) can be used sparingly for a painful joint to reduce pain and swelling.

Is surgery needed for hand arthritis? Most people do not require surgery for hand arthritis. If patients have tried non-surgical treatment and still have severe pain, surgery might be recommended. Depending on the patient and the affected area, either joint replacement or joint fusion surgeries are options. The base of the thumb joint can be treated surgically with arthroplasty, which can significantly decrease pain and improve hand function. Your hand surgeon can discuss these options with you.

Thumb base joint

Raleigh Hand to Shoulder Center doctors are experts in the diagnosis and treatment of hand conditions including osteoarthritis. They are members of the American Society for Surgery of the Hand.

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Best Treatments for Carpal Tunnel Syndrome

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There are many treatments available for carpal tunnel syndrome (CTS). If the hand numbness and tingling symptoms come and go, non-operative treatment is appropriate. People who have severe carpal tunnel syndrome should be evaluated by a hand surgeon. Constant numbness in the hand and loss of muscle tone at the base of the thumb are signs of nerve damage and severe CTS. Surgery is the best way to prevent the nerve from being damaged. If people wait too long before having surgery, some of the hand numbness and weakness can be permanent.

Not all hand pain, numbness, and tingling are caused by CTS. If the symptoms are getting worse or not responding to treatment, a hand specialist should be consulted sooner rather than later.

The recommendations below are intended for Raleigh Hand to Shoulder patients with mild to moderate CTS symptoms. There are some things we can’t change about our health, such as our family history, age and hand anatomy. However, there are many things that we can modify to improve our health.

Helpful treatments other than surgery for carpal tunnel syndrome:

— Wearing a wrist brace at night

— Hand and wrist stretching exercises

— Hand Therapy

— Smoking cessation

— Steroid injection

Treatments which are NOT helpful for carpal tunnel syndrome:

— Magnet therapy

— Laser therapy

— Long-term use of oral NSAIDs

— Expensive custom braces

— Most products on the internet claiming to be a cure for carpal tunnel syndrome

Compassionate-Care
Hands at work

Raleigh Hand to Shoulder Center hand doctors are experts in the diagnosis and treatment of carpal tunnel syndrome.

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Lumps in the Palm of the Hand

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Lumps and bumps in the palm of the hand are very common. Patients should seek evaluation by a trained physician to make the diagnosis. Below are the most common causes of lumps in the palm.

Ganglion Cyst

The most common cause of a hand lump in the palm of the hand is a ganglion cyst. These are fluid filled sacs which come from the joint or tendon fluid in the hand. Ganglion cysts are not cancer. They often fluctuate in size and can go away on their own. If the cyst is painful, it can be drained with a needle by a doctor or removed by a hand surgeon. Drainage of the cyst with a needle is a simple treatment in the office, but the cyst comes back about 50% of the time. After surgery, the chance of recurrence is 5-10%. If the cyst is not painful or bothersome, it does not require treatment. 

Ganglion Cyst in Finger

Dupuytren’s Nodule

Another very common cause for a lump in the palm is due to Dupuytren’s disease. These lumps are called Dupuytren’s nodules. Dupuytren’s nodules are made up of abnormal scar tissue. Dupuytren’s is more common in males of Caucasian ethnicity. Sometimes it is called Viking’s disease because it is prevalent in Scandinavian, Scotch-Irish, and Northern European populations where the Viking’s lived. In many cases the condition occurs in both hands and it runs in families. Most of the time the nodule is not painful, but in some patients it is tender or sore to the touch. Tender nodules can be injected with steroid to reduce the soreness and size of the nodule.

Dupuytrens Nodule

Giant Cell Tumor of Tendon Sheath

Giant Cell Tumors are common tumors in the hand. These are typically firm and slow growing. They can be painful if they press on a nerve or grow to a large size. They are not cancer. Usually these are treated by a surgeon with excision in the operating room. These tumors may come back after surgery. The cause of these tumors is not known but they are usually near a joint or tendon in the hand. 

Epidermal Inclusion Cyst

Epidermal Inclusion Cysts are common following trauma or lacerations to the skin of the hand. These are usually slow growing and occasionally tender. These cysts are made of up keratin material shed from skin cells within the lesion. This is a thick, white-yellow, cheese-like substance. Surgery is usually recommended for epidermal inclusion cysts. Recurrence of the cyst after surgery is very low. 

There are several other causes for lumps in the palm including: lipomas, nerve tumors, neuromas, blood vessel tumors, and cancers. Please seek evaluation with a trained physician to make the diagnosis. Hand surgeons are experts in the diagnosis and treatment of hand lumps, bumps, cysts, and tumors.

Raleigh Hand to Shoulder Center hand doctors are experts in the diagnosis and treatment of hand disorders including lumps in the palm of the hand.

Broken Wrist Treatment

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A distal radius fracture, sometimes called a “broken wrist,” is a common wrist injury. This type of fracture can occur from a variety of trauma, such as a fall at home or a motor vehicle collision. The distal radius is the portion of the radius bone just below the wrist joint. As we age, the bone of the distal radius loses bone mass and becomes more prone to fracture, particularly in post-menopausal women and people with osteoporosis. The distal radius may break (also called a fracture) as a result of a slip and fall in these cases. Younger patients with stronger bones may break the distal radius after high-energy trauma, such as a sports injury or car accident. Broken wrist treatment involves specialized orthopedic care, and proper healing is needed to obtain the best outcome.

Broken wrist treatment depends on the severity of the fracture on the x-rays and the patient’s health and activity level. The distal radius bone usually heals after a fracture; however, a goal of treatment is for the bone to heal in a good position for function. Many people have fractures which are in good alignment. These patients do not require surgery. Treatment in these cases is typically protection in a cast or brace for several weeks. Follow-up x-rays are obtained in clinic to see how the fracture is healing. Waterproof casts are available at the Raleigh Hand to Shoulder Center.

Broken Wrist: Displaced, Intra-Articular Distal Radius Fracture

Some patients have displaced fractures which can be re-aligned without surgery. This is called “closed reduction” and is performed either in the office or emergency room using an injection of a local anesthetic. After the broken bones are “set,” a plaster splint is molded to the wrist to maintain the alignment. After a few days, the patient can often be placed into a cast.

broken wrist treatment ORIF
Broken Wrist Treatment: ORIF of Distal Radius Fracture

Some patients have fractures which are more severe. In these case the fracture alignment is not in good position for hand function. Surgery may be advised to improve the alignment of the bones. Open Reduction and Internal Fixation (ORIF) is a common procedure performed for this injury.

Raleigh Hand to Shoulder Center doctors are all hand specialists and they are members of the American Society for Surgery of the Hand. Broken wrist treatment is one of the many services provided by hand specialists.

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What is Mommy’s Thumb?

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What is Mommy’s Thumb? This is another term for DeQuervain’s tendonitis or Mommy’s Wrist. This is a common condition involving the tendons on the thumb-side of the wrist. The syndrome is named after Fritz de Quervain, a Swiss physician who described the condition in the late 1800s. Symptoms arise when there is entrapment of the tendons of the thumb by their surrounding sheath at the wrist. Instead of gliding smoothly through the sheath, the tendons can meet resistance and cause friction. Over time, these tendons may become irritated and painful. Certain movements of the thumb and wrist can be excruciating. Some patients notice decreased thumb range of motion. Patients may feel a tender bump or notice swelling in the wrist where the tendons and/or sheath are thickened. Lifting objects, gripping, or pinching with the thumb often exacerbates symptoms.

The cause of DeQuervain’s is usually unknown, but symptoms can be aggravated by starting a new, repetitive activity. The condition is common in young females, especially pregnant and post-partum women. Lifting a young child can be very painful making it hard to care for the newborn. This is why it is often called mommy’s thumb.

Treatments for mommy’s thumb include thumb spica splinting, over the counter anti-inflammatory medications, topical medications, hand therapy, and cortisone injections. For most patients, these treatments will clear up the condition. In some cases, surgery is necessary to relieve the symptoms. Surgery is performed as an outpatient and most patients report excellent results. See the image below, which shows the tendons involved in DeQuervain’s tendonitis.

Mommys Thumb
DeQuervains Tendonitis

Raleigh Hand to Shoulder Center doctors are all members of the American Society for Surgery of the Hand and are experts in DeQuervains Tendonitis. Hand specialists can help diagnose and treat hand and wrist conditions and can help explain the answer to the question, What is Mommy’s Thumb?

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Dr. Post gave a talk on Scaphoid Fractures

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Dr. James Post of the Raleigh Hand to Shoulder Center gave a talk on Scaphoid Fractures on August 30, 2021. Scaphoid Fractures are a common wrist injury. Treatments includes casts, surgery and hand therapy.

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Raleigh Hand celebrates 30 years of practice!

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The Raleigh Hand to Shoulder Center (formerly Raleigh Hand Center) has treated patients in North Carolina for 30 years. While our name may be new, it better reflects what we have been doing for many years — caring for patients of all ages with hand, wrist, elbow, and shoulder problems. Dr. Edwards, Jr. co-founded the Raleigh Hand Center in 1991.

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Congratulations Susie Bousquet, CHT

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Susie Bousquet completed the final step in obtaining certification in hand therapy by passing a comprehensive examination. She is now a certified hand therapist (CHT). Congratulations Susie!

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Masks Required in Doctors Offices in North Carolina

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Raleigh Hand to Shoulder Center will continue to require masks due to COVID-19 precautions. This includes patients, visits, and staff in our office.

We review the CDC and NC Department of Health guidelines for recommendations. We routinely monitor local and state COVID-19 case counts. We encourage people in the community to get vaccinated to protect themselves, their families and our community.

Updated 5/17/2021.

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Dr Edwards III gives conference on Shoulder Replacement Surgery

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Dr. George Edwards III gives a talk at WakeMed UNC Orthopedic Resident conference on May 17, 2021. His talk is on Total Shoulder Arthroplasty, also called shoulder joint replacement. Dr Edwards III is a partner at Raleigh Hand to Shoulder Center.

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