The human hand is an intricate instrument, one both tough and delicate. Its functions of sensation and motion allow us to experience and interact with the world around us.
Some of the most common reasons for visits to primary care, family practice, and emergency department physicians are hand injuries and ailments. Given the complexity of the hand, it is important that patients receive a referral to a hand surgery specialist for proper evaluation and examination of their complaints. In actuality, hand surgery specialists are few in number, having completed additional training in the treatment and diagnosis of hand and upper extremity disorders after completing a plastic surgery or orthopedic surgery residency. Whether an acute injury or a progressive process, hand specialists can best discuss treatment options that maximize patient comfort and hand function.
Hand injuries seen in the emergency department are commonly the result of an accident or trauma, and they tend to involve a number of the hand’s different tissues: skin, tendon, bone, nerve, and artery. These injuries are often the result of automobile accidents, or mishaps with lawn mowers and power tools, but they can also result from slamming one’s finger in a car door, suffering a ground-level fall, or cutting one’s hand while preparing a meal. Regardless of the severity, all hand injuries require prompt medical attention and early injury identification in order to promote positive outcomes. Moreover, proper evaluation by a hand specialist is imperative to ensure that all aspects of the injury are addressed and treated.
- Trigger Finger / Tenosynovitis – Tendons are responsible for bending and extending our fingers during activity. They slide within a tunnel that keeps them close to the bones of the finger and hand, but with repeated use, friction can develop, which causes the tendons to become irritated and inflamed. This friction can become severe enough that the tendon will begin to “catch” or “lock”; patients experiencing this painful sensation will often need to use their unaffected hand to forcibly extend their finger into a working position. Initial treatment may include anti-inflammatory medications or cortisone injections, but should these not resolve the problem, surgical correction involves a short outpatient procedure with immediate return of activity for patients.
- Ganglion Cyst – The most common benign tumor of the hand, these cysts arise from any of the joints of the fingers, hand, or wrists. Ganglion cysts have waxing and waning episodes of swelling that can cause significant pain to patients when the affected joint is used. There are both conservative and surgical treatments for ganglions.
- Carpal Tunnel/Cubital Tunnel – The most common of a series of conditions related to excessive pressure on a nerve, carpal tunnel initially presents as altered sensations to one’s fingers and hand – or the “pins and needles” numbness that one feels when a foot or leg falls asleep. Over time, patients will experience such severe numbness and pain that they are awakened from sleep and must shake their hand or allow it to dangle over the edge of the bed to find relief. If allowed to proceed further, symptoms will persist all day, and hand function can become impaired, causing weakness, pain, and loss of fine motor function and manual dexterity. Outpatient surgery to release the areas of compression can facilitate immediate relief for patients, with little down time and small incisions.
- Osteoarthritis – Much like the arthritis in one’s knees and hips, osteoarthritis – or “bone-on-bone” arthritis – develops from hand overuse in manual activities. This “wear and tear” arthritis has several medical treatment options available, including symptom relief with oral medications and injections, as well as surgical treatments like joint fusions and joint reconstructions.
- Dupuytren’s Disease – These patients see progressive scar tissue resembling ropes or cords in the palms of the hands, typically affecting the ring and long fingers. This scar tissue progressively bends the digits into the palm, and restricts their ability to straighten. Though surgery is a viable option for many of these patients, new treatments allow for administration of a medicine to dissolve the scar tissue, avoiding the need for an operation.
- DeQuervain’s Tendinitis – This tendonitis on the thumb side of the wrist can be painful and debilitating, limiting even simple pinching and twisting activities. Treatment often involves rest and anti-inflammatory medications, and often a cortisone injection. Surgical release of these tendons offers a permanent solution to the problem and can be performed in an outpatient setting.
The Nelson Center for Plastic and Reconstructive Surgery helps patients treat both traumatic and progressive hand-related issues, with the goal of minimizing pain and improving patients’ quality of work and home life.
As an Emory, Harvard, and University of Pittsburgh-trained, ASPS board-certified plastic surgeon, Dr. Castillo completed an additional year of fellowship training in diagnosing and treating ailments of the hand and upper extremity. Dr. Castillo provides patients the full breadth of hand surgery care, including evaluations of hand traumas, injuries, and progressive medical conditions like arthritis and carpal tunnel. Your hands deserve the best care, so put them into the skilled hands of our plastic hand surgeon to treat a wide range of elements.
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