Common Diagnoses treated by Occupational Therapy/Hand Therapy
These include the upper extremity: shoulder, elbow, forearm, wrist, and fingers.
One of our specialties is splint fabrication. Here we see Trena making a custom splint, in the picture to the left.
Arthritis of the Hand
Arthritis is inflammation of one or more of your joints. The most common types of arthritis are osteoarthritis and rheumatoid arthritis, but there are more than 100 different forms.
Healthy joints move easily because of a smooth, slippery tissue called articular cartilage. Cartilage covers the ends of bones and provides a smooth gliding surface for the joint. This smooth surface is lubricated by a fluid that looks and feels like oil. It is produced by the joint lining called synovium.
When arthritis occurs due to disease, the onset of symptoms is gradual and the cartilage decreases slowly. The two most common forms of arthritis from disease are osteoarthritis and rheumatoid arthritis.
Osteoarthritis is much more common and generally affects older people. Also known as “wear and tear” arthritis, osteoarthritis causes cartilage to wear away. It appears in a predictable pattern in certain joints.
Rheumatoid arthritis is a chronic disease that can affect many parts of your body. It causes the joint lining (synovium) to swell, which causes pain and stiffness in the joint. Rheumatoid arthritis most often starts in the small joints of the hands and feet. It usually affects the same joints on both sides of the body.
Fractures, particularly those that damage the joint surface, and dislocations are among the most common injuries that lead to arthritis. Even when properly treated, an injured joint is more likely to become arthritic over time.
Dupuytren’s contracture is a thickening of the fibrous tissue layer underneath the skin of the palm and fingers. Although painless, the thickening and tightening (contracture) of this fibrous tissue can cause the fingers to curl (flex).
Dupuytren’s contracture is more common in men than in women.
Symptoms of Dupuytren’s contracture include bumps (nodules) under the skin that develop into tight bands of tissue, causing the fingers to curl.
The cause of Dupuytren’s contracture is not known. It is not caused by an injury or heavy hand use.
There are factors that put people at greater risk for developing Dupuytren’s contracture.
It is most common in people of Northern European (English, Irish, Scottish, French, Dutch) or Scandinavian (Swedish, Norwegian, Finnish) ancestry.
It often runs in families (hereditary). It may be associated with drinking alcohol.
Trigger Finger and De Quervain’s Disease
What is trigger finger?
Trigger finger and thumb are painful conditions that cause the fingers or thumb to catch or “lock” in a bent position. The problems often stem from inflammation of tendons located within a protective covering called the tendon sheath.
The affected tendons are tough, fibrous bands of tissue that connect the muscles of the forearm to your finger and thumb bones. Together, the tendons and muscles allow you to flex and extend your fingers and thumb, for example when making a fist.
A tendon usually glides quite easily through its sheath, due to a lubricating membrane called synovium. Occasionally a tendon may become inflamed and swollen or nodular. When this happens, moving the finger or thumb may pull the inflamed portion through a constricted tendon sheath making it snap or pop.
What are the symptoms of trigger finger?
One of the first symptoms may be soreness at the base of the finger or thumb. The most common symptom is a painful clicking or snapping when attempting to flex or extend the affected finger. In some cases the finger or thumb that is affected locks in a flexed position, or in an extended position as the condition becomes more severe, and must be gently straightened with the other hand. Joint contractures may eventually occur.
What causes trigger finger?
Trigger finger may be caused by highly repetitive or forceful use of the finger and thumb. Medical conditions that cause changes in tissues–such as rheumatoid arthritis, gout or diabetes–may also result in trigger finger. Prolonged, strenuous grasping, such as with power tools, may also aggravate the condition.
Trigger finger frequently affects farmers, industrial workers, and musicians who rely on their fingers or thumbs for multiple repetitive movements.
How is trigger finger treated?
The first step to recovery is to limit activities that aggravate the condition. Occasionally, your physician may put a splint on the affected digit to restrict the joint movement. If symptoms continue, anti-inflammatory medications, such as ibuprofen or naproxen, may be prescribed or steroid injection my be considered. If the condition does not respond to conservative measures or consistently recurs, surgery may be recommended to release the tendon sheath and restore movement
What is de Quervain’s disease?
De Quervain’s disease is a painful inflammation of specific tendons of the thumb. The swollen tendons and their coverings cause friction within the narrow tunnel or sheath through which they pass. The result is pain just below the base of the thumb. It is one of the most common types of tendon lining inflammation.
What are the symptoms of de Quervain’s?
Pain along the back of the thumb, directly over two thumb tendons is common in cases of de Quervain’s. The condition can occur gradually or suddenly, in either case, the pain may travel into the thumb or up the forearm. Thumb motion may be difficult and painful, particularly when pinching or grasping objects.
Some people also experience swelling and pain on the side of the wrist at the base of the thumb. The pain may increase with thumb and wrist motion. Some people feel pain if direct pressure is applied to the area.
What causes de Quervain’s?
Overuse, a direct blow to the thumb, repetitive grasping and certain inflammatory conditions, such as rheumatoid arthritis, can all trigger the disease. Gardening, racquet sports and various workplace tasks are some activities that may aggravate the condition. Often, its cause is unknown. De Quervain’s affects women eight to 10 times more often than men.
How is de Quervain’s diagnosed?
The test most frequently used to diagnose De Quervain’s disease is the Finkelstein test. Your doctor will ask you to make a fist with your thumb placed in your palm. when the wrist is suddenly bent toward the outside, the swollen tendons are pulled throughout the tight space. If this movement is painful, you may have De Quervain’s disease.
How is de Quervain’s treated?
Treatment usually involves wearing a splint 24 hours a day for four to six weeks to immobilize the affected area and refraining from any activities that aggravate the condition. Ice may be applied to reduce inflammation. If symptoms continue, your doctor may give you anti-inflammatory medication such as naproxen or ibuprofen, to decrease swelling. If de Quervain’s disease does not respond to conservative medical treatment, surgery may also be recommended.
Surgery for de Quervain’s disease is an outpatient procedure done under local anesthesia. Surgical release of the tight sheath eliminates the friction that worsens the inflammation, restoring the tendons’ smooth gliding capability. Upon recovery, your physician will recommend an exercise program to strengthen your thumb and wrist. Recovery times vary, depending on your age, general health and long the symptoms have been present.
In cases that have developed gradually, the disease is usually more resistant to management and improvement in function. It may take longer to achieve symptom relief in these cases.