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Live Chat to Professor Stuart Flemming about hand conditions |
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The Check Up live web chat about Hand conditions has now finished. Thanks to everyone who sent in questions for our guest Consultant plastic surgeon
Stuart Flemming.
We had a great response - there just wasn't time to answer them all. Read the full transcript below.
Listen again to this edition of Check Up
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From Graham:
My son, Christopher was born with Poland Syndrome, consequently he has a deformed right hand that is missing the 3 middle fingers. The buds were removed when he was 3 or 4. he is now 18.5. The growth of the arm is also reduced. Is it possible these days for this type of thing to be either cosmetically enhanced or even improve the functionality of the hand. Having just spoken to him, he wonders that he may not be able to use the modifications (as he puts it), having had the problem since birth.
Stuart Flemming: Poland Syndrome can vary from the absence of a muscle in the shoulder area to the more severe condition which your son clearly has. Without seeing him, it's difficult to know what might be done, though he may be right in his assertion that he will be able to do better with his hand than using mechanical devices. Transfer of one or more toes to the hand together with its tendons may help grip if the muscles in the forearm are present to "power" the transfer. Obviously, specialist opinion would be needed on this. There is a hand specialist who may be able to help you with this in the Plastic Surgery Unit at Derreford Hospital, Plymouth.
From Susan: I am a 60-year old woman in generally good health. Except - I have Dupuytrans contractures in both hands, which is not too severe yet - I can almost straighten both hands and the fingers are not yet bent. I understand it is probably too early to consider surgery.
What bothers me more is that I get severe cramps in my hands at night, which often wake me, and are getting worse (although the contractures have remained much the same for two or three years).
Also, the middle finger of my right hand goes white and numb regularly eg if cold, or especially if I grip something with it.
Are these three independent conditions, or are they related? And what is the treatment?
Stuart Flemming: Dupuytren's Contracture doesn't usually cause pain, although the nodules can sometimes be tender. Both the cramps and the numbness in the finger sound like different conditions. It is possible that the little finger on the right hand is affected by Raynaud's and if this is getting worse you should seek the opinion of a rheumatologist. Similarly, the cramping may be helped and it would be worth at least seeing your GP if not a specialist.
From Duncan: How long does it take for the finger to settle down? I damaged it on the 4th January but the joint still swells and it can be sore if I knock it.
Stuart Flemming: Anything up to 12 weeks for the tendon to heal fully and joint injuries in the finger can frequently be sought for 12-18 months. So generally they will become less sore as time passes.
From Niels: I damaged a finger a year ago playing football (in goal). As a result of an 'end-on' impact, the tendon held, but snapped the end off the bone at the tip of my index finger.
I had a few weeks physio, but all this time later movement of the joint is still only approx 25% and painful. Is this normal or is there a way of improving the joint's flexibility?
Stuart Flemming: This sounds like a "mallet finger". Surgery is fraught with complications and it is generally better to treat this with splinting for up to 8-12 weeks if necessary. However, this late on, it can be difficult to treat and the choice lies between surger to try and reconstruct/repair the tendon, fusion of the joint and putting up with it as it is.
From Emma: My daughter (now aged 2 1/2) has been diagnosed with congenital trigger thumb. It has not resolved 6 months after being noticed and I have been told she will need to be operated on. Is there an optimum time window for this operation (I had heard before the age of 3), and should that be balanced against the suggestion that children under 3 should delay surgery if possible due to possible affects of general anaesthesia?
Stuart Flemming: On the whole, general anaesthetic is safe provided it is performed by an anaethetist experienced in this field. It's generally said that about 40% with trigger thumb will resolve by the age of three and I would agree that surgery should be performed after this time if not before.
From Iain: I have a
problem with the fingers of both hands. I wake-up in
the morning and my fingers are curled over like a
claw. I try by massage to free them up but the pain is
bad, I have been to see my GP. He is not convinced that
it is Dupuytrons because of the absence of scar
tissue. Could it be something else? Can I do anything
to help my problem?
Stuart Flemming: There are a lot of things that cause the fingers to "claw". One of the more common is trigger fingers and if the fingers clunk straight, this is possibly the diagnosis. If you can straighten the fingers, the diagnosis of Dupuytren's is unlikely but perhaps it's worth asking for a second opinion.
Steroid injections or surgery may help if it is trigger finger.
From Keith: I am 42 and my good friend Peter is 40. We are both piano players, and in recent years have started to notice alarming symptoms in our hands. I play a lot of Latin piano, which is rhythmic and repetetive and I have had some signs of RSI. In particular there seem to be signs of tendonitis under the middle finger of my right hand. This might also be connected to a lot of computer mouse work.
When the weather is cold I get some pain in finger joints which is exacerbated by cold water. Sudden changes of temperature give me burning pains in the pads of my fingers, which I notice particularly when cycling in winter.
My friend has started to get similar symptoms. What can we do in terms of diet and medication to improve the situation and prolong our musical careers?
Stuart Flemming: You could try contacting the , tel no: 020 724 4500 (calling from London), 0845 602 0235 (elsewhere), or email bpamt@pipex.com
From Peter: I lost a finger a few years ago in an accident with a chainsaw. Occasionally I wake up in the morning with a sensation of acute pain in the missing finger. Can you tell me what is happening?
Stuart Flemming: I'm sorry to hear that you have "phantom limb syndrome" - this can be very distressing. Sometimes there is a tender spot at the end of the nerve which can be dealt with but often the condition is persistent. It would be worth seeing a specialist to see if there's something that could be done.
From Julie: I had a baby 10 weeks ago and wonder if my aching hands are related to this?. I feel a need to stretch out my hands and wiggle my fingers to relieve the general ache. My feet also ache in a similar way.
Stuart Flemming: Laxity in ligaments following pregnancy does occur and sometimes can cause this. If there is also numbness with this, it could be carpal tunnel syndrome which can be brought on by pregnancy.
From Hazel: DeQuervain's tino vaginitis - I have this in my left wrist - what is the treatment?
Stuart Flemming: This is a type of tino synovitis often brought on by repetitive work. Treatment includes the use of anti-inflammatory medicines (provided these are safe for you), rest, injection with steroid, and if all else fails, surgery to release the tendon.
From Steve: I wonder whether 40 years of motorcycling in all weathers has left me prone
to "dead" fingers in cold conditions - or would the sympton have developed
anyway?
There is nothing worse than riding in very cold conditions with fingers.
Apart from anything else, it is not safe because control is compromised.
Solution: My motorycling is now more of a pleasure than ever before, thanks
to electrically-heated gloves. They are a revelation and I wish I had
discovered them before. OK, they cost 拢100, but it's the best money I have
ever spent on two wheels. Fantastic - I commend them to every all-weather
biker!
Stuart Flemming: If you're prone to spasm in the blood vessels to the fingers and the hands in general, keeping warm is very important and a variety of ways of doing this, of which this is one, neoprene gloves and silk liners have also been recommended.
From Anon: I am a 60-year old man, right-handed, enthusiastic tennis player.
My immediate question involves identifying the source of mild occasional stabbing pain over the last three months along the heels (the area near the
wrist) of both palms, running along a u-shaped curve from the small finger to the edge of the thumb. Sometimes the pain is accompanied by visible thickening and reddening. The plot - indeed, the tendons - thicken.
About 8 years ago, I had a trigger-finger release operation on my right hand. A few years later I developed Dupeytrons contracture again on the right hand, just below the operation scar (two bumps, precisely where they appeared in a medical photo I saw). I am not a social drinker, and a very recent blood test declared my liver and kidneys ok.
During the last few months, a bump similar to the Dupeytrons bump appeared on my left hand. It is a single bump, and it is slightly higher on the palm. It does not hurt, but near it I do get occasional mild pain and small puckering on the skin surface.
I also have mild arthritis mostly on the fingers of both hands.
Regarding the pain at the base of my palm - As I noted, the pain is mild and intermittent (worse on my left, less used, non-tennis hand), and does not prevent me from playing tennis and using tools. I am more interested in finding its cause rather than in pain relief.
My GP does not think it is Dupeytrons, did not volunteer that it could be arthritis, and is baffled by it. Does your expert have any suggestions?
Stuart Flemming: Dupuytren's Contracture is known to occur following trauma of any sort so that this appearing after surgery is always a possibility if you have a tendency to it. Although it is associated with drinking, epilepsy, liver disease and other conditions, many cases are familial and not necessarily associated with any other underlying problems.
The pain in the hands sounds as though it may be arthritic but if it is, it is in the early stages because it is intermittent. The fact that you have arthritis in your fingers means that you could get it elsewhere, but in the early stages it wouldn't show up in the same way it does in the fingers.
Glucosomine helps some patients and as suggested in the programme, warmth and wax treatment can be of benefit to some patients.
From Bron: I have an RSI of my right hand that causes darkened swellings in between the knuckles and in the soft area between my thumb and index finger. This was caused by constant use of pipettes in the laboratory I work in. I am told that there is nothing to be done, however it causes pain and makes me unable to do lots of things. The area aches constantly. Any gripping action is painful and sometimes my hand sets in one position and I cannot ungrip! I use Ibuprofen gel on it and put my hand inside a wine cooler wrap when it is bad. I cannot give up my job, although I was off work for 4 months when it was really swollen. I do not have arthritis or anything wrong with my joints (I had x rays etc to rule that out). I also have a ganglion the size of a large pea on the wrist over the tendon to my thumb. This causes real discomfort and I am told there is nothing to be done. Have you any advice for me?
Stuart Flemming: Ganglia sometimes come and go but if they're causing pain then treatment either by sucking the fluid out with a needle or by surgery may be required. It can recur in anything up to 20% of cases following surgery.
RSI is a very complex condition which is difficult to diagnose and I would urge you to seek the advice of a hand surgeon in your area.
Liz Bloom: What is the latest thinking on treatment for this condition in the young, not elderly people whom it usually affects? Having seen the devastating effects of surgery on a young man's hands I would never recommend such treatment to anyone under retirement age! Is there any encouraging research on this crippling and often systemic condition, please?
Stuart Flemming: The younger you are, the more serious this condition tends to be so surgery is more likely to be needed. The recurrence rate following surgery is between 20-80% over five years but some research in Norwich has suggested that grafting the area that is affected with skin from the forearm can reduce recurrence rates. Some would say that this is to be recommended for patients under 40.
Barbara Myers says thanks for all your questions, she hopes you have found the information and advice helpful.
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