COMMON AILMENTS OF THE AGING HAND PART II
By Richard S. Idler, MD, Hand & Upper Extremity Specialist, Colorado Springs Orthopaedic Group, Colorado Springs LIVING WELL Magazine
The hand is an anatomically complex and sophisticated organ that directly impacts our independence and quality of life and merits careful consideration and care as we age.
One of the most common ailments affecting aging hands is carpal tunnel syndrome (CTS)—a type of nerve compression affecting the median nerve. The median nerve is an important sensory and motor nerve found near the wrist that enters the hand via the carpal tunnel. Transient increases in pressure within the carpal tunnel can cause pain, tingling or numbness in the hand primarily affecting the thumb, index, middle and ring fingers. Over time, this pressure interferes with the nutritive lining of the median nerve, causing an actual loss of nerve fibers producing continuous numbness in the affected fingers and loss of strength and movement of the thumb away from the palm.
Patients with CTS frequently experience night hand pain and tingling or note numbness upon awakening. Symptoms can also occur during the day with activities such as driving or gripping objects. Sometimes affected individuals mistakenly think he/she has a vascular problem related to his/her peripheral circulation because CTS often generates the feeling of “pins and needles” that one gets after resting on his/her arm or leg in an awkward position and momentarily cutting off the circulation to the extremity. In terms of diagnosing CTS, the gold standard test is an EMG/nerve conduction study.
In mild cases or early detection and treatment of CTS, conservative management may resolve the problem. Typical conservative treatment involves the use of night splints to keep the wrist in a straight position as opposed to flexed. If symptoms onset during the day with hand-intense activities, these activities can be broken in to shorter 10 to 15-minutes intervals interspersed with flexibility exercises to the fingers.
Treatment for advanced CTS cases involves a carpal tunnel release. In this surgery, the carpal tunnel is widened by releasing a structure called the transverse carpal ligament. After being divided this ligament will heal again, but leaves the space enlarged, decreasing the pressure around the nerve and improving circulation within the nerve.
Another common ailment that develops in aging hands is stenosing tenosynovitis—which affects the tendons that flex the fingers or thumb and results from a thickening of the tendon sheath. It can arise along the thumb side of the wrist involving tendons that extend the thumb and is known as De Quervain’s disease. In the case of a trigger finger, the thickening occurs at the base of the digit in an area known as the first annular pulley. As the pulley thickens there is a loss of elasticity causing interference with the gliding of the tendon. The condition may involve pain at the site and a catching or triggering of the digit as it moves from flexion to extension. In advanced cases, the finger or thumb may become “stuck” so that it cannot be fully extended or flexed.
When the condition is diagnosed early, most will respond to a simple steroid injection to the tendon sheath. In more advanced cases or when a steroid injection fails, a surgical release of the pulley is required.
A less frequent aliment affecting aging hands in people of Northern European descent is a condition known as Dupuytren’s disease—a thickening of the palm’s deeper tissue layer called palmar fascia. Most commonly it presents as a painless nodule in the mid palm, at the base of the ring or small fingers, although nodules may present anywhere on the palm. As the disease progresses, these nodules may combine into cords that pull the fingers into a flexion position. This process usually takes many years to develop. While this is a benign condition, there is no known cure.
Treatment options include injecting each cord with a chemical known as collagenase to rupture it or surgically dividing the cord. As the cord is an extra tissue and not a tendon, dividing it will not affect function of the hand other than improving range of motion. In more advanced cases of Dupuytren’s disease, a formal excision of the abnormal tissue known as a subtotal palmar and digital fasciectomy is required. This surgery has a fairly long recovery time and requires aggressive therapy for some people in order to prevent complications of postoperative stiffness.
In closing, take time to consider the health of your hands and be sure to consult a hand expert if you have questions or concerns regarding any of these ailments or symptoms.
Richard S. Idler, MD, is a hand & upper extremity specialist with Colorado Springs Orthopaedic Group and may be reached at 719-632-7669 or 719-574-8383.