Surgery of Louisville

Conditions we Treat

Hand and Finger

Dupuytren's (du-pwe-TRANZ) contracture is a hand deformity that usually develops over years. The condition affects a layer of tissue that lies under the skin of your palm. Knots of tissue form under the skin — eventually creating a thick cord that can pull one or more fingers into a bent position.  The affected fingers can't be straightened completely, which can complicate everyday activities such as placing your hands in your pockets, putting on gloves or shaking hands.

 For more severe cases, various treatment options are available to straighten the finger(s).  These options may include needles, injectable medicine or surgery.  Splinting and hand therapy are often needed after treatment in order to maintain the improved finger function.

Ganglion cysts are noncancerous lumps that most commonly develop along the tendons or joints of your wrists or hands. Ganglion cysts are typically round or oval and are filled with a jellylike fluid. Small ganglion cysts can be pea-sized, while larger ones can be around an inch (2.5 centimeters) in diameter. Ganglion cysts can be painful if they press on a nearby nerve. Their location can sometimes interfere with joint movement.

If your ganglion cyst is causing you problems, we may try and drain the cyst with a needle. Removing the cyst surgically also is an option.

The bones of the hand serve as a framework. This framework supports the muscles that make the wrist and fingers move.  When one of these hand bones is broken (fractured), it can prevent you from using the hand, wrist, and fingers.  There can be different variations of a fracture, including:

  • Stable fracture, when the bone pieces are aligned
  • Unstable fracture, when there are bone fragments that have shifted
  • Comminuted fracture, when the bone is shattered into many pieces
  • Open (compound) fracture, when a bone fragment breaks through the skin. This causes risk of infection.

In a joint replacement, the abnormal bone and lining structures of the joint are removed surgical-ly, and new parts are inserted in their places. These new parts may be made of special metal or plastic or specific kinds of carbon-coated implants. The new parts allow the joints to move again with little or no pain. Finger joints (called PIP), knuckle joints (called MP) and wrist joints can all be replaced. 

Nail bed injuries can be very painful and prevent you from using your fingers; however, these injuries are treatable. These injuries are typically a result of incidents such as catching the fingertip in a door. Any type of pinching, crushing or sharp cut to the fingertip may result in a nail bed injury.  Simple crushes of the fingertip may result in a very painful collection of blood  under the nail. More severe injuries can result in the nail cracking into pieces, part of the nail or fingertip being torn off, and/or other injuries to the finger.

Collections of blood are drained by making a small hole in the nail in order to relieve the pressure and provide pain relief.  More serious injuries may be treated with surgery and/or need splinting. 

Arthritis—literally, “inflamed joint”—can affect any joint in the body, including the joints between the 29 bones of the wrist, hand, and fingers.   Arthritis of the hand can hurt and keep you from being able to do what you want or need to do. The most common forms of arthritis in the hand are osteoarthritis, post-traumatic arthritis (after an injury), and rheumatoid arthritis. Osteoarthritis is a degenerative joint disease in which the smooth cartilage that covers the bone surfaces at the joints either is injured or wears over time. 

The goals in treating osteoarthritis are to relieve pain and restore function. Brief rest—either by changing activities or wearing a splint—can help.  Anti-inflammatory medication or a steroid injection into the joint can decrease pain, but neither cures osteoarthritis.  Surgery is considered when the non-surgical options above have not helped. One type of surgery is joint fusion.  The worn cartilage is removed and the bones on each side of the joint are fused together, which means that the joint will not move but it will not hurt.  Another choice is joint reconstruction, where the rough joint surface is removed and either replaced with your own soft tissue or with an implant.  The type of surgery depends on the joint(s) involved, your anatomy, and your activities. 

A common vascular disease that causes constriction of the blood vessels in hands when exposed to cold temperatures.  Having cold hands at all times usually occurs due to decreased blood flow to the hands.  Our bodies keep our hands warm primarily by regulating the blood flow that travels from the heart, down the arm, all the way to our fingertips. More blood to the hands means pink, warmer hands; less blood flow means colder and sometimes painful hands.

Rheumatoid arthritis is a chronic inflammatory disorder that can affect more than just your joints. In some people, the condition also can damage a wide variety of body systems, including the skin, eyes, lungs, heart and blood vessels.  An autoimmune disorder, rheumatoid arthritis occurs when your immune system mistakenly attacks your own body's tissues.

Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of your joints, causing a painful swelling that can eventually result in bone erosion and joint deformity.

The muscles that bend (flex) the fingers are called flexor muscles. These flexor muscles move the fingers through cord-like extensions called tendons, which connect the muscles to bone. The flexor muscles start at the elbow and forearm regions, turn into tendons just past the middle of the forearm, and attach to the bones of the fingers. In the finger, the tendons pass through tunnels that keep them close to the bones, which helps them work better.

A cut tendon cannot heal without surgery.  Nearby nerves and blood vessels may need to be repaired as well. After surgery, the injured area will need to be moved to limit stiffness, but the repair must be protected.  

Patients with thumb arthritis report pain and weakness with pinching and grasping.  For instance, opening jars, turning doorknobs or keys, and writing are often painful.  The diagnosis is made by talking with you and examining you.  The appearance of the thumb can change with the development of bone spurs and stretching of soft tissues (ligaments). A grinding sensation may also be present at the joint.  X-rays can help you understand the disease and they can help when surgery is being considered.

Options for treatment include non-surgical methods and surgery.  Treatments without surgery range from ice/heat, pain medicines, splinting, and injections. Surgery consists of removing the joint either by removing a bone or connecting the bones together.  There are options for moving one of your tendons to secure or cushion the bone.  

Trigger finger, also known as stenosing tenosynovitis (stuh-NO-sing ten-o-sin-o-VIE-tis), is a condition in which one of your fingers gets stuck in a bent position. Your finger may straighten with a snap — like a trigger being pulled and released.  Trigger finger occurs when inflammation narrows the space within the sheath that surrounds the tendon in the affected finger. If trigger finger is severe, your finger may become locked in a bent position.

The goal of treatment in trigger finger is to eliminate the swelling and catching/locking, allowing full, painless movement of the finger or thumb. Common non-surgical treatments include; night splints, anti-inflammatory medication, and steroid injections.  If non-surgical treatments do not relieve the symptoms, surgery may be recommended. The goal of surgery is to open the pulley at the base of the finger so that the tendon can glide more freely. The clicking or popping goes away first. Finger motion can return quickly, or there can be some stiffness after surgery.