Rarely do we think about all that we accomplish with our hands, until we begin to lose this ability. As an orthopedic surgeon specializing in the small bones and joints of the hand, wrist and elbow, I see first-hand how debilitating it can be for patients, particularly in a population staying active and living longer than generations past.
A form of osteoarthritis, Basilar joint arthritis, also referred to as Basal Joint and arthritis of the thumb, affects women more commonly than men and generally occurs after 40 years of age. It is unclear why this type of arthritis affects women more than men.
It is prompted by the same joint conditions predisposing any other joint in the body to arthritis, joint instability — possibly caused by the improper healing of an injury or repeated injury to the joint — cartilage deterioration, and general wear and tear.
Patients suffering from rheumatoid arthritis are also more susceptible to osteoarthritis. Arthritis affecting the basilar joint of the thumb, or the first carpometacarpal joint located near the wrist bone, is called Basilar joint arthritis.
How Basilar Joint Arthritis Happens
The unique shapes of the small bones of the thumb permit its movement in and out of the plane of the palm to oppose the other fingers. The stability of the carpometacarpal joint of the thumb depends on several small ligaments, which allow movement but remain close to the joint surfaces.
If the ligaments loosen and permit too much sliding of the joint surfaces, increased wear on the joint cartilage may occur leading to arthritis. A fracture or injury can also lead to joint dysfunction and deterioration, ultimately leading to arthritis as well.
Inflammation may occur as joint degeneration progresses. Pain is prominent when pressure is applied to the joint in pinching and grasping activities. If left untreated, joint surfaces are eventually destroyed and bony spurs may develop around the joint. In severe cases, there may be complete joint destruction, an inward collapse of the metacarpal, and deterioration around the trapezium. Other joints may also become affected as they react to these changes.
Basilar joint arthritis will produce pain that progresses gradually over time. Symptoms may include:
Eventually, the pain discourages use of the thumb, resulting in joint weakness and muscle loss.
After assessing a patient’s history and an examination of the thumb, an X-ray may help show the degree of joint damage. A series of X-rays can help determine the rate of progression.
Treatment is determined based on the affect that the arthritis has had on a patient’s joint at the time of diagnosis. It may involve conservative therapies, such as anti-inflammatory medications, rest from certain irritating activities, corticosteroid injections, rehabilitation and occupational therapy, as well as splinting of the thumb to provide support, reducing pain and preventing deformity.
In more severe cases, advanced arthroplasty procedures and refined joint implants are proving successful. During the procedure the damaged joint surfaces are removed and
replaced with a substitute joint, eliminating pain, and improving strength and range of motion.
Dr. Evan Collins is a board-certified, fellowship-trained orthopedic surgeon who specializes in injuries and conditions affecting the hand, wrist and elbow. He is a published author and continues to participate in research focused on repetitive stress injuries and degenerative joint conditions. Formerly the Chief of the Hand Section and Director of the Hand Fellowship at Baylor College of Medicine, he serves today as Director of The Houston Methodist Hand & Upper Extremity Center and is a member of the faculty of Weill Cornell Medical College. Dr. Collins is located 6560 Fannin, Suite 410 in Houston TX 77030, and he can be reached at 713.441.3535.
Tennis Elbow, a Condition Caused more often by Activity Off…. Than On the Tennis Court
As summer sports heat up and we scramble to fill the long days of daylight with activities we’ve waited all winter to do, injuries and other overuse conditions affecting the hand, wrist and elbow are bound to occur.
A common overuse condition we see in the office throughout the year and particularly during the summer months is Tennis Elbow, also known as lateral epicondylitis. “Epicondylitis” refers to inflammation at the epicondyle (where tendon and muscle attaches to the humeral condyle of the elbow). “Lateral” refers to the outside portion of the elbow.
Considered an overuse or repetitive stress, tendinopathic condition affecting the lower arm muscles and tendons along the outside of the elbow, the condition is named after the sport first identified as a primary cause – affecting five out of 10 recreational and professional tennis players. Though the condition is caused by many different types of activities causing repeated twisting and strain on the lower arm and elbow – including playing certain musical instruments, sports, manual labor and other everyday activities.
Tennis elbow is frequently seen in those between the ages of 40 and 60.
Symptoms of tennis elbow may initially cause only moderate pain in the outer portion of the elbow, but over time may spread down the forearm and back of the middle and ring fingers. If left untreated, the pain can cause severe pain and weakness limiting arm function.
Diagnosis and Treatment
Tennis elbow is generally diagnosed by discussing the discomfort and observing the pain a patient experiences when performing certain arm movements. In many cases tennis elbow is addressed non surgically with conservative treatment that may include refraining from the activity, anti inflammatory medication or physical therapy with instruction on behavior modification.
If conservative treatment does not resolve the condition, a surgical procedure known as lateral epicondyle release is performed to relieve the tension.
Read more about repetitive stress conditions affecting the hand, wrist and elbow.
The vital role that our hands play in daily life is often times only fully understood when we lose use of one or both as a result of an injury. The wrist joint is particularly vulnerable because of its range of motion and location – involved in lifting, twisting, hammering, blocking a blow and softening the impact of a fall. As a result, wrist fractures are among the most common fractures of the hand and upper extremity.
Some of the most common types of wrist fractures include:
Each of these fractures has their own unique challenge, which is why it is important that wrist fractures are treated by a hand and wrist specialist who understands the delicate bones of the hand and wrist, the blood supply to these bones and the intricate network of ligaments, tendons and nerves. The wrong treatment, or lack of treatment, could result in long term damage to the joint and decreased hand function.
Distal Radius Fractures
A distal radius fracture is one of the most common types of wrist fractures. It is named for the location of the break and bone it affects – the distal end of the larger forearm bone known as the radius. This type of fracture should be carefully examined to determine if the fracture extends into the wrist joint (intra articular fracture) or does not impact the wrist joint (extra articular fracture). The type of fracture will determine the type of treatment.
A scaphoid fracture is a fracture of the scaphoid bone in the wrist, located at the thumb side. These types of fractures require special attention, as the blood supply for the scaphoid bone enters from the top and most fractures occur in the middle or bottom portion. This compromises the blood supply and can impede healing. Ensuring its stability is essential in preserving the integrity of the wrist joint and avoiding avascular necrosis.
The treatment for these types of wrist fractures will depend on the severity of the fracture and other soft tissue damage. Treatment will also be based on other aspects of a patients overall health and level of activity. Ensuring the proper alignment and healing of the fracture is important in avoiding future problems in the hand and wrist.
All treatment is followed by hand therapy and rehabilitation exercises to ensure that there is no loss in arm strength and function. The goal of Dr. Collins and his hand and upper extremity support staff is to return patients to their daily lives quickly and as strong as they were before the injury.
Repairing Broken Bones
A broken bone reminds us that our body has its limits. It also prompts a renewed appreciation for our limbs and the significant role they play in not only the sports and hobbies we love but also essential everyday tasks.
Proper treatment and rehabilitation is key in restoring a limb to pre injury condition and avoiding future problems that can range from joint instability to arthritis.
Hand, wrist and other upper extremity fractures are among some of the most common types of fractures – as not only are our hands and upper extremity essential in performing everyday tasks but also serve as the first line of defense in breaking a fall or softening impact in an accident.
There are a number of different ways to treat a fracture depending on the severity of the break, other tissue damage and the characteristics of the break. Once thoroughly assessed, treatment will either be surgical or non surgical.
If surgery is required, it may entail internal fixation. This is hardware that helps hold the broken pieces together so that the bone can regenerate in ideal alignment.
What many of us may not realize is the array of different plates and screws designed uniquely for different finger fractures, wrist fractures, forearm fractures, elbow fractures and upper arm fractures. Each designed precisely for the varying size of these different bones and their natural contour.
What may also come as a surprise is the delicate size of the plates …and the screws that hold them in place – as an X-ray depicts a larger than life image. The actual plates and screws are far less invasive than many patient realize.
Watch Dr. Collins talk about the strength, yet discreet size of the different plates and screws used to repair many of the hand and upper extremity fractures he sees.
Professional Musicians and Common Overuse Conditions – New Hand Treatments Music to Their EarsAmid the melodic sounds of the Houston Symphony and Orchestra it is hard to imagine that there are many types of injuries and performance-related conditions that come with a musician’s occupation.
Compared to athletes in a recent presentation for the Center for Performing Arts Medicine, Performing Artists As Athletes: A New Perspective, Dr. Evan Collins talked about the hundreds of thousands of musicians each year incurring an injury as a result of rigorous practice and performance. In fact nearly 76% of musicians experience some kind of injury or condition as a result of their profession over the course of their career.
Athletes have had for years a dedicated Sports Medicine team knowledgeable about the physiological demands that certain sports have on their body – establishing treatment plans accordingly. Not much unlike athletes, musicians have the same demands repeatedly placed on specific joints and muscle groups, which causes excessive strain and damage.
Thinking about the intricate movement of fingers and the fact that nearly a quarter of the motor cortex in the brain is devoted to hand muscles – connected to over 50 nerves, 120 known ligaments, 30 major joints and approximately 30 bones – it’s not hard to understand how injuries can occur with such demands as a musician places on their hands and wrist.
Among the most commonly diagnosed injuries and conditions affecting musicians include overuse and overstress syndrome, mayofascial pain, and tendonitis. These conditions cause persistent pain and loss of endurance, facility and strength.
Fortunately today a number of minimally invasive procedures are allowing musicians to address their injury without lengthy recovery times and obtrusive scarring.
Endoscopic and arthroscopic procedures using fine instruments respectful of the small joint spaces and bones of the hand and wrist are reducing the size of the required incision and causing minimal disruption to surrounding soft tissue.
And the latest advances in non surgical therapies, including injection therapy and rehabilitative therapies designed specifically for musicians are making it easier for these artists to seek help and return quickly to their work… to the delight of us all.