5 Causes of Thumb Pain

Article featured on American Society for Surgery on the Hand

The thumb is involved in about 50% of all hand functions. When the thumb is painful or injured, it becomes very difficult to use the hand. During normal life, we take our thumbs for granted. When the thumb is not working properly, tasks are more difficult, and we then realize how important the thumb is. There are several causes of thumb pain including:

  1. Trigger thumb
  2. Arthritis
  3. Tendonitis
  4. Carpal tunnel syndrome
  5. Skier’s thumb.

Read below to learn more.

1. Trigger thumb

The tendon that bends or flexes the thumb is called the flexor pollicis longus (FPL). If there is swelling or inflammation around the thumb tendon, it will not glide smoothly. Sometimes the tendon gets stuck in the thumb pulley, causing the thumb joint to click, catch, or lock. This is called a trigger thumb. The thumb can also become swollen, stiff, and very painful. Treatment includes rest, anti-inflammatory medications, splinting, and steroid injections. Most patients improve without surgery. If symptoms persist with treatment, trigger thumb release surgery is very effective and has low risks.

2. Thumb arthritis

The human thumb is unique. We can touch the tip of the thumb to the small finger — a function called opposition. Most animals do not have an “opposable” thumb. This gives us the ability to write, use a needle and thread, and use hand tools. The joint at the base of the thumb which allows opposition is called the carpometacarpal (CMC) joint. Normal, every day activities can cause wear and tear in the thumb CMC joint. When the joint wears out, it can become inflamed and painful. This process is called osteoarthritis or degenerative joint disease.

Anyone can get osteoarthritis if they live long enough. So far, we have not found a way to prevent osteoarthritis. Wear and tear is part of the normal aging process. However, the symptoms of osteoarthritis can be treated by reducing inflammation in the joint. Ways to reduce inflammation and treat thumb CMC osteoarthritis include topical anti-inflammatory gels, oral over-the-counter medications, adjusting hand activities, using a thumb splint, and steroid injections. Most patients improve without surgery. If symptoms persist with treatment, thumb CMC surgery can greatly improve quality of life.

3. DeQuervain’s tendonitis

The tendons in the wrist that lift the thumb up are prone to tendonitis. These tendons travel through a tight compartment on the thumb side of the wrist. If there is friction on the tendons, they can become inflamed and very painful. This is classic in young mothers, and is sometimes called mommy’s thumb. Treatment consists of splinting, anti-inflammatory medications, therapy, and steroid injections. DeQuervain’s release surgery is occasionally necessary to resolve this condition.

4. Carpal tunnel syndrome

Carpal tunnel syndrome is a type of pinched nerve. When the nerve is pinched in the carpal tunnel, patients have numbness and tingling in the thumb, index, middle, and/or ring fingers. Initially symptoms come and go, and are often worse at night. Some patients feel electric shock sensations or burning pain in their thumbs. In severe cases, the thumb muscles can become weak and atrophied. Treatment for most patients includes wearing a wrist brace at night, stretching exercises, hand therapy, and steroid injections. Carpal tunnel surgery is very effective for most patients if non-operative treatment is not successful or if nerve compression is severe.

5. Skier’s thumb

Trauma to the thumb is common. During a fall, most people land on an outstretched hand to brace themselves. Unfortunately the ligaments in the thumb can become injured in this way. The ulnar collateral ligament (UCL) of the thumb is vulnerable to tearing as the thumb is bent backwards and away from the hand. If this ligament does not heal properly, patients can have pain and weakness with pinch tasks. For most minor sprains of the thumb, temporary immobilization in a splint or cast is successful to allow healing. If the ulnar collateral ligament is fully torn, however, surgery is usually recommended to fix the injury. Hand therapy is often helpful during the recovery process to regain range of motion and strength.

If you have an injury to your hand or thumb, or pain which does not go away with conservative treatment, make an appointment with a hand specialist to get an accurate diagnosis and good treatment plan.


The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

How to Treat a Broken Finger Tip

Article featured on American Society for Hand Surgery

The finger tip is one of the most commonly injured areas of the upper extremity because we use our finger tips in so many daily activities. Your finger tip can be injured in a variety of different ways, including being crushed by a door, hit with a hammer, getting stuck under a heavy object, or cut with a knife.

While some finger tip injuries may be minor, others can be more severe. You can the bone, nail bed, tendons or even the nerve endings, which allow you to have sensation in the finger tips. Here’s how to treat a finger tip injury, depending on the severity:

  • Dressing (a gauze wrapping or tape): Dressings can treat more minor finger tip injuries, such as when just the skin is affected or if there is a small amount of bone exposed.
  • Splints or metal pins: These can be used if you’re suffering from a broken finger tip. The metal pins will hold the bone fragments in the proper position.
  • Drainage: If blood is collecting under your nail, your hand specialist may make a small hole in the nail to drain it.
  • Surgery or amputation: These treatment options are reserved for more severe nail bed injuries.

Regardless of which treatment you receive, it’s important to remember that your finger tip may never look or feel the same after an injury, especially a severe one.

Your treatment plan will vary based on your specific circumstances. Visit a hand specialist as soon as you’ve injured your finger tip to determine the best plan. The sooner you receive treatment, the better. Delaying treatment may result in loss of feeling in your finger tip.


The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

Is My Hand Pain from Carpal Tunnel Syndrome or Something Else?

Article featured on Spine-Health.

We all wake up sometimes with a numb and tingly hand. But ongoing hand pain and numbness can be a disabling problem that requires diagnosis and treatment.

Here are 3 of the main causes of hand pain and numbness—and tips for how you can tell them apart.

Carpal tunnel syndrome

When hand pain is experienced, it’s common to first suspect carpal tunnel syndrome. This condition is caused by the narrowing of a bony passageway in your wrist, which irritates or compresses the median nerve that runs through it.

Symptoms tend to be in the thumb, index finger, or middle finger, along the path of the median nerve. The pain may wake you up at night or be worse in the morning. In the early stages, shaking your hand may bring relief.

Rheumatoid arthritis

Another possible cause of hand pain and numbness is rheumatoid arthritis.

Hand pain from rheumatoid arthritis tends to be different from carpal tunnel syndrome in 2 main ways:

  1. It causes pain and stiffness in the large knuckles or joints of the wrist, rather than along a nerve path.
  2. Its pain is symmetrical, meaning it will affect both hands simultaneously.

Cervical radiculopathy caused by spine conditions

While it may not seem obvious, your hand pain and/or tingling may actually be caused by a problem in your neck.

The nerves that give sensation to your hands originate in your cervical spine. When one or more of the 8 nerve roots that exit the cervical spine become irritated, it causes pain and other neurological symptoms down the nerve path. This is known as cervical radiculopathy.

The most common conditions that can trigger radiculopathy include:

  • Cervical herniated disc
  • Cervical spinal stenosis
  • Cervical degenerative disc disease
  • Cervical osteoarthritis

Cervical radiculopathy pain can be mildly achy or sharp and stabbing. It can also cause numbness and/or pins-and-needles tingling sensations. Symptoms can affect different sections of the hand depending on what level of the spine is the source of the irritated nerve.

Since carpal tunnel syndrome and cervical radiculopathy can both affect the median nerve, it’s important to note one key difference: Carpal tunnel syndrome pain will only affect the hand and wrist. Cervical radiculopathy from the C6 spine level (where the median nerve originates) will often cause pain and symptoms along the arm and in the bicep, as well as in the hand.

Aside from these 3 causes, hand pain can also be caused by a variety of other conditions, including diabetes and nutritional issues.

The best way to tackle hand pain that doesn’t resolve is to see your doctor, who can diagnose the correct cause and start a treatment plan. Many conditions that cause hand pain are more easily treated if they’re caught early.


The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday

What to Do for Hand and Wrist Pain

Article featured on verywellfit,   

Office work is well known for being detrimental to people’s backs due to prolonged periods of sitting.

But, there’s another body part that excessive typing, texting, scrolling, and mouse-clicking wreak havoc on, too—the hands and wrists.

Hand and wrist pain is a notable side effect of office work that many people assume they have to live with. Thankfully, there are actually numerous ways to lessen office-work-induced hand and wrist pain, and ways to help prevent it.

Let’s look at why hand and wrist pain are so prevalent and what you can do about it.

Common Causes And Effects of Hand And Wrist Pain

There is an abundance of hand movement repetition in the tasks for office work, with the main activities performed being typing, scrolling or clicking with a mouse, and texting on a cell phone.

When we type, we use our fingers in an unnatural way, and we often keep them hovered awkwardly above the keyboard for prolonged periods of time. This puts stress on our wrists, and the typing itself overworks our fingers far more than anything else we generally do in life.

When we overuse our hands and wrists by typing, our bodies are put at risk of developing numerous conditions. These include:

  • Carpal tunnel syndrome
  • Trigger finger
  • Wrist tendonitis
  • Repetitive strain (or stress) injury

These effects are usually not permanent, but they can be very painful. Once you have frequent hand and wrist pain from typing, other activities in your life, such as exercise or sports, or even opening doors, might also be affected.

Additionally, the prolonged inflammation in your hands and wrists can lead to arthritis in coming years.

Ways to Reduce Hand and Wrist Pain

In addition to life being better when you’re not in pain, it’s important to take steps to prevent that potential occurrence too. Luckily, there are numerous actions you can take to prevent your hand and wrist pain from worsening.

Pausing to stretch your hands and wrists can help bring back flexibility and can improve the blood flow that may be impacted by a lack of arm movement.

If you notice that stretching your hands and wrists reduces your pain, you may opt to stretch briefly every hour or two. In the same way as it’s a good idea to get up and stand every hour to break up your sitting, it’s a good idea to keep your hands and wrists flexible as you use them throughout the day.

Wrist Stretching

Stretching your wrists is an easy way to reduce the pain in them caused by typing. Some examples of wrist stretches you can try are below:

  • Raise and lower your hands in a “stop” position with your arms outstretched in front of you.
  • Make and hold a fist.
  • Rotate your hand up and down while making a fist.

Hand and Finger Stretching

Stretching our hands and fingers isn’t something we tend to think a lot about unless we’re doing a sport that involves gripping, but it can be very helpful in reducing the pain from typing and texting all day.

Here are some ways to stretch your hands and fingers:

  • Straighten your fingers and palms flat against a surface and hold this position for thirty seconds.
  • Bend your fingertips down to make a bear claw shape and hold for 30 seconds.
  • Straighten your fingers and palm on a surface and slowly lift and lower each finger and thumb individually.
It can also be helpful to use a grip strengthener. To use one for hand stretching, you’ll hold it in your hands, squeeze, hold briefly, and release. This act of squeezing and relaxing helps to loosen the muscles. Grips strengtheners can also be used to reduce tension.

Strengthening Exercises

You don’t need a whole workout for your hands and wrists, but taking the time to strengthen this part of your body can have the effect of less pain due to overuse. You don’t need any gym equipment for these exercises.

Use Household Items

There are numerous household items that can be used to help strengthen your hands and wrists such as:

  • Rubber bands
  • Towels
  • A hammer

Exercises using those items can be done in just a few short minutes and are very simple, such as putting a rubber band around your fingers and then pushing your fingers out against it.

Wrist Curls

Unlike the small and simple moves with household items, wrist curls are a more common move for actual exercise workouts.

They can be beneficial to your hands and wrists as well as your forearms, which is the part they’re best known for strengthening.

The goal for this exercise isn’t to get sore, as it might be for some people when they use weights, but too slowly and gradually build strength so that your hands and wrists are in the best possible condition for the daily activities they perform.

Home Remedies For Pain

There are many inexpensive and easy ways to manage pain by reducing inflammation. You could take an over-the-counter pain reducer, which serves to temporarily lower inflammation, or try one of the following remedies below.

Heat and Cold

Alternating between hot and cold treatments through the use of a heating pad and an ice pack can lower inflammation while also providing temporary relief from pain. In the same way that you’d use heat and cold to relieve a sports injury, you can do the same for hand and wrist pain caused by overuse.

Turmeric

This Ayurvedic root is well proven to relieve pain and inflammation. It has been used for millennia and is an incredibly effective natural pain reliever.

With a bright golden color and a mild flavor, you can use ground turmeric in your meals, drink shots of the fresh juice, or make it into a tea.

Ginger

Also an Ayurvedic root used for many generations as a pain and inflammation reducer, ginger has been proven effective for relieving symptoms of arthritis.

Similarly to turmeric, you can use ginger as a dried spice in your cooking, make a tea from the root or powder, or drink fresh juice shots.

Reduce Systemic Inflammation With Everyday Activities

When you make efforts to reduce inflammation, it won’t only be your hands and wrists that will thank you.

Reducing systemic inflammation improves health overall and helps lower your risk for an assortment of illnesses.

There are many ways to go about reducing inflammation on a daily basis. Some you can try include yoga, eating fewer inflammatory foods, managing stress, and getting a sufficient amount of sleep.

How to Prevent Hand and Wrist Pain

Now that you know of ways to reduce the wrist and hand pain you may already have, it’s helpful to know how to keep it gone once you get rid of it.

In addition to taking steps to lower inflammation in your body, and stretching and strengthening your wrists, proper positioning when typing and the use of wrist and hand supports can lower the chances of your pain returning.

Positioning

When sitting to type, start by making sure you’re using a supportive chair that allows for good posture. Having your back straight will assist with the positioning of your arms and wrists. You’ll want to keep your hands hovered lightly over the keyboard, not resting on it, and your fingers curved over the keys.

If you aren’t able to find a comfortable position, you can try a keyboard with a different shape than the one you currently use.

Cushioning

In addition to choosing a keyboard that feels comfortable for your hands, you may find extra comfort in a mouse cushion and a keyboard cushion.

Though a mouse cushion can be used while you are actively using your mouse, a keyboard cushion should only be used when you are paused on typing. That’s because if you use it while you’re typing, you’ll be pushing your wrists up at a sharp angle.

Utilize a keyboard cushion while scrolling with your mouse, taking a brief break in typing, or reading.

Wrist Support Products

There are several types of products that provide support to your hands and wrists. In order to find one that allows you enough mobility while simultaneously providing sufficient support, you may need to try a few on.

Support options for hands and wrists include stabilizers, wraps, and braces.

Your wrists and hands may be in pain, but they don’t have to be! Try one or more of these suggestions to keep yourself pain free, no matter how much you type.


The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

Arthritis of the Hand

Article Featured on Bidneeham.org

Arthritis, the medical term for joint inflammation, is an extremely common problem for older adults. Arthritis in the hands can make it difficult to perform everyday tasks. While the condition can be managed with proper medical care, first you must recognize its common warning signs.
Read more

What Is Dupuytren’s Disease and How Is It Treated?

Article Featured on Michigan Hand & Wrist

If you begin to notice lumps on the palm side of your hand, then you might just have Dupuytren’s disease, and if left untreated, you could possibly lose motion in your fingers. While Dupuytren’s disease is called a disease, it is actually a genetic condition. You would need to have a physical exam to get tested for it. If you think you may have this disease, you should reach out to a hand specialist to look into treatment options as soon as possible.

Read more

What are some common hand problems?

Article Featured on Johns Hopkins

Anatomy of the hand

The hand is composed of many different bones, muscles, and ligaments that allow for a large amount of movement and dexterity. There are 3 major types of bones in the hand itself, including:

  Read more

A Surgeon’s Guide to Recovering From Hand Surgery

Article Featured on Ark Surgery Hospital

Hand surgery recovery is a delicate and often frustrating process. Be sure to follow all of your surgeon’s instruction to ensure you regain your full range of motion.

Whatever the reason for your hand surgery, you can prepare yourself by planning a hand surgery recovery timeline with the help of your orthopedic surgeon and following these helpful guidelines:

Tips for Hand Surgery Recovery

All hand surgery recovery periods last at least several weeks— and sometimes months—before you can return to your everyday activities. You can make several minor lifestyle modifications to help keep you comfortable while you are recovering.

Read more

What Is Kienböck’s Disease?

Kienböck’s disease is a condition where the blood supply to one of the small bones in the wrist, the lunate, is interrupted. Bone is living tissue that requires a regular supply of blood for nourishment. If the blood supply to a bone stops, the bone can die. This is called osteonecrosis.

Damage to the lunate causes a painful, stiff wrist and, over time, can lead to arthritis.

Normal anatomy of the hand and wrist

Normal skeletal anatomy of the hand. The lunate is one of the small bones in the wrist.
Reproduced and modified with permission from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.

Causes

The cause of Kienböck’s disease is not known. Many people with Kienböck’s disease think they have a sprained wrist at first. They may have experienced some form of trauma to the wrist, such as a fall. This type of trauma can disrupt the blood flow to the lunate.

Some things may put you more at risk for the disease. For example, most people have two vessels that supply blood to the lunate, but in some people there is only one source. This may slow the blood flow to the bone. In addition, if the two bones of the forearm (the radius and ulna) are different lengths, extra pressure can be put on the lunate during some wrist motions. Over time, this extra stress on the bone may lead to Kienböck’s disease.

Symptoms

The most common symptoms of Kienböck’s disease include:

  • A painful and sometimes swollen wrist
  • Limited range of motion in the affected wrist (stiffness)
  • Decreased grip strength in the hand
  • Tenderness directly over the bone (on the top of the hand at about the middle of the wrist)
  • Pain or difficulty in turning the hand upward

Doctor Examination

Kienböck’s disease is a condition that progresses slowly, and many people do not decide to see a doctor until they have lived with symptoms for several months, perhaps longer.

During your first appointment, your doctor will discuss your symptoms and medical history, then examine your hand and wrist. In its early stages, Kienböck’s disease may be difficult for your doctor to diagnose because the symptoms are so similar to those of a sprained wrist. Imaging tests, such as x-rays and magnetic resonance imaging (MRI) scans, are used to confirm a diagnosis of Kienböck’s disease.

Kienböck’s disease progresses through four stages of severity. If you are diagnosed with Kienböck’s disease, your doctor will plan your treatment based on several factors, most importantly, the stage of your progression.

Stage 1

During the first stage of the disease, the symptoms are similar to those of a wrist sprain. Although the blood supply to the lunate has been disrupted, x-rays may still appear normal or suggest a possible fracture. An MRI scan can better detect blood flow and is helpful in making the diagnosis in this early stage.

Kienböck's disease stage 1

Stage 1. An x-ray of a patient’s wrist during Stage I shows no deterioration of the lunate bone.
Reproduced with permission from Allan CH, Joshi A, Lichtman DM: Kienböck’s disease: diagnosis and treatment. J Am Acad Orthop Surg 2001; 9 : 128-136.

Stage 2

The lunate bone begins to harden due to the lack of blood supply during Stage 2. This hardening process is called sclerosis. In addition, the lunate will appear brighter or whiter in areas on x-rays, which indicates that the bone is dying. To better assess the condition of the lunate, your doctor may also order either MRI scans or computed tomography (CT) scans.

The most common symptoms during this stage are wrist pain, swelling, and tenderness.

Kienböck's disease stage 2

Stage 2. (Left) This illustration shows that the lunate has hardened with more than one fracture line. (Right) The lunate is brighter than the surrounding bones, which indicates that the bone is dying.

Reproduced and adapted with permission from Allan CH, Joshi A, Lichtman DM: Kienböck’s disease: diagnosis and treatment. J Am Acad Orthop Surg 2001; 9 : 128-136.

Stage 3

In Stage 3, the dead lunate bone begins to collapse and break into pieces. As the bone begins to break apart, the surrounding bones may begin to shift position.

During this stage, patients typically experience increasing pain, weakness in gripping, and limited wrist motion.
Kienböck's disease stage 3

Stage 3. Both the illustration and x-ray image show that the lunate has begun to collapse and several bones in the wrist have shifted out of position.
Reproduced and adapted with permission from Allan CH, Joshi A, Lichtman DM: Kienböck’s disease: diagnosis and treatment. J Am Acad Orthop Surg 2001; 9 : 128-136.

Stage 4

If the condition progresses to Stage 4, the surfaces of the bones surrounding the lunate also deteriorate, and the wrist may become arthritic.

Kienböck's disease stage 4

Stage 4. (Left) This illustration shows damage to several bones in the wrist. (Right) This CT scan also shows deterioration in the bones of the wrist.
Reproduced and adapted with permission from Allan CH, Joshi A, Lichtman DM: Kienböck’s disease: diagnosis and treatment. J Am Acad Orthop Surg 2001; 9 : 128-136.

Treatment

Although there is no complete cure for Kienböck’s disease, there are several nonsurgical and surgical options for treating it. The goals of treatment are to relieve the pressure on the lunate and to try to restore blood flow within the bone.

Nonsurgical Treatment

In the very early stage of the disease, pain and swelling may be managed with anti-inflammatory medications, such as aspirin or ibuprofen. Immobilizing your wrist for a period of time can help relieve pressure on the lunate, and your doctor may recommend splinting or casting for 2 to 3 weeks.

It is important to monitor any changes in your symptoms during the early stage of Kienböck’s disease. If the pain is not relieved with simple treatments or it returns, your doctor may recommend surgery.

Surgical Treatment

There are several surgical options for treating Kienböck’s disease. The choice of procedure will depend on several factors, in particular how far the disease has progressed. Additional factors to consider are the patient’s activity level, personal goals, and the surgeon’s experience with the procedures.

Revascularization. In some cases, it may be possible to return the blood supply to the lunate bone. This procedure is called revascularization. It is more successful during early phases of the disease — stages 1 and 2 — before the lunate has significantly deteriorated.

Revascularization involves removing a portion of bone with attached blood vessels from another bone — most often a forearm bone (radius) or an adjacent bone in the hand. This piece of bone with its blood supply is called a vascularized graft. It is inserted into the lunate bone.

To help the bones stay in place during healing, an external fixator may be temporarily applied. This is a metal device that is attached to the outside of the wrist with pins that insert into the bones. It can relieve pressure on the lunate while the graft is healing and restoring a blood supply.

Joint leveling. If the two bones of the lower arm are not the same length, a joint leveling procedure may be recommended. Bones can be made longer using bone grafts or shortened by removing a section of the bone. This leveling procedure reduces the forces that compress the lunate and often stops the progression of the disease.

Proximal row carpectomy. If the lunate is severely collapsed or broken into pieces, it can be removed. In this procedure, the two bones on either side of the lunate are also removed. This procedure, called a proximal row carpectomy, will relieve pain while maintaining partial wrist motion.

Wrist before and after proximal row carpectomy

(Left) The three wrist bones that are removed in a proximal row carpectomy, are shaded here. (Right) An x-ray image of a wrist after a proximal row carpectomy.

Fusion. To ease pressure on the lunate, nearby wrist bones can be fused together to make one, solid bone. A fusion can be partial, in which just some of the bones are fused together. This procedure relieves pain and retains some wrist motion.

If the disease has progressed to severe arthritis of the wrist, fusing all of the bones of the wrist to the radius will relieve pain and and improve hand function. Although all wrist motion is eliminated in a complete fusion, forearm rotation is preserved.

Wrist fusion

In a fusion, the bones of the wrist are held together with a plate, screws, and pins.

Outcomes

Kienböck’s disease varies considerably in its severity, as well as its rate of progression. Each patient’s response to treatment depends on the degree of damage to the lunate and surrounding wrist bones. Some patients may require more than one procedure if the disease continues to progress.

In summary, patients with Kienböck’s disease should not expect to ever return to normal wrist function after any treatment. However, treatment gives the greatest opportunity for long-term preservation of function and pain relief.


Orthopedic Sports Medicine Center of Oregon is located in Downtown Portland Oregon. Dr. Dominic Patillo, one of our Board-Certified Orthopedic Surgeons, specializes in hand surgery. His practice focuses on the treatment of both simple and complex hand and upper extremity conditions as well as general orthopaedic trauma. He is experienced with modern microsurgical techniques including nerve and vessel reconstruction.

Common problems treated include:

  • carpal tunnel syndrome
  • tennis elbow
  • wrist pain
  • sports injuries of the hand and wrist
  • fractures of the hand, wrist, and forearm
  • trigger finger

Other problems treated can include arthritis, nerve and tendon injuries, and congenital limb differences (birth defects).

If you have pain in your fingers, hand, wrist or arm, or if you have other upper-extremity related concerns, please consult our hand specialist Dr. Dominic Patillo for a consultation.

What Is Mallet Finger?

Description

A mallet finger is a deformity of the finger caused when the tendon that straightens your finger (the extensor tendon) is damaged.

When a ball or other object strikes the tip of the finger or thumb and forcibly bends it, the force tears the tendon that straightens the finger (see Figure 1a and 1b). The force of the blow may even pull away a piece of bone along with the tendon (see Figure 2). The tip of the finger or thumb no longer straightens. This condition is sometimes referred to as baseball finger.

Signs & Symptoms

In a mallet finger, the fingertip droops: it cannot straighten on its own power. The finger may be painful, swollen and bruised, especially if there is an associated fracture, but often the only finding is the inability to straighten the tip. Occasionally, blood collects beneath the nail. The nail can even become detached from beneath the skin fold at the base of the nail.

Treatment

Diagnosis

The diagnosis is evident by the appearance of the finger. Doctors will often order x-rays to see if a piece of bone pulled away and to make sure the joint is aligned.

Nonsurgical Treatment

The majority of mallet finger injuries can be treated without surgery. Ice should be applied immediately and the hand should be elevated (fingers toward the ceiling.) Medical attention should be sought within a week after injury. It is especially important to seek immediate attention if there is blood beneath the nail or if the nail is detached. This may be a sign of a nail bed laceration or an open (compound) fracture.

There are many different types of splints/casts for mallet fingers. The goal is to keep the fingertip straight until the tendon heals. Most of the time, a splint will be worn full-time for eight weeks (see Figure 3). Over the next three to four weeks, most patients gradually begin to wear the splint less frequently. The finger usually regains acceptable function and appearance with this treatment. Nevertheless, it is not unusual to lack some extension at the conclusion of treatment. Your surgeon or hand therapist will instruct you about how to wear the splint and will also show you exercises to maintain motion in the middle joint (the proximal interphalangeal joint) so your finger does not become stiff. Once your mallet finger has healed, your surgeon or hand therapist will teach you exercises to regain motion in the fingertip.

In children, mallet finger injuries may involve the cartilage that controls bone growth. The doctor must carefully evaluate and treat this injury in children so that the finger does not become stunted or deformed.

Surgical Treatment

Surgical repair may be considered when mallet finger injuries have large bone fragments or joint mal-alignment. In these cases, pins, wires or even small screws are used to secure the bone fragment and realign the joint (see Figure 4). Surgery may also be considered if splint wear is not feasible or if non-surgical treatment is not successful in restoring adequate finger extension. Surgical treatment of the damaged tendon can include tightening the stretched tendon tissue, using tendon grafts or even fusing the joint straight. Your surgeon will advise you on the best technique in your situation.


Orthopedic Sports Medicine Center of Oregon is located in Downtown Portland Oregon. Dr. Dominic Patillo, one of our Board-Certified Orthopedic Surgeons, specializes in hand surgery. His practice focuses on the treatment of both simple and complex hand and upper extremity conditions as well as general orthopaedic trauma. He is experienced with modern microsurgical techniques including nerve and vessel reconstruction.

Common problems treated include:

  • carpal tunnel syndrome
  • tennis elbow
  • wrist pain
  • sports injuries of the hand and wrist
  • fractures of the hand, wrist, and forearm
  • trigger finger

Other problems treated can include arthritis, nerve and tendon injuries, and congenital limb differences (birth defects).

If you have pain in your fingers, hand, wrist or arm, or if you have other upper-extremity related concerns, please consult our hand specialist Dr. Dominic Patillo for a consultation.