On June 12, 21 Seniors Today hosted its weekly Health Live webinar with Dr Pankaj Ahire
Dr Pankaj Ahire is a leading orthopaedic surgeon and is attached to the PD Hinduja Khar, Nanavati Max, Godrej Memorial, Holy Spirit and Saifee hospitals in Mumbai. He is Honorary Secretary of the Indian Society for Surgery of the Hand, a member of the Bombay Orthopeedic Society, American Society for the Surgery of the Hand and the International Wrist Investigators Workshop. His special interests include Wrist Trauma, Wrist Arthroscopy and Sports Injuries of the Upper Limb.
During the webinar he spoke about hand and wrist pain in senior citizens and answered questions about the same.
– When it comes to degeneration and arthritis of the joints, the joint which is at to the tips of the finger, is called the distal interphalygeal (D.I.P) joint it develops the deformities. These deformities occur as a result of bone growth, these are called “Heberden’s nodes”. When these bony growths and deformities/ swelling involves the joints closer to the wrist, that is the Proximal interphalyngeal joint (P.I.P), it is called “Bouchards nodes”.
Osteoarthritis typically presents with these swellings/ nodes and pain in the joints. If it is the early stage of the disease, the pain decreases and the range of movement increases as the day progresses.
– You can have joint erosion due to rheumatoid disease. It presents as more problem in the knuckle area. It is also a soft tissue problem causing imbalance, asymmetry and various deformities such as the ulnar drift.
This is a systemic problem and not specific to the hand.
– The most common degenerative disease of the hand is the arthritis of the base of the thumb. It’s also the most common arthritis of the upper limb. It is extremely painful.
– If not treated on time, it can lead to a very grotesque deformity of the thumb.
– It needs to be identified, graded, treated and then followed up on time.
– Arthritis of the wrist alone is not common. But it can present either as a part of rheumatoid disease or as a result of old fractures or ligament injuries of the wrist or age related degenerative secondary writs arthritis.
– The most common fracture involving the wrist is the Cole’s fracture.
It is common in the elderly due to weak bones.
In most of the cases, this fracture can be treated without any complex intervention.
– Trigger finger is a finger that gets stuck in the palm and snaps out when you try to open it, much like a trigger. It happens because the tendon gets stuck somewhere near the knuckle and only when you exert some power the tendon travel across a pulley and snaps.
The treatment measure is surgery though many of the trigger fingers might not need surgery and may resolve spontaneously in 18-20 months.
But until the surgery is done, you do not have to go out looking for other forms of treatment. It can very easily be fixed with a minor surgery under local anesthesia.
– De Quervain’s tenosynovitis occurs across the thumb tendons. It is similar to trigger finger, however here triggering is not common because the tendons are very slender.
But it causes acute pain. Small activities such as opening the door, turning on the tap can cause severe pain.
Occasionally, it can be treated with injectable steroids in the joint. But most often they either resolve spontaneously or it will require surgery.
– Commonest nerve related problem with this age group is the carpel tunnel syndrome.
The bones present over your palm are placed in such a way that they form a tunnel. These bones are called “carpels”, under the tunnel/ roof passes a nerve that supplies 3.5 digits of the hand. When for any reason there is compression of the nerve, the person stats getting tingling sensations or hypoaesthetia, wasting of the muscle can also be seen.
- If the symptoms are aggravated at night, it is highly suggestive of carpel tunnel syndrome.
- This condition requires surgery.
- Some preventative practices and techniques include:
- Avoiding and preventing activities that apply too much pressure on the wrist, for example, people who use their computer/ mouse very frequently. Keep some padding between the table and the wrist.
- Diabetes needs to be well-controlled
- Your vitamin B levels need to be checked every once a year
- Thyroid disorders can lead to swelling of the tissue some compression of the nerve.
- Being overweight can add to the volume of the tissue and weight and cause compression of the nerve.
- You can also learn Nero dynamic exercises.
- Investigations such as EMNC (electromyography nerve conduction study) can be done, it takes 45 mins of time and can tell which nerve is compressed and how badly.
– The deformities of the hand such as swan neck deformity, boutonnière deformity is due to either the degeneration of the ligament or the tendons.
– The boutonnière deformity does not need any intervention where as the swan neck deformity requires surgical intervention.
– Diabetic patients are more prone to develop carpel tunnel syndrome since the quality of the nerve and nerve fibre, it’s ability to regenerate and the micro circulation can be reduced.