Too Much or Too Little Weight May Worsen Rheumatoid Arthritis

Too Much or Too Little Weight May Worsen Rheumatoid Arthritis

Obesity may accelerate and amplify the crippling symptoms of rheumatoid arthritis, new research suggests.

Conversely, the researchers also found that unexplained weight loss might also signal problems for these patients, because it could mean that they’re at greater risk for disability.

“While patients and rheumatologists may be focused mostly on disease activity, we should also consider this common condition [obesity], which can contribute to problems that are usually attributed to the arthritis itself,” said study author Dr. Joshua Baker.

“In addition, unintentional weight loss should alert us that the patient may be becoming frail and is at risk for developing new disability,” he added. Baker is an assistant professor of medicine at the University of Pennsylvania’s Perelman School of Medicine.

Rheumatoid arthritis is an autoimmune condition. It develops when immune cells that normally fight germs attack the lining of the joints, or cartilage. This causes the joints to swell and the surrounding bones, ligaments and muscles to gradually erode. Rheumatoid arthritis worsens over time, often leading to disability.

For the study, Baker and his colleagues looked at the effects of obesity on the progression of rheumatoid arthritis in just over 25,000 people with the disease.

The investigators found that the disease advanced more quickly among those who were very obese. This was true regardless of the level of inflammation in their joints.

In addition, people who were thin but lost weight without trying also became disabled more quickly.

The study was published April 30 in the journal Arthritis Care & Research.

“So, this study suggests that patients with rheumatoid arthritis and obesity would benefit from intentional weight loss through a comprehensive management strategy,” Baker said in a journal news release.”

“However, when we see that someone is losing weight without trying, it’s probably a poor prognostic sign, especially if they are already thin,” he added.

Although the study could not prove a cause-and-effect link, the researchers suggested that new treatments and strategies to help people maintain a healthy weight might help prevent disability among people with rheumatoid arthritis.

And, Baker’s team noted, the findings could help doctors recognize signs of frailty among their rheumatoid arthritis patients who may benefit from strength training and physical therapy.

More information

The Arthritis Foundation has more about obesity and rheumatoid arthritis.

SOURCE: Arthritis Care & Research, news release, April 30, 2018

4 in 10 People Will Suffer Arthritic Hands Over Lifetime

4 in 10 People Will Suffer Arthritic Hands Over Lifetime

If you have stiff, aching fingers and hands, you’re not alone — a new study reports that 40 percent of people will be affected by the pain of arthritis in at least one hand.

The rate seen in the new research is “just slightly below the percentage of osteoarthritis seen in knees and is significantly greater than that seen in hips,” noted Dr. Daniel Polatsch. He’s co-director of the New York Hand & Wrist Center at Lenox Hill Hospital in New York City.

Arthritis “affects hand strength and function and causes difficulty doing activities of daily living,” Polatsch said.

The study team was led by Jin Qin, of the Arthritis Program at the U.S. Centers for Disease Control and Prevention. The researchers looked at 1999-2010 data on more than 2,200 people from North Carolina. All people in the study were aged 45 or older.

The information collected included symptoms the participants reported as well as hand X-rays.

Women were at higher risk than men, with nearly half of women (47 percent) developing hand arthritis. Only about a quarter of men had hand arthritis, Qin’s team said. Whites were more prone to the ailment than blacks, with rates of 41 percent and 29 percent, respectively.

Excess weight was also a risk factor for hand arthritis. Lifetime risk among obese people was 47 percent, compared to 36 percent for non-obese people, the study found.

Dr. Steven Carsons is chief of rheumatology at NYU Winthrop Hospital in Mineola, N.Y. He said the finding that hand arthritis is more common in women “has been long thought to have a genetic and hormonal basis.”

The obesity link is more intriguing, Carsons said.

“While obesity has always been assumed to be a risk factor for osteoarthritis of weight-bearing joints, such as the knee, these data reveal the somewhat surprising association of obesity and lifetime risk of development of hand osteoarthritis,” he said.

Recent studies have suggested that obesity may set up “systemic inflammation” in the body, Carsons said, which may raise the odds of arthritis in a non-weight-bearing joint, such as the hand.

Because arthritis in the hands can be disabling, Polatsch said, “treatment options and access to hand specialists need to improve in order to minimize the impact of this potentially disabling condition in our aging population.”

The study was published May 4 in Arthritis & Rheumatology.

More information

Find out more about arthritis at the Arthritis Foundation.

Boxer’s Fracture

Boxer’s Fracture

What is a boxer’s fracture?

A boxer’s fracture is a break in the neck of the fifth metacarpal bone in the hand. It gets its name because the injury is common in inexperienced boxers.

The metacarpal bones are the intermediate bones of the hand found inside the flat of the hand. They connect the bones of the fingers (the phalanges) to the bones of the wrist (the carpals). The fifth metacarpal is the metacarpal of the fifth (pinky) finger. The neck of the metacarpal bone is where the main shaft of the bone starts to widen outwards towards the knuckle.

Boxers are not the only people who can get a boxer’s fracture, but usually the injury results from direct injury to a clenched fist. The force fractures the neck of the metacarpal bone below the pinky.

Your doctor will need to distinguish boxer’s fractures from other metacarpal fractures, which break the shaft of the metacarpal, or fractures of the base of the small finger. These injuries may need different treatments.

Metacarpal bones, in general, are some of the most commonly fractured bones in the hands. A large percentage of these qualify as “boxer’s fractures.”

What causes a boxer’s fracture?

Usually, a boxer’s fracture happens when you punch a wall or another solid object at a high speed. You also might get a boxer’s fracture if you fall hard on your closed fist. The neck of the metacarpal bone is its weakest point, so it tends to fracture here.

What are the symptoms of a boxer’s fracture?

Symptoms of a boxer’s fracture can include:

  • Painful bruising and swelling of the back and front of the hand
  • Tenderness of the back of the hand in the region of the fractured fifth metacarpal
  • Bent, “claw-like” pinky finger that appears out of alignment
  • Limited range of motion of the hand and of the fourth and fifth fingers

Your knuckle may also not have its normal bumpy shape. Your symptoms may vary in severity depending on the complexity of your fracture. You might have only mild pain, or the pain might be more severe.

How is a boxer’s fracture diagnosed?

Your doctor will ask you about your symptoms, how you injured the hand, and your past medical problems. Your doctor will also examine your hand carefully, checking for tenderness, strength, misalignment, range of motion, breaks in the skin, and other features.

An X-ray of the hand can clearly confirm a boxer’s fracture.

How is a boxer’s fracture treated?

Your treatment depends on how severe the fracture is. Initial treatment might include:

  • Washing any cuts that are present in the skin
  • Getting a tetanus shot if you have a cut and haven’t had a shot for several years
  • Resting your hand for a few days
  • Keeping your hand above the level of your heart for a few days
  • Icing your injury several times a day
  • Taking pain medicine (prescription or over-the-counter)
  • Wearing a splint for several weeks

Before your doctor puts your hand into a splint, he or she may need to put your bones back into alignment. Usually, you’ll receive a local anesthetic to keep you from feeling any pain, and your doctor will physically manipulate the bones back into place. In some cases, your doctor might have to open up your hand surgically to get the bones back into alignment.

You also may need to work with a physical therapist for a while as your fracture heals. You’ll learn exercises to strengthen the muscles of your hand and keep them from getting stiff.

If you have an unusually severe boxer’s fracture, you may need immediate and more complicated surgery. For example, if your bone has broken through the skin, or if it has broken in several places, you will probably need surgery. You might also need surgery if you have a job or significant hobby that requires a lot of fine-motor movement of the hand, like playing the piano.

Even if you don’t need surgery right away, you might need it at some point. If your hand doesn’t heal as well as expected, surgery might be an option.

What are the complications of a boxer’s fracture?

An untreated boxer’s fracture can lead to a decrease in your ability to grip, limited range of motion of the finger, and an abnormal looking finger. With proper treatment, these complications are usually minor, if present at all.

What can I do to prevent a boxer’s fracture?

Avoid fistfights and punching solid objects to prevent many cases of boxer’s fracture. If you box, make sure you use the correct technique and the proper equipment.

How to manage a boxer’s fracture

Your doctor may give you some instructions about how to manage your boxer’s fracture, such as:

  • Keep your bones strong by eating a healthy diet with enough vitamin D, calcium, and protein
  • Stopping smoking, to help your fracture heal more quickly
  • Keeping your splint from getting wet

Your hand will be very easy to reinjure for 4 to 6 weeks after your splint is gone. You may need to use a hand brace if you return to contact sports during this time. Talk with your doctor about what makes sense for you.

When should I call my healthcare provider?

Call your doctor if:

  • You have numbness or tingling in your fingers
  • You fingers look blue
  • You have severe pain or worsening swelling
  • Your splint gets damaged and you need a new one

Key Points

A boxer’s fracture is a break in the neck of the fifth metacarpal bone in the hand. It usually happens when you punch an object at a high speed.

  • Symptoms of a boxer’s fracture include pain and swelling of the hand, limited range of motion of the pinky finger, and misalignment of the finger.
  • Your doctor can diagnose your boxer’s fracture with a medical history, physical exam, and X-ray.
  • You might need treatment with simple rest, ice, pain medicine, and splinting.
  • You might need surgery for your injury if it is severe.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.
Can Smartphone Use Bring on Carpal Tunnel Syndrome?

Can Smartphone Use Bring on Carpal Tunnel Syndrome?

FRIDAY, June 23, 2017 (HealthDay News) — People who spend lots of time on their smartphones may be scrolling, tapping and swiping their way to carpal tunnel syndrome, a painful wrist and hand disorder.

A small study found a link between extended use of smartphones and other hand-held electronic devices and a greater likelihood for experiencing the telltale wrist and hand pain of the syndrome.

But the researchers did not prove that heavy smartphone use caused carpal tunnel syndrome, and one hand surgeon said very few people in the real world use their smartphones as much as the heavy users in the study did.

Study author Peter White said the findings suggest “caution may be warranted when using hand-held electronic devices, in order to minimize the chance of developing carpal tunnel syndrome.”

White is an assistant professor in the department of health technology and informatics at Hong Kong Polytechnic University.

The carpal tunnel is a narrow and hard pathway of bone and ligament found at the base of the hand, according to the U.S. National Institute of Neurological Disorders and Stroke. It contains tendons, which enable finger-bending, as well as the so-called “median nerve,” which runs from the forearm to the palm and provides feeling to some fingers.

Carpal tunnel syndrome can gradually develop following repeated pressure to the point where the median nerve passes into the hand and meets the wrist.

A common cause, said White, are work conditions that call for “repetitive, forceful or awkward hand movements, for example, when typing.” And the result is often pain (sometimes extending up the arm), numbness, finger tingling and weakened grip strength.

To explore whether smartphone use might up the carpal tunnel syndrome risk, White and his associates followed up on their prior investigation involving 500 Hong Kong University students.

Those students fell into two camps: intensive users of hand-held electronic devices (meaning five or more hours of use per day) and non-intensive users (less than five hours per day). Hand-held devices included mobile phones, tablet computers and game consoles.

More than half (54 percent) of the intensive group reported musculoskeletal pain and/or discomfort, compared with 12 percent among the less intensive group.

The new study looked at 48 students from the first study. Half were intensive users who spent (on average) more than nine hours a day using their devices. Those in the other group spent just under three hours a day on their devices.

The participants answered questionnaires on electronic device habits and any pain or discomfort in their neck, shoulder, back, elbow or wrist/hand region.

Ultrasounds and physical exams on the wrist region were also done.

Muscle pain was found to be more common among intensive users.

The researchers also found that intensive electronics users had “significantly” more discomfort, and more severe discomfort, in their wrist and hand.

The more time a person spent using a hand-held electronic device, the more intense and long-lasting their wrist and hand pain was.

To explain why, the researchers pointed to device design, which requires the repeated use of fingers to click, swipe, scroll, tap and press. The result is an enlargement and flattening of the median nerve, alongside bulging of a key ligament.

To minimize risk, White advises keeping the wrist as straight as possible when using devices.

He added, “One should try to minimize repetitive movements of one’s fingers and thumb when using hand-held electronic devices, especially for single-hand use. It is also important to take regular rest periods, so as to avoid continuous intensive use, so as to allow recovery time and to prevent prolonged stress.”

But hand surgeon Dr. Dori Cage questioned how much of a risk smartphone use really poses.

“The strong correlation of carpal tunnel syndrome with smartphone use is surprising, as I have not seen that in my practice,” said Cage, an American Academy of Orthopaedic Surgeons spokesperson.

Cage, who’s with San Diego Hand Specialists, also suggested that “it is unlikely that the general population would have [the] degree of phone use” seen among the intensive users in the study.

“This is likely an issue affecting only a small percentage of cellphone users,” she said.

The study was published June 21 in the journal Muscle and Nerve.

More information

There’s more information on carpal tunnel syndrome at U.S. National Institute of Neurological Disorders and Stroke.

Carpal Tunnel Release

Carpal Tunnel Release

What is carpal tunnel release surgery?

Carpal tunnel release is a surgery used to treat and potentially heal the painful condition known as carpal tunnel syndrome. Doctors used to think that carpal tunnel syndrome was caused by an overuse injury or a repetitive motion performed by the wrist or hand, often at work. They now know that it’s most likely a congenital predisposition (something that runs in families) – some people simply have smaller carpal tunnels than others. Carpal tunnel syndrome can also be caused by injury, such as a sprain or fracture, or repetitive use of a vibrating tool. It’s also been linked to pregnancy, diabetes, thyroid disease, and rheumatoid arthritis.

The median nerve and tendons that allow your fingers to move pass through a narrow passageway in the wrist called the carpal tunnel. The carpal tunnel is formed by the wrist bones on the bottom and the transverse carpal ligament across the top (or inside) of the wrist. When this part of the body is injured or tight, swelling of the tissues within the tunnel can press on the median nerve. This causes numbness and tingling of the hand, pain, and loss of function if not treated. Symptoms usually start slowly, and may get worse over time. They tend to be worse on the thumb side of the hand.

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During a carpal tunnel release, a surgeon cuts through the ligament that is pressing down on the carpal tunnel. This makes more room for the median nerve and tendons passing through the tunnel, and usually improves pain and function.

Why might I need carpal tunnel surgery?

A diagnosis of carpal tunnel syndrome is about the only reason to have a carpal tunnel surgery. And even then, your doctor will likely want you to try nonsurgical treatments first. These may include over-the-counter pain medicines, physical therapy, changes to the equipment you use at work, wrist splints, or shots of steroids in the wrist to help relieve swelling and pain.

The reasons that a doctor would recommend a carpal tunnel release surgery may include:

  • The nonsurgical interventions for carpal tunnel syndrome don’t relieve the pain.
  • The doctor performs an electromyography test of the median nerve and determines that you have carpal tunnel syndrome.
  • The muscles of the hands or wrists are weak and actually getting smaller because of the severe pinching of the median nerve.
  • The symptoms of carpal tunnel syndrome have lasted 6 months or longer with no relief.

What are the risks of carpal tunnel surgery?

As with most surgeries, carpal tunnel release is not without its risks. Your wrist will be made numb and you may be given medicine to make you sleepy and not feel pain (called local anesthesia) for the procedure. In some cases general anesthesia is used, this when drugs are used to put you into a deep sleep during surgery. Anesthesia poses risks for some people. Other potential risks of a carpal tunnel release surgery include:

  • Bleeding
  • Infection
  • Injury to the median nerve or nerves that branch out from it
  • Injuries to nearby blood vessels
  • A sensitive scar

The recovery from carpal tunnel surgery takes time – anywhere from several weeks to several months. If the nerve has been compressed for a long period of time, recovery may take even longer. Recovery involves splinting your wrist and getting physical therapy to strengthen and heal the wrist and hand.

There may be other risks, depending on your specific medical condition. Be sure to discuss any concerns with your doctor before the procedure.

How do I get ready for carpal tunnel surgery?

  • Tell your doctor about all medicines you are currently taking, including over-the-counter drugs, vitamins, herbs, and supplements. You will probably need to stop taking any medicines that make it harder for the blood to clot, such as ibuprofen, aspirin, or naproxen.
  • If you’re a smoker, try to quit before to the surgery. Smoking can delay healing.
  • You may need to get blood tests or an electrocardiogram (ECG) before surgery.
  • You will usually be asked not to eat or drink anything for 6 to 12 hours before the surgery.

Based on your medical condition, your doctor may request other specific preparations.

What happens during carpal tunnel surgery?

Carpal tunnel release is usually an outpatient procedure, which means that you can go home the same day as the surgery if all goes well. There are 2 types of carpal tunnel release surgery. The traditional method is the open release, in which the surgeon cuts open the wrist to do the surgery.

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The other method is endoscopic carpal tunnel release, in which a thin, flexible tube that contains a camera is put into the wrist through a tiny incision (cut). The camera guides the doctor as the surgery is done with thin tools put into the wrist through another small cut.

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In either case, here is the general sequence of events in a carpal tunnel release surgery:

  1. You will usually be asked to remove your clothing, or at least your shirt, and put on a hospital gown.
  2. Typically, local anesthetic is used for this procedure to numb the hand and wrist.
  3. In an open release surgery, the surgeon cuts about a 2-inch incision on the wrist. Then he or she uses common surgical instruments to cut the carpal ligament and enlarge the carpal tunnel.
  4. In an endoscopic carpal tunnel release, the doctor makes 2, half-inch incisions. One is on the wrist, and one is on the palm. Then he or she inserts a camera attached to a narrow tube into one incision. The camera guides your doctor as he or she inserts the instruments and cuts the carpal ligament through the other incision.
  5. The surgeon will stitch up the incision or incisions.
  6. Your hand and wrist will be placed in a splint or bandaged heavily to keep you from moving your wrist.

Once the surgery is done, you’ll be monitored for a short time, and then allowed to go home. Only in rare cases or complications is an overnight stay needed for a carpal tunnel release surgery.

What happens after carpal tunnel surgery?

Your wrist will likely be in a heavy bandage or a splint for 1 to 2 weeks. Doctors usually schedule another appointment to remove the bandage or splint. During this time, you may be encouraged to move your fingers to help prevent stiffness.

You’ll probably have pain in your hand and wrist after surgery. It’s usually controlled with pain medicines taken by mouth. The surgeon may also have you keep the affected hand elevated while sleeping at night to help decrease swelling.

Once the splint is removed, you will likely begin a physical therapy program. The physical therapist will teach you motion exercises to improve the movement of your wrist and hand. These exercises will speed healing and strengthen the area. You may still need to sometimes use a splint or brace for a month or so after surgery.

The recovery period can take anywhere from a few days to a few months. In the meantime, you may need to adjust job duties or even take time off from work while you heal. Your doctor will talk to you about activity restrictions you should follow after surgery.

Let your doctor know about any of the following:

  • Fever
  • Redness, swelling, bleeding, or other drainage from the incision
  • Increased pain around the incision

These problems may need to be treated. Talk to your doctor about what you should expect and what problems mean you need to see your doctor right away.

Next steps

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure
  • The reason you are having the test or procedure
  • What results to expect and what they mean
  • The risks and benefits of the test or procedure
  • What the possible side effects or complications are
  • When and where you are to have the test or procedure
  • Who will do the test or procedure and what that person’s qualifications are
  • What would  happen if you did not have the test or procedure
  • Any alternative tests or procedures to think about
  • When and how will you get the results
  • Who to call after the test or procedure if you have questions or problems
  • How much will you have to pay for the test or procedure

Overview of Hand Surgery

What is hand surgery?

Hand surgery is a broad term that covers many different types of procedures. Plastic surgeons who perform hand surgery seek to restore hand and finger function. But they also try to make the hand look as normal as possible, as well. Hand surgery may be done for many reasons, including:

  • Hand injuries
  • Rheumatic diseases, such as osteoarthritis and rheumatoid arthritis, that change and damage the structures in the hand
  • Degenerative changes to the structures in the hand
  • Problems or defects that are present at birth, or congenital
  • Infections

What are the different types of hand surgery?

Many different types of surgeries can be performed on the hand. It depends on the underlying cause of the problem. These procedures include:

Skin grafts

Skin grafts involve replacing or attaching skin to a part of the hand that has missing skin. This surgery is most often done for fingertip amputations or injuries. Skin grafts are done by taking a piece of healthy skin from another area of the body, called the donor site, and attaching it to the injured area.

Skin flaps

Like a skin graft, a skin flap involves taking skin from another part of the body. But this procedure uses skin that has its own blood supply. That’s because the section of skin that is used includes the underlying blood vessels, fat, and muscles. Flaps may be used when an area that is missing skin does not have a good blood supply. This may be because of the location, damage to the vessels, or extensive tissue damage.

Closed reduction and fixation

This may be used when there is a bone fracture, or broken bone, in part of the hand, including the fingers. This type of surgery realigns the broken bone and then holds it in place, or immobilizes it, while it heals. Immobilization can be done with internal fixtures, such as with wires, rods, splints, and casts.

Tendon repair

Tendons are the fibers that join muscle to bone. Tendon repair is a difficult surgery because of the structure of the tendon. Tendon injuries can occur due to infection, trauma, or sudden rupture. There are 3 types of tendon repair: primary, delayed primary, or secondary.

  • Primary repair of an acute or sudden injury is often done within 24 hours of the injury.  This is usually a direct surgery to fix the injury.
  • Delayed primary repair is usually done a few days after the injury, but while there is still an opening in the skin from the wound.
  • Secondary repairs may occur 2 to 5 weeks or longer after the injury. They may include tendon grafts. This is when tendons from other areas of the body are inserted in place of the damaged tendon. Or other more complex procedures may be used.

Nerve repairs

An injury can damage the nerves in the hand. This can cause a loss of hand function and a loss of feeling in the hand. Some nerve injuries may heal on their own. Others may require surgery. Generally, surgery is done about 3 to 6 weeks after the injury. This is the best time for nerve repairs that are linked with other more complicated injuries.

In cases where nerve damage is not linked to more complicated injuries, surgery to check the damaged nerve is usually done soon after the injury. This increases the chance of a full recovery. If the nerve is cut or severed, it may be fixed by reattaching it to the other end of the nerve. Or a nerve graft may be done. This involves replacing the damaged nerve with nerves taken from other areas of the body.

Fasciotomy

This procedure is done to help treat compartment syndrome. This painful condition occurs when there is swelling and increased pressure in a small space, or compartment, in the body. Often this is caused by an injury. This pressure can interfere with blood flow to the body tissues and destroy function. In the hand, a compartment syndrome may cause severe and increasing pain and muscle weakness. Over time, it can cause a change in color of the fingers or nailbeds.

For a fasciotomy, your doctor will make a cut or incision in your hand or arm. This decreases the pressure, lets the muscle tissue swell, and restores blood flow. Any tissue inside the area that is already damaged may be removed at this time. This procedure helps prevent any further damage and decrease in function of the affected hand.

Surgical drainage or debridement

Hand infections are very common. Treatment for hand infections may include rest, using heat, elevation, antibiotics, and surgery. If there is a sore or abscess in the hand, surgical drainage may help remove any pus. If the infection or wound is severe, debridement may be used to clean dead and contaminated tissue from the wound. This prevents further infection and helps promote healing.

Joint replacement

This type of surgery, also called arthroplasty, is used in cases of severe hand arthritis. It involves replacing a joint that has been destroyed by arthritis with an artificial joint look at here now. This artificial joint may be made of metal, plastic, silicone rubber, or your own body tissue, such as a tendon.

Replantation

This type of surgery reattaches a body part, such as a finger, hand, or toe, which has been completely cut or severed from the body. The goal is to restore as much function as possible. Replantation uses microsurgery. This is a complex type of surgery that uses tiny tools and is done under magnification using a microscope. In some severe cases, more than 1 surgery may be needed.

What are the risks of hand surgery?

Most surgery carries the risks of anesthesia and bleeding. Additional risks associated with surgery depend greatly on the type of surgery being performed and may include:

  • Infection
  • Incomplete healing
  • Loss of feeling or movement of the hand or fingers
  • Blood clots may form