The metacarpals are the bones in the palm of your hand that connect the wrist to the finger bones, known as phalanges. The metacarpals can be injured via blunt (sports injuries) and/or penetrating (gun shot injuries) trauma, a fall, and crushing injury to name a few. You may experience swelling over the fracture, pain, sometimes a clear deformity (hump or inability to see your knuckle), and inability to move the fingers. Sometimes, the affected finger, when you flex your fingers will cross and touch the finger next to it, preventing you from grabbing things. The goal of treatment is to identify the fracture, reduce the fracture to its normal position, and allow the bone to heal. Sometimes physical and occupational therapy might be required.
Flexor tendons are a rope like structure that connects the muscle in your forearm to the bones in your fingers on the palm-side. Tendons allow the fingers to be flexed for grasping and gripping objects. Extensor tendons are on the top side of fingers, and allow the fingers to extend for grasping and gripping objects. Lacerations to tendons from penetrating injuries such as a knife, broken glass, table saw injuries, or more drastically from gun shot injuries can cause swelling, pain, and inability to move the finger. The goal of treatment is to explore the injury, and repair the tendon laceration. As the structures around the tendon repair heal, they form scar tissue, and this can trap the tendon that was repaired and prevent its motion. Therefore, you will need to be started on a early motion therapy protocol to prevent the tendons from being stuck in scar tissue.
Dupuytren’s Contracture is when scar tissue forms underneath the palm of the hand over a period of time developing a visible cord under the palmar fascia that causes muscles in the appendages to tighten. This results in curled fingers and impairing the hands. Dupuytren’s Contracture disables a person’s ability to fully extend the fingers and makes it difficult to grasp objects or do other mundane tasks. The ring finger and the little finger are the ones most affected by the disease however the index and thumb remain fully functional.
Symptoms of Dupuytren Contracture
Symptoms include the slow and painless formation of lumps located in the palm. The lump is actually scar tissue that is building and in time will cause the contraction of the affected appendages. Studies show no connection between Dupuytren’s disease and dominant or non dominant hands, both hands can be affected equally.
Causes of Dupuytren’s Contracture
Dupuytren’s Contracture is commonly found in men with Northern European and Scandinavian ancestry and is inherited. For a certain period of time it was notoriously known as the Viking disease. Dupuytren’s disease primarily affects men ages 40 and up. Rock climbers are prone to getting the disease due to the tremendous stress on tendons their sport requires. There has been studies that indicate the highest rate in Dupuytren’s cases are people with diabetes, seizures, epilepsy and It is also associated with the consumption of alcohol but the direct cause of the disease is currently unknown. Though some suspect that hand trauma or shocks, such as tremors of impact traveling through a baseball bat to the hands could lead to Dupuytren’s Contracture but has yet to be proven.