My daughter is a hand surgeon now. We are so very proud. But I hardly know how to chat with her about her work. I thought maybe if I looked up some of the latest things in hand work, I might be able to draw her out more when we talk on the phone. She told me this week she is in a clinic where they just treat hand ligament injuries. Imagine that! Can you give me some tips on what to ask about?
Perhaps a bits of information on the hand and hand anatomy might get you started. Few structures of the human anatomy are as unique as the hand. The hand needs to be mobile in order to position the fingers and thumb. Adequate strength forms the basis for normal hand function. The hand also must be coordinated to perform fine motor tasks with precision. The structures that form and move the hand require proper alignment and control in order for normal hand function to occur.
Ligaments are an important feature in the hand. We take them for granted until an injury puts them out of commission. Then we realize just how important they are. Ligaments are tough bands of tissue that connect bones together. Two important structures, called collateral ligaments, are found on either side of each finger and thumb joint. The function of the collateral ligaments is to prevent abnormal sideways bending of each joint.
Other important ligamentous structures include the volar plates and flexor tendon pulleys. You'll really impress your daughter if you ask about volar plates and tendon pulleys. The volar plate is the strongest ligament in the fingers. This ligament connects the proximal phalanx (finger bone closest to the palm) to the middle phalanx on the palm side of the joint. The ligament tightens as the joint is straightened and keeps the proximal interphalangeal (PIP) joint from bending back too far (hyperextending). Finger deformities can occur when the volar plate loosens from disease or injury.
The tendons that move the fingers are held in place on the bones by a series of ligaments called pulleys. These ligaments form an arch on the surface of the bone that creates a sort of tunnel for the tendon to run in along the bone. To keep the tendons moving smoothly under the ligaments, the tendons are wrapped in a slippery coating called tenosynovium. The tenosynovium reduces the friction and allows the flexor tendons to glide through the tunnel formed by the pulleys as the hand is used to grasp objects.
Five of the most common ligament injuries affecting the hand and fingers include: 1) thumb collateral ligament injury, 2) finger collateral ligament injuries, 3) volar plate injuries, 4) flexor pulley injuries, and 5) carpometacarpal (CMC) ligament. You could pick one or two of these and ask her if she has treated any of these injuries this week.
It might also help you if you understand a little bit more about how treatment decisions are made since your daughter will be making this kind of decision every day of her practice. Most of the time, only severe injuries will require surgery to repair or reconstruct torn or damaged soft tissue (ligamentous) structures. Conservative (nonoperative) care is more often the case. When making treatment decisions, the surgeon takes into consideration the patient's age, severity of injury, the presence of other injuries (e.g., bone fractures, joint dislocations), and how long ago the injury occurred.
Surgery to repair or reconstruct the damaged soft tissues is advised when there is a partial or complete (avulsion) tear of the ligament away from the bone. Operative care is also required when the patient does not respond to conservative care and/or when joint instability persists.
Hopefully, this little primer will give you enough information to get you started. Once you get your daughter talking about her work, you may not have to say much else or ask any further questions until the next phone call! Good luck and let us know if you need more conversational "ammunition."
Zahab S. Ahsan, and Jeffrey Yao, MD. Ligamentous Injuries of the Hand. In Current Orthopaedic Practice. July/August 2012. Vol. 23. No. 4. Pp. 313-317.
*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.