Treatment of osteoarthritis in the hand and wrist. Nonoperative treatment.

Osteoarthritis should initially be treated conservatively with the use of oral medication, intra-articular steroid injections, hand therapy, and splinting. The reduction of pain and the resultant increase in function to the patient are the ultimate goals of this treatment.

Common tumors of the hand.

Many types of cell structures that exist within the hand contribute to the broad spectrum of hand tumors, the majority of which are benign. When evaluating patients, the physician must be aware of the various types of tumors that can exist in order to predict the type of tumor present and also to advise the patient preoperatively concerning the possibility of recurrences, relief of symptoms, and the chances of malignancy.

Vascular tumors of the hand and forearm.

Although blood vessel tumors are rare, they are frequently encountered in the hand and forearm, being the fourth most common tumor of the hand. The treating physician should be aware of the acquired, traumatic, and congenital vascular tumors that are so prevalent in this area.

Chondrosarcoma of the hand.

Eighteen consecutive cases with the histologic diagnosis of chondrosarcoma of the hand were reviewed and followed up from 1 to 10 years. The primary tumor originated without a preexisting lesion in 78%. Secondary tumors arose in patients who had multiple enchondromas but not in patients with a solitary enchondroma. The onset is usually in the 60- to 80-year age group with the tumor almost always occurring in the epiphyseal area of the proximal phalanx (56%) or the metacarpals (39%). Roentgenographic features included indiscrete lytic areas of bone destruction (83%). The diagnostic finding of intraosseous or extraosseous scattered, punctate, calcific densities of dystrophic calcification occurred in 66%. Ray resection of the tumor is the treatment of choice. Local recurrences occurred in 11% and distant metastases were not seen.

Subcutaneous hemangiomas of the hand.

Subcutaneous hemangiomas, the fourth most common tumor of the hand, consist primarily of proliferating blood vessels within the soft tissue. One hundred and sixty consecutive patients with the histologic diagnosis of subcutaneous hemangiomas were reviewed. Patients with diffuse hemangiomas, strawberry nevi, and arteriovenous fistulae were not included in the study. The median age was 32 years, the youngest being 2 years old and the oldest 68. Sixty-two percent of the patients were female. None had a history of trauma. The palm was the most common location. Progressive enlargement of the lesion and throbbing pain were the most common symptoms. As is characteristic of hemangiomas, they were readily compressible, poorly defined, bluish, subcutaneous masses that distended when the venous return was obstructed and contracted when the extremity was elevated. Roentgenographic evaluation rarely showed the typical calcification of phleboliths, but a soft tissue mass was almost always present. All of these hemangiomas were surgically excised, with the tributory vessels being identified and ligated as far distant from the tumor as possible in order to diminish the chances of recurrence.

Pisiform area pain treatment by pisiform excision.

Thirty-three patients with pisiform area pain have been treated. Of these, the pisiform bone was excised in 21 patients who had intractable pisiform bone pain that was not relieved by the conservative methods of immobilization, local steroid injection, and anti-inflammatory medication. The indications for excision were painful union or nonunion of pisiform fractures, pisiform-triquetrial arthritis, and tendonitis of the flexor carpi ulnaris (FCU) insertion. Wrist strength and mobility was maintained by doing a subperiosteal dissection and removal of the pisiform bone. This technique preserves the insertion of the FCU tendon and its distal extension, the piso hamate and the piso metacarpal ligaments.

The use of silicone rubber implant arthroplasty in treatment of true symphalangism.

In four patients with true symphalangism, in which the fingers were of normal or nearly normal length and active flexion of the distal interphalangeal joints was present, silicone rubber implants were inserted in the proximal interphalangeal joint areas of the middle fingers. Fifty degree of motion resulted.