Gardening 101

Help for Hurting Hands

A gardener’s hands are their most important tools. As a hand surgeon, I diagnose and treat patients with a multitude of ailments affecting their hands. Three conditions that are frequently encountered in gardeners include carpal tunnel syndrome, Dequervain’s [wrist] tendonitis, and basilar thumb arthritis.

The carpal tunnel is a passageway in the wrist through which a major nerve and the finger flexor tendons pass. Increased pressure in the carpal tunnel results in compression of the nerve, restricting blood its flow. This may often cause a sensation of numbness, burning, or tingling in one or more of the fingers. These symptoms may extend up the arm. In some cases, patients may also experience clumsiness and weakness in the hand.

Activities that involve repeated flexing of the fingers or wrist or prolonged exposure to vibration often provokes symptoms of carpal tunnel syndrome. Symptoms in gardeners are frequently associated with repetitive grasping of garden tools and lawn mower control handles.

Conservative treatment often begins with a splint, which restricts movement of the wrist and avoidance of aggravating activities. In some instances a steroid injection may be administered into the carpal tunnel to decrease swelling. When conservative treatment does not achieve the desired results, surgery may be recommended. Surgery involves cutting the ligament that forms the roof of the carpal tunnel, which relieves the pressure on the nerve.

The most commonly encountered form of wrist tendonitis is referred to as Dequervain’s stenosing tenosynovitis. This is a painful inflammation of the tendons that course along the thumb side of the wrist. The lining tissue surrounding the tendons generally thickens and swells as a result of inflammation. Patients may experience swelling and pain along the thumb side of the wrist, as well as a feeling of “snapping” when the thumb is moved.

Wrist tendonitis is frequently caused by activities requiring sideways motion of the wrist while gripping. Activities such as using a leaf blower or weed eater and raking leaves commonly are associated with Dequervain’s tendonitis.

Treatment generally begins with a 2 to 4 week trial of anti-inflammatory medication. A splint may be used to immobilize the wrist and thumb as well. Steroid injections may be done to decrease inflammation and are generally very effective for Dequervain’s tendonitis. In cases not responding to conservative treatment, surgery may be warranted. Surgery involves releasing a constrictive layer of tissue covering the tendons.

Basilar thumb arthritis is typically a degenerative condition, which occurs with “wear and tear” over many years. As the cartilage covering of the ends of the bones along the basilar thumb joint wears out, inflammation of the joint lining ensues. Symptoms of basilar thumb arthritis include aching pain and swelling.  Later in the disease process, the basilar thumb joint may appear enlarged and thumb motion may be limited.

Activities that involve pinching and gripping will often exacerbate basilar thumb arthritis. Patients often complain of pain and weakness with use of garden tools and scissors or inability to open tight containers.

Conservative treatment may begin with use of an anti-inflammatory medication and a protective splint. Additional relief may be achieved by a steroid injection into the joint. Reconstructive surgery may be beneficial in refractory cases.

A common theme of these and other hand conditions is that they may be caused or aggravated by repetitive forceful gripping. Ergonomic gardening tools are designed to lessen the amount of grip force, and thereby may serve to limit flare-ups. Make sure that your handheld shears have sharp, well-oiled blades. Well-conditioned power equipment typically transmits less vibration and is more efficient. Lightweight tools will place less strain on the hand and wrist. And be sure to always use the right tool for the job. Traumatic gardening injuries are frequently encountered when a tool is used for a purpose other than for which it was designed.

More in-depth information regarding these and other hand conditions may be found on the American Society for Surgery of the Hand (ASSH) website at ASSH.org.

Byline:
Dr. Wein is a board-certified orthopaedic surgeon with subspecialty training in hand surgery. He is a partner at Raleigh Orthopaedic, raleighortho.com.