You use your fingers and thumbs to do everything from grasping objects to playing musical instruments to typing. When there is something wrong with them, it can make life difficult. Common problems include

• Injuries that result in fractures, ruptured ligaments and dislocations
• Osteoarthritis - wear-and-tear arthritis. It can also cause deformity.
• Tendinitis - irritation of the tendons
• Dupuytren's contracture - a hereditary thickening of the tough tissue that lies just below the skin of your palm. It causes the fingers to stiffen and bend.
• Trigger finger - an irritation of the sheath that surrounds the flexor tendons. It can cause the tendon to catch and release like a trigger.

Your toenails and fingernails protect the tissues of your toes and fingers. They are made up of layers of a hardened protein called keratin, which is also in your hair and skin. The health of your nails can be a clue to your overall health. Healthy nails are usually smooth and consistent in color. Specific types of nail discoloration and changes in growth rate can be signs of lung, heart, kidney, and liver diseases, as well as diabetes and anemia. White spots and vertical ridges are harmless.

Nail problems that sometimes require treatment include

• Bacterial and fungal infections
• Ingrown nails
• Tumors
• Warts

Keeping your nails clean, dry, and trimmed can help you avoid some problems. Do not remove the cuticle, which can cause infection.

The fingers and thumb contain 14 bones, each of which is called a phalanx bone (plural = phalanges), named after the ancient Greek phalanx (a rectangular block of soldiers). The thumb (pollex) is digit number 1 and has two phalanges, a proximal phalanx, and a distal phalanx bone (see Figure). Digits 2 (index finger) through 5 (little finger) have three phalanges each, called the proximal, middle, and distal phalanx bones. An interphalangeal joint is one of the articulations between adjacent phalanges of the digits (see Figure).

Bones of the Wrist and Hand

The eight carpal bones form the base of the hand. These are arranged into proximal and distal rows of four bones each. The metacarpal bones form the palm of the hand. The thumb and fingers consist of the phalanx bones.

Bones of the Hand

This radiograph shows the position of the bones within the hand. Note the carpal bones that form the base of the hand. (credit: modification of work by Trace Meek)

General or unspecified injuries involving the fingers.

A painful disability in the hand affecting the finger or thumb. It is caused by mechanical impingement of the digital flexor tendons as they pass through a narrowed retinacular pulley at the level of the metacarpal head. Thickening of the sheath and fibrocartilaginous metaplasia can occur, and nodules can form. (From Green's Operative Hand Surgery, 5th ed, p2137-58).

Partial or total replacement of one or more FINGERS, or a FINGER JOINT.

Mallet finger injuries are commonly encountered in everyday clinical practice. Mallet, which means hammer, was the term used to describe the hammer-like deformity that occurred in sports-related injuries in the 1800s. As some individuals do not see the hammer resemblance, some have proposed changing the name to drop the word "finger" due to its appearance. It is also known as "baseball" finger. Although it is the most common closed tendon injury seen in athletes as a result of high velocity and contact sports, it also can be the result of a relatively minor trauma such as doing household chores (tucking in a shirt, tucking in sheets) or work-related activities. Though some athletes and coaches often believe mallet injuries to be minor, each case should have a systematic evaluation performed.

Metacarpal fractures account for 40% of all hand fractures. A Boxer’s fracture is a fracture of the fifth metacarpal neck, named for the classic mechanism of injury in which direct trauma is applied to a clenched fist.  This represents 10% of all hand fractures. Treatment for a Boxer’s fracture varies based on whether the fracture is open or closed, characteristics of the fracture including the degree of angulation, shortening, and rotation, and other concomitant injuries. Immobilization with an ulnar gutter splint may be the definitive treatment for closed, non-displaced fractures without angulation or rotation, while open fractures, significantly angulated or malrotated fractures or those involving injury to neurovascular structures may require operative fixation.

Treatment / Management

The appropriate treatment for a Boxer’s fracture on initial presentation varies based on whether the fracture is open or closed, the degree of angulation, rotation, and other concomitant injuries. Due to the risk of infection from "fight bite," even very small wounds should be thoroughly irrigated, and there should be a low threshold for antibiotic treatment.

Immobilization Alone

For a Boxer’s fracture that is closed, not angulated, and not malrotated or otherwise displaced, splinting is used for initial immobilization. A Boxer’s fracture should be immobilized with an ulnar gutter splint. Alternatively, a pre-made Galveston splint or a custom orthosis may be used.

The hand should be positioned in the intrinsic plus position for splinting: mild wrist extension, 70 to 90 degrees of flexion at MCP joint, and slight flexion at the DIP and PIP joints. Flexion of these joints is important to prevent shortening of the collateral ligaments and subsequent loss of range of motion and functional impairment.

Closed Reduction

Closed reduction is required for a Boxer’s fracture with significant angulation greater than 30 degrees.

Analgesia options for the procedure include a hematoma block or an ulnar nerve block. Younger children or very anxious patients may require procedural sedation, but this procedure typically is tolerated well without sedation.

Closed reduction of a Boxer’s fracture is accomplished by using the “90-90 method.” The MCP, DIP, and PIP joints should all be flexed to 90 degrees. The clinician should then apply volar pressure over the dorsal aspect of the fracture site while applying pressure axially to the flexed PIP joint. This axial pressure to the PIP applies dorsal force to the distal fracture fragment. The clinician should be able to feel the reduction when it has been achieved. The injury should be immobilized with an ulnar gutter splint, and post-reduction films should be taken to assess for adequate reduction. The fifth metacarpal neck can tolerate angulation of up to 50-60 degrees and management may be continued non-operatively if remains within the acceptable tolerances.

Surgical Referral

Surgical referral is indicated for fractures that are open, severely comminuted, associated with neurovascular injury, and for fractures with any malrotation. Surgical referral is also appropriate for fractures with significant angulation if the initial provider is unsuccessful in achieving adequate reduction and alignment outside acceptable parameters.  Surgical options include open reduction internal fixation, or closed reduction percutaneous pinning. 

Follow-Up

Boxer’s fractures should be sent for repeat radiographs within one week to assess alignment. Radiographs should be obtained every two weeks following, until clinical and radiographic healing are present, typically between four to six weeks. Even with the adequate reduction, some cosmetic deformity may persist, with loss of the normal knuckle contour. After a short period of immobilization, the passive and active range of motion exercises should be performed to alleviate stiffness of the MCP and PIP joints. Literature supports early mobilization of these injuries rather than prolonged immobilization. If any loss of function persists after several weeks of these exercises, referral to occupational therapy is warranted.

Displacement of bones from their normal positions at a joint.

Do you have tingling or numbness in your hand or fingers? It could be a sign that you have carpal tunnel syndrome. Often, you’ll get pain in your thumb, index, and middle finger. You may find that your hands are clumsy, and it’s harder to grip things.

Symptoms of carpal tunnel usually start slowly. Many people first notice the signs overnight because they sleep with their wrists bent. As time goes on, that tingling or numbness may last through the day as well.

Carpal tunnel syndrome occurs when one of the main nerves in your forearm, called the median nerve, is squeezed or compressed.

“That nerve is really important in the function of the hand,” says Dr. Kevin Chung, chief of hand surgery at the University of Michigan. It gives sensation to the palm side of your thumb, index, middle finger, and part of the ring finger. It also moves some of your hand muscles.

“It can become trapped in the very tight space that goes through your wrists,” he says. “That space is known as the carpal tunnel.”

Carpal tunnel syndrome is usually caused by a combination of factors that shrink this space. The heavy, repetitive work of certain jobs can contribute to carpal tunnel syndrome. It’s common to people who work in meat-packing plants or perform intense assembly line work. Injury to the wrist can also cause swelling that compresses the median nerve.

But it’s often unclear why some people develop carpal tunnel syndrome. People who have rheumatoid arthritis or an underactive thyroid gland are more likely to develop carpal tunnel syndrome. Fluid retention during pregnancy or menopause can also contribute.

To treat the issue, doctors will first try splinting the wrist. This limits movement and helps reduce pressure on the nerve. Sometimes splints are only worn at night. During the day, experts recommend taking breaks from tasks that put stress on your hands. Over-the-counter pain relievers can help manage the discomfort.

For more tips that may help relieve carpal tunnel symptoms, see the Wise Choices box. If these steps don’t improve the condition, it may be time to turn to surgery.

“Surgery is necessary when the patient has persistent numbness of the hand and when the muscles stop working because the nerve is not functioning well,” says Chung.

Carpal tunnel surgery is one of the most common surgeries in the U.S. It involves dividing the ligaments—bands of elastic tissue—that support the wrist to reduce pressure on the median nerve. These ligaments usually grow back after surgery in a way that gives the nerve more room. The surgery only takes about 10 to 30 minutes.

“Relief can be quite immediate, between one to two weeks,” says Chung. “But it depends on how badly the nerve was compressed and for how long.”

Some strategies, like stretching your hands and wearing fingerless gloves, may help prevent carpal tunnel syndrome. But research hasn’t proven that these approaches work.

Many conditions can mimic carpal tunnel symptoms, so it’s important to go to a medical professional with expertise in the condition.

“Carpal tunnel syndrome can be disabling. It is so important that patients choose a surgeon wisely,” says Chung. He recommends choosing a board-certified hand surgeon trained to diagnose and treat carpal tunnel.

Carpal Tunnel Relief

These strategies may provide short-term relief from carpal tunnel syndrome:

• Take frequent breaks from repetitive physical activities.
• Apply cool packs if the wrist is red, warm, and swollen.
• Be sure to use correct posture and wrist position.
• Wear a brace at night to keep wrists straight while asleep.
• Take over-the-counter medicines that reduce swelling.

Polydactyly is a condition in which a person has more than five fingers per hand or five toes per foot. It is the most common birth defect of the hand and foot. Polydactyly can occur as an isolated finding such that the person has no other physical anomalies or intellectual impairment. However, it can occur in association with other birth defects and cognitive abnormalities as part of a genetic syndrome. In some cases, the extra digits may be well-formed and functional. Surgery may be considered especially for poorly formed digits or very large extra digits. Surgical management depends greatly on the complexity of the deformity.

An abnormal bone development that is characterized by extra long and slender hands and fingers, such that the clenched thumb extends beyond the ulnar side of the hand. Arachnodactyly can include feet and toes. Arachnodactyly has been associated with several gene mutations and syndromes.

Dupuytren contracture is characterized by a deformity of the hand in which the joints of one or more fingers cannot be fully straightened (extended); their mobility is limited to a range of bent (flexed) positions. The condition is a disorder of connective tissue, which supports the body's muscles, joints, organs, and skin and provides strength and flexibility to structures throughout the body. In particular, Dupuytren contracture results from shortening and thickening of connective tissues in the hand, including fat and bands of fibrous tissue called fascia; the skin is also involved.

In men, Dupuytren contracture most often occurs after age 50. In women, it tends to appear later and be less severe. However, Dupuytren contracture can occur at any time of life, including childhood. The disorder can make it more difficult or impossible for affected individuals to perform manual tasks such as preparing food, writing, or playing musical instruments.

Dupuytren contracture often first occurs in only one hand, affecting the right hand twice as often as the left. About 80 percent of affected individuals eventually develop features of the condition in both hands.

Dupuytren contracture typically first appears as one or more small hard nodules that can be seen and felt under the skin of the palm. In some affected individuals the nodules remain the only sign of the disorder, and occasionally even go away without treatment, but in most cases the condition gradually gets worse. Over months or years, tight bands of tissue called cords develop. These cords gradually draw the affected fingers downward so that they curl toward the palm. As the condition worsens, it becomes difficult or impossible to extend the affected fingers. The fourth (ring) finger is most often involved, followed by the fifth (little), third (middle), and second (index) fingers. Occasionally the thumb is involved. The condition is also known as Dupuytren disease, and "Dupuytren contracture" most accurately refers to later stages when finger mobility is affected; however, the term is also commonly used as a general name for the condition.

About one-quarter of people with Dupuytren contracture experience uncomfortable inflammation or sensations of tenderness, burning, or itching in the affected hand. They may also feel pressure or tension, especially when attempting to straighten affected joints.

People with Dupuytren contracture are at increased risk of developing other disorders in which similar connective tissue abnormalities affect other parts of the body. These include Garrod pads, which are nodules that develop on the knuckles; Ledderhose disease, also called plantar fibromatosis, which affects the feet; scar tissue in the shoulder that causes pain and stiffness (adhesive capsulitis or frozen shoulder); and, in males, Peyronie disease, which causes abnormal curvature of the penis.