Take care of your hands - what problems to watch for and how to deal with them

Helpis athand

Looking after your hands means more than just using a nice cream and sunscreen. With time problems can arise that we should watch for, and which we can and must deal with.

by ELSA KRÜGER styling HANNES KOEGELENBERG photos ED OʼRILEY

‘Iput and out my my the arms into my momʼs hands sleeves, jersey came

ʼ wrote the late Dr Cecile Cilliers in one of her columns. That image stayed with me for years.

The skin on our hands gives away our age, even more than our face does. There are various cosmetic procedures that can be done by an aesthetic doctor or a specialist to make your hands look younger, similar to the procedures that are used for facial rejuvenation.

But what if your hands donʼt look old yet, but are starting to play oldpeople tricks? My moment of truth came when I realised I was making more typing errors, after more than five decades in front of a keyboard. I was also dropping things; the grip of my left hand in particular was not what it should be. And as synchronicity would have it, I met Dr Pieter Jordaan when I went to say hello to Dr Chetan Patel at a restaurant in George. Dr Patel is a top plastic surgeon who practised in Johannesburg before he (also) pulled up his roots and semigrated to the Garden Route a couple of years ago.

Dr Jordaan is an orthopaedic hand surgeon who in 2021 became

the first South African to pass the European Board of Hand Surgeryʼs exam. He is now a fellow of the board. He and Dr Petrus Pelser, who also has an international qualification in hand surgery, run the Garden Route Hand Unit. It wasnʼt long before Dr Jordaan and Dr Patel realised that together they form an A-team when it comes to complicated hand surgery.

Dr Patel has a specific interest in micro hand surgery, peripheral nerve surgery and the treatment of serious hand trauma. With their combined skills they can treat, very effectively, issues ranging from traumatic injuries such as a hand or fingers that have been cut off, to nail-bed damage, painful conditions like arthritis and a ganglion (a cyst that develops in the wrist), and tendon and nerve issues. Their focus stretches from the elbow, forearm and wrists to the hands.

The two specialists were chatting over a cup of coffee about how few people know how much they can benefit from combined plastic or reconstructive and hand surgery, especially as they get older and their hands start to protest against a lifetimeʼs misuse. Lots of people accept this as a given with the passing of the years, but for many painful symptoms there is plenty that can be done to ease the discomfort.

It was a lightbulb moment for me and X-rays confirmed it: The knuckle of my ring finger had serious osteoarthritis and only a knuckle replacement would help. That is why I wasnʼt hitting the keyboard hard enough and because my hand couldnʼt close properly, my grip was weak. And so a finger operation was on my horizon.

Our readers for the most part are people who create and work with their hands and I wanted to know from the doctors what they can do, medically and aesthetically, for hands with problems.

MEDICAL What are the typical hand problems?

According to Dr Jordaan, it depends on the patientʼs age. Children and younger people land up in theatre because of trauma caused by bicycle or motorcycle accidents, or injuries on the sports field or at work, as well as congenital abnormalities or deformities like fingers that are fused together (webbed), six fingers or a club hand. Many parents donʼt know that there is help for these conditions, he says. Hand problems can sometimes be an indication of other problems as well. They can also have a psychological effect on the child, who may be embarrassed because the hand doesnʼt look normal even though it functions perfectly well.

A new baby often causes De Quervainʼs tenosynovitis, which is similar to carpal tunnel syndrome. But different from the latter, where a nerve is pinched, the new motherʼs thumb tendons become inflamed because she suddenly starts picking up a baby all the time. This irritates or pinches the tendons at the base of the thumb, which swell and cause pain from the thumb to the wrist. A cortisone injection helps. Itʼs painful, but brings relief, sometimes permanent. The pain sometimes resolves by itself within six weeks to three months. This condition also occurs in people who ʻover useʼ their thumbs with hobbies such as gardening, regular use of a hammer, racquet sports (tennis, squash) and skiing.

The doctors say they are increasingly seeing children, who have their thumbs almost permanently on electronic gadgets, developing the same problem as new mothers: pain at the base of the thumb. ʻChildren should play outside and hang from trees when they are little, ʼ says Dr Patel.

Traumas where hand bones are broken, or tendons, veins and nerves are torn or severed, donʼt necessarily mean the loss of the use of the hand. A severed finger or hand can be reattached with micro surgery, which helps to keep the hand functioning and restores blood circulation. ʻBut with amputations it is vitally important to get the patient to the correct doctor as fast as possible. Every hour after the injury counts; place the hand in a sealable plastic bag, in ice water in a cooler box, and get to a surgeon as soon as possible. This is a typical case where an orthopaedic surgeon and a plastic surgeon would work together to save the hand. ʼ

Stroke, cerebral palsy or a neck injury can all require hand reconstruction to make the hand functional again and to look normal cosmetically. There are surgical options to loosen a hand that has contracted inwards, so the palm can open again.

You also donʼt have resign yourself to living with injured or compressed nerves. ʻWe can adapt a little to make

the hand work better. Small nerve branches can be transferred to drive a muscle so it functions better. The sooner you get help, the better, ʼ says Dr Jordaan. ʻDonʼt wait too long ‒ the options become fewer with time. ʼ

AESTHETIC VS MEDICAL

Many women, especially those who type a lot or create with their hands and have hobbies that require hand strength, become worried not only when their hands start to look different but also when they are painful. Two of the most common problems are the above-mentioned carpal tunnel syndrome, which is very sore and impairs movement, and what is known as trigger finger, a condition where a finger gets stuck in a bent position, throbs with pain and wonʼt straighten. What causes it canʼt be said with certainty, but inflammation plays a big role.

A cortisone injection can help to relax the muscle that causes the finger to ʻcatchʼ . With carpal tunnel syndrome, the symptoms include pins and needles in the fingers, and fingers that feel stiff and lame or ʻdeadʼ in the mornings.

According to Dr Patel, people are often reluctant to consider surgery as a solution for carpal tunnel syndrome and prefer temporary relief through repeated injections. ʻBut surgery is the best long-term solution. With a proper examination we can see how long the symptoms have been present. If untreated, the nerves can be irreparably damaged and may cause the muscles to collapse, especially on the side of the hand. ʼ

With osteoarthritis, the options are cortisone injections or an operation. A surgeon uses X-rays for planning surgery rather than diagnosis. ʻMany women come to us with a cosmetic problem caused by arthritis. Fingers that are very crooked can be straightened, but cosmetically there is little we can do. It also makes the fingers stiff and unbending. ʼ

Arthritis of the fingers is more common in women, says Dr Jordaan. ʻThey come to me and complain that their hands look bad, they look ugly. The knuckles and thumb change shape. Golfers also complain about pain at the base of the thumb. Not everyone has painful arthritis; for some people it is painless, inexplicably. Others push through and only approach us for help after 20 years. ʼ

Osteoarthritis differs from rheumatoid arthritis: The former is a result of the bodyʼs wear and tear over the years while rheumatoid arthritis is an inflammatory autoimmune condition in which the body attacks itself. ʻPain can be treated and movement retained if replacements are done. A ganglion (the so-called Bible bump on top of the hand) and cysts that affect nails can be removed surgically. But you need to realise: Your hands are not going to look the way they did in your twenties. ʼ

It requires a delicate balance to make a hand, with its multitude of tendons, joints, muscles and nerves, look normal again. Itʼs almost impossible without a precise combination of orthopaedic and plastic surgery, the doctors emphasise.

After hand surgery, hand therapy is vitally important ‒ it can take a year or more of rehabilitation before your hand looks right and works properly again. Itʼs easier to work with the hands of a sportsperson, for example, than someone like a pianist or violinist whose hands have to perform delicate movements.

Cosmetically speaking, there are many women who find it difficult to live with hands that become bony and have blue veins on the back ‒and not to mention age marks.

There are a number of rejuvenation procedures for hands, including laser treatments that lighten sun, liver and age spots, intense pulsed light (IPL) therapy, filler injections to restore volume, chemical peels and fat transplants.

Dr Patel advises you first to visit your family doctor to make sure that you can have fillers. ʻWe must first ensure there are no nerve problems or injuries and functional issues. ʼ

So: If my hands start to look like Madonnaʼs, gnarled and veiny, who do I see first? ʻFirst see the hand specialist and then, if thereʼs no medical cause, go to see a cosmetic surgeon. Sometimes a problem looks the same but the cause is different. Only a hand surgeon can see the difference ‒ you may possibly only need the release of a nerve rather than a filler. ʼ

Fat transplants are the filler procedure that he prefers and recommends, says Dr Patel. Although there are cosmetic hyaluronic fillers with different degrees of softness available, he prefers to do fillers with the patientʼs own fat. ʻIt is better to do a fat transplant in one procedure ‒instead of fillers every four months. Your own fat is bio-identical. It lasts forever, you donʼt have to repeat the procedure. In my opinion, itʼs better value for money. ʼ

Your expectations must realistic however, he warns. ʻYou shouldnʼt hope to have a youthful pair of hands at the age of 70. ʼ

If you have a troublesome mark or knob on your hand that wonʼt heal, donʼt delay in going to see a dermatologist or surgeon. Many women first turn to an aesthetic practitioner to have the mark removed by laser. ʻRather have a biopsy done first. Itʼs more important than treating the hand aesthetically. We often see that it is skin cancer or melanoma because of this sunny country in which we live. The hands are very vulnerable to exposure to the sun, for instance when you are driving your car. ʼ

And what about nails? Can the blue light that is used for acrylic and gel nails cause skin cancer? Neither of the doctors is keen on false nails. Exposure to certain blue lights can indeed cause cancer, while acrylic nails can damage the nail bed. Gel nails thin and weaken the natural nails because the nailʼs top layer has to be filed away. ʻYour nails are a very good indicator of general health, because they are where a doctor can see things such as a protein deficiency, cancer and other problems, ʼ says Dr Patel.

People who develop a ganglion are often afraid that the swelling is cancerous, but it is actually a hernia on the wrist and can be removed through arthroscopic surgery. ʻItʼs actually more cosmetic, but can be troublesome and cause an obstruction and nerve irritation, especially for extreme movements. ʼ

Can I keep my hands young for longer?

What can you do to keep your hands supple, strong, youthful and healthy? Are there supplements or exercises for this?

Dr Patel says he takes a holistic approach to this. ʻKeep yourself busy. It works like your head ‒ how busy are you? If you keep yourself active and get some general exercise, it benefits the whole body, hand-brain coordination, left and right brain crossover. ʼ

For something like tennis elbow, he says, the core of the body, the whole kinetic chain, must be treated. ʻYou must use your hands. Even with painful arthritis ‒ use your hands, donʼt let them rest. Also remember, poor circulation in the hands is often caused by smoking. ʼ

Heʼs sceptical about supplements. ʻEat well, maintain a healthy lifestyle. You must do something every day, donʼt be too careful because it is sore. Everything needs to keep working, you must walk, move every day. ʼ

A final tip: Use a sunscreen with an SPF of at least 15 on the back of your hands daily.