Keep your hands comfortable!

A colleague of mine has been complaining for quite some time that both her hands go numb in the mornings, but no matter how unpleasant it is, she won’t go see a doctor. After all, it goes away! AIVARS TIHONOVS, a plastic surgeon, microsurgeon, and hand surgeon at the Latvian Microsurgery Center, explains why it’s important not to ignore hand problems and to consult a specialist in a timely manner.

We do everything with our hands—we use them to work and support ourselves, to care for ourselves and our loved ones, and to enjoy our favorite hobbies. But hands can get tired, too; overuse can sooner or later lead to various strain-related problems, and then our hands start to ache and go numb.

When asked whether these problems affect manual laborers—such as construction workers—more often than those who spend long hours working on a computer every day, Aivars Tihonovs points out two things: «People who regularly do heavy work are usually in good physical shape, and they’re generally fine until they overwork themselves. However, with monotonous work—which can be either physical or sedentary—fatigue gradually builds up, and any forced posture where muscles are improperly tensed gradually leads to physical problems. Second—problems arise after a person suddenly does work they don’t normally do on a daily basis. For example, an office worker goes out to the countryside and spends the whole day working with a trimmer. And then they’re surprised that their hand is numb or their fingers hurt. So one cause is chronic, prolonged fatigue, repetitive movements, or an awkward posture; the other is a sudden, excessive physical strain.»

Symptoms that indicate something is wrong!

The most common symptom people complain about is pain in their arms. This pain is a sign that you’ve overdone it. Mild pain that occurs after a hard day’s work and goes away quickly without recurring can usually be ignored. But if the pain lasts for several days, if it gets worse, if it prevents you from sleeping and resting normally, or if it’s disruptive, you should definitely see a doctor. It’s possible that the pain is a sign of a chronic condition that is gradually progressing. «Pain can have various causes. It may result from joint deformities caused by osteoarthritis or another form of arthritis. Pain can result from overuse of the joints, causing inflammation of the joint capsules. Pain can also stem from inflamed tendons that no longer glide smoothly. Pain can result from overstrained muscles. However, the most unpleasant is pain caused by a pinched nerve—the pain of a pinched nerve is worse than a toothache. »It’s constant and very irritating, and it’s impossible to ignore,” says the hand surgeon.

The second most common symptom is numbness in the hands. This is serious—even more serious than pain—because it indicates that a nerve is being compressed somewhere. This doesn’t always mean something extremely dangerous, but it prompts the doctor to be vigilant and understand that nerve compression, if prolonged, can cause serious damage to the nerve.

«If someone, like your colleague, wakes up every morning with numb hands, that’s an unpleasant symptom. Because one morning she might wake up and the numbness might not go away. If she waits until then to see a doctor and start treatment, it will take longer than if she had acted sooner. The sooner we act, the better and faster the results we can achieve. Imagine that a nerve is like a multi-strand electrical cable with a sheath around it—the nerve is surrounded by a myelin sheath that nourishes it, insulates it, and helps conduct electrical signals. When a nerve is compressed for a long time, the sheath gradually atrophies, or demyelinates. This means that electrical conduction deteriorates and the nerve becomes increasingly vulnerable. When the sheath atrophies completely, the compression severs the nerve fibers inside, and at that point, permanent numbness sets in. And then, even if the hand is surgically released, it takes a very long time for the nerves to recover—if they are capable of recovering at all.

On the other hand, if the symptoms are not ignored and treatment or surgery is performed in a timely manner, the nerve is protected, the person does not experience prolonged numbness, and recovers much more quickly.

The next stage of nerve compression is numbness. At first, the person feels numbness and pain from the nerve compression, but later, when most of the nerve’s internal fibers are compressed, the hand no longer feels any pain, and this is much worse and much harder to treat. But it can be avoided if you see a doctor in time,» Aivars Tihonovs emphasizes once again.

Watch out for injuries!

A large part of a hand surgeon’s work involves treating hand injuries. Aivars Tihonovs explains that, as spring arrives, more and more people are pulling saws, axes, and other tools out of their sheds, but they’ve somewhat forgotten that they haven’t used them all winter and their skills have faded. When they get to work, many sustain injuries, especially if they haven’t taken care to wear safe clothing and protective gear, which is very important.

«Yesterday, a man came to see me who, without taking any safety precautions, had been cutting frozen meat. When cutting meat in the palm of your hand, there’s a high chance the knife will slip because the meat is hard, and the person will seriously injure themselves. Another classic injury: holding an avocado in your hand and trying to remove the pit with a knife. Similarly, when the weather warms up, people go on picnics, and then—well, it varies: some put their fingers in the coals and burn them, while others break a glass or bottle and cut themselves on the shards. Motorcycle and scooter season has also begun, and a common injury is a broken arm.

Unfortunately, even when they suffer an injury, some people decide they don’t need to see a doctor. However, the longer they wait and let the problem go, the more difficult and time-consuming recovery can be. »That’s why, if you’ve suffered an injury, you need to take action immediately,” the hand surgeon reminds us.

The key is early diagnosis

Regardless of the reason why your hands hurt or feel numb, the most important thing is to consult a doctor, because an experienced doctor can diagnose the problem immediately, and additional tests are needed only to determine the extent and severity of the condition; moreover, the examination can be combined with treatment. Ultrasound is very informative—it can be used to diagnose nerve compression, tendon damage, and inflammation, as well as to detect growths in the hands. If an injury has occurred, at least an X-ray is needed to ensure that the bones and joints are intact. Nerve conduction studies—tests that measure nerve impulse transmission—are typically performed when there is numbness in the hands. «We’re seeing what I consider to be a rather concerning trend—some people come to the doctor already armed with test results and assumptions that could actually be harmful to them, but often these tests don’t provide the necessary information. Sometimes a patient brings an MRI scan, but there’s a bone fracture, and I need a standard X-ray, which is sufficient to determine the exact location of the fracture and plan the surgery. »However, the patient has already wasted time undergoing unnecessary tests and spent their own money,” notes Aivars Tihonovs.

Treatment and Rehabilitation—All in One Place!

The Latvian Microsurgery Center (LMC) offers a full range of treatment services under one roof—from diagnosis to surgery and rehabilitation. The LMC’s new hospital is located at 332 Brīvības gatve, Riga; tel.: 679 698 30; for more information: microsurgery.lv

Aivars Tihonovs explains that LMC can perform X-rays, sonography, and neurography, as well as begin immediate treatment. In some cases, a person simply needs rest and relaxation, but carpal tunnel syndrome that has recently developed can be treated solely with a brace worn overnight. Sometimes additional medication or an injection—commonly known as a “block”—is required. The injection is administered precisely at the site of inflammation, and its greatest advantage is that the pain subsides within a week. Sometimes hand surgery is necessary. These procedures vary: from simple ones, such as removing a lump from the skin, to serious microsurgical procedures. The new LMC hospital also offers rehabilitation, as well as consultations with physical therapists and occupational therapists. 

«These specialists help you understand ergonomics, teach you how to set up your work routine properly, how to work, what positions to use, when to rest, and which tools are most comfortable to use. At the Microsurgery Center, we can treat the hand from A to Z, which means the patient doesn’t have to go to different places. First, they see a doctor, and eventually they’re referred to a physical therapist or occupational therapist, who do everything possible to restore hand function as much as possible. Of course, it’s important to understand that we’re not a car repair shop that can simply replace a part. If a person keeps working continuously, sooner or later some part of the hand will break down, just like a bushing or bearing in a car. You can replace that part on a car, but keep in mind—if you keep driving on rough roads, the parts will break down again. It’s the same with a person—we can perform surgery, but if they continue doing the work that causes these problems, the symptoms will most likely return sooner or later,» summarizes Aivars Tihonovs.

Red flags that must not be ignored:

– Nighttime pain that interferes with sleep;

– Numbness;

– Burning sensation in the fingers;

– Numbness in the fingers;

– Finger snapping, or snapping the fingers with a sharp, painful sound.

Keep your hands comfortable!

– Hands don't like being constantly busy, so they need a break every now and then.

– Your hands benefit from regular stretching. Every so often, you should perform full-range movements, stretching your fingers in all directions, so that any tendons that may be inflamed do not form adhesions and do not restrict your range of motion.

The magazine ‘Ieva’s Health’