We provide treatment for hand disorders, primarily for individuals in and after menopause. If you experience symptoms such as pain in the fingers or wrists, numbness in the hands, or joint deformities in the fingers, please don’t assume they are simply due to aging. Through specialized treatments focusing on restoring hand function, we aim to help you improve your condition and regain a comfortable, healthy daily life.
It is difficult to move the fingers, and when you try to move them, you may experience a springy sensation, as if they are getting caught. As the condition progresses, the fingers remain bent and cannot be straightened. This condition occurs most often in the middle finger and thumb, but can occur in any finger. It is common in women during menopause, pregnancy, and postpartum, but can also occur in men. It is also common in diabetic and dialysis patients.
Main symptoms
My fingers are numb
It stays bent and won't stretch or bend.
Pain at the base of the fingers
How the disease works
The flexor tendons that bend the fingers slide through a tunnel-like tube called a tendon sheath. If the tendons or tendon sheath swell for some reason, the tendons become blocked, making it difficult to move the fingers.
Method of treatments
Local rest is necessary. In many cases, local injection of steroids into the tendon sheath is effective. If the condition persists despite several local steroid injections, surgery may be indicated. The narrowed tendon sheath is opened through a small incision in the palm (tendon sheath resection). This procedure improves symptoms in most patients. However, some patients may experience persistent pain. This is due to persistent tension in the finger joints caused by long-standing tendon inflammation. For these patients, surgery (superficial flexor tenotomy) is performed to remove one flexor tendon (the tendon that bends the fingers). Because each finger has two flexor tendons, the finger remains flexed. After tenotomy, fine movements may be slightly impaired, but this will improve over a few months. Most patients will no longer experience pain, making it easier to use their fingers.
De Quervain's disease
This is the disease
Swelling and pain occur on the thumb side of the wrist, and the pain worsens when you straighten or bend the thumb.
Main symptoms
Pain in the thumb side of the wrist makes it difficult to grasp things
How the disease works
This area contains a tendon sheath called the first compartment, within which two tendons that move the thumb, the extensor pollicis brevis tendon and the abductor pollicis longus tendon, glide. When the tendon sheath thickens, the tendon's gliding is impaired, leading to inflammation (tenosynovitis). This condition is common among people who use their thumbs frequently, such as those who do a lot of computer work or athletes, but it is also common among women whose estrogen levels decrease during pregnancy, postpartum, and menopause, and is thought to be related to fluctuations and declines in female hormones. Women in this age group are more likely to develop this condition if they continue to support something with their thumbs for long periods of time, such as holding a newborn baby by its neck.
Method of treatments
Depending on the severity of the symptoms, if the condition is mild, rest and equol-containing foods (supplements) are effective. Simply wrapping a bandage or support around the thumb and wrist to restrict the movement of the thumb can be effective. Cold compresses are also effective. For moderate to severe cases, local injection of steroids into the tendon sheath can be dramatically effective.
The surgical method involves a small incision to remove the tendon sheath. Recently, the number of surgical cases has been decreasing due to the effectiveness of ingesting foods (supplements) containing equol and local injections of steroids.
Heberden's nodes
This is the disease
The first joint of the finger (DIP joint) swells, bends, and is painful. The pain makes it difficult to grip the finger tightly. Many patients are reluctant to show their finger in public due to the poor shape. Blister-like swellings (mucoceles) may also appear.
Main symptoms
The first joint of the finger has become deformed.
There is not much deformation, but it is swollen and very painful.
How the disease works
It is generally seen more frequently in women over the age of 40, and is thought to be caused in part by fluctuations and declines in female hormones. Not only does it cause joint deformation, but it can also cause severe pain, interfering with daily life. X-rays can reveal joint deformation, narrowing of the joint space, and bone spurs.
Method of treatments
In the early stages, taking equol-containing foods (supplements) and taping can be effective. Furthermore, since many osteoarthritis patients are sensitive to cold, administering peripheral circulation-improving agents can also be effective. If taping alone does not relieve pain, steroid joint injections can be effective. In cases where these conservative treatments are ineffective or the deformity is severe, surgery is performed to reshape or fix the DIP joint. Fixation is performed using screws. After surgery, the DIP joint will become immobile, but if the second joint moves normally, the fingers will be able to move without pain, making daily life much easier.
Bouchard's nodes
This is the disease
The second joint from the tip of the finger (PIP joint) swells like a bump, causing the finger to bend and become deformed. There may be severe pain or no pain at all, but as the joint deformation progresses, it becomes difficult to bend the finger.
Main symptoms
The second joint of the finger is swollen and painful, making it difficult to bend the finger.
The second joint of the finger became thicker and deformed, and began to bend toward the little finger.
How the disease works
It is most common in women around the time of menopause or after menopause. Due to cartilage degeneration, narrowing of the joint space and the formation of bone spurs can be seen on X-rays. It often runs in families, and some women may have untreated tendonitis. The underlying cause is an imbalance of female hormones.
Method of treatments
Conservative treatment involves administering equol-containing foods (supplements), peripheral circulation improvers (oral vitamins), and anti-inflammatory analgesics (topical ointments). Intra-articular steroid injections are also effective in relieving pain. If conservative treatment does not improve the condition, or if the condition improves but quickly recurs, surgical treatment is indicated.
There are three main surgical treatment options depending on the symptoms. In mild to moderate cases where tendonitis is suspected to be the cause, tenosynovectomy or superficial flexor tenectomy (removal of one of the tendons that flexes the finger) is performed. While this procedure does not significantly affect finger movement, it improves finger mobility and is effective in alleviating pain. On the other hand, in severe cases with severe joint deformity, surgery to replace the PIP joint with an artificial joint (artificial joint replacement) is performed. At our hospital, we use a silicone integrated implant. The primary goals of artificial joint replacement are to remove the damaged joint to relieve pain, repair loosened soft tissue to correct deformity as much as possible, and improve lost joint function by inserting a mobile artificial joint. While the degree of improvement in joint movement varies from person to person, artificial joint replacement is indicated when improved movement is desired. Postoperative rehabilitation is also important.
Thumb CM joint arthritis
This is the disease
Pain occurs at the base of the thumb when pinching something or opening a jar. Sometimes there is no pain during the movement, but the pain becomes severe after the movement. As the condition progresses, the joint at the base of the thumb (CM joint) becomes protruding and deformed, making it difficult to open the thumb. As the condition progresses further, the second joint of the thumb (MP joint) may become hyperextended, causing pain in this joint as well.
Main symptoms
The base of my thumb hurts and I can't open bottle caps or plastic bottles.
How the disease works
The CM joint of the thumb is a saddle-shaped joint that has multi-directional mobility. For this reason, it is said to be prone to instability, and the ligaments around the joint are prone to loosening, which is thought to progress to osteoarthritis. As the condition progresses, subluxation progresses and the articular cartilage of the CM joint wears down, causing deformation.
Method of treatments
Conservative treatments include taking equol-containing foods (supplements), taking anti-inflammatory and analgesic drugs, intra-articular steroid injections, and using a brace to prevent instability. In cases where these treatments do not improve symptoms, or if symptoms improve but quickly recur, or if the deformity has progressed, surgical treatment is indicated.
Surgical treatment options include arthrodesis and arthroplasty. Arthrodesis involves fixing the painful CM joint with titanium screws and is appropriate for patients who frequently perform forceful tasks, such as shoveling snow. While pain is relieved, the immobilization of the joint makes it difficult to close the thumb. Arthropelasty, on the other hand, involves fully or partially removing the trapezius, the bone causing the pain, and suspending the first metacarpal bone to the second metacarpal bone with an artificial cord (suture button suspension). While pinch and grip strength may be reduced, this procedure preserves joint movement, making it appropriate for patients who perform more delicate tasks than forceful tasks. This procedure has become less invasive, and recently, there have been cases where the trapezius is not removed depending on the condition of the joint. In advanced cases of MP joint hyperextension, the MP joint may be temporarily fixed in a straight position with wires for three weeks. If the hyperextension does not resolve after three weeks of temporary fixation, the MP joint may be fixed with titanium screws.
carpal tunnel syndrome
This is the disease
Carpal tunnel syndrome causes numbness and pain in the tips of the fingers on the thumb side, from the thumb to the ring finger. Symptoms are particularly severe between 2 and 3 a.m. and early morning, with some people waking up in pain. When you wake up in the morning, your hands often feel stiff, and shaking your hand provides relief. As the condition progresses, sensation decreases, leading to an inability to sense that something is hot. If left untreated, the muscles at the base of the thumb (thenar muscles) can become weaker, making it difficult to use chopsticks, write, or button your clothes, resulting in significant disruption to daily life. Some people also complain of pain and fatigue in their elbows and shoulders, despite the condition being caused by nerve compression at the wrist.
Carpal tunnel syndrome can usually be diagnosed during the initial examination, but X-rays, CT scans, and nerve conduction tests may be performed to make a more accurate diagnosis.
Main symptoms
Numbness from the thumb to the ring finger.
I wake up in the middle of the night in pain.
It's especially painful when I wake up in the morning.
It has become difficult to button clothes and do other tasks with my thumb.
How the disease works
How the disease works
At the base of the palm, there is a tunnel called the carpal tunnel, surrounded by the wrist bones (carpal bones) and ligaments (transverse carpal ligament). Nine tendons and one nerve (median nerve) run through this tunnel. When hormonal imbalance occurs, such as during menopause, the synovial membrane surrounding the tendons swells. In the early stages, the transverse carpal ligament remains flexible, allowing the ligament to stretch and release internal pressure. However, as the swelling of the synovial membrane intensifies, it is unable to release the pressure, compressing the median nerve and causing the condition. This pattern is commonly seen in menopausal women, and because it is related to hormonal imbalance, oral intake of foods (supplements) containing equol can be effective.
On the other hand, if the transverse carpal ligament has thickened and hardened, it cannot release the internal pressure and quickly compresses the median nerve, causing the condition. In this case, conservative treatment is often not very effective and surgical treatment is recommended.
In the early stages, only the sensory nerves are often affected, but the motor nerves that control the thenar muscles may also be affected. In this case, conservative treatment is unlikely to improve the condition, so surgical treatment is recommended.
Method of treatments
For early-stage carpal tunnel syndrome, taking equol-containing foods (supplements) and injecting steroids into the carpal tunnel are effective. However, if these treatments do not result in improvement, if symptoms quickly return despite a response to treatment, or if atrophy of the thenar muscles progresses, surgical treatment is indicated.
Surgical treatment involves cutting the transverse carpal ligament and relieving pressure on the median nerve. At our hospital, we perform this surgery through a 2cm incision in the palm of the hand. While some facilities use an endoscope to perform the procedure through a 5mm incision, we choose to perform the surgery through a 2cm incision for several reasons. Simply cutting the transverse carpal ligament can lead to adhesions between the ligament and the median nerve, potentially resulting in a recurrence of symptoms. At our hospital, we remove 2mm of the ligament on the thumb side, where adhesions are more likely to occur, to prevent recurrence. Furthermore, direct vision is essential for more accurate surgery, such as preserving the motor nerves to the thenar muscles and removing specialized muscles (e.g., skeletal muscles) and ganglia. For other areas, we use an arthroscope to release the nerves, eliminating the need for long incisions all the way down to the forearm. However, in cases where a large area requires direct vision, such as in cases of widespread synovial swelling, the incision must be extended further.
In addition, if the nerve itself has become hard and constricted due to pressure from the surrounding area, the nerve will be fully excised (neurolysis), which will allow for a more rapid and reliable recovery.
In cases where thenar muscles have atrophied, it is necessary to thoroughly dissect the thin nerves that go to thenar muscles. If it has not been long since the atrophy, recovery of thenar muscles can be expected.
This is a time-consuming treatment, so if you want to be able to move your thumb again as soon as possible, tendon transfer surgery can be performed at the same time.
Doctor’s Profile
Yuichi Hirase
Tokyo Midtown Clinic Department in charge: Hand Surgery
Certifications and Affiliations
Specialist and instructor of the Japanese Society for Surgery of the Hand Specialist and Instructor of the Japanese Society of Plastic and Reconstructive Surgery Skin tumor surgery specialist (certified by the Japanese Society of Plastic and Reconstructive Surgery) Designated physician under Article 15 of the Welfare Law for the Physically Disabled (Tokyo, Chiba) Doctor of Medicine Fellow, Japanese Society for Surgery of the Hand
Councilor of the Japanese Society of Microsurgery Japan Society of Plastic and Reconstructive Surgery Corresponding member of the American Society of Plastic Surgeons International member of the American Society for Surgery of the Hand Associate member of the American Society for Reconstructive Microsurgery
International Federation of Societies for Surgery of the Hand (IFSSH)
International Society for Reconstructive Microsurgery (ISRM)
Biography
Graduated from Jikei University School of Medicine Studied at the University of California, San Francisco Studied under Professor Harry Buncke Lecturer at Jikei University School of Medicine Visiting Professor at Davis Medical Center, San Francisco, USA Chief of Plastic Surgery at Jikei University Kashiwa Hospital Director of Plastic Surgery, Saitama Seikeikai Hospital (Saitama Hand Surgery Institute) Part-time lecturer at Yokohama City University School of Medicine
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We have an in-house laboratory, and therefore, we can provide testing and explanation of general blood test results, excluding tumor markers, can be otained within about an hour.
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We have a wide selection of high-precision medical equipment, including 3.0 Tesla MRI, and 80-slice CT scan, and can provide detailed examinations for various symptoms.
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