Helping Hands: Expert Care can Help with Hand Conditions

Sketch pencil in her right hand, Laida Arcia Carro (pictured above) adds tiny details to complete her portrait of a strong Haitian woman. Ms. Carro can’t imagine a day without drawing, yet at age 71 the osteoarthritis in her hands often forces her to end her sketch sessions sooner than she’d like.

“Four or five years ago I noticed that my grasp wasn’t as good as it had been, and I had pain with certain motions, like opening a jar,” said Ms. Carro, a retired elementary school art teacher. “It got progressively worse and now the bone on the inner side of my wrist protrudes. It’s in both hands, but my right is worse than my left.”

Unfortunately, just being female places Ms. Carro at a higher risk for a hand or wrist problem. According to the National Institutes of Health, women are about three times more likely than men to suffer from rheumatoid arthritis and carpal tunnel syndrome, and twice as likely to fracture a wrist or have osteoarthritis in their hands. The gender gap is true across all age groups, yet it widens as we age.

“Genetics, hormones, anatomy and metabolism all play a role,” said Elizabeth Anne Ouellette, M.D., chief of hand surgery at Miami Orthopedics & Sports Medicine Institute. In addition, women often lack adequate levels of calcium and vitamin D, important in forming and maintaining strong bones.

Although Dr. Ouellette is an orthopedic surgeon, she isn’t quick to take a patient to the operating room. “I’m going to talk you out of surgery if I can,” she said. “If you aren’t sleeping because of the pain or your life is severely disrupted — for example, you can’t turn the key in your front door — then we have a conversation about surgery.”

Dr. Ouellette understands what her patients are experiencing because early in her career, just after having her second child, she underwent carpal tunnel surgery on both wrists at the same time. “I was beginning to lose finger sensation and I was not sleeping. This could have brought an end to my career.”

Because of the impact a hand problem may have on daily life, it’s important to see a specialist if you have symptoms. The hand and wrist are delicate and complex, with 27 bones and many muscles, tendons, ligaments, arteries, veins and nerves. Many conditions can be addressed, and technology is constantly evolving to improve and expand treatment. Dr. Ouellette is involved in a wide range of research on everything from nerve injuries to the use of tiny anchors in the wrist for tendon repairs. In addition to her role at Baptist Health, she is chief of hand surgery and a clinical professor of orthopedics at Florida International University’s Herbert Wertheim College of Medicine.

Although Ms. Carro is a candidate for surgery, she and Dr. Ouellette discussed the options, and together, they decided to watch and wait. “Her symptoms could improve with conservative treatment,” Dr. Ouellette said.“ And sometimes patients have no pain after the cartilage has worn down and the joint is bone on bone. Then we do nothing.” Waiting could also mean that medical developments, such as tissue re-engineering, could move from the research setting to everyday use.

Occasionally, Ms. Carro wears a splint on her hand, takes anti-inflammatory medicines and rubs on a topical numbing cream. She hopes to avoid the disruption surgery would require. When she can, she still teaches private art lessons and attends regular drawing classes, and hopes those resume soon. Careful to maintain social distancing during the pandemic, Ms. Carro has filled her days by continuing her sketching, except without live models.

“My art is so important,” she said. "I don’t want to stop. It keeps me alive.”

Tips for “handling” the future:

Dr. Ouellette has 30 years of experience in research and in treating athletes and people of all ages who need small joint replacement or surgery for hand, wrist and joint injuries. She offers patients plenty of advice when it comes to preventing — or slowing — problems that can become debilitating.

Some suggestions:

• MAINTAIN A HEALTHY WEIGHT. Fat contributes to a higher level of the hormone leptin, which leads to inflammation. “It’s not the extra weight on joints that causes problems,” she explained. “Inflammation can cause swelling, cartilage and bone damage, and pain.” Leptin has been linked to arthritis, lupus, multiple sclerosis and even heart disease.

• EXERCISE. It keeps bones strong, improves balance, builds muscle and has long-lasting health benefits for the whole body.

• FEED YOUR BONES. Take a vitamin D supplement and eat plenty of dark green, leafy vegetables to increase your calcium level.

• CHOOSE ORGANIC. The fewer chemicals you absorb from skin care products, makeup and food, the better. Apps such as EWGHealthy Living, Think Dirty and Detox Me can help you determine your toxicity exposure.