On Hand: Deep Knowledge Enables Effective Treatments to Preserve Crucial Function


Nancy McRay has played the piano since she was a small child, not just for her entertainment, but as a professional. Often her jobs required her to play for hours at a time.

I knew my mother had had arthritis, and I wondered if it could be that.

-Nancy McRay, Stanford Hospital hand patient

After hand surgery at Stanford Hospital & Clinics, Nancy McRay can play the piano again, without pain. She's learned new playing techniques to help her avoid extra stress on her hands.

The first sign of trouble for Nancy McRay was pain in the base of her left thumb.

Stanford hand surgeon Amy Ladd, MD, restored McRay's ability to play by placing a piece of tendon from McRay's forearm in the joint as a buffer.

Nancy McRay's hand surgeon, Amy Ladd, MD, couldn't have been a better fit for her. Ladd is also a pianist who understood the mobility and strength needed to play.

I'm a great believer in not expecting something like this is going to make everything perfect again. I am trying to do everything I can to take care of it.

-Nancy McRay, Stanford Hospital hand patient
  • Sprains, fractures or other injuries to the bones in the hand raise the likelihood of osteoarthritis. So can repetitive motions in certain occupations-- construction workers who hold jackhammers damage the cartilage from the harsh vibrations of that kind of equipment. When possible, wear protective gear.
  • Keep scissors handy to get through some of the tough packaging that seems impossible to open by hand-- and can cause injury.
  • Use jar openers whenever possible. Twisting while grasping puts heavy strain on the thumb and wrist.
  • Ask about an ergonomic keyboard for work on a computer. Posture and proper chair are also important tools to reducing the stress of hours of typing.
  • Consider stretching and light weightlifting to keep flexible and build strength in the muscles of your joints.
  • Self-massage of the hands can also loosen tightness after hours at work.
  • Monitor how long and how tightly you pinch or grasp an object. More stress on the joint means faster breakdown.
  • Electric can openers, food processors, oval-shaped rubber handles, gel pens and ergonomically-shaped knives can all reduce the work load on the thumb joint.
  • Listen to your body. If you are using your hands and the activity is painful, your body is trying to tell you something. Ignoring the pain allows the damage to continue. Ask yourself if there is a different way you can do an activity with less stress to your hand.

It's a tiny little joint much harder to study with imaging techniques and motion studies.

-Amy Ladd, MD, Stanford Hospital, Robert M. Chase Hand and Upper LImb Center