Most people are aware of the harm that smoking causes to the heart and lungs. In 1964 the U.S. Surgeon General released the landmark report linking tobacco use and lung cancer and cardiovascular disease. Since then, cardiologists, pulmonologists, and primary-care physicians have helped to educate the public about the risks. However, the negative effects of tobacco smoking on the hand and musculoskeletal system – the bones, joints, muscles, tendons, and ligaments in the body – are not as well-known.
Nicotine and other toxins in tobacco smoke contribute to constriction of the blood vessels and decrease the blood flow to the hands and all parts of the body. All organ systems require adequate blood flow, oxygen, and nutrition in order to remain alive and healthy. After an injury or surgery, the body requires proper blood flow in order to heal the area.
People who smoke tobacco have an increased risk of fracture due to decreased bone mineral density or osteoporosis. Broken bones in the wrist, hip, and spine are more common in these patients. Additionally, smokers sometimes can take twice as long or longer to heal their fractures. In some patients, the bone does not have enough blood flow to heal, which can result in a painful “non-union.” Fractures of the scaphoid bone (scaphoid fractures) in the wrist and the tibia in the lower leg are more prone to these complications. Many of these fractures do not heal without surgery.
Smokers also have a higher risk of Dupuytren’s contracture in the hands, rotator cuff tears in the shoulder, and lumbar spine disc herniation in the back. Patients with nerve problems can also have worsening neuropathy if they smoke.
The risk of wound healing problems and infections after surgery is more than double in smokers. Delayed healing has been reported in spine fusion surgery, hip and knee joint replacement surgery, Anterior Cruciate Ligament (ACL) reconstruction, foot surgery, and hand surgery. If you are a smoker, you should quit several weeks prior to hand surgery to improve your chances of healing.
Over time, tobacco smoking can cause peripheral vascular disease, or hardening of the arteries. This lack of blood flow can cause chronic, non-healing ulcers in the fingers and toes. Amputations of the fingers or legs can be an unfortunate end-result from this disease!
Vaping products and “electronic cigarettes” have become more popular recently, especially among teenagers and young adults. Some people think these products are much safer than traditional tobacco cigarettes. However, they are wrong! There are many risks associated with vaping including worsening of asthma, increased heart rate, chest pain, and addiction to nicotine. There have been several reports of severe pulmonary complications and deaths related to these products. Additionally, the nicotine chemical in the inhaled vapor has many harmful effects to the body, similar to the nicotine in cigarette smoke.
Thankfully, there has been an overall decline in tobacco use in the United States since the 1964 Surgeon General report. Various efforts to reduce tobacco use have helped, but we have a long way to go. Currently over 40 million Americans are estimated to smoke, and tobacco use is still the leading cause of preventable death in the United States.
If you or a loved one uses tobacco products, please talk to your primary care doctor about smoking cessation, especially smoking before surgery. Smokers should plan to quit several weeks prior to elective surgery. Nicotine is a very addicting drug, and many patients need help to kick the habit. Choose to quit now – it may be the most important health decision you will make!
Dr. John M. Erickson is a hand and upper extremity specialist at the Raleigh Hand Center. He trained in orthopedic surgery at the University of Michigan and completed a hand surgery fellowship at Vanderbilt University. He is an active member of the American Society for Surgery of the Hand (ASSH).