Hand & Wrist

Arthritis frequently targets the hand and wrist joints, often serving as the initial location for the onset of rheumatoid arthritis, a chronic autoimmune disorder. Common symptoms encompass joint inflammation and pain. When left untreated, it can lead to painful hand deformities and restricted mobility. Management approaches for rheumatoid arthritis may involve immunosuppressant medications, physical therapy, and potentially, surgical interventions.

In contrast, osteoarthritis stands as the most prevalent form of arthritis. This degenerative joint condition arises from the gradual deterioration of cartilage at the bone ends, resulting in bone-on-bone friction that can induce pain, inflammation, stiffness, and the formation of bone spurs. Treatment strategies are tailored to arthritis severity and individual symptoms and may incorporate medication, physical therapy, or surgical procedures.

Carpal tunnel syndrome arises when frequent pressure is exerted on the median nerve, a significant nerve responsible for hand functions, at the wrist. This nerve traverses a narrow passage known as the carpal tunnel. When compression occurs within this tunnel, it can result in sensations of numbness, tingling, and discomfort in the arm and hand.

The primary causes of carpal tunnel syndrome typically involve overuse or repetitive strain. Managing this condition often necessitates a combination of approaches, including periods of rest, the use of immobilization devices, medication to alleviate symptoms, and in some cases, surgical intervention to relieve the pressure on the median nerve.

De Quervain’s tendonitis, characterized by the inflammation of tendons along the thumb side of the wrist, manifests as pain and tenderness, particularly near the base of the thumb. Activities involving making a fist or twisting the wrist can be uncomfortable.

Overuse, particularly of the wrist, is the primary cause of this condition, much like other forms of tendonitis. Additionally, trauma or rheumatoid arthritis may trigger de Quervain's tendonitis.

Early intervention yields the most effective treatment results, often involving medication and physical therapy. Surgical intervention is rarely necessary but may be considered in exceptional cases.

Dupuytren’s contracture contracture occurs when the tissue just beneath the palm of the hand thickens and tightens, resulting in the deformation of the hand. This condition causes the affected fingers, typically those farthest from the thumb, to gradually curve inwards towards the palm, rendering them unable to straighten over time.

Although Dupuytren's contracture is not painful, it is regarded as a hand deformity that can impede everyday hand functionality. Treatment options range from minimally invasive procedures like breaking up the constricting tissue or softening it through enzyme injections to more extensive surgical interventions. These treatments aim to restore hand function and alleviate the contracture's impact on daily activities.

Ganglion cysts, characterized by benign, fluid-filled round lumps, often form near the joints or tendons of the hand or wrist, and occasionally, they can appear at the ankles or feet. While these cysts may exert pressure on nerves, resulting in pain or other discomfort, they often resolve spontaneously.

Treatment approaches for ganglion cysts may involve drainage or surgical removal, depending on the severity of symptoms. Decisions about treatment should be made in consultation with a healthcare professional and tailored to individual needs and preferences.

The hand and wrist encompass a complex array of bones within a relatively small area, making them susceptible to partial or complete fractures, often caused by incidents like attempting to break a fall.

When a fracture occurs, sudden and intense pain in the hand or wrist, exacerbated by hand use or wrist movement, may be indicative of a broken bone. Additional signs can include swelling, bruising, or stiffness. Diagnostic imaging plays a crucial role in confirming the presence and extent of the fracture.

Treatment options may entail surgical intervention using surgical-grade pins and screws to repair the break, followed by immobilization and hand therapy during the healing process. These measures aim to ensure proper recovery and restore optimal hand and wrist functionality.

The hands and wrists are used very often throughout our daily routines, making them prone to minor injuries like scratches, scrapes, and cuts. While these injuries may seem minor, they create openings in the skin, allowing bacteria and other microorganisms to enter, potentially leading to infections.

The hands and wrists are susceptible to various infections, such as the following, necessitating medical attention:

• Cellulitis: An infection of the skin characterized by redness, warmth, tenderness, and inflammation. It often occurs when bacteria enter the body through minor skin breaks.
• Infectious tenosynovitis: An infection affecting the tendon sheath in the hand, which can lead to tendon stiffness and rupture. Symptoms include finger rigidity, pain, and inflammation.
• Necrotizing fasciitis ("flesh-eating bacteria"): A rare yet severe infection that destroys skin, muscle, and surrounding tissues through bacteria entering the body via cuts. Surgical removal of dead tissue is typically required.
• Osteomyelitis: An infection of the bone.
• Septic arthritis: A painful infection that damages the joint's cartilage, often caused by germs traveling through the bloodstream. Immediate treatment is crucial to prevent further complications, typically involving surgery and intravenous antibiotics.

Nerves are essential for transmitting messages between the brain and muscles or organs. In the upper extremities, various nerves, such as the radial, median, and ulnar nerves, enable hand, wrist, and finger movement and provide sensation.

Nerve irritation, compression, or injury can cause symptoms like tingling, numbness, and pain while limiting movement. Carpal tunnel syndrome is a common hand nerve injury, resulting from compression of the median nerve at the wrist, leading to discomfort and weakness in the hand and forearm.

Treatment varies based on the injury's location and severity. Mild cases may resolve naturally, while more severe injuries may require carpal tunnel surgery. Rest, bracing, and physical therapy often aid recovery for hand and wrist nerve injuries, promoting healing and function restoration.

The radial nerve, spanning the length of the arm, is responsible for extending the fingers and wrist and providing sensation to parts of the hand.

Radial tunnel syndrome arises when this nerve becomes compressed within a small tunnel located on the top of the forearm, consisting of muscles, tendons, and ligaments. Compression may result from factors like tumors, inflammation, or trauma.

Interestingly, unlike other nerve-related conditions, radial tunnel syndrome primarily manifests as muscle pain and forearm weakness, rather than tingling or numbness. However, when these latter symptoms do occur, they may affect the arm, wrist, or fingers.

Initial treatment typically involves supportive measures such as splints. In certain cases, surgery may be necessary to relieve pressure on the radial nerve.

The hand and wrist consist of numerous bones, including the scaphoid, a carpal bone situated near the base of the thumb within two rows of small round bones forming the wrist.

Scaphoid fractures rank as the second most common type of wrist fracture, following forearm radius bone fractures near the wrist. Typically resulting from trauma, these fractures occur when individuals instinctively use an outstretched hand to break a fall.

The treatment approach for a scaphoid fracture depends on its location and severity. Proximity to the thumb often allows nonsurgical methods like casting to suffice. However, fractures farther from the thumb pose challenges for healing due to limited blood supply in that region. In such cases, surgery becomes a necessary option to promote proper healing.

Tendons, composed of strong collagen fibers, play a crucial role in connecting muscles to bones, facilitating bodily movement and functionality. Tendon injuries can occur through partial or complete tears (ruptures) or by becoming irritated and inflamed.

Tendonitis, for instance, often results from repetitive movements over time, although acute injuries can also trigger it, albeit less frequently.

In the hand and wrist, extensor tendons, running along the back of the hand and fingers, enable straightening (extension) of fingers, thumb, and wrist, while flexor tendons on the palm side facilitate bending (flexion) of the fingers. Positioned just beneath the skin, these tendons are susceptible to injuries like cuts or trauma. Chronic conditions such as arthritis can weaken tendons, increasing the risk of tears.

Treatment for tendon injuries varies based on their severity and may involve rest, splinting, or surgical intervention, as necessary.

Trigger finger, also known as trigger thumb, is characterized by a finger or thumb getting caught and locked in a bent position before suddenly snapping straight. This condition, medically termed stenosing tenosynovitis, arises when the tendon encounters difficulty moving smoothly, hindering the finger's bending and extending.

Individuals with diabetes, rheumatoid arthritis, or gout are at a higher risk of developing trigger finger.

Management of this condition can involve anti-inflammatory medication, splints, and steroid injections to alleviate symptoms. In more severe cases, surgical intervention and hand therapy may be necessary to restore proper hand function and movement.

A TFCC (Triangular Fibrocartilage Complex) injury is a condition affecting the wrist's stability and function. This complex structure, composed of cartilage and ligaments, provides support to the wrist joint, enabling smooth movement. TFCC injuries commonly result from trauma or overuse, causing symptoms such as pain, swelling, and limited wrist mobility. These injuries can significantly impact daily activities and sports performance. Diagnosis typically involves a physical examination, imaging studies, and, in some cases, arthroscopy.