The wrist is made up of eight small bones and the two forearm bones, the radius and ulna (see Figure 1). The shape of the bones allows the wrist to bend and straighten, move side-to-side, and rotate, as in twisting the palm up or down. A fracture may occur in any of these bones when enough force is applied, such as when falling down onto an outstretched hand. Severe injuries may occur from a more forceful injury, such as a car accident or a fall off a roof or ladder. Osteoporosis, a common condition in which the bone becomes more brittle, may make one more susceptible to getting a wrist fracture.
Extensor tendons are just under the skin. They lie next to the bone on the back of the hands and fingers and straighten the wrist, fingers and thumb (Figure 1). They can be injured by a minor cut or jamming a finger, which may cause the thin tendons to rip from their attachment to bone. If not treated, it may be hard to straighten one or more joints.
Carpal tunnel syndrome is essentially a pinched nerve in the wrist. There is a space in the wrist called the carpal tunnel where the median nerve and nine tendons pass from the forearm into the hand (Figure 1). Carpal tunnel syndrome happens when pressure builds up from swelling in this tunnel and puts pressure on the nerve.
Pressure on the nerve can happen several ways, including:
- Swelling of the lining of the flexor tendons, called tenosynovitis
- Joint dislocations
- Fluid retention during pregnancy
Fingertip injuries are one of the more common injuries in the hand. The fingertips are exposed in many of our activities.
Fingertip injuries can be caused by many things. They can be crushed, closed in a door, or hit by a hammer. A heavy object can be dropped onto the finger. They can also be cut by a kitchen knife, power tool or another sharp object. A fingertip injury can result in damage to the skin, bone, nailbed, tendons and the pulp, the padded area of the fingertip (see Figure 1). You can also damage the nerve endings in the fingertips.
Amputation to tip of finger
One specific example of a tendon rupture is that of a mallet injury. This is where the tendon that allows the distal joint (the one by the nail) to extend is pulled out of the bone. Sometimes a piece of bone is attached to the tendon as it is pulled away. You may notice that the tip of the finger is drooping downwards and you cannot lift it up. Treatment involves constant splinting or immobilization of this joint for a period of time, generally 6 to 7 weeks. A surgical option is available to internally splint the joint so that an external splint does not have to be worn at all times. This allows you to perform hygiene activities more easily. After the splinting period formal therapy is necessary.
These are fluid filled bumps that may develop near a tendon or a joint. They are very common at the tips of the digits near the nail and at the level of the wrist. They may be associated with arthritis especially at the tip of the finger or as a result of an injury. They are not a cancer. They can change in size by themselves or even disappear completely. Treatment may involve aspiration (using a needle to remove the fluid) or surgery. Keep in mind that even with treatment the cysts can recur. Surgery offers the greatest chance of the cyst not returning.
A joint is where two bones connect. Either through genetics or an injury the joint can wear out. The cartilage that was protecting the joint surface can be lost causing rubbing of bone on bone. While it is not always the case this can be quite painful and limit activities with the use of the hand. A very common place for this to occur is at the base of the thumb. This is more common in woman than men. Treatment options include nonsteroidal anti-inflammatory’s, splinting, corticosteroid injection and possible surgery. The treatment is tailored to each patient’s symptoms and needs.
This refers to inflammation of a tendon or group of tendons. It can be caused either from repetitive activities or an injury. Generally you may experience pain as a result of motion in the region of the involved tendon or tendons. Treatment involves anti-inflammatory medication, hand therapy, splinting and on occasion surgery is necessary.
This is a specific type of tendinitis that occurs at the level of the wrist on the thumb side. You might see swelling in this area and it can be tender to touch. Twisting and grasping motions of the hand can be quite painful as a result. Treatment includes anti-inflammatory medication, hand therapy, splinting, corticosteroid injection, and surgery for those that do not gain sustained relief from the above.
This is a condition whereby in it’s mildest case you may experience pain in the palm of the hand at the base of a finger or thumb. This may progress to where you feel a clicking or popping (triggering) of the digit. Some people feel like a joint is dislocating. This is not the case however. It is the result of thickened tissue in the palm that does not allow for smooth gliding of the tendons that control motion of the finger. In more severe cases the finger may get locked in the palm and you have to use your other fingers to unlock it. The majority of cases that I see are from repetitive grip type activities. They occur more commonly in patients with diabetes or rheumatoid arthritis. It may seem quite concerning but the treatment is actually quite simple. One or two corticosteroid injections will resolve most cases however surgery may be necessary for those that do not resolve. It is not uncommon for this to be the case with diabetics.
Dupytren’s Contracture (Disease)
This is a condition where the tissue beneath the skin (fascia) becomes thickened. In the early stages all you may see are lumps or pits in the palm. However this may progress to where you feel thickened bands that extend from the palm to the fingers. You may be able to make a fist without a problem but cannot fully extend the fingers or lay the hand flat on a table. It is generally not a painful problem. However it can interfere with activities of daily living as a result of the inability to fully open the fingers from the palm. Several causes have been identified but the most common is that of a genetic predisposition. It occurs mostly in males over 40 of Northern European descent. It can occur in women as well but less commonly. Not all people with this problem require treatment. It is only those that have contractures and functional problems with the hand that treatment is recommended. Unlike many hand related problems treatment can be very successful even after having this condition for many years. There are several options available for treatment including injections or surgery. Treatment is tailored for the individual. While not all people will regain full range of motion treatment for this condition is generally very successful. A course of hand therapy is generally necessary as a part of their treatment.
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