The hand and wrist consist of dozens of bones, joints, ligaments, tendons, and muscles that need to work together seamlessly in a variety of positions hundreds of times a day. As such, they often require highly specialized medical care when they become injured.
SYMPTOMS & CONDITIONS WE TREAT
When patients suffer from hand and wrist pain, the cause can be due to any number of conditions. Our specialists help patients find relief from:
Pets and stray animals often bite people when they feel threatened, or when infected with rabies. Animal bites may cause significant tissue damage such as a crushing injury or deep punctures, which can damage the skin, blood vessels, nerves, muscles, bones, ligaments and tendons. When the skin is broken, the wound can become contaminated by dirt, clothing or the animal’s saliva and become infected, showing signs of warmth, swelling, pus formation and redness possibly with streaking.
Arthritis is an inflammatory condition of joints. There are several types of arthritis and the most common type is osteoarthritis or wear-and-tear arthritis. Arthritis affects various joints in the body and the arthritis in hand affects the joint at the base of the thumb.
Arthritis is an inflammatory condition of joints. There are several types of arthritis; the most common type is osteoarthritis or wear-and-tear arthritis that affects the joint at the base of the thumb. Thumb arthritis is more common in women than men, and usually occurs after the age of 40 years. Patients who have arthritis of the fingers may have swelling, pain, stiffness, and malformation all of which interfere with use of the hand.
Your doctor can usually make the diagnosis of thumb arthritis by examining the thumb. X-rays of the joint may be taken to know the severity of the disease and to determine any bone spurs or calcium deposits.
Arthritis is an inflammatory condition of joints. There are several types of arthritis and the most common type is osteoarthritis or wear-and-tear arthritis. Arthritis affects various joints in the body, the arthritis in the wrists and hands are the common types of arthritis. The arthritis in hand affects the joint at the base of the thumb.
Tendons in your fingers connect the finger bones to finger muscles and help bend and straighten the finger at the joint when the muscles contract. Boutonnière deformity is a condition in which a tendon injury to the middle joint of the finger results in the inability to straighten the affected finger.
Boutonnière deformity can occur as a result of forceful trauma to the top of the middle joint when bent, laceration to the middle joint or from arthritis. Symptoms associated with this deformity may appear immediately or after a few weeks and may include swelling, pain and restricted movement. In severe cases, a fragment of the bone may be displaced from its original position.
Carpal Tunnel Syndrome is a common, painful, progressive condition that is caused by compression of the median nerve at the wrist area.
Hand pain is characterized by distress in the joints and tissues of the hand or fingers. Hand pain can be depicted as pulsating, aching, increased warmth, prickling, irritation and inflexibility. The hand is composed of nerves, bones, blood vessels, muscles, tendons and skin. Each part has its specific function such as nerves transfer sensation, joints control movements, blood vessels maintain circulation, muscles provides motion, tendons anchor the muscles to the bones and skin receives sensations.
Injury or inflammation of any of these structures, due to a disorder or disease condition, may produce hand pain. Even compression of the nerves supplying these structures may cause hand pain.
De Quervain’s Tenosynovitis is a hand condition affecting a patients’ ability to move their thumb. It used to be referred to as washerwoman’s sprain or mother’s wrist but with the advent of technology, is now commonly referred to as “Blackberry thumb” from typing and texting on small handheld devices.
De Quervain’s Tenosynovitis is named after the Swiss surgeon who first identified the condition, Dr. Fritz de Quervain. Patients with this condition have difficulty gripping objects and performing their daily activities.
The forearm consists of two bones, the radius and ulna. The radius is the larger of the two forearm bones, and the region towards the wrist is called the distal end. Fractures in this end are most common.
The distal radius can be broken in various ways, but generally occurs around 1 inch from the distal end of the wrist. The most commonly occurring distal radius fracture is the colles fracture, which leads to an upward tilting of the broken radius bone. Other types of distal radius fractures include:
- Intra-articular fracture:Fracture extending into the wrist joint
- Extra-articular fracture:Fracture not extending into the wrist joint
- Open fracture:Fractured bone, which breaks through the skin
- Comminuted fracture:Bone fractured into more than two pieces
Injuries to the fingertip can involve crushing, tearing, or amputation (cutting-off) of the tips of the fingers, which can occur at home, work or during play. Fingertip injuries can occur during every-day activities while using a knife, a lawnmower or snow blower, or when we jam our hands/fingers in the door. They are the most common injuries that occur to the hand. The tips of the longer fingers are more prone to such injuries. The skin, soft tissue, bone, nail and/or nail bed can become damaged with these types of injuries.
Injuries to the fingertip can involve crushing, tearing, or amputation (cutting-off) of the tips of the fingers, which can occur at home, work or during play. Fingertip injuries can occur during every-day activities while using a knife, a lawnmower or snow blower, or when we jam our hands/fingers in the door. They are the most common injuries that occur to the hand. The tips of the longer fingers are more prone to such injuries. The skin, soft tissue, bone, nail and/or nail bed can become damaged with these types of injuries.
Fingers are fine structures of the human body which assist in daily routine activities through coordinated movements. Any abnormality affecting the fingers can have a huge impact on quality of life of the patient. A finger fracture is usually a minor injury but if left untreated it may lead to major consequences due to interference with the specialized functions such as grasping or manipulating objects in the palm. A fracture of the finger may disrupt the alignment of whole hand and cause pain and stiffness.
The hand contains approximately 27 small bones. The 8 carpal bones together form the wrist and the 5 metacarpal bones spread out across the palm and join the phalanges of the fingers; the five fingers of each hand comprise of approximately 14 phalanges.
Fingers are fine structures of the human body which assist in daily routine activities through coordinated movements. Any abnormality affecting the fingers can have a huge impact on quality of life of the patient. A finger fracture is usually a minor injury but if left untreated it may lead to major consequences due to interference with the specialized functions such as grasping or manipulating objects in the palm. A fracture of the finger may disrupt the alignment of whole hand and cause pain and stiffness.
The hand contains approximately 27 small bones. The 8 carpal bones together form the wrist and the 5 metacarpal bones spread out across the palm and join the phalanges of the fingers; the five fingers of each hand comprise of approximately 14 phalanges.
Ganglion cysts are swellings that most commonly develop along the tendons or joints of wrists or hands. They can be found either at the top of the wrist, palm side of the wrist, end joint of a finger, or at the base of a finger. Ganglion cyst is not cancerous and will not spread to the other parts of the body. It looks like a water balloon on a stalk and contains a clear fluid or jelly material. Ganglion cysts can be found in people of all ages.
The hand is one of the most flexible and useful parts of our body. In the wrist, many small bones are connected to each other and help you perform various activities. Because of overuse of hand in various activities hands are more prone to injuries and you may suffer from sprains and strains; fractures when lifting and carrying heavy objects, hand injury while operating machinery, bracing against a fall, or sports-related injuries. Any injury to bones or the attached ligaments may cause pain and strain, thereby limiting the activities of hands and wrists. A broken wrist is among the most common broken injuries. Fracture is a break in the bone and sprain is the tear of the ligament, the connective tissue. Fracture or sprain limits the activities of hand and may be corrected.
A bite from another person may be mild to severe but the risk of infection is high as the human mouth contains many organisms. It could potentially transmit diseases such as HIV and hepatitis. A bite can also cause tendon, joint and nerve injuries.
A human bite may produce skin breaks, bleeding and bruising. If the wound becomes infected there will be pain, swelling, warmth and pus formation. In cases of tendon or nerve damage you will experience numbness, loss of sensation, or the inability to straighten or bend the affected finger.
Kienbock’s disease is a condition in which the lunate, one of the small bones of the wrist loses its blood supply leading to death of the bone. This results in pain, stiffness, and degenerative changes in the wrist joint.
Mallet finger is a condition where the end of the finger is bent and does not straighten. It occurs when the extensor tendon on the back of the finger is damaged. The finger joint is a hinge-joint that allows bending and straightening of the fingers. Each finger is composed of 3 phalanges bones, joined by 2 interphalangeal joints (IP joints). The joint near the base of the finger is called the proximal IP joint or PIP joint, and the joint near the tip of the finger is called the distal IP joint or DIP joint.
Mallet finger occurs from sports activities causing a “jammed” finger or from excessive stress on the finger such as with a crushing injury. The injury causes either rupture of the extensor tendon without a bone fracture or rupture with a small or large bone fracture.
Traumatic nerve injury occurs from trauma such as sharp cuts by glass, breaking of major nerves while stretching, compression due to sitting in cramped postures, and penetrating wound such as with gunshots. Any injury to the peripheral nerve results in the loss of motor and sensory function. During surgeries accidental damage to the large nerves such as motor nerves can result in loss of movement and sensation. Pain is the most common symptom in traumatic nerve injuries and individuals may also experience weakness and numbness.
Symptomatic treatments include non-steroidal anti-inflammatory drugs and corticosteroids. Severe injuries necessitate neurosurgery. Some factors that are considered before deciding to perform surgery are patient’s age, if there is a tear in the nerve from the injury, or if there is a loss of function without disruption of the nerve.
Complex regional pain syndrome (CRPS) is a chronic pain condition characterized by severe pain, swelling, and changes in the skin. It usually affects the arms, hands, legs, or feet. It is also known as reflex sympathetic dystrophy or causalgia. It usually begins after trauma such as an injury to the tissue, bone, or nerves of your limb. With early treatment, CRPS may be prevented from getting worse.
Sprains and strains are common sports injuries. Sprains are injuries caused to the ligaments (connect bone to bone).
Injuries caused due to stretching or tearing of the ligaments in the wrist are called wrist sprains. These injuries are usually caused by a fall during daily activities or sports activities. Sprains can range from mild to severe based on the extent of injury to the ligament. Some of the main symptoms of wrist sprains include:
- Swelling and pain in the wrist
- Difficulty in moving your wrist
- Bruising around the wrist
- Popping sensation inside the wrist
- A feeling of warmth or feverishness in the wrist
Guyon’s canal syndrome refers to compression of the ulnar nerve while it passes from the wrist into the hand through a space called the ulnar tunnel or Guyon’s canal.
Guyon’s canal syndrome is also called ulnar tunnel syndrome or handlebar palsy.
The scaphoid bone is a small, boat-shaped bone in the wrist, which, along with 7 other bones, forms the wrist joint. It is present on the thumb side of the wrist causing it to be at a high risk for fractures. A scaphoid fracture is usually seen in young men aged 20 to 30 years. They can occur at two places: near the thumb or near the forearm.
Injuries that involve tearing or stretching of the ligaments of your fingers is termed a sprain. Sprains in the fingers are most often caused from a fall when you extend your arms to reduce the impact of the fall, or from overuse or repetitive activity of the thumb such as with texting.
Some of the symptoms of finger sprains include:
- Reduction in your ability to grasp items
- Pain immediately after the injury
- Swelling and bruising of the fingers
- Redness and tenderness
A break or a crack in the bones of the thumb is known as a thumb fracture. Thumb fractures can occur from a direct blow, a fall, and muscle contractions or twisting during sports such as football, hockey, skiing and wrestling. Fractures may occur anywhere on the thumb, but a fracture at the base of the thumb, near the wrist, is considered the most serious. A fractured thumb is associated with severe pain, tenderness and swelling at the fracture site, little or no thumb movement, deformed appearance or coldness or numbness in the thumb.
A diagnosis of a fracture in the thumb is done by reviewing your medical history and performing a detailed examination of your thumb. X-rays are usually ordered to confirm the diagnosis.
Trigger Finger, also known as stenosing tenosynovitis or flexor tendonitis, is a condition where one of the fingers or thumb of the hand is caught in a bent position. The affected digit may straighten with a quick snap, similar to pulling and releasing the trigger on a gun, hence the name trigger finger.
Commonly reported symptoms associated with trigger finger include the following:-
- Bent finger suddenly pops out and straightens
- Finger movement creates a “popping” or “clicking” sound or sensation
- Finger feels stiff and sore
- Finger becomes bent with inability to straighten
- Symptoms are worse in morning
TREATMENTS
Hand surgery is performed to restore the structure and functionality of the fingers, wrist and hand secondary to a traumatic injury, medical condition, severe infection, or birth defect causing pain and/or deformity of the hand. It is performed by trained and certified plastic surgeons. The surgery is done either as an emergency procedure or as an elective procedure depending on the condition and its severity.
Replantation is a surgical procedure performed to reattach a severed body part such as a finger, toe or hand, with the goal of restoring the appearance and function of the body part to its full potential. It is a complex surgery that involves the repair and reattachment of the amputated region along with the various structures supporting it. This is made possible by advances in microsurgery, where surgery is performed using operating microscopes and fine sutures.
A clean cut with minimal tissue damage responds well to replantation. If there is excessive tissue damage, or the replanted part would not function well, your doctor may suggest an artificial replacement or prosthesis. Your doctor will review your medical history and closely examine your injury before discussing whether you are a good candidate for replantation and what to expect from the procedure.
Spinal cord injuries damage nerves entering and exiting the spine, and in turn affect various movements controlled by them. When the upper spine is involved, injury may result in disabling paralysis to the arms or legs called tetraplegia. A surgical procedure known as tendon transfer is indicated to restore function to the arms and hands, thereby reinstating your independence in performing daily functions.
Restoration of hand functions indicated for tendon transfer include:
- Straightening and bending of the elbow
- Straightening and bending of the wrist
- Grip/pinch function of the hand and fingers
Wrist is also called as carpus, a complex joint comprised of bones and joints, ligaments and tendons, nerves, blood vessels, and muscles that hold the bones together. A fibrous cartilage present between the radius and ulna (forearm bones of the hand) separates the radioulnar joint from the rest of the wrist. Wrist connects the forearm to the hand and allows it to move. Carpal tunnel is an opening in the wrist through which the nerves and blood vessels pass.
Some of the common problems of the wrist which can be treated by arthroscopy include carpal tunnel syndrome (the nerves in the carpal tunnel are compressed), arthritis, bone fractures, dislocations, inflamed tendons and ligaments, ganglion cysts, chronic wrist pain.
Wrist Joint Replacement surgery, also called Total Wrist Arthroplasty, is used to treat the symptoms of arthritis that have not responded to non-surgical treatments such as medication or therapy. Arthritis is a general term covering numerous conditions where the joint surfaces wear out. The joint surface is covered by a smooth articular surface made of cartilage that allows pain free movement in the joint. This surface can wear out for a number of reasons. Often the definite cause is unknown.
When the articular cartilage wears out, the bone ends rub on one another causing pain. There are numerous conditions that can cause arthritis and often the exact cause is never known. In general, but not always, it affects people as they get older. This type of arthritis is called “wear and tear” arthritis or Osteoarthritis.
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