Hand / Wrist
Complexly designed with an intricate network of nerves, muscles, tendons, and bones, hands are those amazing tools none of us would want to live without. Often taken for granted, hands are used in almost everything we do from eating to dressing, writing, playing music, creating art, and so many more of our daily activities. We depend on the seamlessly orchestrated function of joint motion, tendon gliding, and muscle contraction to do these activities. When an accident or problem occurs involving the hand, almost everything we do is affected.
Hand surgeons use both surgical and non-surgical methods for treating conditions and injuries of the hands. At Orthopedic Associates of Dutchess County, we successfully treat most problems of the hands non-surgically, including carpal tunnel, tendonitis, arthritis, sprains, ganglions and fractures. When problems fail to respond to non-surgical methods, a minimally invasive surgical procedure may help. With minimally invasive surgical procedures, there is very little “down time.” Tendon and nerve lacerations, crush injuries, and severe soft tissue injuries usually require immediate surgery.
If you have pain in your fingers, hand, wrist or arm, or have other upper-extremity related concerns, our skilled team of physicians can help!
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The hand and wrist have multiple small joints that work together to produce motion, including the fine motion needed to thread a needle or tie a shoelace. When the joints are affected by arthritis, activities of daily living can be difficult. Arthritis can occur in many areas of the hand and wrist and can have more than one cause.
Over time, if the arthritis is not treated, the bones that make up the joint can lose their normal shape. This causes more pain and further limits motion.
Early symptoms of arthritis of the hand include joint pain that may feel “dull,” or a “burning” sensation. The pain often occurs after periods of increased joint use, such as heavy gripping or grasping. The pain may not be present immediately, but may show up hours later or even the following day. Morning pain and stiffness are typical.
As the cartilage wears away and there is less material to provide shock absorption, the symptoms occur more frequently. In advanced disease, the joint pain may wake you up at night.
Pain might be made worse with use and relieved by rest. Many people with arthritis complain of increased joint pain with rainy weather. Activities that once were easy, such as opening a jar or starting the car, become difficult due to pain. To prevent pain at the arthritic joint, you might change the way you use your hand.
When the affected joint is subject to greater stress than it can bear, it may swell in an attempt to prevent further joint use.
Changes in Surrounding Joints
In patients with advanced thumb base arthritis, the neighboring joints may become more mobile than normal.
The arthritic joint may feel warm to touch. This is due to the body’s inflammatory response.
Crepitation and Looseness
There may be a sensation of grating or grinding in the affected joint (crepitation). This is caused by damaged cartilage surfaces rubbing against one another. If arthritis is due to damaged ligaments, the support structures of the joint may be unstable or “loose.” In advanced cases, the joint may appear larger than normal (hypertrophic). This is usually due to a combination of bone changes, loss of cartilage, and joint swelling.
When arthritis affects the end joints of the fingers (DIP joints), small cysts (mucous cysts) may develop. The cysts may then cause ridging or dents in the nail plate of the affected finger.
Although the bones in the hand are small, a broken (fractured) finger is not a minor injury. The bones in a normal hand line up precisely. They let you perform many specialized functions, such as grasping a pen or manipulating small objects in your palm. When you fracture a finger bone, it can cause your whole hand to be out of alignment. Without treatment, your broken finger might stay stiff and painful.
•Swelling of the fracture site
•Tenderness at the fracture site
•Bruising at the fracture site
•Inability to move the injured finger in completely
•Deformity of the injured finger
A hand fracture is a break in one of the bones in the hand. This includes the small bones of the fingers (phalanges) and the long bones within the palm (metacarpals). A broken hand can be caused by a fall, crush injury, twisting injury, or through direct contact in sports.
In most cases, a hand fracture will heal well with nonsurgical treatment. Depending on the type and location of the fracture, this may include wearing a cast, splint or buddy straps for a period of time. For more serious fractures or for fractures that do not line up properly, however, surgery may be required to realign the broken pieces of bone.
Signs and symptoms of a hand fracture may include:
•Tenderness or pain
•Inability to move the finger
•The injured finger crosses or “scissors” over its neighbor when making a partial fist
In the case of a boxer’s fracture, the patient’s knuckle may look sunken in or depressed. This is caused by the displacement or angulation of the end or “head” of the metacarpal bone.
A scaphoid (navicular) fracture is a break in one of the small bones of the wrist. This type of fracture occurs most often after a fall onto an outstretched hand. Symptoms of a scaphoid fracture typically include pain and tenderness in the area just below the base of the thumb. These symptoms may worsen when you try to pinch or grasp something.
Treatment for a scaphoid fracture can range from casting to surgery, depending on the fracture’s severity and location on the bone. Because portions of the scaphoid have a poor blood supply-and a fracture can further disrupt the flow of blood to the bone-complications with the healing process are common.
Scaphoid fractures usually cause pain and swelling in the anatomic snuffbox and on the thumb side of the wrist. The pain may be severe when you move your thumb or wrist, or when you try to pinch or grasp something.
Unless your wrist is deformed, it might not be obvious that your scaphoid bone is broken. With some scaphoid fractures, the pain is not severe and may be mistaken for a wrist sprain.
Pain in your wrist that does not go away within a day of injury may be a sign of a fracture-so it is important to see a doctor if your pain persists. Prompt treatment of a scaphoid fracture will help avoid potential complications.
A sprained thumb occurs when the ligaments that support the thumb stretch beyond their limits or tear. This usually happens when a strong force bends the thumb backwards, away from the palm of the hand. The most common way for this to occur is by falling onto an outstretched hand.
A broken thumb is a serious problem. It affects the ability to grasp items. A broken thumb can increase the risk of arthritis later in life.
Symptoms of a fractured thumb include:
•Severe pain at the fracture site
•Limited or no ability to move the thumb
•A misshapen or deformed look to the thumb
•Numbness or coldness in the thumb
A wrist sprain occurs when the strong ligaments that support the wrist stretch beyond their limits or tear. This occurs when the wrist is bent or twisted forcefully, such as caused by a fall onto an outstretched hand. Wrist sprains are common injuries. They can range from mild to severe, depending on how much damage there is to the ligaments.
A sprained wrist is painful. Other symptoms may include:
•Tenderness to touch
•A feeling of popping or tearing inside the wrist
•A feeling of warmth around the wrist
Even a wrist injury that seems mild with minimal swelling could still involve a torn ligament and require surgery to avoid long-term problems.
Similarly, an unrecognized (occult) fracture can be mistaken for a mild or moderate sprain. If left untreated, the fracture may not heal properly and the patient could require a surgery that might have been avoided with early, appropriate treatment. The most common example of this is an occult fracture of the scaphoid, one of the small bones in the wrist.
It is important for your doctor to evaluate even a mild wrist injury if it does not improve quickly. This is especially important if the injury causes persistent wrist pain. Proper diagnosis and treatment of wrist injuries is necessary to avoid long-term problems, including chronic pain, stiffness, and arthritis.