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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Fractures of the forearm can occur near the wrist at the farthest (distal) end of the bone, in the middle of the forearm, or near the elbow at the top (proximal) end of the bone. This article focuses on fractures that occur in the middle segments of the radius and ulna. Fractures that involve the wrist or the elbow are discussed in separate articles.
A broken forearm usually causes immediate pain. Because both bones are usually involved, forearm fractures often cause an obvious deformity – your forearm may appear bent and shorter than your other arm. You will most likely need to support your injured arm with your other hand.
Additional symptoms include:
- Bruising (not as common as in other broken bones)
- Inability to rotate arm
- Numbness or weakness in the fingers or wrist (rare)
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.
- Pain with activities that involve gripping or pinching, such as turning a key, opening a door, or snapping your fingers
- Swelling and tenderness at the base of the thumb
- An aching discomfort after prolonged use
- Loss of strength in gripping or pinching activities
- An enlarged, “out-of-joint” appearance
- Development of a bony prominence or bump over the joint
- Limited motion
There are many types of arthritis, and most of these can affect the wrist. Although the severity of symptoms related to arthritis can vary, most arthritis-related diseases are chronic. This means that they are long-lasting-even permanent-and can eventually cause serious joint damage.
Your wrist is a complex joint-it is actually made up of multiple small joints. When healthy, the bones glide easily over each other during movement, protected by smooth cartilage that coats the joint surfaces. Arthritis damages this cartilage. As the disease progresses, there is a gradual loss of cartilage. Without a smooth joint surface, the bones rub against each other, leading to joint damage that cannot be repaired.
Although there is no cure for arthritis today, there are many treatment options available to help relieve your symptoms. Some options may also slow the progression of joint damage. With proper treatment, many people are able to manage their symptoms and stay active.
Not all patients with arthritis will experience symptoms. When they do occur, the severity varies greatly from patient to patient. For some patients, the symptoms are not constant-but may come and go depending on their level of activity and other factors.
Symptoms of arthritis may include:
- Reduced range of motion or stiffness
- Weakness in the joint
Signs of boutonnière deformity can develop immediately following an injury to the finger or may develop a week to 3 weeks later.
•The finger at the middle joint cannot be straightened and the fingertip cannot be bent.
•Swelling and pain occur and continue on the top of the middle joint of the finger.
In most patients, carpal tunnel syndrome gets worse over time, so early diagnosis and treatment are important. Early on, symptoms can often be relieved with simple measures like wearing a wrist splint or avoiding certain activities.
If pressure on the median nerve continues, however, it can lead to nerve damage and worsening symptoms. To prevent permanent damage, surgery to take pressure off the median nerve may be recommended for some patients.
Symptoms of carpal tunnel syndrome may include:
•Numbness, tingling, burning, and pain-primarily in the thumb and index, middle, and ring fingers
•Occasional shock-like sensations that radiate to the thumb and index, middle, and ring fingers
•Pain or tingling that may travel up the forearm toward the shoulder
•Weakness and clumsiness in the hand-this may make it difficult to perform fine movements such as buttoning your clothes
•Dropping things-due to weakness, numbness, or a loss of proprioception (awareness of where your hand is in space)
In most cases, the symptoms of carpal tunnel syndrome begin gradually-without a specific injury. Many patients find that their symptoms come and go at first. However, as the condition worsens, symptoms may occur more frequently or may persist for longer periods of time.
Night-time symptoms are very common. Because many people sleep with their wrists bent, symptoms may awaken you from sleep. During the day, symptoms often occur when holding something for a prolonged period of time with the wrist bent forward or backward, such as when using a phone, driving, or reading a book.
Many patients find that moving or shaking their hands helps relieve their symptoms.
Compartment syndrome can be either acute or chronic.
Acute compartment syndrome is a medical emergency. It is usually caused by a severe injury. Without treatment, it can lead to permanent muscle damage.
Chronic compartment syndrome, also known as exertional compartment syndrome, is usually not a medical emergency. It is most often caused by athletic exertion.
Acute Compartment Syndrome
The classic sign of acute compartment syndrome is pain, especially when the muscle within the compartment is stretched.
•The pain is more intense than what would be expected from the injury itself. Using or stretching the involved muscles increases the pain.
•There may also be tingling or burning sensations (paresthesias) in the skin.
•The muscle may feel tight or full.
•Numbness or paralysis are late signs of compartment syndrome. They usually indicate permanent tissue injury.
Chronic (Exertional) Compartment Syndrome
Chronic compartment syndrome causes pain or cramping during exercise. This pain subsides when activity stops. It most often occurs in the leg.
Symptoms may also include:
•Difficulty moving the foot
•Visible muscle bulging
Signs of De Quervain’s tenosynovitis:
•Pain may be felt over the thumb side of the wrist. This is the main symptom. The pain may appear either gradually or suddenly. Pain is felt in the wrist and can travel up the forearm. The pain is usually worse when the hand and thumb are in use. This is especially true when forcefully grasping objects or twisting the wrist.
•Swelling may be seen over the thumb side of the wrist. This swelling may accompany a fluid-filled cyst in this region.
•A “catching” or “snapping” sensation may be felt when moving the thumb.
•Pain and swelling may make it difficult to move the thumb and wrist.
Distal radius fractures are very common. In fact, the radius is the most commonly broken bone in the arm.
A broken wrist usually causes immediate pain, tenderness, bruising, and swelling. In many cases, the wrist hangs in an odd or bent way (deformity).
In some patients, a worsening Dupuytren’s contracture can interfere with hand function, making it difficult for them to perform their daily activities. When this occurs, there are nonsurgical and surgical treatment options available to help slow the progression of the disease and improve motion in the affected fingers.
A Dupuytren’s contracture typically progresses very slowly, over a period of years. Signs and symptoms of the condition may include:
You may develop one or more small lumps, or nodules, in the palm of your hand. These nodules are typically fixed to the overlying skin. Initially, the nodules may feel tender but, over time, this tenderness usually goes away. In some cases, there can be “pitting” or deep indentation of the skin near the nodules.
The nodules may thicken and contract, contributing to the formation of dense and tough cords of tissue under the skin. These cords can restrict or tether the fingers and thumb from straightening or from spreading apart.
As the tissue under the skin tightens, one or more of your fingers may be pulled toward your palm and may be restricted from spreading apart. The ring and little fingers are most commonly affected, but any or all of the fingers can be involved, even the thumb. Most commonly, the first joint (knuckle joint) of the finger is affected, but the other joints may also be involved.
As the bend in your finger increases, it may be hard to straighten it fully. It may be difficult to grasp large objects, put your hand in your pocket, or perform other simple activities.
Some patients with Dupuytren’s disease may develop thickened tissue on the feet (Ledderhose disease) or penis (Peyronie’s disease). Symptoms do not occur anywhere else on the body.
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
Forearm fractures often occur when children are playing on the playground or participating in sports. If a child takes a tumble and falls onto an outstretched arm, there is a chance it may result in a forearm fracture. A child’s bones heal more quickly than an adult’s, so it is important to treat a fracture promptly-before healing begins-to avoid future problems.
A forearm fracture usually results in severe pain. Your child’s forearm and hand may also feel numb, a sign of potential nerve injury.
These fluid-filled cysts can quickly appear, disappear, and change size. Many ganglion cysts do not require treatment. However, if the cyst is painful, interferes with function, or has an unacceptable appearance, there are several treatment options available.
Most ganglions form a visible lump, however, smaller ganglions can remain hidden under the skin (occult ganglions). Although many ganglions produce no other symptoms, if a cyst puts pressure on the nerves that pass through the joint, it can cause pain, tingling, and muscle weakness.
Large cysts, even if they are not painful, can cause concerns about appearance.
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.
Bone is living tissue that requires a regular supply of blood for nourishment. If the blood supply to a bone stops, the bone can die. This is called osteonecrosis.
Damage to the lunate causes a painful, stiff wrist and, over time, can lead to arthritis.
The most common symptoms of Kienböck’s disease include:
•A painful and sometimes swollen wrist
•Limited range of motion in the affected wrist (stiffness)
•Decreased grip strength in the hand
•Tenderness directly over the bone (on the top of the hand at about the middle of the wrist)
•Pain or difficulty in turning the hand upward
The finger is usually painful, swollen, and bruised. The fingertip will droop noticeably and will straighten only if you push it up with your other hand.
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
Symptoms of trigger finger often start without a single injury. They may follow a period of heavy or extensive hand use, particularly pinching and grasping activities.
Symptoms may include:
•A tender lump at the base of the finger on the palm side of the hand
•A catching, popping, or locking sensation with finger movement
•Pain when you bend or straighten the finger
Stiffness and locking tend to be worse after periods of inactivity, such as when you wake up in the morning.
In a severe case, the involved finger may become locked in a bent position.
When pressure on the nerve occurs at the wrist, it causes numbness and tingling in the little finger and along the outside of the ring finger. In addition, ulnar tunnel syndrome can sometimes cause weakness of hand pinch and grip.
Symptoms develop gradually. Weakness and increasing numbness, particularly on the little finger side of the hand are usual signs of ulnar tunnel syndrome. The degree of weakness and numbness depends on the location of the pressure point. Pain may or may not be present.
As the syndrome progresses, it may become more difficult to open jars, hold objects, or coordinate the fingers during such tasks as typing or playing a musical instrument.
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.