Hand / Wrist injuries

The hand is made up of the wrist, palm, and fingers and consists of bones, joints, muscles, ligaments, tendons, and many blood vessels and nerves. It is one of the most flexible and useful parts of our body and can suffer injury due to overuse or trauma. The hand can also be affected by certain chronic medical conditions.

Common Hand Injuries and Conditions

Common hand injuries and conditions include:

• Broken finger/fractured hand: A fracture is a break in the bone that occurs when more force than the bearable limit is applied against a bone. A hand fracture can occur in the fingers, thumb, or bones within the palm of the hand.
• Carpal tunnel syndrome: Carpal tunnel syndrome is a condition characterized by numbness or pain in the thumb and first two fingers due to compression of the median nerve at the wrist.
• Osteoarthritis: This is most common type of arthritis (joint inflammation due to cartilage loss). It is caused by wear and tear of the joints usually seen with aging.
• Rheumatoid arthritis: This is an autoimmune condition which can lead to arthritis in the hands as well as other joints.
• Ganglion cysts: Ganglion cysts are noncancerous lumps that usually form around the tendons or joints of the wrists or hands.
• Hand nerve injuries: Nerve injuries in the hands may be caused by excessive strain, stretching, or a cut.
• Tendinitis: Tendinitis is a condition in which the tendons in the hands become irritated and inflamed due to overuse.
• Trigger finger: This is a common condition in which the sheath through which tendons move becomes irritated or swollen.
• Dupuytren's contracture: A disorder caused by the thickening of the tissues of the palm. 

Symptoms 

Signs and symptoms of hand injuries include:

• Pain
• Bruising
• Swelling
• Deformity
• Inability to move the fingers
• Warmth around the area of injury
• Tenderness
• Loss of motion
• Weakness
• Numbness

Diagnosis of Hand Injuries and Conditions

Your doctor will review your symptoms and medical history and perform a thorough physical examination to check for range of motion and stability, and any ligament or tendon damage.  Blood flow and skin color are evaluated. The following diagnostic tests may be performed for further evaluation:

• X-rays: During this study, high-energy electromagnetic beams are used to produce images of the bones.
• CT scan: Multiple x-rays are used to produce detailed cross-section images of the hand.
• Electromyography (EMG) and nerve conduction studies to measure nerve impulses and nerve damage. 

Treatment for Hand Injuries

Hand injuries may be treated by resting the hand, medications, bracing, heat or ice application, compression, stretching, and strengthening exercises, and by treating the underlying cause or condition.
Some of the most common procedures used for the treatment of hand conditions and injuries include:

• Skin grafts: This involves the use of healthy skin from an area of the patient's body to cover or resurface the injured area. This is most commonly used for burn reconstruction and amputation of fingers.
• Tendon repair: This is performed with special sutures for the management of ruptured tendons caused by trauma or sports injury. Surgery performed within 24 hours of the injury is associated with better outcomes.
• Nerve repair: This is a complex surgery performed immediately after a nerve injury, as damage to any of the three main nerves of the hand may lead to limited use or compromised range of motion of the hand, fingers, and wrist.
• Open reduction and internal fixation (ORIF): This is treatment for fractures with completely displaced and/or crushed bones. It involves the realignment of the bones of the hand with the help of rods, wires, splints, and casts. 
• Joint replacement: This involves the replacement of the joints in the fingers and the wrist with a new joint made of silicone rubber, a portion of the patient's own tendon, or a plastic or metal implant. This is usually performed in patients with osteoarthritis or traumatic arthritis of the hand to relieve pain and restore function.

Causes of Wrist Pain

The wrist is a commonly injured joint in the body. Problems include sprains and strains as well as fractures that can occur with lifting and carrying heavy objects, while operating machinery, bracing against a fall, or from sports-related injuries. 

Common Wrist Injuries 

Some of the common wrist injuries include:

Sprains and Strains 

Sprains and strains are the two most common types of injuries affecting the wrist. A sprain refers to an injury to a ligament and a strain refers to a muscle injury. 

They occur due to excessive force applied during a stretching, twisting or thrusting action. Most sprains and strains will repair themselves with adequate rest, ice application, compression and elevation. Surgery is occasionally required to repair the damage. 

Ligamentous Injuries

Ligaments are tissues that connect bones to other bones. They are made up of several fibers and one or all the fibers may be involved. Complete ligament injury occurs when all the fibers are torn. A ligament injury may cause pain and swelling, and limit the movement of the wrist joints. 

Ligament injuries are effectively treated with splinting and taping, and restricting the movement of the injured structures.

Fractures

A fracture is a break in the bone which occurs when more force than the bearable limit is applied against a bone. Crushing injuries to the wrist occur due to high degrees of force or pressure and may also cause fractures. 

A fracture may lead to severe pain, swelling, bruising or bleeding, discoloration of the skin and limit the mobility of the limb. 

Fractures of the wrist bones can be treated by using a cast or splint while the bone heals. Sometimes, surgery may be needed where plates, pins or screws may be placed to keep the joint stable while healing. 

Repetitive Trauma Syndrome

Repetitive stress injury occurs because of repeated similar movements for long periods of time. This often causes pressure on the joints resulting in inflammation, pain and decreased function in the extremity. 

The condition is more likely to develop with repetitive, rapid, forceful and prolonged movements of the wrist, or from vibration or frequent pushing, pulling or carrying heavy objects. Carpal tunnel syndrome is the most common of these syndromes.

Carpal Tunnel Syndrome

Carpal tunnel syndrome is a condition characterized by numbness or pain in the thumb and first two fingers, and occurs when the median nerve is compressed at the wrist. It is a common complaint in individuals who use their hands for prolonged periods of time in an occupation such as computer work. 

Immobilization of the affected part for a certain period may help heal the condition. Medications, physical therapy and surgery may also be recommended. Often, splinting for a short period of time can treat the condition. 

Any problem causing pain, swelling, discoloration, numbness or a tingling sensation, or abnormal position of the wrist that persists for more than two or three days should be evaluated by your doctor to establish the cause and obtain the best treatment as early as possible.