Hand & Wrist

Arthritis occurs often in the joints of the hands and wrists. It’s where rheumatoid arthritis, a chronic autoimmune system disorder, typically starts. Symptoms include inflammation and pain at the joints. If left untreated, it can lead to painful deformity of the hands and inhibited movement. Immunosuppressant medications, physical therapy, and surgery may be used to treat rheumatoid arthritis.

It is osteoarthritis, however, that is the most common form of arthritis. This degenerative joint disease occurs when cartilage at the end of bones wears down over time, resulting in bone-on-bone friction, which can cause pain, inflammation, stiffness, and the development of bone spurs. Treatment will depend on the extent of the arthritis and your symptoms but may include medication, physical therapy, and surgery.

Carpal tunnel syndrome occurs when the median nerve, one of the major nerves to the hand, is pinched at the wrist. The median nerve travels through a passageway called the carpal tunnel. When the nerve is compressed, it can cause numbness, tingling, and pain in the arm and hand.

Carpal tunnel syndrome is most commonly caused by overuse or repetitive strain. Treatment may include rest, an immobilizing device, medication, and surgery.

Inflammation of the tendons along the thumb-side of the wrist is known as de Quervain’s tendonitis. It can cause pain and tenderness in the wrist, especially near the base of the thumb. It may hurt to make a fist or turn your wrist.

As with other types of tendonitis, overuse – in this case, of the wrist – is the prime culprit causing this condition. Trauma and rheumatoid arthritis may also cause de Quervain’s tendonitis.

Treatment is most successful when begun early and may include medication and physical therapy; surgery may be indicated in rare instances.

When tissue just under the palm of the hand becomes thick and tight, it is called Dupuytren’s contracture. As the thickening tissue constricts the skin, fingers are pulled in toward the palm. Fingers farthest from the thumb tend to be affected, and over time, the bent fingers cannot be straightened.

Dupuytren’s contracture is considered a deformity of the hand. Although it causes no pain, Dupuytren’s contracture can inhibit everyday use of the hands.

Treatment may include minimally invasive measures (such as breaking up the tissue that is causing a finger to bend or softening tightened tissue with enzyme injections) and surgery.

These benign, fluid-filled round lumps typically develop at the joints or tendons of the hand or wrist but may also occur at the ankles or feet. Ganglion cysts may press on a nerve and cause pain or other symptoms. In most cases, these cysts go away on their own. However, treatment to drain the cyst or surgically remove it may be preferable depending on your symptoms.

For a relatively small area, there are a lot of bones in the hand and wrist that can be damaged by a partial or complete fracture. Hands and wrists are particularly susceptible to breaks because they are typically used in an attempt to break a fall, for example.

Sudden, severe pain in the hand or wrist may indicate a broken bone – especially if it worsens when using the hand or moving the wrist. There may be some swelling, bruising, or stiffness in the area. Imaging tests are used to identify the presence and extent of a break.

Surgery using surgical-grade pins and screws may be necessary to fix the break, followed by some type of immobilization and hand therapy as the area heals.

Because we use our hands for so much of what we do during the day, they are especially prone to scratches, scrapes, cuts, and the like. Although these may be minor injuries, they create a break in the skin through which bacteria and other microorganisms can enter the body and cause infection.

It’s no wonder the hands and wrists are subject to a host of infections requiring medical attention, including:

• Cellulitis – Any infection of the skin with the telltale symptoms of redness, warmth, tenderness, and inflammation. Cellulitis typically occurs after bacteria enter the body through a minor break in the skin.
• Infectious tenosynovitis – An infection of the tendon sheath in the hand. It can cause the tendon to stiffen and rupture. Symptoms may include finger rigidity, pain, and inflammation.
• Necrotizing fasciitis (“flesh-eating bacteria”) – A rare but serious infection in which the bacteria that enters the body through a cut in the skin destroys skin, muscle, and other tissue it comes into contact with. Surgery to remove the dead tissue is usually required.
• Osteomyelitis – Infection of the bone
• Septic arthritis – A severe, painful infection that destroys the cartilage cushioning a joint. The germs causing the infection may travel to the joint via the bloodstream. If immediate treatment isn’t obtained, it can lead to infection of the bone (osteomyelitis). Surgery and intravenous antibiotics are usually needed.

Nerves transmit messages between your brain and your muscles or organs. In the upper extremity, there are many nerves that run down the arm and into the hands, including the radial, median, and ulnar nerves. These nerves allow you to move your hands, wrists, and fingers, and experience certain sensations.

When a nerve is irritated, compressed, or otherwise injured, it can cause a range of symptoms, including tingling, numbness, and pain. It can also restrict movement in the area.

Carpal tunnel syndrome is probably the most common nerve injury affecting the hand – and the one most people have heard of. It occurs when the median nerve is compressed at the wrist, causing pain and weakness in the hand, wrist, or forearm.

Depending on the location and severity of the injury, mild nerve injuries may heal themselves, although surgery may be required, especially if a nerve is severed. Rest, supportive bracing, and physical therapy are often recommended for nerve injuries to the hand and wrist.

The radial nerve runs the length of your arm. It allows you to extend your fingers and wrist and provides sensation in parts of the hand.

Radial tunnel syndrome occurs when the nerve is pinched as it passes through a small tunnel located on the top of the forearm made up of muscles, tendon, and ligaments. Tumors, inflammation, or trauma can result in radial nerve compression.

Interestingly, because the radial nerve controls movement more than sensation, muscle pain and weakness in the forearm are the usual symptoms, rather than tingling or numbness. But when these latter symptoms occur, they may be felt in the arm, wrist, or fingers.

Supportive gear such as a splint is the usual first-line therapy for radial tunnel syndrome. In some cases, surgery may be required to alleviate pressure on the radial nerve.

There are dozens of bones in the hand and wrist. The scaphoid is one of the carpal bones that form two rows of small round bones in the wrist and is located near the base of the thumb.

Scaphoid fractures are the second-most common type of wrist fracture, after breaks in the radius bone of the forearm where it meets the wrist. These fractures occur due to trauma, typically when a person uses an outstretched hand in an attempt to break a fall.

Treatment of a scaphoid fracture will depend on the location and severity of the break. The closer the break is to the thumb, the greater the likelihood that nonsurgical measures such as the use of a cast will work. The farther the break is from the thumb, the more difficult the healing process because the area does not receive a good supply of blood, which is necessary for healing. In these cases, surgery may be necessary.

Tendons are strong fibrous cords of collagen that connect muscle to bone for proper body movement and function. Tendons can be injured in a number of ways such as partial or complete tears (ruptures), or by becoming irritated and inflamed.

An example of the latter is tendonitis, which is often due to repetition of a particular movement over time. It can also occur due to an acute injury, although this is less common.

In the hand and wrist, it is the extensor tendons and flexor tendons that are prone to injury.

Extensor tendons run along the bones of the back of the hands and fingers. They allow the fingers, thumb, and wrist to straighten (extend). Flexor tendons are located on the palm side of the hand, and they help bend (flex) the fingers.

Both types of tendons are located just under the skin, making them susceptible to injuries such as cuts or trauma. Chronic conditions like arthritis can weaken tendons, increasing the likelihood of a tear.

Depending on the severity of the injury, rest, splinting, or surgery may be required.

Trigger finger or trigger thumb describes a catching and locking of a finger or thumb, when the finger or thumb becomes stuck in the bent position and then suddenly snaps straight.

The condition is also called stenosing tenosynovitis. It occurs because the tendon becomes unable to move as easily and freely as it needs to in order to bend and extend the fingers.

People with diabetes, rheumatoid arthritis, and gout are more susceptible to trigger finger.

Anti-inflammatory medication, splints, and steroid injections may help the condition. Surgery and hand therapy may be required in some cases.