The hand and wrist comprise numerous small bones that could be fractured due to high impact when hit by a hard surface or fall to the ground on an outstretched hand. Diseases like arthritis and osteoporosis weaken bones making them fragile and thin, leaning towards easy bone fractures. One or more bones in the hand or wrist could be subject to breaking or cracking causing swelling and unending pain. Instant treatment help lessen pain, stiffness and also prevent misalignment, infection or evolution of other complications interfering with routine activities.
Diagnosis is grounded on physical and internal examination. An orthopedist checks for bruises, swelling, restricted range of motion and deformity due to fracture. An imaging test is demanded to get an internal view, spotting possible damage to blood vessels, tissues and the presence of bone fragments that need to be removed before essential repairs.
Mild injuries are curable through external methods like immobilizing hand joints by a cast, splint or brace whereas surgery is the only remedy to correct severe fractures. Surgical procedures include:
- Pinning of fracture after aligning to let it heal in a proper position, later on, pins are removed.
- External fixation is structured above the hand with pins through the skin into both sides of the fracture. Externally pins are connected by wires and bolts. Desirable alignment could be achieved by adjusting bolts. This provides high immobilization and is kept until the fracture heals.
- In cases where healing doesn’t take place on its own, a bone graft is secured at the affected bone to initiate healing. Pins, plates, screws or rods are incorporated to hold the bone in position.
In both cases, certain painkillers and anti-inflammatory drugs are prescribed for oral administration followed by physiotherapy after the fracture heals for keeping healthy motion intact.
The exact cause is variable but hand and wrist pain may arise because of an injury like fracture or sprains, repetitive stress over hand joints, and a disease or syndrome. It is essential to consult a doctor if the pain doesn’t get better through the icing, rest or compression. A delay could prove crucial and depreciate condition. An orthopedist gives a physical examination to your hand looking for cuts, bruises, tender areas, swelling, deformity and moving the hand to check motion disturbances. Observation of internal damages is managed by bringing in imaging tests comprising x-ray, CT-scan, MRI, bone scan and ultrasound. The doctor may consider hand and wrist arthroscopy to mark the cause more precisely. He even makes repairs through the arthroscopic procedure as it holds a high standard as a diagnostic and surgical method. Further, an electromyogram is ordered to explore nerve damage. Blood tests reveal if the pain is due to an infected joint.
Based on test results treatment plan is developed consisting of medications for pain and inflammation. Physical therapy is provided to see if the condition improves without surgery however the patient is put on to certain exercises after recovery from an operation. Surgical procedures contain removal or repair of bone fragments, ligament release, and tendon repair. Under any circumstances, the hand is immobilized through a cast or splint for betterment.
Joint inflammation which is known as arthritis has many forms but the hand and wrist are subject to three common ones namely:
- Rheumatoid arthritis, when the body’s immune system attacks and damage healthy body tissues like cartilage and ligaments.
- Osteoarthritis, the degeneration of cartilage with the growing age due to constant use of joints.
- Post-traumatic arthritis may develop over time after an injury, causing direct damage to the cartilage.
Symptoms vary among patients some experience severe while others mild reliant on certain factors and their activity pattern. A person affected with hand and wrist arthritis feel pain, swelling, and stiffness in the joints. Reduction in the range of motion and weakness is felt make it hard to grip the objects. Bending fingers or moving wrist become painful. An orthopedist inquires about medical history and description of symptoms prevail. He looks for tender areas overhand, moves a hand in various directions to check the range of motion, joint instability, and swelling. Internal evaluation is based on an x-ray to see damage to the cartilage in case of osteoarthritis and blood tests if he suspects the occurrence of rheumatoid or any inflammatory arthritis.
Complete eradication of arthritis is not possible but the frequency of symptoms could be reduced, relieving pain and improving functionality. Non-surgical treatment comprises immobilization of the hand and wrist through a splint or cast for a short period to reduce stress over joints. Oral medications and sometimes steroid injections are administered to relieve pain and inflammation. Patients are guided to practice certain hand and wrist exercises for improvement. Surgical treatment is instigated if no improvement is seen through other remedies. It includes the removal of three bones in the wrist (proximal row corpectomy) to reduce pain due to motion. The affected joint may be welded to restrict movement permanently through the bone fusion technique. This method is conceived when the motion of a joint is the reason for pain. Under crucial circumstances, an arthritic joint is replaced with a prosthetic one to provide immediate pain reduction. In any case, the motive is to ease pain and bring back peaceful mobility.
Tendon or ligament injury
The hand and wrist are composed of many small bones accompanied by tendons, ligaments and muscles that provide stability and support movement of joints between bones. An injury to ligaments is termed a sprain and those of tendons is strain. Ligaments connect bones while tendons are a source of attachment for muscles to bones. Repetitive use of fingers like typing or writing puts stress over joints, giving way to such injuries. Contacting the hand with a hard surface during sports or falling on an outstretched hand could also be a reason for tendon or ligament damage. Pain, swelling, tenderness and restricted range of motion are symptoms an orthopedist inquire while physical examination. Internal evaluation is made on visuals attained after imaging tests, including x-ray, CT-scan, and MRI. A popping is heard or felt at the instance of injury which the doctor may ponder as a part of an investigation.
Stretched ligament and tendon can be treated by immobilizing the hand through a cast or splint. It provides rest to the joints and helps in recovering naturally. Oral medication is provided to reduce pain and inflammation. Physical therapy could also help improve range of motion and strengthen ligaments or tendons. When a tear occurs surgery becomes essential for necessary repairs. The torn ligament is sewn back and held in place using surgical hardware like pins, plates, screws, staples however if a ligament is too short to stitch back reconstruction method is incorporated. A graft tendon is extracted from a healthy joint and secured at the injured site providing ground for ligament restoration.
Carpal tunnel syndrome
A Carpal tunnel is a pathway lying between wrist and palm, surrounded by ligaments and bones. The median nerve runs from the forearm, through this passage in the wrist into the palm of a hand. A compression to the median nerve cause tingling sensation and numbness in the hand giving shape to carpal tunnel syndrome. With this condition, a patient feels weakness in the arm and hand due to a lack of feeling. Losing grip on things and dropping objects is the major symptom. However, symptoms develop gradually. Wrist fractures, activities that put stress over the wrist or swelling and inflammation due to arthritis can put pressure on the median nerve.
An orthopedist effort to explore the patient’s medical history and activities that trigger the symptoms. Then proceed by giving physical examination, checking feeling in fingers and muscles strength. Bend the wrist, tap the nerve as in some cases instant pressure over the median nerve trigger symptoms. It is important to have an x-ray which a doctor pursue to exclude other possible reasons. Other prescribed tests include electromyography and nerve conduction to examine electrical nerve impulse activity.
Immediate remedy advised is giving rest to the hand and wrist, abstain from activities that aggravate the symptoms, and should apply cold compresses for reducing swelling and soothing inflammation. After viewing test reports doctor will immobilize the wrist through splinting, painkillers are prescribed and steroids are injected directly to the affected area for relief. Still, if the symptoms persist or are severe and hindering daily work. The situation is improved by releasing pressure over the median nerve via cutting the bothersome ligament. The procedure is either done through endoscopy using a device with a camera or by open surgery.
A ganglion cyst is a non-cancerous, painless fluid-filled lump formed beside joints or tendons of the hand and wrist. It secures a substance akin to lubricating fluid for joints. Oval or round shape could be as small as a pea or may expand one inch in diameter. Pain doesn’t arise unless this lump put pressure over nerves passing by. Common symptoms associated are interference to joint movement, tingling sensation and muscle weakness. Usually, it sources no issue and vanishes on its own but if a cyst hinders work efficiency it requires treatment.
A lump is visible over the skin like a swelling, an orthopedist press the cyst to check for tenderness and any discomfort it causes. He even does a light test to confirm it’s a solid body or a transparent fluid. X-ray, MRI, and ultrasound is conceived to rule out other possible causes. Further, aspiration is done to extract fluid specimens for laboratory tests through a needle. Once diagnosed, a hand is immobilized using a splint or brace for a short span to release the pressure over nerves due to motion. In a few cases, fluid is drained by aspiration procedure or cyst is removed through surgery but there’s no guarantee of cyst recurrence.
An injury, repetitive use, strain, diseases like arthritis, diabetes or overuse of tendons in the hand and wrist can arise a condition referred to as tendinitis. Tendons connect muscles to bones playing a significant part in joint movement. Tendinitis cause swelling, pain while straightening or bending fingers. Tendons inflammation could hinder motion, interfering with routine activities like writing, gripping, pinching, or throwing. Symptoms such as grating or grinding of joint while motion, pain and swelling are experienced.
Diagnosis is proceeded through physical examination, exploring the medical history and inquiring about daily activities triggering symptoms. An orthopedist moves the hand joints to check the range of motion and test grip over things. X-ray or MRI may be ordered to drive out other possible causes. Once diagnosed, tendinitis is treated through immobilization of the hand providing complete rest. Physical therapies, massages, stretching exercises as guided by the doctor helps to improve. Oral medicine is prescribed for inflammation and pain relief. Cases, where non-surgical procedures are of no help treating tendons through surgery, is the best decision to make. Injured tendons are sewn back to bone using surgical hardware or tendon grafting is made by extracting a tendon from a healthy joint, implanting it in the affected one to restore function. An open wrist surgery may be performed by making an incision over the affected area, removing damaged tissues and releasing inflamed tendons. Other surgical methods include minimally invasive procedures like arthroscopy, surgery made through inserting an arthroscope or tenotomy, a procedure where the surgical needle is inserted and guided through ultrasound or x-ray into the wrist for cutting the affected tendon. Under both procedures, the wound heals quickly as an incision is small and the patient recovers quickly.
Condition get up as tendon in a hand suffer wear and tear due to an injury. People using their hands most frequently putting stress over tendons are prone to such ailment. Sportsmen who usually have to make contact with hard surfaces like basketball players, typists whose routine activity is to type consistently and an aged person are reported with such complaints. On a visit to a clinic, an orthopedist inquires about the matter physically looking for bruises, swelling, inflammation, and pain due to motion. He may demand imaging tests like x-ray, MRI or CT-scan for further assurance. Common symptoms detected are a popping sound at the instance of injury, weakness, bruising, pain, and difficulty in hand or wrist motion.
The worn tendon usually repairs naturally on its own after joint immobilization and certain medications to relieve pain and inflammation. But, under circumstances where it doesn’t get better surgery is conceived for mending. Restoration is made by confiscating dead tissues and sewing torn tendons using surgical hardware. If a tendon is too short to stick back, tendon grafting is instigated wherein a tendon is extracted from a healthy joint and secured to the affected area for regrowth. Arthroscopic or open surgery, the decision is made over the patient’s health condition and nature of the damage.
Osteomyelitis is a condition that occurs due to bone contamination. The major reason for this infirmity come out to be an infection that travels through the bloodstream into bone, maybe due to nearby infected tissue and exposure of hand or wrist bone to germs through an injury or past surgery. Diabetic patients are more at risk of getting osteomyelitis. It cannot be ignored as delay give shape to septic arthritis. An orthopedist physically examines the patient’s hand figuring out the area with warmth, redness, swelling and pain. Fever is the major symptom pointing towards the existence of infection within the body.
A blood sample is taken and a laboratory test is recommended to investigate the presence of any blood infection. Imaging tests are prescribed to check the nature of damages caused. If nearby nerves, blood vessels and other soft tissues are spoiled because of progressing infection, surgical repairs become essential. Bone biopsy is adhered to reveal the type of germs that infected the bone. This makes it easy to select the most appropriate antibiotic to go for. Whether open or arthroscopic surgery depends on the severity of the condition. However minimal invasive methods prove best with quick recovery and shorter hospital stay. Pus if present is drained and dead bone cells are removed, blood flow is improved towards the bone, and foreign object is detached. Surgery is followed by doses of antibiotics either orally or under extreme conditions injected into the blood. Hand amputation is the ultimate solution if an infection is incurable and suspected to advance further damaging other body parts, arising life-threatening conditions.