Good hand function depends on healthy and intact bones and joints. 31 bones from the skeleton of the hand and wrist. Between the bones are joints that allow the fingers and wrist to move. Muscles and tendon attach to the bones, moving the joints when they contract and relax. The nerves and blood vessels are supported and protected by the solid bones.
With sudden forceful impact or twisting, the bones may break causing a fracture. This can happen when one breaks a fall with the hand; during sporting activities particularly contact sports such as marital arts, basketball or football; in traffic accidents, or when working with tools. When this happens, pain, swelling and deformity will severely impair hand function. In more severe injuries, the soft tissues such as nerves and blood vessels may be injured, jeopardising the entire finger or hand. All fractures and dislocations must be treated quickly and properly to ensure that good hand function is restored.
How do I know if There is a Fracture?
If you have hit or twisted your finger or wrist, or fallen hard on your hand, you may have fractured a bone. If the hand or wrist is obviously deformed and looks abnormal, then there is probably a bad fracture or dislocation. However, even if there isn’t any obvious deformity but there is swelling, bruising and pain when trying to move a finger or wrist, then you should suspect there is a fracture.
When Should I see a Doctor?
If you think you may have a fracture or dislocation, it is important to see a doctor as soon as possible to have an X-ray taken. X-rays show the bones and joints under the skin, revealing any breaks in the bone or dislocated joints. You should see a doctor immediately if you also have an open wound, numbness in the injured finger or hand, or if the injured finger is turning blue or pale. These are signs that there is also injury to the skin, nerves and blood vessels respectively, all of which need urgent surgical treatment.
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Our hands are used almost unconsciously to get things done whether at work or at play. We seldom think about them until something is not quite right, and even then, we often push it our of mind until it becomes an obstacle to using our hands properly.
Some conditions can cause slowly progressing or chronic pain in our hands in the absence of any injury. Most can be treated and cured if diagnosed early; but if left untreated these conditions may cause significant disability. Three of the most common chronic painful hand conditions and their treatments are discussed.
Trigger finger is one of the most common painful conditions of the hand between the ages of 40 to 60. Along with pain, the affected fingers or thumb also become stiff and may “lock” when fully flexed. Straightening the fingers is difficult and accompanied by a clicking sensation. In more severe cases, one may have to use the other hand to pull the finger straight. The finger is especially stiff and prone to to locking just after waking in the morning. This condition is caused by a combination of repetitive stress on the flexor tendons of the fingers and ageing. The flexor tendons go through a tunnel along each finger. As we age, microscopic damage caused by daily friction between the tendons and the tunnel accumulates. The opening of the tunnel becomes thicker and tighter, making it more difficult for the tendon to move the finger. When the tendon gets stuck, the finger locks. The most reliable treatment is surgery to divide the tight opening of the tunnel, allowing the tendon to move freely again. Steroid injections to the tunnel are also useful, but there is a 30% chance that the condition will recur after an injection.
Trigger Finger Video
This is an inflammation and tightness of the tendons going across the wrist to the thumb caused by overuse. Young mothers are very prone to this due to hormonal changes, inexperience with carrying a baby for breastfeeding, and having to hand-wash a lot of baby clothes. Office workers who use a keyboard and mouse for long hours with poor hand and wrist posture are also prone to this. The use of tablets and smartphones requiring a lot of thumb movements to type messages is nor also becoming common cause. This condition causes pain along the border of the thumb going into the wrist and the forearm, particularly with thumb and wrist movements. Simple actions like opening doors or bottles, brushing teeth, tying hair or hooking a bra can become impossible because of the pain. Even typing on a keyboard is painful when the thumb is used. In the early stages, resting the thumb and wrist in a splint or brace and taking anti-inflammatory tablets may cure the problem. However, once it has been present for more than a month, an anti-inflammatory injection to the tendons is needed. Most, importantly, long-term changes in the way the hand and thumb are used are essential to prevent the condition from recurring. If the injection doesn’t work or the pain keeps coming back, then surgery is needed to release the tendons from their tunnel at the wrist.
Carpal Tunnel Syndrome
This is caused by excessive pressure on the median nerve as it goes across the wrist into the hand. The median nerve is the main nerve providing sensation in the hand and control of the thumb muscles. Along with the flexor tendons to the fingers, this nerve goes through a tunnel at the wrist, consisting of the wrist bones and a thick band of fibrous tissue across the top. The pressure in this tunnel increases as we grow older due to thickening of the tendons from repeated daily use. Other conditions such as wrist fractures, gout, and tumours may also increase the pressure in this tunnel. The increased pressure decreases blood flow to the nerve, impairing its function, resulting in numbness, tingling, and burning pain in the hand.
Symptoms are usually worse the morning on waking up, and sometimes can wake you from sleep. If left untreated, the nerve may become permanently damaged, with decreased sensation in the fingers and weakness of the thumb. Mild cases may resolve with resting in a splint, doing exercises for the nerve and taking high potency supplements. However, the best treatment is most cases is to decompress the nerve by cutting the band of tissue going across it. This is now done via keyhole or endoscopic surgery under local anaesthesia. Symptoms usually disappear within one to two weeks if operated on before permanent nerve damage occurs. In severe cases with permanent damage, recovery of lost function may be poor even with surgery, but surgery will prevent worsening function.
Timely surgical management can cure those common painful hand conditions
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A physical examination help determine if the syndrome are related to daily activities or to an underlying disorder and can rule out other painful conditions that mimic carpal tunnel syndrome.
What are the Causes?
Carpal tunnel syndrome is often the result of a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself. Most likely the disorder is due to a congenital predisposition. Other contributing factors include trauma or injury to the wrist that cause swelling, such as sprain or fracture. It can also be caused by medical conditions such as diabetes, arthritis, pregnancy and obesity.
What are the Treatments?
Treatments for carpal tunnel syndrome should begin as early as possible under a doctor’s direction. Initial treatment generally involves resting the affected hand and wrist for at least 2 weeks, avoiding activities that may worsen symptoms and immobilizing the wrist in a splint to avoid further damage from twisting or bending. If there is inflammation, applying cool packs can help reduce swelling. Surgery is recommended if symptoms last for more than 6 months. Surgery involves severing the band of tissue around the wrist to reduce pressure on the median nerve.
Trigger finger is a common disorder of the hand which causes painful snapping or locking of the fingers or thumb.
Trigger Finger Video
What are the causes of trigger finger?
The exact cause of trigger finger or thumb is not readily evident. In many cases, the condition may be the result of repetitive strain of the area due to work or hobby activities. Tasks that require monotonous grasping or prolonged use of tools for example scissors, screwdrivers, etc. which press firmly on the tendon sheath at the base of the finger or thumb may irritate the tendons and result in thickening of the tendons themselves or the tendon sheath. Trigger finger may also be associated with conditions such as rheumatoid arthritis, gout or metabolic disorders such as diabetes that produce changes in the connective tissues and synovium.
What are the treatments for trigger finger?
Conservative non-surgical treatment involves avoiding or modifying the activities that have caused the inflammation. Oral anti-inflammatory medications are used to reduce the inflammation or discomfort. Steroid injection may be administered directly into the tendon sheath to reduce the soft tissue swelling. In the event when it does not respond to conservative treatment, surgery may be recommended. Surgery is performed where a horizontal incision is made in the palm at the base of the affected finger or thumb. The surgeon will release the first annular band, relieving the constriction of the tendon as it passes through the sheath.