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.

Hand Anatomy

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.

Wrist 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.

Can I use traditional or “alternative” medicine instead?

You should never allow a “bone setter”, chiropractor or traditional medicine practitioner to manipulate an injured finger, hand or wrist without an X-ray confirming that there isn’t a fracture or dislocation.

Such manipulation may cause more injury or delay the diagnosis, making the treatment more difficult and the outcome poorer.

How are the fractures treated?

All fractures require immobilisation of the bone to allow it to heal. Usually, healing takes six weeks for adults and three to four weeks for children. During this time, the broken bone ends and the joints at either end of the fractured bone must be immobilised. Fractures that are displaced or deformed need to be manipulated to make the bone straight and bring the ends together to allow them to heal without deformity. The most common way to immobilise the fracture is to put the hand or wrist in a cast. However, some fractures are too unstable and may shift in the cast. A surgery called “open reduction internal fixation” or ORIF is needed to fix them with metal wires, plates or screws. ORIF is also necessary when perfect alignment is needed. Even simple fractures that are not badly displaced can benefit from ORIF, which allows immediate use of the hand, instead of putting it in a cast for four to six weeks.

Physical therapy is frequent needed after the fracture heals to regain mobility, strength and function in the hand. If the fracture has been fixed surgically, therapy starts immediately after surgery, without waiting for it to heal, as the metal implants prevent the fracture from moving. This allows much faster return to full function.

What is the outcome?

It is vital for hand and wrist fractures to be treated by an experienced orthopaedic surgeon. Poorly fixed or badly managed fractures result in permanent deformity and stiffness, greatly impairing hand function. More complex surgery may be needed later to correct the deformity and restore function. If diagnosed and treated appropriately, most fractures heal with minimal deformity and goof hand function can be expected.

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Brief Outline of Wrist Tendinitis

Wrist tendinitis is due to irritation and inflammation of one or more tendons around the wrist joint. Wrist tendinitis tends to occur in areas where the tendons cross each other or pass over an underlying bony structure, and affects individuals involved in strenuous and repetitive training.

Anatomy and physiology

The joint of the wrist is formed at the proximal end by the distal surfaces of the radius and ulna and a disc of fibrocartilage, and at the distal end by the scaphoid, lunate, and triquetral bones. The wrist helps orient and support the hand. Tendons of the wrist are encased in tendon sheaths known as the tenosynovium. Such sheaths provide for the smooth, friction-free sliding of tendons in the wrist. Swelling, irritation, and inflammation of the tenosynovium causes a thickening of the sheath, which constricts proper movement of the tendons, resulting in pain and a related affliction, tenosynovitis. Most wrist tendinitis occurs where a tendon passes through constricted tunnels of fascia. Four common sites of tendinitis are the first dorsal compartment (De Quervain’s tenosynovitis), digital flexors (trigger finger), flexor carpi radialis tendinitis, and lateral epicondylitis, (the latter associated with tennis elbow). The abductor pollicis longus and extensor pollicis brevis are also commonly affected.

De Quervain's Disease

Cause of Wrist Tendinitis

Sports involving wrist overuse, including all ball sports, racket sports, rowing, weightlifting, gymnastics, etc. Repetitive stress from typing. Other wrist overuse, as is common to nursing mothers.

Signs and symptoms

Pain in the wrist, particularly at the joint. Inflammation in the region of the affected tendon(s). Limited mobility in the affected wrist.

Complications if left unattended

If the activity causing tendinitis is continued and the condition left untreated, the inflammation and associated pain can worsen. The condition can also lead to permanent weakening of the tendon(s).

Treatment

  • Injection
  • Physiotherapy
  • Surgery

Rehabilitation and prevention

Often, a physician will use a splint or brace to prevent movement of the injured wrist. In athletic events, tendinitis sometimes results from improper technique. the best therapy for tendinitis is to restrict or temporarily discontinue the activity causing tendon inflammation.

Long-term prognosis

Most enjoy a full recovery from tendinitis, providing the affected wrist is permitted proper recuperation from inflammation.

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Brief Outline of Wrist Ganglion Cyst

A ganglion (Greek: knot of tissue) cyst is a bump or mass that forms under the skin. They can occur at any joint or tendon sheath, but most often on the back of the wrist or on the fingers. Ganglion cysts are probably the most common lumps that occur in the hand. Most often, ganglion cysts occur in the 25-45 year old age group, and they are more common in women than they are in men. Ganglion cysts are benign tumours (so do not spread to other body areas), and their cause is unknown. Sometimes they are also called synovial hernias or synovial cysts because of their relationship to the synovial cavities in the joint. Also known as subchondral cysts.

Ganglion Cyst Wrist

Anatomy and physiology

Ganglion cysts are thin, fibrous capsules containing a clear, mucinous fluid, and feel soft and moveable. Ganglion cysts have a smooth translucent wall, generally connected to an underlying joint capsule or ligament via a think stalk. Ganglion cysts can involve any joint in the hand or wrist, mainly occur on an aponeurosis  or tendon, and are palpable between the extensor tendons. The ganglion cyst forms when tissue around the joint becomes inflamed and swells with fluid. As this happens, the balloon-like ganglion grows in the connective tissue of the joint or even in the membrane that covers the nearby tendon. Often, cysts associated with the scapholunate ligament or scaphotrapezial joint of the wrist. Most cysts occur at the dorsal wrist, volar wrist, and volar retinacular of distal interphalangeal area.

Cause of Wrist Ganglion Cyst

Flaw in the joint capsule. Flaw in the tendon sheath. Tissue trauma.

Signs and symptoms

Swollen sac-like area, which changes size. May or may not produce pain. Wrist weakness.

Complications if left unattended

Most ganglion cyst disappear without treatment, though in some cases, they recur over time. Such cysts generally do not pose a serious health risk, even if left untreated, though pain and weakness of the wrist may persist without medical care.

Treatment

  • Needle aspiration
  • Surgically removal

Rehabilitation and prevention

Cysts may be drained of fluid by a physician. The patient should not attempt this. Often, cysts will gradually disappear without draining or surgical intervention, though they may recur. If the ganglion cyst is painful, sports involving intensive use of the wrist should be limited or avoided until shrinkage or disappearance of the cyst.

Long-term prognosis

Cysts may be asymptomatic and self-limiting. Should medical attention be required, the prognosis for full recovery is excellent.

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Brief Outline Of Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is a progressive affliction caused by direct trauma or repetitive overuse, which results in squeezing or compression of the median nerve at the wrist. The condition is three times more likely to affect women, largely due to occupational tasks such as keyboard work.

Anatomy and physiology

The carpal tunnel is a narrow, rigid structure composed of ligament and bone at the base of the hand. This nerve runs from the forearm to the hand and transmits sensation from the palm side of the thumb and fingers, as well as impulses to certain small muscles of the hand involved in movement. The tunnel surrounds the median nerve (which enters the hand between the carpal bones), and tendons. A narrowing of the tunnel may occur as a result of irritated or inflamed tendons, leading to pressure and compression of the median nerve, causing pain, weakness or numbness in the hand, which gradually radiates up the arm. The conditions is one of a variety of entrapment neuropathies – afflictions involving compression or trauma to peripheral nerves.

Carpal Tunnel Syndrome

Cause of Carpal Tunnel Syndrome

Sporting activities that involve repetitive flexion and extension of the wrist, e.g. cycling, throwing events, racket sports, and gymnastics. Congenital predisposition. Trauma or injury including fracture or sprain. Occupational tasks.

Signs and symptoms

Burning, numbness or itching in the palm of the hand and fingers. Sensation of finger and wrist swelling. Decreased grip strength. Pain that may wake the individual during the night.

Carpal Tunnel Syndrome

Complications if left unattended

Left untreated, carpal tunnel syndrome can lead to decreased or absent sensation in some fingers and permanent weakness of the thumb, as muscles of the thumb degenerate. Proper sensation of hot and cold temperatures may also be diminished in untreated CTS cases.

Treatment

  • Oral Medicines
  • Injection
  • Physiotherapy
  • Surgery if all conservative treatment fails

Rehabilitation and prevention

Halting the repetitive sport or activity and allowing for rest and rehabilitation time following diagnosis of carpal tunnel syndrome is essential. A bandage or splint may be used to stabilise the injured hand. Releasing the tension in the wrist and hand during sports and periodic exercises to retain mobility and retard stiffness in the hands may help prevent the onset of CTS.

Long-term prognosis

Recurrence of carpal tunnel syndrome following treatment is rare, (except in cases of underlying disease, diabetes, endocrine disorders, etc.). The majority of patients properly attending to the injury recover completely.

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Brief Outline of Wrist Dislocation

Most dislocations of the wrist involve the lunate bone, though other bones may also be involved. When a bone is dislocated, it no longer properly makes contact with adjoining bones. The injury affects the soft tissue surrounding the region of dislocation, including muscles, nerves, tendons, ligaments, and blood vessels.

Anatomy and physiology

The wrist consists of a series of radio-carpal and intercarpal articulations. However, most wrist movement occurs at the radio-carpal joint, an ellipsoid joint. The distal surface of the radius and articular disc articulates with the proximal row of carpals, which are the scaphoid, lunate and triquestral (triquetrum). Movements are in combination with the intercarpal joints. The intercarpal joints are a series of plane joints, which have articulations between the two carpal rows (midcarpal joint), plus articulations between each bone of the proximal carpal row and of the distal carpal row. The distal radio-ulnar joint is immediately adjacent to the radio-carpal joint. A cartilaginous disc separates the distal ulna and radius from the lunate and triquetral bones. An elaborate complex of ligaments holds these bones together and allows for their proper coordination. Dorsal ligaments of the wrist are weaker and more likely to be involved in dislocations.

Wrist Anatomy Bones

Cause of Wrist Dislocation

Complication of a severe wrist sprain. Hard fall on an outstretched hand. Congenital abnormality, including malformed joint surfaces.

Signs and symptoms

Loss of hand and wrist dislocation are largely unpredictable, with some cases of full recovery and restoration of movement. Complications however may restrict motion of the wrist and produce ongoing pain, joint stiffness, discomfort, and impaired flexibility and movement. Arthritis may develop in the injured region.

Treatment

  • Immobilisation using Fibreglass cast
  • Ice
  • Oral Medicines
  • Physiotherapy
  • Injection

Rehabilitation and prevention

Exercises designed to strengthen wrist muscles and ligaments will help prevent re-injury. Protection of the wrist during athletics, with gloves, wrist guards or taping may also offer some protection against wrist dislocations.

Long-term prognosis

Prognosis depends on the severity of the dislocation and any attendant complications, including fracture. Proper early treatment and appropriate rehabilitation leads to full recovery in most cases.

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