Problems Affecting the Hand and Wrist
The hand and wrist are subject to a variety of problems. Some problems are the result of how you use your hands in everyday activities – for example, sprains and strains as well as fractures can occur with lifting and carrying heavy objects, operating machinery, bracing against a fall, or sports-related injuries.
Other problems of the wrist and hand can also attributed to everyday use but are actually a chronic condition or long-term problem, including carpal tunnel syndrome, that develop over periods of time. Your hands and wrists may also be affected by systemic disease, such as rheumatoid arthritis, and those that affect primarily the joints, such as osteoarthritis.
Seeking early medical attention to hand and wrist problems is important for proper diagnosis and effective treatment, as well as for preventive measures that will provide long-term strengthening and relief. Additionally, your doctor can recommend a variety of measures that can help halt or minimize the progression of chronic problems, such as arthritis, so the impact on your daily life is lessened.
Any problem causing pain, swelling, discoloration, numbness or a tingling sensation, or abnormal contour of the hand or 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.
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- Sprains and Strains
- Ligamentous Injuries
- Repetitive Trauma Syndrome
- Carpal Tunnel Syndrome
- Rheumatoid Arthritis
- Wrist Ganglion
- Trigger Finger
Sprains and strains are the two most common types of injuries affecting the hand and wrist. They occur as a result of excessive stress applied during a stretching, twisting, or thrusting action. A sprain occurs when a ligament holding bones together is damaged. Ligaments are made up of separate fibers, and some or all of the fibers can be damaged. A strain occurs when a muscle or the sheath covering it is damaged. A muscle is also made up of groups of fibers, and some or all of the fibers can be damaged.
The severity of the injury is determined by how many ligament or muscle fibers are torn or damaged. The extent of the injury also depends on whether these fibers are just pulled and stretched or actually torn. A mild sprain or strain may cause very little damage, while a severe stress to the ligament or muscle may result in a complete tear.
The symptoms and treatment will vary depending on the amount of damage the tissue has suffered. In a mild sprain or strain, there will be mild tenderness and slight swelling at the site of injury. A severe sprain or strain will be extremely painful, very swollen, and bruised, and the function of the hand and wrist will be limited. An avulsion fracture, in which the ligament pulls a bone fragment loose or pulls the bones out of their normal position, may also occur.
Radiographic examination of the affected structures may be required to determine the extent of damage and to see if there are any fractures in the bones. These tests may include x-ray films, a CT scan, or an MRI. Occasionally, surgery will be required to repair the damage, however most sprains and strains will repair themselves with the RICE treatment formula (rest, ice, compression, and elevation).
Once swelling, bruising, or pain is gone, it is important to begin gentle exercises to regain hand strength. View the rehabilitation section of this site to learn more about exercise for the hand and wrist. If any symptoms return, however, exercises should be stopped and further evaluation considered. It is also important to review the cause of the original injury to learn how to prevent a recurrence. For example, if the injury occurred from a fall in the home, home safety may need to be improved. If the injury is from sports, proper stretching and warm up exercises or a sports brace may be helpful.
Ligaments are the soft tissues connecting one bone to another. Because ligaments do not show up on x-ray films, the ligament condition may be difficult to evaluate. Often, a diagnosis is based on symptoms and a description of how the injury occurred.
Symptoms of ligament problems depend on the severity of the trauma or injury. Ligaments are made up of several fibers and one or all of the fibers may be involved. The involvement of each fiber can vary as well. A fiber may be just partially bruised or inflamed or the fiber may be completely torn. When all of the fibers are torn, the injury is described as a complete ligament tear.
Ligaments, unlike other structures and organs of the body, do not have blood vessels that bring nutrients directly to the tissues. The synovial fluid surrounding joints is responsible for providing the nourishment for ligaments to grow and heal. For this reason, when ligaments are damaged, they require an extended period of time to heal.
A mild ligament injury may cause a minimal amount of pain and swelling and may make the use of your hand uncomfortable, but still possible. When hand ligaments tear, there is a tremendous amount of pain and swelling and the hand and wrist joints are only minimally functional.
A bone fracture, or break, occurs when the force applied against a bone is stronger than the bone. Joints are especially vulnerable to fractures because the bones that make up the joint are held together by soft tissues — the muscles, ligaments, and tendons. The bones of the hands and wrists are very small in comparison to the bones of other joints, such as the hips, knees, and shoulders, and a fracture may be caused by a severe strain of a ligament or muscle. Crushing injuries to the hand or wrist also may cause fractures.
A fracture to the hand is quite painful and there may be swelling and discoloration of the skin. Mobility of the affected area is also usually limited. The severity of a bone fracture in the wrist or hand varies significantly, and some people are not certain there is a broken bone until the injured area is evaluated by a physician. In other cases, the break is obvious.
It is important to seek medical attention anytime you think you have broken a bone. Sometimes a fracture of a finger bone can only be treated by using a splint or other traction device while the bone heals. Other breaks are more serious and first aid will be important even before you see the doctor. Anytime there is bleeding and deformity or protrusion of the bone through the skin, emergency medical attention should be obtained.
When you have to repeat similar movements over extended periods of time, such as when operating equipment at work, stress is applied to certain joints. Often, this can lead to pressure on the joints causing inflammation, pain, and decreased function in the extremity. Your hands are your primary work tools, and they are highly susceptible to repetitive trauma syndrome. The most common of these syndromes is carpal tunnel syndrome.
Some of the factors identified as being associated with the likelihood of developing a repetitive stress injury include:
- Repetitive, forceful, or prolonged exertions of the hands
- Rapid hand and wrist movement
- Frequent or heavy lifting, pushing, pulling, or carrying heavy objects
Intensity, frequency, and duration of the exposure to these conditions, coupled with your capacity to deal with the conditions, and personal factors such as age and physical condition, also have significant influence of the likelihood of developing repetitive trauma syndrome.
Carpal tunnel syndrome is characterized by numbness or pain in the thumb and first two fingers. It is a common problem for people who use their hands for extended periods of time, such as workers in textile manufacturing, upholstering, assembly line, and in clerical keyboard work.
Carpal tunnel syndrome occurs when the median nerve is compressed at the wrist. Repeated bending and extending the wrist may cause a swelling of the flexor tendons and sheaths, which then press on the median nerve as it passes through the carpal tunnel.
Numbness may first be felt in the index and second finger or in the thumb and is often noticed at night. The condition can be minimized or prevented by being sure that the wrist and hand are always in a straight line.
Carpal tunnel syndrome may be treated through immobilization, medication, therapy, or surgery. Splinting to prevent bending and extending of the wrist for a period of time is often the only treatment required. Injections of anti-inflammatory drugs such as steroids are sometimes useful either alone or in combination with other treatment. If surgery is necessary, a simple operation to loosen the transverse carpal ligament and open up the carpal tunnel often succeeds in relieving the pressure on the median nerve.
Osteoarthritis is also known as degenerative joint disease or DJD. It is a progressive degeneration of the joint cartilage. Although it primarily affects weight-bearing joints, such as the hips and knees, hands are often affected. Almost 33% of adults have some evidence of joint degeneration on x-ray examination. By the age of 60, the percentage increases to approximately 70%. Of those adults who have arthritic changes visible on x-ray, only about half say they experience significant symptoms.
Osteoarthritis may occur as a result of another disorder, such as an infection, fracture, or previous trauma. Or the cause may not be known. When the cause of osteoarthritis is unknown, it is described as primary osteoarthritis. What occurs is a gradual process resulting in damage to joint cartilage.
Cartilage is normally a smooth, white, translucent substance with nearly the same strength as bone. With osteoarthritis, the texture and strength of cartilage tissue changes to a rough, yellow, opaque, soft, and thin substance. The cartilage serves as a cushion between bony surfaces, so when it thins, the bony surfaces move closer together and begin to rub against each other. Some of the cartilage may tear away from the bone and fluid accumulates, causing swelling and further impairment of joint mobility. A progressive disease, the inflammation of arthritis continues and damage to the bony structures and cartilage increases. New bony outgrowths are formed causing joint deformities.
Several predisposing factors are known to accelerate the degenerative changes of osteoarthritis. In the hands, excessive use, for example by an artist or seamstress, can contribute to the development of osteoarthritis. Other predisposing factors include diabetes mellitus, hemophilia, or bone structure defects. Osteoarthritis appears to have a genetic influence as well.
The symptoms of osteoarthritis are primarily confined to the affected joints. This differentiates osteoarthritis from rheumatoid arthritis, which is a systemic disease, meaning it affects the entire body.
In osteoarthritis, the joints feel stiff and painful, and the affected joints are swollen. You may notice a grating sensation when the bones in the hand and wrist rub against each other. The left and right hands may be affected to different degrees. Occasionally, nodules, or new bony growths occur in the fingers. Heberden’s nodes may be seen at the ends of the fingers or Bouchard’s nodes may grow at the base of the fingers near the palm of the hand. As the disease progresses, the hand and fingers become more uncomfortable, less functional, joints may lose their normal alignment, and severe deformities may result.
Treatment of arthritis has improved dramatically over the past decade, with new medications as well as improved surgical techniques helping people find effective options.
Rheumatoid arthritis is a systemic disease that involves the entire body. It differs from osteoarthritis in that both hands will usually be affected to the same degree and in a similar way. Also rheumatoid arthritis is often accompanied by fatigue, weight loss, rashes, and generalized joint stiffness. There also may be anemia, an elevated sedimentation rate, and a “rheumatoid factor” detectable in the blood. Synovial fluid surrounding the joint can be tested for inflammation and you may experience a high white blood cell count.
Radiographic examination will indicate bone weakening and soft-tissue swelling. As the disease progresses, x-ray films will show joint-space narrowing and cartilage destruction, similar to the changes seen with osteoarthritis.
A ganglion is a small cyst filled with synovial fluid from around the joint. These cysts can usually be seen at the back of the wrist. It is usually painless, but excessive use of the hand or pressure to the ganglion may cause discomfort.
Ganglions may disappear on their own, but often return at a later date. If the ganglion is not painful and does not interfere with the use of the hand and wrist, no treatment is necessary. If the ganglion becomes painful or large, your doctor may consider using a needle to aspirate, or withdraw fluid from the cyst. Surgery to remove the ganglion may be necessary if aspiration of the fluid does not provide permanent relief.
Trigger finger is an inflammation of the tendon of one or more fingers. If you have the condition, it is usually difficult to extend or straighten the affected finger. Occasionally, when trying to open or extend the finger, it will pop or “trigger” out into a straight position.
Anti-inflammatory medications or steroid injections may provide effective treatment for a trigger finger. However, surgery may be required to repair the finger in some cases.