Of all hand and wrist injuries, the distal radius fractures of the wrist are the most common, and the incidence of these injuries typically increases during winter months. The surgeons at Orthopaedic Associates of Muskegon are highly experienced in treating these common injuries and utilize the latest technology in plate and screw fixation when surgery is necessary. Below are a few of the common hand and wrist conditions treated.
Carpal tunnel syndrome is a common source of hand numbness and pain. It is more common in women than men. Carpal tunnel syndrome is caused by pressure on the median nerve traveling through the carpal tunnel.
The carpal tunnel is a narrow, tunnel-like structure in the wrist. The bottom and sides of this tunnel are formed by wrist (carpal) bones. The top of the tunnel is covered by a strong band of connective tissue called the transverse carpal ligament. The median nerve travels from the forearm into the hand through this tunnel in the wrist. This nerve is responsible for thumb, index, and middle finger sensation. The tendons that bend the fingers and thumb also travel through the carpal tunnel.
Carpal tunnel syndrome occurs when the tissues surrounding the tendons in the wrist swell and place pressure on the median nerve. Swelling occurs as a result; which leads to crowding of the nerve causing pain and numbness.
Many things contribute to the development of carpal tunnel syndrome:
To determine whether you have carpal tunnel syndrome, your doctor will discuss your symptoms and medical history. He or she will also examine your hand and perform a number of physical tests.
Electrophysiological tests. Electrical testing of median nerve function is often done to help confirm the diagnosis and clarify the best treatment option in your case.
For most people, carpal tunnel syndrome will progressively worsen without some form of treatment. It may, however, be modified or stopped in the early stages. For example, if symptoms are clearly related to an activity or occupation, the condition may not progress if the occupation or activity is stopped or modified.
If diagnosed and treated early, carpal tunnel syndrome can be relieved without surgery. In cases where the diagnosis is uncertain or the condition is mild to moderate, your doctor will always try simple treatment measures first:
For additional information about treatment, we have included this complete patient eduction sheet as a pdf to view, download and print:
The most common symptoms are:
There are several suggested causes for cubital tunnel syndrome. Part of the reason might reside in the very way the elbow is designed to work. One common factor might be the constant bending of the elbow itself–reaching, lifting, or pulling levers. When this occurs, the ulnar nerve is stretched several millimeters. At times the ulnar nerve will shift or snap over the bony point on the inside of the elbow called the medial epicondyle. Over time, this can progressively irritate the nerve, resulting in the pain, tingling, and numbness along with weakness of some of the muscles of the hand and forearm. Nerve damage can result. The ulnar nerve can also be damaged from trauma inflicted directly to the cubital tunnel.
De Quervain’s tendinitis occurs when the tendons around the base of the thumb are irritated or constricted. The word "tendinitis" refers to a swelling of the tendons. Thickening of the tendons can cause pain and tenderness along the thumb side of the wrist. This is particularly noticeable when forming a fist, grasping or gripping things, or when turning the wrist.
Two of the main tendons to the thumb pass through a tunnel (or series of pulleys) located on the thumb side of the wrist. Tendons are rope-like structures that attach muscle to bone. Ten-dons are covered by a slippery thin soft-tissue layer, called synovium. This layer allows the tendons to slide easily through the tunnel. Any swelling of the tendons located near these nerves can put pressure on the nerves. This can cause wrist pain or numbness in the fingers.
De Quervain’s tendinitis is caused when tendons on the thumb side of the wrist are swollen or irritated. The irritation causes the lining (synovium) around the tendon to swell, which changes the shape of the compartment. This makes it difficult for the tendons to move as they should.
Tendinitis may be caused by overuse. It can be seen in association with pregnancy. It may be found in inflammatory arthritis, such as rheumatoid disease. De Quervain’s tendinitis is usually most common in middle-aged women.
Signs of De Quervain’s tendinitis:
The Finkelstein test is conducted by making a fist with the fingers closed over the thumb and the wrist is bent toward the little finger. The Finkelstein test can be quite painful for the person with De Quervain’s tendinitis.
Tenderness directly over the tendons on the thumb side of the wrist is a common finding with this test.
The radius is the larger of the two bones of the forearm. The end toward the wrist is called the distal end. A fracture of the distal radius occurs when the area of the radius near the wrist breaks.
Distal radius fractures are very common. In fact, the radius is the most commonly broken bone in the arm. The break usually happens when a fall causes someone to land on their outstretched hands. It can also happen in a car accident, a bike accident, a skiing accident, and similar situations.
Sometimes, the other bone of the forearm (the ulna) is also broken. When this happens, it is called a distal ulna fracture.
A broken wrist usually causes immediate (acute) pain, tenderness, bruising, and swelling. Frequently, the wrist hangs in an odd or bent way (deformity).
The doctor will take an X-ray of the wrist. This is important to understand the extent of the injury.
Osteoporosis (decreased density of the bones) can make a relatively minor fall result in a broken wrist. Many distal radius fractures in people older than 60 years of age are caused by a fall from a standing position. A broken wrist can happen even in healthy bones, if the force of the trauma is severe enough. For example, a car accident or a fall off a bike may generate enough force to break a wrist.
Good bone health remains an important prevention option. Wrist guards may help to prevent some fractures, but they will not prevent them all.
Dupuytren's contracture is a condition that affects the palmar fascia, the connective tissue that lies beneath the skin in the palm of the hand. The condition causes contractures, or tightening of this tissue in the hand. Because of the contractures, the fingers can become permanently flexed and the function of the hand is impaired.
The palmar fascia is a thick tissue that lies above the tendons and below the skin of the hand. The fascia is attached both to the skin above and to structures below. Through these attachments the palmar fascia acts as an anchor to enhance the grip ability of the hand. In Dupuytren's, the fascia becomes diseased and thickened, which leads to the finger contractures.
There is no effective means by which the course of Dupuytren's disease can be altered, so the early, nodular stages are usually a case of observation only. Patients are generally seen by a physician every few months to monitor the extent of the condition.
The wrist and hand have many small joints that work in conjunction with each other to produce motion. This provides individuals the exquisite dexterity required to tie a shoelace or thread a needle. However, when joints become afflicted with arthritis, daily activities can become difficult. Arthritis can appear in only one or multiple joints of the wrist and hand.
Cartilage works as a natural "shock absorber." It provides a smooth, gliding surface for joints. With this loss of cartilage, the joint is deprived of its painless, mobile area of motion. Once cartilage is lost, our bodies cannot replace it. This condition is termed "arthritis."
The body attempts to accommodate the lost cartilage by producing extra tissue in the joint lining (termed synovium). In addition, the joint lining creates more of the lubricating (synovial) fluid that is normally found in joints. This addition of extra tissue and fluid causes the joint to swell, thus restricting motion. The swelling also causes stretching of the joint covering, which in turn causes further pain. With time, the bones of the joint can lose their normal shape as bone spurs form. This creates even more pain while further limiting motion.
Statistics indicate that approximately 20 percent of people living in the United States suffer with symptoms or signs of arthritis in at least one joint. Nearly half of all arthritis sufferers are under 50 years old. In fact, arthritis ranks as the leading cause of disability in the country. The precise number of individuals with arthritis in the wrist and hand is unknown.
The two most common types of arthritis are degenerative and inflammatory. Degenerative arthritis (also named osteoarthritis) is most common, and can occur from "wear and tear" on the joints and generally affects older individuals. Some younger patients, especially women, are often afflicted by osteoarthritis of the thumb. Another subset of younger patients who develop osteoarthritis is those with a history of injury about a joint, a condition termed post-traumatic arthritis. The most common injuries that lead to arthritis are fractures, especially fractures that involve the joint surfaces.
The second type of arthritis is inflammatory arthritis, which is often associated with systemic symptoms that may appear throughout the individual's body. The most common form of this type of arthritis is rheumatoid arthritis, and other common forms are psoriasis and lupus.
The development of arthritis does not necessarily have to result in a sedentary or painful existence. Early treatment is essential to helping the individual maintain a healthy and active lifestyle.
The extensor tendons, which are located on the back of the hand, allow individuals to straighten the thumb and fingers. These tendons originate from the muscles in the forearm. The tendons become thin and flat as they continue on into the fingers of the hand. It is these small tendons that allow for coordination and delicate finger motions.
Extensor tendons are located just beneath the top surface of the skin, directly on the bone, and on the back of the fingers and hands. Due to their location, these tendons are often injured. Even the common trauma of jamming a finger could cause these thin tendons to rip away from their attachment to the bone. After an injury of this type, it may prove difficult to straighten one or more of the finger joints. Treatment is required to help return the tendon to normal functionality.
A mallet finger is caused when the extensor tendon which helps to extend the knuckle of the finger closest to the tip of the finger is pulled off the bone. When an object such as a ball strikes the tip of the finger or thumb, the force of the blow damages the thin tendon required to straighten the finger. This type of injury is often referred to as a "baseball finger." The injured finger may droop noticeably and is usually swollen, bruised, and very painful.
For additional information about treatment, we have included this complete patient eduction sheet as a pdf to view, download and print:
Arthritis is a condition that irritates or destroys a joint. Although there are several types of arthritis, the one that most often affects the joint at the base of the thumb (the basal joint) is osteoarthritis (degenerative or "wear-and-tear" arthritis).
The joint at the base of the thumb, near the wrist and at the fleshy part of the thumb, enables the thumb to swivel, pivot, and pinch so that you can grip things in your hand. Osteoarthritis occurs when cartilage (a substance that covers the base of the joints) begins to wear away.
Your physician will ask you about your symptoms, any prior injury, pain patterns, or activities that aggravate the condition. One of the tests used during the examination involves holding the joint firmly while moving the thumb. If pain or a gritty feeling results, or if a grinding sound (crepitus) can be heard, the bones are rubbing directly against each other. The physical examination may show tenderness or swelling at the base of the thumb.
An X-ray may show deterioration of the joint as well as any bone spurs or calcium deposits that have developed.
Many people with arthritis at the base of the thumb also have symptoms of carpal tunnel syndrome, so your physician may check for that as well.
Trigger finger limits finger movement. When you try to straighten your finger, it will lock or catch before popping out straight. This is a condition that affects the tendons in your fingers or thumb.
Tendons are tissues that connect muscles to bone. When muscles contract, tendons pull on bones. This is what causes some parts of the body to move. The tendon sheath attaches to the finger bones and keeps the flexor tendon in place as it moves.
The flexor tendons control the movements of the fingers and thumb. When you bend or straighten your finger, the flexor tendon slides through a snug tunnel, called the tendon sheath; this keeps the tendon in place next to the bones.
The flexor tendon can become irritated as it slides through the tendon sheath tunnel. The tendon sheath may also become irritated over time. Trigger finger occurs when the tendon becomes “stuck” at the opening of the tunnel. You might feel a “pop” as the tendon slips through the tight area and your finger will suddenly shoot straight out.
The cause of trigger finger is usually unknown. There are factors that put people at greater risk for developing it:
Symptoms of trigger finger usually start without any injury, although they may follow a period of heavy hand use. Symptoms may include:
Stiffness and catching tend to be worse after inactivity, such as when you wake in the morning. Your fingers will often loosen up as you move them.
Sometimes, when the tendon breaks free, it may feel like your finger joint is dislocating. In severe cases of trigger finger, the finger cannot be straightened, even with help. Sometimes, one or more fingers are affected.
Your doctor can diagnose the problem by talking with you and examining your hand. No other testing or x-rays are usually needed to diagnose trigger finger.
Ganglion cysts arise from the capsule of a joint or the sheath of a tendon. They can be found at different places on the wrist. A ganglion cyst that grows on the top of the wrist is called a dorsal ganglion. Others are found on the underside of the wrist between the thumb and your pulse point, at the end joint of a finger, or at the base of a finger. Most of the time, these are harmless and will often disappear in time.
A ganglion cyst contains a thick, clear, mucus-like fluid similar to the fluid found in the joint. No one knows what triggers the formation of a ganglion. Women are more likely to be affected than men. Ganglia are common among gymnasts, who repeatedly apply stress to the wrist.
Wrist tendonitis is one of the most common causes of wrist pain. This condition is primarily characterized by inflammation and irritation of the tendons surrounding the wrist joint. Wrist tendonitis is also called tenosynovitis, and it usually affects one of the wrist tendons, but it may also involve two or more tendons. In most cases, wrist tendonitis develops at those points where the tendons cross each other or pass over a bony prominence.
As wrist tendons pass by the wrist joint, they slide through sheaths that contain fluid. These tendon sheaths are designed to allow the tendons to glide effortlessly with little friction.
Wrist tendonitis becomes a problem when the tendon sheath becomes thickened and begins to constrict the smooth gliding motion of the tendons. The accompanying inflammation also makes the movements painful.
Injuries can happen anytime so we have immediate appointments available at our Muskegon office. Our orthopaedic urgent care is open to accommodate same day visits for the evaluation of hand and wrist injuries.