The hand and wrist are a complex series of bones, tendons, and ligaments that allow you the dexterity to do anything from writing on paper to turning a screwdriver. This system is not without its problems, and since it has so many moving parts, it can often breakdown in ways that are painful and difficult to treat.
Many patients, when confronted with a hand or wrist problem, consult a hand specialist, but some orthopedic surgeons are able to perform more simple surgeries on the hand, such as securing a fracture with screws.
Depending on the severity and type of problem you have with your hand and wrist, you may need to seek out a specialist or determine if your primary orthopedist is the doctor for your condition.
The hand and wrist are comprised of many small bones. Starting at the wrist, the radius and ulna interface with the carpals to comprise the wrist. This gliding set of bones allows for the maneuverability of the wrist against the end of the forearm.
In front of the carpals are the metacarpals that make up the hand, followed by the phalanges that make up the fingers. Any of these bones, from the forearm to the fingertips, is capable of sustaining a fracture. Usually, fixators of some type, such as screws and plates, are necessary in addition to casting when trying to heal a fractured wrist or hand.
In many cases, simple casting isn’t sufficient, and orthopedic surgery is needed.
Carpal Tunnel Syndrome
Carpal tunnel syndrome is a complex problem involving the nerves, bones, and ligaments that supply the hand. As stated above, the carpals make up the bulk of the wrist. Through these bones, the nerves, ligaments, and tendons snake their way to serve the needs of the hand.
An important nerve, the median nerve, runs through a particular opening in the bones. When this opening is compromised, due to fracture or the irritation of nearby ligaments, the nerve becomes impinged.
Although most carpal tunnel is treated by splints and ergonomics, sometimes surgery is needed to free the median nerve and provide feeling and movement to the hand.
Flexor Tendon Injuries
Flexor tendons are the strings of tissue that allow you to move and curl your fingers and thumbs. Injury to them usually means that the hand is incapable of moving through its normal range of motion. For instance, a deep cut to the finger or the palm can definitively interfere with the action of the flexor tendons.
In addition, these tendons can easily become pulled away from the bone and out of their normal anatomical placement, causing difficulty moving the fingers. Treatment usually involves splinting at first, but most flexor tendon injuries require surgery to reattach the tissue and restore movement to the hand.
Sprains can occur to any part of the hand or wrist, but it is most common in the wrist and thumb. A sprain is an overextension of the tendons and ligaments that support the movement of the hand.
It is usually caused by overextension or over flexion of the wrist, creating small tears in the tissue or lengthening the ligaments beyond their normal range of motion. It can happen as a result of traumatic sports injuries, but wrist and hand sprains can occur from every day occurrences, as well, such as bracing the hand against a fall.
Treatment is usually conservative, with rest, medications, and physical therapy comprising the most common care options. However, if the sprain is severe or complicated by fracture, a surgical procedure may be necessary to surgically repair the ligaments and stabilize the hand.
Arthritis can strike any joint in the body, but it is often the most painful and noticeable in the hands and wrist. Since these joints perform so many functions, when the condition strikes it may be difficult to move the hands at all.
Osteoarthritis is particularly common in the wrist, especially when repetitive motion or sports play is involved. This describes the wear and tear of the joint. On the other hand, rheumatoid arthritis tends to affect the knuckles and small joints of the hands, disfiguring the joints and causing painful swelling.
Treatment usually involves anti-inflammatory drugs for both conditions, and some immunosuppressant drugs are prescribed for rheumatoid forms.
Ulnar Tunnel Syndrome of the Wrist
Ulnar tunnel syndrome may be confused with carpal tunnel syndrome or the problem with this nerve at the level of the elbow. Like carpal tunnel, the ulnar nerve runs through the wrist at areas where narrow channels are made by the bones.
It affects the nerve on the outside of the hand, or the one that serves the pinky, ring finger, and outside portion of the palm. When this tunnel is compressed due to fracture or ligament swelling, the pain and numbness will present in these areas.
Like carpal tunnel, this condition is treated with splinting, removing the wrist from repetitive stress, and sometimes surgery to open the tunnel for the ulnar nerve. While carpal tunnel tends to affect the thumb and first two fingers, this condition is easy to spot if you have numbness in your small finger.
Finally, compartment syndrome is usually associated with crush injuries. For instance, if your hand is crushed in a car accident, the blood can swell into the small area and easily overwhelm the space.
Compartment syndrome describes a condition in which the fluids are collecting so fast and so much that the blood vessels and nerves are compressed. With severe injuries that occur in sports, this condition is possible to a lesser extent.
However, crush, tears, and fractures can lead to the hand and forearm compartment becoming overloaded. When it is stretched to that extent, blood flow decreases, nerves die, and the hand can become gangrenous. Usually surgery is necessary to relieve the pressure, and this is done by creating incisions that allow fluids to drain.
It isn’t a common sports medicine condition, but it is often seen in trauma victims and those who have severe injuries of the hand and wrist that require treatment from an orthopedic surgeon.