Disorders of the Wrist and the Hand

The hand consists of the wrist, palm, and fingers. The wrist has eight bones (carpals); four are connected to the forearm bones (radius and ulna), and four are connected to the five bones of the palm (metacarpals). Each of the bones of the palm is connected to one of the finger bones (phalanges). Each finger has three phalanges; the thumb has two phalanges. Hand movements are controlled by a complex network of ligaments, tendons, and muscles. The hand has a wide range of motion that allows you to perform a wide variety of manual tasks. The complexity and versatility of the hand make it particularly vulnerable to injury.

Carpal Tunnel Syndrome

Carpal tunnel syndrome is a common repetitive-stress injury that can affect one or both hands. Repeating the same hand motions over a prolonged period may lead to swelling of the tendons that bend the fingers and the thumb, which in turn puts pressure on the median nerve where it enters the hand (the carpal tunnel). Repetitive motions such as keyboard work (including operating a computer,

Bones and Joints

Common

Health

Concerns adding machine, or cash register), assembly line work, painting, driving, and some sports (such as handball and racquetball) can cause this injury.

Common symptoms of carpal tunnel syndrome include numbness, tingling, and pain in the hand and forearm (especially at night), pain or weakness when gripping objects, and clumsiness in handling objects.

Diagnosis of carpal tunnel syndrome is based on your symptoms and the results of a doctor's examination of your hand and wrist. If pain shoots down into your hand and fingers or up into your forearm when the doctor taps lightly on the front of your wrist, you probably have carpal tunnel syndrome. Nerve conduction tests such as electromyography (EMG) may be performed to determine whether there is any nerve damage.

Your doctor probably will recommend that you rest the affected hand and avoid the repetitive activity that is causing the problem. You also may need to wear a splint or a brace to immobilize your wrist while allowing you to continue using your hand. Nonsteroidal anti-inflammatory drugs such as aspirin or ibuprofen can relieve pain and inflammation. Injections with corticosteroids may be prescribed if pain persists. Surgery to relieve the pressure on the median nerve (a procedure called carpal tunnel release) is performed in severe cases that do not respond to other forms of treatment.

Baseball Finger

Baseball finger (also known as a jammed finger or mallet finger) refers to a tear in the tendons at the outermost joint in the finger. The condition results from a sudden blow to the fingertip, such as when the finger is hit by a ball. Symptoms include pain, swelling, and bruising. If the injury is severe, you will not be able to straighten the affected finger.

To reduce pain and swelling, place an ice pack on the finger immediately after the injury occurs. See your doctor as soon as possible. He or she may X ray the finger to make sure it is not broken. The doctor probably will immobilize your finger with a splint for 2 to 3 months to help the joint heal properly. In some cases the doctor may insert a wire through the joint to hold the finger straight while the tendons are healing. Nonsteroidal anti-inflammatory medications such as aspirin or ibuprofen will help relieve pain and reduce swelling.

You should avoid athletic activities until after the injury has healed. Your doctor may recommend that you work with a physical therapist or an athletic trainer on exercises that will strengthen the tendons and help restore normal function to the joint. Apply ice packs to the finger if swelling occurs. If the injury is severe, you may never be able to fully straighten the affected finger.

Trigger Finger

Trigger finger (tenosynovitis of the hand) is inflammation of the tendons and surrounding tendon sheaths in a finger. This condition prevents the finger joints from moving smoothly. Trigger finger is a repetitive-stress injury caused by repetitive motions such as keyboarding or assembly line work.

You may have difficulty straightening the affected finger. You also may feel a slight clicking sensation when you straighten or bend the finger. Once the affected finger is bent, the tendon may catch for a few seconds and then suddenly release with a jerking motion (like a trigger). Symptoms include pain, tenderness, and swelling in the hand and wrist.

Nonsteroidal anti-inflammatory medications such as aspirin or ibuprofen will help relieve pain and reduce swelling. Your doctor probably will recommend that you rest your hand and change your work habits or avoid the activity that is causing the problem. You also may need to wear a splint or brace to immobilize your wrist while allowing you to continue using your hand. If the pain persists, your doctor may prescribe injections of a corticosteroid drug such as cortisone. In severe cases, surgery may be performed to relieve pressure on the tendons.

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