The Hand & Wrist

The hand allows us to perform daily tasks and is incredible at minute intricate movements. Unfortunately, the hand is one of the most commonly injured joints during everyday falls and repetitive use injuries. As this joint is used so frequently, injuries to the hand can be quite noticeable during everyday living and thus are important to treat promptly.

If you’re experiencing hand or wrist pain, call one of the offices in San Francisco or book an appointment online to get started.

Hand Anatomy

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The hand and wrist incorporate many structures and smaller joints that seamlessly work together to create motion. The wrist joint is a hinge joint that includes the forearm bones called the radius and ulna and many of the smaller carpal bones in the wrist. There are many other bones called the metacarpals and phalanges that compromise your hand and fingers. Lastly, there are a multitude of tendons that attach to your hand and fingers to allow for delicate movement. The median and ulnar nerve are the two major nerves that travel through the hand. The bones, tendons, and nerves function together to intricately create the movements of the hand and wrist.

What causes hand & wrist pain?

What causes hand & wrist pain?

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There are many causes of hand and wrist pain. Commonly, fractures and tendon tears can occur from acute falls or injuries. As this joint is frequently used, chronic injuries such as tendonitis, carpal tunnel, and arthritis can also occur. Lastly, there are many nerve related conditions that occur in the neck and upper extremities that can present as hand pain. Proper evaluation by a professional is recommended to diagnose all hand and wrist pain.

Common Conditions

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Wrist fractures are the most common orthopedic injury and can encompass either a distal ulna fracture or, more commonly, a distal radius fracture. These can occur in any age group and typically are due to a fall on an outstretched wrist. The extent of the fracture can be evaluated on an X-ray. Treatment of wrist fractures is based on the fracture pattern. Simple nondisplaced fractures are more commonly treated in a cast for around 6 weeks. Fractures with a more complex or unstable pattern may require either a closed reduction or surgical fixation. Symptoms of a fracture include immediate pain, swelling, and decreased range of motion after an injury. Diagnosis is based on a physical exam and, most importantly, X-rays are taken to evaluate the extent of a fracture.

Treatment of elbow fractures varies greatly depending on the severity of the fracture and should be evaluated by your provider. Non-surgical treatment can involve immobilization in a splint and sling and is typically followed by early range of motion exercises with the help of a physical therapist. Surgical treatment will often involve placing a combination of plates and screws at the site of the fracture in order to stabilize the bone and allow for good future outcomes and function.

The scaphoid is the most frequently fractured carpal bone, commonly occurring from a fall on an outstretched wrist. Like most fractures, the extent of the fracture can be evaluated on X-ray and occasionally a CT if needed. Unfortunately, scaphoid fractures can be complex due to the pattern of blood supply in the bone creating an environment that is poor for fracture healing. Depending on the fracture pattern, most are treated in a thumb spica cast for approximately 3 months. Those that do not heal after cast immobilization or are too displaced, to begin with are treated with surgical percutaneous screw fixation. Proper healing of this fracture is important for the long-term efficacy and health of the wrist.

Carpal Tunnel Syndrome is a syndrome characterized by compression of the median nerve in the wrist. Symptoms include numbness and tingling in the thumb, index, and ring finger as well as clumsiness and, occasionally, pain at night. Treatment for carpal tunnel begins conservatively with night splinting in a wrist brace, anti-inflammatories, ergonomic work setups, and, occasionally, a corticosteroid injection into the area. Nerve conduction studies may be recommended for further diagnostic purposes. For those patients who are not improving or are experiencing weakness in the hand, a surgical nerve carpal tunnel release may be recommended

De Quervain’s Tenosynovitis is an inflammation of the first dorsal compartment of the wrist. This compartment is where three of the tendons that are important for movement of the thumb are located. This is an overuse injury that typically occurs when patients are doing repetitive activity with the thumb and can cause pain on the radial side of the wrist that is worse with movement of the thumb. Commonly this occurs in postpartum women who are lifting their newborns, but can occur in anyone. Treatment for De Quervain’s begins conservatively with a thumb spica wrist brace, anti-inflammatories, activity modification, and occasionally a corticosteroid injection into the area. Although rare, for severe refractory cases, a surgical release of the first dorsal compartment in the wrist can be done.

The hand encompasses many tendons that all work together to aid in flexion, extension, and vertical movement of the fingers. Injuries to tendons can occur from a direct impact to the hand, catching something incorrectly, or a laceration. Mallet finger occurs when the tendon that attaches to the distal phalanx is hyperextended and avulses off the bone. This can cause inability to extend the distal end of the finger, and is diagnosed on physical exam and with x-rays. Treatment can change based on if there is a fracture involved as well but typically involves extension splinting for 6-8 weeks. Depending on the injury surgical fixation may also be an option.

Although mallet finger injuries are some of the most common tendon injuries of the hand, there are many other tendon injuries that can also occur. Immediate careful evaluation from a provider is recommended to properly diagnose an injury and maintain full function of the hand and fingers.

Osteoarthritis is usually caused by age along with wear and tear from activity and work. As such, it usually develops slowly over time and is most common in patients over 60 years of age. Progressive loss of cartilage leads to pain and joint stiffness. Osteoarthritis can occur in any joint, but most commonly occurs in the wrist joint or the CMC joint of the thumb. Symptoms usually begin very gradually with only a slight increase in pain or subtle loss of motion. Sometimes an unrelated injury in the wrist can make underlying arthritis suddenly symptomatic. These symptoms tend to worsen over time especially as a person gets older. More severe arthritis can be associated with significant loss of motion as well as catching or cracking noises known as crepitus.

CMC joint or wrist arthritis is diagnosed primarily on X-ray, as this best shows the extent to which the joint has worn out. Once diagnosed, treatment for arthritis depends on its severity. For more mild cases, preservation of range of motion and strengthening with physical therapy is very helpful. Significant flares of pain can sometimes also be controlled with cortisone injections or anti-inflammatories. In severe cases, there are various surgical procedures available that are most commonly performed by hand specialists.

Treatment

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At Pacific Crest Orthopedics, we customize a treatment plan to meet your individual needs. In the wrist, some of the most common treatments can include different types of injections, the use of anti-inflammatories, physical therapy, and the use of a wrist brace.

Ephraim Dickinson, MD at Pacific Crest Orthopedics has extensive experience treating your hand and wrist pain and providing therapies to prevent future problems and to keep you active and healthy. If you have questions about your symptoms, call Pacific Crest Orthopedics in San Francisco or use the online booking tool to schedule an appointment today.

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“I came to the office with a huge pain. Dr Ephraim Dickinson not only quickly assist my problem and gave me the treatment plan. He was very nice and explain everything clear and answer all my questions. I recommend Dr. Dickinson and his office!”

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