Wrist / Hand Injury Guide
COMMON INJURIES
> Carpal Tunnel Syndrome
General Information
Carpal tunnel syndrome is a common condition that causes numbness, tingling, and pain in the hand and forearm. The condition occurs when one of the major nerves to the hand — the median nerve — is squeezed or compressed as it travels through the wrist.
In most patients, carpal tunnel syndrome gets worse over time. If untreated for too long, it can lead to permanent dysfunction of the hand, including loss of sensation in the fingers and weakness. for this reason, it is important to diagnose and treat carpal tunnel syndrome promptly. Early symptoms can often be relieved with simple measures like:
- Wearing a wrist splint while sleeping
- Exercises to keep the nerve mobile
- Avoiding certain activities that aggravate your symptoms
- A steroid injection into the carpal tunnel
If pressure on the median nerve continues, however, it can lead to nerve damage and worsening symptoms. To prevent permanent damage, surgery to take pressure off the median nerve may be recommended for some patients.
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> De Quervains Tenosynovitis
General Information
De Quervain's tenosynovitis is swelling of the tendons that run along the thumb side of the wrist and attach to the base of the thumb. This occurs when the tendons are constricted by the sheath that they run through to get from the wrist to the hand.
This condition can cause pain and tenderness along the thumb side of the wrist. This is particularly noticeable when you are:
- Moving the thumb
- Forming a fist
- Grasping or gripping something
- Turning the wrist
- Lifting something with your arms in front of you and thumbs pointed toward the ceiling (e.g., lifting a child)
De Quervain’s Syndrome is usually considered to be an overuse injury. Activities involving repetitive pinching, grasping, pulling or pushing may put you at higher risk. This risk is further increased if it comes with a sudden increase in activity. It is common for new mothers to develop De Quervain’s Syndrome, as they start to pick-up their new born with an extended thumb far more frequently.
De Quervain's tendinosis is treated by reducing the swelling/irritation of the tendons and tendon sheath, thereby relieving the pain caused by the condition. A removeable splint that keeps the wrist straight and the thumb still in a comfortable position may improve pain, especially when worn at night.
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> Sprained Thumb (Skier's Thumb)
General Information
A sprained thumb occurs when the ligaments that support the thumb stretch beyond their limits or tear. This usually happens when a strong force bends the thumb backwards, away from the palm of the hand. The most common way for this to occur is by falling onto an outstretched hand.
Most thumb sprains involve the ulnar collateral ligament, which is located on the inside of the knuckle joint. A tear to this ligament can be painful and may make your thumb feel unstable. It may also weaken your ability to grasp objects between your thumb and index finger.
Treatment for a sprained thumb usually involves wearing a splint or cast to keep the thumb from moving while the ligament heals. For more severe sprains, surgery may be needed to restore stability to the joint.
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> Wrist Sprains
General Information
A wrist sprain occurs when the strong ligaments that support the wrist stretch beyond their limits or tear. This occurs when the wrist is bent or twisted forcefully, such as caused by a fall onto an outstretched hand. Wrist sprains are common injuries. They can range from mild to severe, depending on how much damage there is to the ligaments.
Ligaments are strong, fibrous tissues that connect bones to other bones. The ligaments in the wrist help to keep the bones in proper position and stabilize the joint.Sprains can range from a stretch or tiny tear in the fibers that make up the ligament to a complete tear through the ligament or through its attachment to the bone.
Wrist sprains are caused most often by a fall onto an outstretched hand. This might happen during everyday activities, but frequently occurs during sports and outdoor recreation.
Treatment for a wrist sprain depends upon the severity of the injury. Mild wrist sprains will usually improve with home treatment that includes the RICE protocol. Moderate sprains may need to be immobilized with a wrist splint for one week or more. Severe sprains may require surgery to repair the fully torn ligament.
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> Distal Radius Fractures (Broken Wrist)
General Information
There are two long bones that make up the forearm:
- The radius is on the thumb side of the forearm.
- The ulna is on the small finger (pinky) side.
At the proximal forearm, the part of the forearm closest to the elbow, the ulna is larger. At the distal forearm, the part of the forearm closest to the wrist, the radius is larger.
A distal radius fracture almost always occurs about 1 inch from the end of the bone. This very common fracture can occur in many different ways to people of all ages. In young people, such fractures typically occur in high-energy accidents, such as a fall from a ladder or a car crash. In older people, especially those with osteoporosis, distal radius fractures can occur from a simple fall onto the wrist.
One of the most common distal radius fractures is a Colles fracture, in which the broken fragment of the radius tilts upward.
The most common cause of a distal radius fracture is a fall onto an outstretched arm.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 in a young and healthy person.
The treatment of broken bones follows one basic rule: The broken pieces must be put back into position and prevented from moving out of place until they are healed.
There are many treatment options for a distal radius fracture. The choice depends on many factors, such as the nature of the fracture, your age and activity level, and the surgeon's best judgment. In non-operative fractures, the cast is typically removed about 6 weeks after the fracture happened. At that point, you will likely start physical therapy to help improve the motion and function of the injured wrist. Typically, you will wear a removeable splint between therapy sessions to protect the healing bone.
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> Arthritis of the Wrist
General Information
Arthritis involves inflammation of one or more of your joints. Pain and stiffness are common symptoms of arthritis, and when these occur in your wrist, simple daily activities can become more difficult.
There are many types of arthritis, and most of these can affect the wrist. Although the severity of symptoms related to arthritis can vary, most arthritis-related diseases are chronic. This means that they are long-lasting—even permanent—and can eventually cause serious joint damage.
Your wrist is a complex joint—it is actually made up of multiple small joints. When healthy, the bones glide easily over each other during movement, protected by smooth cartilage that coats the joint surfaces. Arthritis damages this cartilage. As the disease progresses, there is a gradual loss of cartilage. Without a smooth joint surface, the bones rub against each other, leading to joint damage that cannot be repaired.
Symptoms of arthritis may include:
- Pain
- Swelling
- Reduced range of motion or stiffness
- Weakness in the joint
There is no cure for arthritis, but there are a number of treatments that may help reduce the frequency of your symptoms and relieve the pain and loss of function it can cause. In general, initial treatment for arthritis is nonsurgical in nature and designed to help minimize your symptoms. Wearing a wrist splint for a short time will help support the joint and ease the stress placed on it by frequent use and activities.
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