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Hand, Wrist, and Finger Injuries & Conditions

Hand, Wrist, and Finger Injuries & Conditions

Your hand has 27 bones and, left untreated, one injury will have a domino effect on the rest of your hand bones. Even the tiniest bones in your fingers can cause major problems. Considering how much we rely on our hands, fingers and wrists on a daily basis, it’s important to pay close attention to injuries to this part of the body.

When you think of hand, wrist and finger injuries, fractures and carpal tunnel syndrome probably first come to mind. However, these kinds of injuries can run the gamut from trigger finger to ganglion cysts. Read on to learn more about these conditions and treatment options.

CARPAL TUNNEL

If you experience pain, numbness, and tingling in the hand and arm, you may have carpal tunnel syndrome. This common condition occurs when one of the main nerves to the hand is compressed as it travels through the wrist.

In most patients, carpal tunnel syndrome gets worse over time, so early diagnosis and treatment are important. Early on, symptoms can often be relieved by simply wearing a wrist splint or avoiding certain activities. Left untreated, surgery may be required. Without any intervention, carpal tunnel syndrome can lead to permanent damage.

Causes for carpal tunnel syndrome include heredity, repetitive movement, or pregnancy. Certain health conditions such as diabetes, rheumatoid arthritis, and thyroid gland imbalance are also associated with the condition.

Symptoms

The symptoms of carpal tunnel syndrome begin gradually and include numbness, tingling, burning, and pain—primarily in the thumb and index, middle, and ring fingers. That pain may travel up the forearm toward the shoulder. Occasional feelings like “shock” or weakness in the hand may also occur. It’s common to experience symptoms at night because many people sleep with their wrists bent.

Treatments

For most people, the condition worsens over time unless they seek treatment. That’s why it’s important to see your doctor in the early stages. In the early stages, nonsurgical treatment options include:

  • Brace or splint – During the day to keep your wrist straight and at night to prevent it from bending while you sleep.
  • Medications or injections – Non-steroidal drugs, such as ibuprofen, can help relieve pain and inflammation. Steroid injections may also temporarily relieve symptoms.
  • Change activities – Changing or repetitive motions and/or modifying your workspace can slow or stop the progression of the disease.

Your doctor may recommend surgery if nonsurgical treatment isn’t working. Usually, surgery can be done on an outpatient basis under local anesthesia.

After your procedure, you can expect some pain, swelling, and stiffness. For most people, surgery will improve the symptoms of carpal tunnel syndrome. Complete recovery may take up to a year.

Surgical Procedures

Carpal Tunnel Release

Carpal tunnel syndrome occurs when compression placed on the median nerve in the wrist causes symptoms such as numbness, weakness or pain. Pain may occur in the hand, arm, or fingers. This commonly occurs at night and with certain activities. Through a surgical procedure called a carpal tunnel release, an orthopedic surgeon can release the ligament, which relieves pressure on the nerve and allows it to heal.

A ganglion cyst is a fluid-filled mass or lump in the hand that can quickly appear, disappear or change size. The cysts most often develop on the back of the wrist and are usually harmless and don’t require treatment. However, you may choose to seek treatment if the cyst is painful, prevents you from normal activities, or has a concerning appearance.

A ganglion is most common in people between the ages of 15 and 40 years, and women are more likely to be affected than men. Because they repeatedly apply stress to the wrist, gymnasts frequently have the cysts. Ganglion, or mucous, cysts develop at the end joint of a finger and are typically associated with arthritis. These occur mostly in women between the ages of 40 and 70 years.

Symptoms

Ganglions usually appear as a visible lump, although smaller ganglions can remain hidden under the skin. If a cyst puts pressure on the nerves that pass through the joint, it can cause pain, tingling, and muscle weakness.  Even if they don’t cause symptoms, large ganglions may cause people to feel discomfort or embarrassment about their appearance.

Treatments

Your doctor will visually examine the cyst and may order imaging tests, such as X-ray or MRI to rule out other conditions. Non-surgical treatments include:

  • Watch and wait – Initially, if you don’t have other symptoms, your doctor may recommend waiting to see if the ganglion resolves on its own.
  • Brace or splint – If an activity is aggravating the condition, a wrist brace or splint may relieve symptoms and reduce the size of the ganglion. Your doctor also may prescribe exercises to strengthen your wrist and improve its range of motion.
  • Drain – A procedure called aspiration drains fluid from the cyst to relieve pain or pressure. However, ganglions are like weeds and unless the “root” connecting them to the joint is removed, they frequently return after the procedure.

If your symptoms are not relieved by nonsurgical methods, your doctor may recommend surgery to remove the cyst. The procedure, called excision, will remove the cyst and part of the joint capsule or tendon sheath (the root) that is involved. Even after excision, there is a small chance the ganglion will return.

The procedure is usually outpatient and patients can expect tenderness, discomfort, and swelling after surgery. You can usually resume normal activities two to six weeks after surgery.

Even though it has a funny name, trigger finger is not a laughing matter to those affected by the condition. Trigger finger, also known as “stenosing tenosynovitis,” causes pain, stiffness and a feeling as if your finger is locking or catching when you bend and straighten it. Usually trigger finger affects the thumb and ring finger, but other fingers also can be affected. The condition is called “trigger thumb” when the thumb is involved.

Risk factors for developing trigger finger include certain medical conditions, such as diabetes and rheumatoid arthritis. Forceful hand activities involving the fingers and thumb also area believed to cause the condition.

Symptoms

Trigger finger often comes with no warning or injury. Symptoms may occur following heavy or extensive hand use, particularly pinching and grasping, over time. Patients with trigger finger may have a tender bump on the palm side of the base of the finger. Additional symptoms include a popping or locking sensation with finger movement or pain when you bend or straighten the finger.

After periods of inactivity, such as when you wake up in the morning, symptoms may worsen. In severe cases, the finger may become locked in a bent position.

Treatments

Your doctor will examine your hand and talk to you about symptoms to determine if you have trigger finger. Usually, trigger finger can be treated without surgery. Nonsurgical treatments may include:

  • Rest – Avoiding activities that aggravate the condition may help resolve the condition.
  • Splint – Keeping the affected finger or thumb in a straight position with a splint while you sleep may help.
  • Exercise – Gentle stretching to relieve stiffness and improve range of motion.
  • Medication – Over-the-counter pain medications and nonsteroidal anti-inflammatory drugs (NSAIDs) can help relieve pain and inflammation.
  • Injections – An anti-inflammatory steroid can be injected at the base of the trigger finger to prevent the triggering. A second injection may be given if symptoms don’t improve over time.

If two injections do not help relieve symptoms, your doctor may recommend surgery. The procedure is typically done in an outpatient setting with local anesthetic. You can expect your incision to heal within a few weeks, but it may take from four to six months for swelling and stiffness to subside. In some cases, your doctor may recommend seeing a hand therapist to help with your recovery.

Surgical Procedures

Trigger Finger Release

Trigger finger is the narrowing around the tendons of a finger or thumb. This causes pain, stiffness and a feeling as if your finger is “locking” or “catching” when you bend and straighten it. Trigger finger release is a surgical procedure to open or release the “tunnel” or pulley the tendon travels through, allowing smooth transit.

Most of us probably take the tasks that our hands perform on a daily basis for granted – until a finger fracture occurs. A single fracture can make everyday functions, such as holding a pen or brushing your teeth, painful if not nearly impossible. Fractured fingers usually occur due to a fall or injury. Left untreated, a broken finger could be left permanently stiff and painful.

Symptoms

Contact your doctor immediately if you experience the following symptoms in the injured finger:

  • Swelling, bruising and/or tenderness
  • Stillness or inability to move
  • Abnormal appearance

Treatments

Be sure to tell your doctor how and when you injured your finger. He or she will physically examine your finger and may order and X-ray of each of your hands to compare the injured and uninjured fingers and determine the severity of the fracture.

Usually,  your doctor can put your broken bone back into place without surgery. A splint or cast will help keep your finger straight and protect it while it heals. Your doctor will recommend how long you should wear the splint. He or she may also order additional X-rays during this time to see how your finger is healing.

If the fracture is more severe, you may need surgery. Your doctor will use screws, pins or wire to hold your fractured bones together.  After your finger has healed well enough to move, your doctor may recommend simple rehabilitation exercises to help reduce stiffness and swelling. Visits to a physical therapist may be necessary to help with these exercises.

Surgical Procedures

Fracture Care

When a bone is broken is it called a fracture. Orthopedic surgeons can work to realign the broken bones and secure the bones in place. The goal is to restore proper alignment and stabilize the bone ends to allow healing. This can be accomplished through a variety of surgical techniques including open and minimally invasive methods such as plate and screws, “nailing,” or “pinning”.

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