hand injuries

Hand Injuries

Another quarter of your body's bones is found in your hands and wrists - each of which has 27 bones. The wrist has 8 bones, the palm has 5, and the fingers, including the thumb, have 14 small bones. The connection between each bone forms a joint, allowing the hands to move freely and comfortably. Hand injuries, especially to the dominant hand, can impair motion and daily activity.

Any of the 27 bones in either hand can suffer a fracture.

Any of the 27 bones in either hand can suffer a fracture. People often place their hands in front of them to brace for a fall or blow, and the hands suffer injury. As with a foot bone fracture, a hand bone fracture is diagnosed by x-ray. A hand specialist will usually suggest a brace or cast be placed on a broken hand to immobilize it for healing. Any injury to the hands increases the potential for developing arthritis.

When muscles, ligaments, or tendons are over-stretched or over-used, painful sprains and strains may occur. Most mild sprains and strains heal naturally, and the patient is advised to rest the affected hand or wrist, limit its use, apply ice, and take over-the-counter pain reliever or anti-inflammatory as needed. In severe cases, a sprain or strain may require surgical repair to restore full, fluid function.

Arthritis of Hand or Wrist

Rheumatoid arthritis is one of the most common forms of arthritis in the hand, in addition to osteoarthritis and post-traumatic arthritis. Rheumatoid arthritis affects the cells that line and normally lubricate the joints (synovial tissue). This is a systemic condition (can affect the whole body), which means that it may affect multiple joints, usually on both sides of the body.

SIGNS AND SYMPTOMS

Stiffness, swelling and pain are symptoms common to all forms of arthritis in the hand. In rheumatoid arthritis, some joints may be more swollen than others. There is often a sausage-shaped swelling of the finger. Other symptoms of rheumatoid arthritis of the hand include:

 

• A soft lump over the back of the hand that moves when straightening the fingers
• A creaking sound during movement
• Fingers shifting away from the direction of the thumb (see Figure 2)
• Swelling and inflammation of the tendons that bend the fingers, resulting in clicking or triggering of the finger as it bends, sometimes causing numbness and tingling in the fingers (carpal tunnel syndrome)
• Inability to straighten or bend certain fingers or the thumb
• A bent middle finger (Boutonnière Deformity (see Figure 3))
• An over-extended middle joint and bent fingertip (Swan-Neck Deformity (see Figure 3))

Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is pressure on a nerve in your wrist. It causes tingling, numbness and pain in your hand and fingers. You can often treat it yourself, but it can take months to get better.

Symptoms

Carpal tunnel syndrome causes discomfort in the hand and up into the forearm. Symptoms tend to develop gradually over time. The first symptoms often appear during the night, or on waking up in the morning. Patients may feel the need to "shake out" their hands when they wake up. The discomfort may wake them repeatedly during the night.

The three main symptoms associated with CTS are:

• pain
• numbness
• tingling

These symptoms occur in the thumb and the two fingers next to it, as well as half of the ring finger. They may extend to the rest of the hand and into the forearm.

As the condition progresses, symptoms may persist during the day. The person may lose grip strength and find it harder to form a fist or grasp small objects. Opening a bottle of soda, doing up buttons, or typing on a keyboard can become a challenge.

If left untreated, the muscles at the base of the thumb may wither away, and the person may no longer be able to tell hot from cold with the thumb and finger.

Symptoms tend to emerge or get worse after using the affected hand. The sensation of tingling, burning, and pain may worsen if the arm or hand has been in the same position for a long time.

Dupuytren's Contracture

Dupuytren's (du-pwe-TRANZ) contracture is a condition that gradually causes connective tissue (fascia) under the skin of your palm to thicken and become scar-like. Although Dupuytren's isn't  always painful, it does restrict movement. The thickened tissue forces several fingers -- usually your ring and pinky fingers -- to curl in toward your palm. The bending caused by the thick tissue is called contracture.

Symptoms:

The lumps can be uncomfortable in some people, but Dupuytren’s contracture is not typically painful. The disease may first be noticed because of difficulty placing the hand flat on a surface (Figure 3). As the fingers are drawn into the palm, it may be more difficult to wash hands, wear gloves, shake hands, and get hands into pockets. It is difficult to predict how the disease will progress. Some people have only small lumps or cords while others will develop severely bent fingers. The disease tends to be more severe if it occurs at an earlier age.

Ganglion Cysts

DESCRIPTION :

Ganglion cysts are very common lumps within the hand and wrist that occur adjacent to joints or tendons.  The most common locations are the top of the wrist (see Figure 1), the palm side of the wrist, the base of the finger on the palm side, and the top of the end joint of the finger (see Figure 2). The ganglion cyst often resembles a water balloon on a stalk (see Figure 3), and is filled with clear fluid or gel.

CAUSES

The cause of these cysts is unknown although they may form in the presence of joint or tendon irritation or mechanical changes. They occur in patients of all ages.

These cysts may change in size or even disappear completely, and they may or may not be painful. These cysts are not cancerous and will not spread to other areas.

Ganglion Cyst Symptoms

• The ganglion cyst usually appears as a bump (mass) that changes size.
• It is usually soft, anywhere from 1-3 cm in diameter, and doesn't move.
• The swelling may appear over time or appear suddenly, may get smaller in size, and may even go away, only to come back at another time.
• Most ganglion cysts cause some degree of pain, usually following acute or repetitive trauma, but up to 35% are without symptoms except for appearance.
• If pain is present, it is usually chronic and made worse by joint motion.
• When the cyst is connected to a tendon, you may feel a sense of weakness in the affected finger.

TENDON AND NERVE LACERATIONS

A laceration is a tear or ragged opening in the skin usually caused by an injury or trauma. A laceration may be either a partial laceration or a complete laceration. Tendons connect muscles to bones and allow coordinated movement of the joints. A deep cut or laceration on the palm side of the hand can damage the flexor tendons, which control movement in your hand. Since the nerves of the hands are located very close to the tendons, a laceration may damage them as well, causing numbness in your fingers.

Causes

Tendon and nerve lacerations may be caused by blunt trauma such as a sudden blow or a fall or by sharp objects such as a knife or broken glass.

Symptoms

The symptoms of a tendon laceration include pain, tenderness, and inability to bend the joints of your finger. Lacerated nerves often cause pain and numbness in your fingers.

Diagnosis

The diagnosis of tendon and nerve lacerations is made on the basis of your history and physical examination. An X-ray may be taken to rule out any fractures. If the nerves are lacerated your doctor may order an electromyography (EMG) or nerve conduction velocity (NCV), an electrical conduction test to determine the extent of damage to the nerve. Sometimes, an MRI Neurography or CT scan also may be recommended

Tendonitis

Tendinitis of the wrist : This can affect badminton players and production line workers, who repeatedly use the same motion with their wrist. Tendinopathy is another type of injury that affects the wrist tendons. This is a degenerative condition rather than an inflammation.

Symptoms

Symptoms occur where the tendon attaches to a bone.

They usually include:

• pain which worsens on movement
• a feeling that the tendon is crackling or grating as it moves
• swelling, heat, and redness
• a lump may develop along the tendon. If there is a rupture, a gap may be felt in the line of the tendon, and movement will be difficult.

Symptoms may last from a few days to several weeks or months.

Thumb Injuries

What is the EPL tendon? :The long extensor tendon to the thumb is called the Extensor Pollicis Longus (EPL). This tendon straightens the end joint of the thumb and also helps pull the thumb in towards the index finger. The tendon runs around a bony prominence on the back of the wrist called Lister’s tubercle. In this area it is confined to a tight tunnel. (See diagram)

Why does it rupture?

This tendon is vulnerable to rupture in the tunnel at the wrist. There are two situations that are associated with rupture. The first is after a fracture of the wrist, in particular where the fracture is not very displaced. The second is in Rheumatoid Arthritis where there is inflammation round the tendon in this area.

What are the signs of rupture?

• There may be pain felt at the wrist but not always.
• Inability to straighten the end joint of the thumb easily.
• Inability to place the hand flat on the table and lift the thumb off the table. (See diagram)

Some patients may be able to feel a “ping” when the tendon ruptures. Many patients simply notice the thumb has an abnormal posture and isn’t working as it should be. Investigations may include an x-ray of the wrist and hand. Ultrasound is often used to confirm the rupture.