Wrist & Hand
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Tendon Injuries-Mallet finger
Refers to an avulsion of the terminal extensor tendon. X-ray is used to rule out fracture. These injuries are typically treated with prolonged (>6 weeks) extension splinting. Results are almost uniformly good. Chronic injuries may result in significant swan-neck deformities .
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De Quervain disease
Refers to stenosing tenosynovitis of the first dorsal wrist compartment (abductor pollicis longus [APL] and extensor pollicis brevis [EPB]) and typically occurs in racquet sports and in golfers. Ulnar deviation of the wrist with the thumb in the palm (Finkelstein's test) generally reproduces patient symptoms. Treatment includes activity modification, splinting, local corticosteroid injection, and occasionally surgical release
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Extensor carpi ulnaris tendinitis
Extensor carpi ulnaris tendinitis Tendinitis or subluxation of the sixth dorsal compartment frequently occurs in tennis and hockey players. Patients experience painful snapping with forearm pronation and supination. Long-arm cast immobilization in pronation may allow healing. Surgical débridement are occasionally necessary
Flexor carpi radialis/flexor carpi ulnaris tendinitisWrist flexor tendinitis is common and is associated with overuse, especially in golfers and in players of racquet sports. Activity modification, splinting, and NSAIDs are generally effective. Surgical tenolysis is rarely necessary.
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«Jersey finger»
Refers to an avulsion injury of the flexor digitorum profundus tendon from its insertion at the base of the distal interphalangeal joint (DIP).The avulsion occurs with sudden hyperextension during finger flexion and may be seen on plain x-ray. The Leddy classification describes three types: type I, retraction of tendon into palm; type II, retraction to PIP; and type III; associated with a large, bony articular fragment, usually without significant retraction. These injuries require retrieval of the retracted tendon and reattachment to the base of the DIP. Type I injuries must be repaired early (within 1 week) because of loss of blood supply to the tendon. Arthrodesis is generally favored over late (>3 months).
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Scaphoid fracture
Fractures here occur frequently in contact sports. Because the vascular supply enters distally, proximal fractures have a high rate of nonunion and avascular necrosis. Acute and subacute, nondisplaced fractures less than 8 weeks old may be treated in a thumb-spica cast. Percutaneous fixation of nondisplaced fractures leads to earlier union, ROM, return to work, and possibly return to play. Displaced fractures should be managed operatively with either percutaneous or limited open fixation. Nonunion may be managed with a local vascularized bone graft and internal fixation. A CT scan can be used to assess displacement, while MRI is helpful to rule out occult fracture and assess vascularity.
Metacarpal and phalanx fractures
Many of these fractures heal with closed reduction and immobilization. Fourth and fifth metacarpal fractures can accept greater angulation than the index and long finger. Displaced fractures, those involving the joints, and those resulting in rotational malalignment should be treated surgically. Early motion is the key to successful rehabilitation. Fractures involving the base of the thumb carpometacarpal (CMC) joint (Bennett's fracture, Rolando's fracture) often require operative reduction and stabilization
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Carpal Tunnel Syndrome
The carpal tunnel is the passageway in the wrist and consists of the arching carpal bones (eight bones in the wrist) and the transverse carpal ligament. The median nerve and the tendons that connect the fingers to the muscles of the forearm pass through the narrow tunnel. Carpal tunnel syndrome occurs when the median nerve is compressed because of swelling of the nerve or tendons or both. The median nerve provides sensation to the palm side of the thumb, index, middle finger, and the inside half of the ring finger. When this nerve becomes impinged, or pinched, numbness, tingling, and sometimes pain of the affected fingers and hand may occur and radiate into the forearm. Any condition that puts pressure on the median nerve at the wrist can cause the syndrome. We do know that excessive repetitive movements of the wrists and hands (such as uninterrupted prolonged typing) can trigger the symptoms of carpal tunnel syndrome. Untreated, the symptoms can become chronic, but when detected early, carpal tunnel syndrome can be treated more easily and recovery is possible in a few months. Severe carpal tunnel syndrome can also be treated, but recovery may take up to a year or longer and may not be complete.
What Are the Symptoms of Carpal Tunnel Syndrome?
Usually, people with carpal tunnel syndrome first notice that their fingers become numb at night. The reason they may experience symptoms at night may be the relaxed flexed position of the hand and wrist while sleeping. They often wake up with numbness and tingling in their hands. The feeling of burning pain and numbness may generally run up the center of the person's forearm, sometimes as far as the shoulder. Carpal tunnel syndrome may be temporary and resolve by itself or become persistent and worsen over time.
What Happens in Severe Cases of Carpal Tunnel Syndrome?
As carpal tunnel syndrome becomes more severe, a person may have decreased grip strength with atrophy, or wasting, of the muscles in the hand. Pain and muscle cramping become more severe. The median nerve itself begins to deteriorate with chronic irritation or pressure around it. This results in a slowing of nerve impulses, loss of feeling in the fingers, and a loss of strength and coordination at the base of the thumb. If the condition is not treated, it could result in permanent deterioration of muscle tissue and loss of hand function.
Common medical conditions associated with carpal tunnel syndrome include obesity, pregnancy, hypothyroidism, arthritis, and diabetes. Trauma can also cause carpal tunnel syndrome. In the case of pregnancy, the symptoms usually resolve within a few months after delivery. Women are three times more likely than men to develop the condition, which may be caused by having a smaller carpal tunnel than men in general.
Certain occupations, such as assembly line workers, seamstresses, and hairstylists, may have a higher risk associated with developing carpal tunnel syndrome. Any activity requiring prolonged repetitive use of the arms, wrists, and hands have a significant increased incidence of the developing symptoms.
What Tests Help Diagnose Carpal Tunnel Syndrome?
Two useful clinical tests for diagnosing carpal tunnel syndrome are the Tinel and Phalen maneuvers. Tingling sensations in the fingers caused by tapping on the palm side of the wrist is a positive Tinel test, whereas reproduction of symptoms by flexing the wrist is a positive Phalen test (Dr. Phalen created this maneuver many years ago when he was a hand surgeon at The Cleveland Clinic).
An electromyogram is a test that measures the electrical activity in your nerves and muscles.
How Is Carpal Tunnel Syndrome Treated?
Τhere are several ways to treat carpal tunnel syndrome:
Lifestyle changes. Treatment first involves adjusting the way the person performs a repetitive motion: Changing the frequency with which the person performs the motion and increasing the amount of rest time between movements.
Immobilization. Treatment also includes immobilizing the wrist in a splint to minimize or prevent pressure on the nerves. Splints that support the wrist in a comfortable neutral position can be of great value if worn at night to relieve painful numbness or tingling. This can provide a restful sleep and allow the median nerve to endure daytime activities.
Medication . Patients may be given short courses of anti-inflammatory drugs or injections of steroids in their wrist to reduce swelling. Injections are most successful when people have mild to moderate carpal tunnel syndrome as a result of an acute (severe) flare-up.
Surgery. If carpal tunnel syndrome does not respond to conservative treatment, then surgery is the next treatment option. During surgery, your surgeon will open the carpal tunnel and cut the ligament, relieving the pressure.
What Can I Do to Prevent Carpal Tunnel Syndrome?
Sleep with your wrists straight or use a splint.
Keep your wrists straight when using tools but try not to use splints.
Avoid flexing and extending your wrists repeatedly.
Perform conditioning and stretching exercises.
Use correct positioning of hands and wrists while working.
Arrange your activity and workspace using ergonomic (correct posture of the wrist and hand) guidelines to help prevent carpal tunnel syndrome. For example, office ergonomics focuses on how a workstation is set up, including the placement of your desk, computer monitor, paperwork, chair, and associated tools, especially the computer keyboard and mouse.
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Carpometacarpal Arthritis
