Orthopedic Hand & Wrist

What are some common hand and wrist problems?

There are many common hand problems that can interfere with activities of daily living, including the following:

Arthritis

Arthritis is joint inflammation and can occur in multiple areas of the hand and wrist. Arthritis of the hand can be very painful.

Osteoarthritis

Osteoarthritis is one of the most common forms of arthritis in the hands and may be caused by normal use of the hand or it may develop after an injury. Osteoarthritis usually develops in one of 3 places: the base of the thumb, at the end joint closest to the finger tip, or at the middle joint of a finger.

Signs and symptoms of osteoarthritis include:

• Stiffness
• Swelling and pain
• Bony nodules at the middle or end joints of the finger
• Pain and possibly swelling at the base of the thumb
• Loss of strength in the fingers and the grip of the hand

Carpal tunnel syndrome

Carpal tunnel syndrome is a condition in which the median nerve is compressed as it passes through the carpal tunnel in the wrist, a narrow confined space. Since the median nerve provides sensory and motor functions to the thumb and 3 middle fingers, many symptoms may result.

The following are the most common symptoms for carpal tunnel syndrome. However, each individual may experience symptoms differently. Symptoms may include:

• Trouble gripping objects with the hand(s)
• Pain or numbness in the hand(s)
• "Pins and needles" feeling in the fingers
• Swollen feeling in the fingers
• Burning or tingling in the fingers, especially the thumb and the index and middle fingers

The symptoms of carpal tunnel syndrome may look like other conditions such as tendonitis, bursitis, or rheumatoid arthritis. 

Tendon problems

Two major problems associated with tendons include tendonitis and tenosynovitis. Tendonitis, inflammation of a tendon (the tough cords of tissue that connect muscles to bones) can affect any tendon, but is most commonly seen in the wrist and fingers. When the tendons become irritated, swelling, pain, and discomfort will occur.

Tenosynovitis is the inflammation of the lining of the tendon sheaths which enclose the tendons. The tendon sheath is usually the site which becomes inflamed, but both the sheath and the tendon can become inflamed simultaneously. The cause of tenosynovitis is often unknown, but usually strain, overuse, injury, or excessive exercise may be implicated. Tendonitis may also be related to disease (such as, diabetes or rheumatoid arthritis).

Common tendon disorders include the following:

• Lateral epicondylitis (commonly known as tennis elbow). A condition characterized by pain in the back side of the elbow and forearm, along the thumb side when the arm is alongside the body with the thumb turned away. The pain is caused by damage to the tendons that bend the wrist backward away from the palm.
• Medial epicondylitis (commonly known as golfer's or baseball elbow). A condition characterized by pain from the elbow to the wrist on the palm side of the forearm. The pain is caused by damage to the tendons that bend the wrist toward the palm.
• Rotator cuff tendonitis. A shoulder disorder characterized by the inflammation of the shoulder capsule and related tendons.
• DeQuervain's tenosynovitis. The most common type of tenosynovitis disorder characterized by the tendon sheath swelling in the tendons of the thumb.
• Trigger finger/trigger thumb. A tenosynovitis condition in which the tendon sheath becomes inflamed and thickened, thus preventing the smooth extension or flexion of the finger/thumb. The finger/thumb may lock or "trigger" suddenly.

Treatment Options

Bone tissue has remarkable healing ability. If a fractured bone can be held together correctly, it can regenerate the tissue, heal properly and regain most of its original strength.

For severe fractures, an orthopedic surgeon will perform surgery to set the fracture. The bone fragments are first re-positioned (reduced) into their normal alignment. Then, the surgeon holds the bone in place with special implants, such as plates, screws, nails and wires.

One Plate Does Not Fix All Fracture Types

Up until recently, all wrist fractures were treated with a single type of plate. The issue with this “one plate fixes all” approach is that certain fracture patterns cannot be stabilized this way. Patients may develop complications such as arthritis and experience long-term pain and stiffness.

A New Treatment Approach

Fragment-specific fixation for wrist fracture is a relatively new treatment approach that addresses the unique properties of wrist fractures with specialized types of plates. These different plate options enable the surgeon to match the type of plate to the fracture.

Better Outcomes

Outcomes for patients with “fragment-specific fixation” of wrist fractures are much better, with more stable fixation and fewer complications.

CHI Health Orthopedic Surgeons perform many fragment-specific fixation surgeries. For more information about this procedure or to schedule an appointment with one of our physicians, contact CHI Health Orthopedics, (402) 717-0820.