Hand & Wrist

Hand and wrist pain are common conditions which may develop due to a sudden impact or injury. The wrist joint is made up of bones, ligaments, and connective tissue surrounding the area so any disease or injury affecting any aspect of the hand and wrist, results in pain.

Possible Causes: 

The hand and wrist give you the ability to write, gesture, pick things up, play musical instruments, draw, use a computer, and much more. They are made up of bones, joints, and muscles working together. The wrist contains eight bones, while the hand involves a system of metacarpals and phalanges (small bones of the fingers). 

Pain in the hand or wrist can be caused by crushing trauma, sports injury, or degenerative diseases like diabetes and arthritis.

• Sprain - when the ligaments of the wrist are stretched beyond their normal limits due to an injury.
• Tendonitis - tendons help your fingers to flex for grasping and gripping objects, when these get inflamed it causes pain and swelling.
• Arthritis - rheumatoid arthritis (RA) commonly affects the wrist joint, and gout (another type of inflammatory arthritis) may affect the wrist joint as well.
• Brachial Plexus Injury - Brachial Plexus group of nerves control the muscles of the shoulder, elbow, wrist and hand. An injury to them causes loss of feeling in the muscles of the arm and hand.
• Carpal Tunnel Syndrome (CTS) - This condition occurs when the median nerve to the hand is compressed through the wrist. It causes pain, numbness, and tingling in the hand and arm. 
• Dupuytren's Contracture - This affects the fascia, the fibrous layer of tissue underneath the skin in the palm and fingers. The fascia thickens, then tightens over time restricting movement.
• Fractures or other injuries of the hand or fingers -  a broken hand can be caused by a fall, crush injury, twisting injury, or through direct contact in sports.
• Osteoporosis - a decrease in the density of bone, decreasing its strength and resulting in fragile bones.
• Raynaud's Phenomenon (RP) - Raynaud's phenomenon occurs because of a spasm of blood vessels during which your body does not send enough blood to the hands and feet.
• Reactive arthritis - a painful form of inflammatory arthritis (joint disease due to inflammation). It occurs in reaction to an infection by certain bacteria and affects the heels, toes, fingers, low back, and joints, especially of the knees or ankles.
• Trigger finger - This condition can occur in the other fingers, as well but when the thumb is involved, the condition is called “trigger thumb.” It causes pain, stiffness, and a sensation of locking or catching when you bend and straighten your finger.
• Ganglion cysts - These are small sacs of fluid that forms over a joint or tendon and may sometimes be painful.
• Kienböck’s disease - This is a condition in which the lunate bone, one of eight small bones in the wrist, loses its blood supply, leading to death of the bone. 

Risk Factors: 

The risk factors for pain in the hand and wrist include overuse or repetitive actions due to work or sports, suffering from degenerative diseases such as rheumatoid arthritis or trauma related injuries.

Signs & Symptoms: 

Bone injury and diseases affect all parts of the hand or wrist. Signs and symptoms of hand and wrist problems could be:

• Pain – either top of wrist pain, or wrist pain when bending, or back of hand pain, or pain in both hands, or pain in centre of palm of hand, or a sharp pain in top of hand, or pain in hands and fingers.
• A burning sensation, swelling and bruising are signs of a sprain or tendonitis.
• Numbness - nerve injuries can stop signals to and from the brain, preventing the muscles of the arm and hand from working properly, and causing loss of feeling in the area.
• A tingling sensation - when blood stops for a bit and then the blood flow to the fingers and toes returns, they may turn red, tingle and begin to hurt.
• Difficulty with holding objects may be due to tendonitis in which fingers become swollen and painful.
• Difficulty with moving the hand or fingers will happen if you have a fracture.
• A painful clicking or snapping in the fingers if you have ‘Trigger Finger’. It causes pain, stiffness, and a sensation of locking or catching when you bend and straighten your finger.
• Cords, bumps or nodules on the palm if you have Ganglion cysts, which are sometimes not painful.

Diagnosis: 

Visit Medcare for a correct and thorough wrist pain diagnosis. The wrist is made up of several bones, muscles, and tissues therefore, a comprehensive medical history and physical examination are needed to make the diagnosis behind your wrist pain.

To diagnose the underlying cause of hand and wrist pain, the orthopaedic specialist will consider:

• Your symptoms
• Imaging by x-ray scans, CT scans or MRI scans
• A blood test for rheumatoid factor
• Tinel’s sign, wrist flexion or Phalen’s test to diagnose CTS 
• Electromyography to evaluate the electrical activity in the muscles
• Strength and feeling in the hand and fingers
• Finkelstein test to diagnose de Quervain’s disease

Treatment Options: 

The orthopaedic specialists at the Medcare Orthopaedics Hospital will prescribe a wrist pain treatment plan based on your overall health and the underlying cause of the pain. Certain immediate remedies known as R.I.C.E may be considered especially if you have a sprain or tendonitis. R.I.C.E stands for resting the joint and allowing the acute inflammation to subside, ice application to reduce the pain, compression with an elastic bandage to reduce swelling and elevation of the injured part of the body above heart level.

Once you visit your doctor, he may recommend some activity modifications if your condition is a result of overuse or sports injuries. This may be followed up with physical therapy. Fractures require wearing a cast or a splint. Other serious conditions may require medications. 

Once the correct diagnosis has been made, then non-steroidal anti-inflammatory pain medications referred to as NSAIDs, are commonly prescribed except for carpal tunnel syndrome. Cortisone injections are powerful medication that also treats inflammation.

Some wrist conditions require a surgical procedure for treatment, such as certain types of fractures, ganglion cysts, and median or ulnar nerve decompression. Wrist arthroscopy is a surgical procedure to insert a small camera inside the joint to repair or remove damaged structures. Wrist fusion is recommended for the treatment of severe arthritis of the wrist. If required a carpectomy may be done, which is a surgical procedure to remove the small bones of the wrist joint

Finally, your doctor may advise wrist replacement where the joint is replaced with metal and plastic implants that allow movement of the joint between the hand and forearm. Needle aponeurotomy procedure are used to treat Dupuytren's disease.