Wrist/Hand Trauma

Hand Pain

Hand pain is characterized by distress in the joints and tissues of the hand or fingers. Hand pain can be depicted as pulsating, aching, increased warmth, prickling, irritation and inflexibility. The hand is composed of nerves, bones, blood vessels, muscles, tendons and skin. Each part has its specific function such as nerves transfer sensation, joints control movements, blood vessels maintain circulation, muscles provides motion, tendons anchor the muscles to the bones and skin receives sensations.

Injury or inflammation of any of these structures, due to a disorder or disease condition, may produce hand pain. Even compression of the nerves supplying these structures may cause hand pain.

Causes

The conditions and disorder that frequently play a role in hand pain are:

  • Accidental injury and trauma
  • Serious infections in the blood (Septicemia)
  • Fracture of the hand bones
  • Nerve compression
  • Incident of conditions such as tenosynovitis and carpal tunnel syndrome
  • Strains in muscles and ligaments
  • Osteoarthritis and rheumatoid arthritis
  • Suffering from diabetes and peripheral neuropathy
  • Tedious lifting, twisting or gripping
  • Long-term use of keyboards

Treatment

Hand pain can be treated normally by resting the hand, medications, bracing, heat or ice application, compression, stretching and strengthening exercises, and by treating the underlying cause or condition. In cases of chronic hand pain unresponsive to conservative treatment measures, hand surgery may be recommended.

Wrist Pain

The wrist is a commonly seen injured joint in the body. Problems include sprains and strains as well as fractures which can occur with lifting and carrying heavy objects, while operating machinery, bracing against a fall, or from sports-related injuries.

Some of the common wrist injuries include:

Sprains and Strains: Sprains and strains are the two most common types of injuries affecting the wrist.  A sprain refers to an injury to a ligament and a strain refers to a muscle injury. Sprains and strains occur due to excessive force applied during a stretching, twisting, or thrusting action.  Most sprains and strains will repair themselves with adequate rest, ice application, compression, and elevation. Surgery is occasionally required to repair the damage.

Ligamentous Injuries: Ligaments are tissues that connect bones to other bones. They are made up of several fibers and one or all of the fibers may be involved. Complete ligament injury occurs when all the fibers are torn. A ligament injury may cause pain and swelling and limit the movement of wrist joints. Ligament injuries are effectively treated with splinting and taping with restriction of movement of the injured structures.

Fractures: A fracture is a break in the bone which occurs when more force than the bearable limit is applied against a bone. Crushing injuries to the wrist occur due to high degrees of force or pressure and may also cause fractures. A fracture may cause severe pain, swelling, bruising or bleeding, discoloration of the skin and limit the mobility of the limb. Fractures of the wrist bones can be treated by using a cast or splint while the bone heals. Sometimes surgery may be needed where plates, pins or screws may be placed to keep the joint stable while healing.

Repetitive Trauma Syndrome: Repetitive stress injury occurs as a result of repeated similar movements for long periods of time. This often causes pressure on the joints resulting in inflammation, pain, and decreased function in the extremity. The condition is more likely to develop with repetitive, rapid, forceful and prolonged movements of the wrist, or from vibration or frequent pushing, pulling or carrying heavy objects. Carpal tunnel syndrome is the most common of these syndromes.

Carpal Tunnel Syndrome: Carpal tunnel syndrome is a condition characterized by numbness or pain in the thumb and first two fingers and occurs when the median nerve is compressed at the wrist. Carpal tunnel syndrome is often a common complaint in individuals who use their hands for prolonged periods of time in a particular occupation such as computer work. Immobilization of the affected part for a certain period may help heal the condition. Medications, physical therapy, and surgery may also be recommended. Often, splinting for a short period of time can treat the condition.

Any problem causing pain, swelling, discoloration, numbness or a tingling sensation, or abnormal position of the wrist that persists for more than two or three days should be evaluated by your doctor to establish the cause and obtain the best treatment as early as possible.

Wrist Fracture

The wrist is comprised of two bones in the forearm (the radius and the ulna) and eight other tiny bones. The bones meet to form multiple large and small joints. A wrist fracture refers to a break in one or more bones in the wrist. Wrist fracture can be caused due to a fall on the outstretched arm or an injury due to accidents such as a car accident or workplace injuries. A wrist fracture is more common in people with osteoporosis, a condition marked by brittleness of the bones.

Common symptoms of a wrist fracture include pain, swelling, and deformity at the wrist site, as well as movement constraint in hand and wrist. More commonly, fracture in radius is seen in many fractures exhibiting deformity of the wrist. Deformity may not be apparent in the case of fractures of the smaller bones such as the scaphoid.

Wrist fractures are simple if the pieces of the fractured bone are well aligned and stable; and unstable if the broken bone fragments are misaligned and cause wrist deformity. Some fractures result in breaking of the joint surface and some don’t. Open (compound) fracture is one in which the broken bone can be seen through the skin. In such a fracture the risk of infection is higher. Misalignment of the bone fragments in a healed fracture might permanently limit motion, cause pain, or arthritis.

Your doctor will perform a preliminary examination followed by an X-ray of the wrist to diagnose a fracture and the state of alignment of the bones. Sometimes a CT scan may be used to gather more details of the fracture and the associated injuries. Injuries to ligaments (the structures that hold the bones together), tendons, muscles, and nerves may also occur when the wrist is broken. In such cases these injuries also need to be treated concurrently.

Factors such as age, activity level, hand dominance, previous injuries, and arthritis of the wrist besides other medical conditions, and possible predisposing causes in hobbies and occupation of the patient are considered before treating a wrist fracture. Fractures that are not displaced are treated with either a splint or a cast to hold the wrist in place. For displaced fractures surgery may be needed to properly set the bone and hold it in place, sometimes using external devices, with pins, screws, rods, or plates. These implants are placed deep inside through an incision on the lower or upper side of the wrist.

If the wrist fracture is treated externally, pins are fixed above and below the fracture site and these pins are held in place by an external frame outside the body. This keeps the bone stable until healing occurs.

Sometimes, if the bone is crushed or missing, surgical treatment such as bone grafting may be required. Bone grafting involves taking the bone from another part of the body or a bone bank or using a bone graft substitute to treat the fracture.

During the period of healing, fingers and shoulder are allowed to remain flexible unless there are other injuries that require their immobilization. When the fracture heals and the limb is stable, you may be asked to do some motion exercises to keep the wrist flexible. In many cases, hand therapy may be indicated to restore flexibility, function, and strength. There is no standard wrist fracture recovery time. While some fractures take a few weeks, some others may take several months to heal.