Your hands and wrists take part in almost everything you do. Even when you are walking, you use your hands and wrists to help maintain your balance. This integral role means that injury can arise from a variety of causes and the impact can be significant.

Many of the injuries that can affect the hand and wrist are well known, such as a fractured bone or sprains and strains of the supporting soft tissues. Other problems, such as carpal tunnel syndrome and repetitive motion trauma, have assumed prominence only relatively recently. And research continues to add to the knowledge of the seemingly “contemporary” problems, and new treatment techniques have improved the ability to restore normal function to problems not well understood only a decade ago. Click on a topic below to learn more about injuries that may affect the hand or wrist.

Sprains and Strains
Ligamentous Injuries
Fractures
Repetitive Trauma Syndrome
Carpal Tunnel Syndrome
Osteoarthritis
Rheumatoid Arthritis
Wrist Ganglion
Trigger Finger

       
Sprains and strains
Sprains and strains are terms that are often used interchangeable. And while they are among the most common types of injuries affecting the extremities, they are separate problems. A sprain is an injury in which a ligament is injured. A ligament is the soft-tissue structure that holds two bones together. A strain is an injury in which a muscle or its protective sheath is damaged. Both muscles and ligaments are made of numerous, separate fibers, and the severity of a sprain or strain depends on how many of the fibers are damaged and on whether the fibers are “pulled” or torn. Specific degrees of injury are described below.

• Mild sprain or strain results in tenderness and moderate swelling at the site of the injury.

• Severe sprain or strain produces significant pain and swelling, with bruising and reduced ability to move or use the hand or wrist for normal functions.

• An avulsion fracture is an injury in which a ligament pulls a bone fragment loose or causes the bone to be pulled out of normal alignment.
  

Immediate treatment for an injury, such as a sprain or strain of the hand or wrist, includes the RICE formula – rest, ice, compression, and elevation. However, any injury that affects normal function or does not resume a normal appearance after 24 to 48 hours should be brought to your doctor’s attention. It can be difficult to distinguish between a sprain or strain and a fracture, and your doctor’s evaluation will be important to appropriate treatment.

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Ligamentous injuries
The ligaments of the hand and wrist are the soft-tissue structures that connect two bones together. They are made up of separate fibers and injury is defined by how many of the fibers are damaged and how severe the damage is, from partial bruising or inflammation of one or more fibers to a complete ligament tear.

Symptoms of a ligamentous injury will vary with the severity of the injury, with a minimal amount of pain and swelling accompanying moderate injury. A complete ligament tear will produce significant pain and swelling, and it may not be possible to use the hand or wrist normally.

Healing of an injured ligament can require more time than other soft-tissue injuries, because ligaments do not receive nourishment from the body’s blood supply. Instead, their nutrients are supplied by the synovial fluid that surrounds a joint.

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Fracture
A fracture is a break in a bone. The number and size of the small bones and joints in the hand and wrist make them more susceptible to fractures. The break may be caused by one of several events -- a force stronger than the bone is applied against a bone, causing it to break; a severe strain of a ligament or muscle, which exerts a traumatic force against the site of attachment to the bone; or by a crushing force against one or more bones of the hand and wrist.

A bone fracture is usually very painful and may be accompanied by swelling and discoloration of the skin. Your ability to move the affected area also may be limited. However, it is possible to have a fracture in the hand or wrist and not be certain the injury is serious. Evaluation by your doctor is essential for the correct diagnosis and effective treatment. In cases of a severe or obvious injury, you should apply the RICE treatment until you can obtain medical attention. If you are bleeding or there is a protrusion of bone through the skin, you should always seek emergency treatment immediately.

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Repetitive Trauma Syndrome
The repetition of any action over time, such as operating machinery, can cause sufficient stress on the joints to produce an inflammatory response. This response may be accompanied by pain and reduced mobility in the affected joints. Unless the way you perform the activity is changed, or the activity is eliminated from your daily routine, the inflammation can become chronic. This chronic inflammation is referred to as repetitive trauma syndrome. The most common is now known as carpal tunnel syndrome.

Those activities that are most often associated with a repetitive trauma injury to the hand or wrist are:      

• Repetitive, forceful, or prolonged exertions of the hands.

• Rapid hand and wrist movement.

• Frequent or heavy lifting, pushing, pulling, or carrying heavy objects.

• Vibration

Carpal tunnel syndrome has gained notoriety in past decades, in part, because of the differences in how a person uses the keyboard of a personal computer compared to the same activity on a typewriter.

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Carpal tunnel syndrome
Carpal tunnel syndrome is a repetitive trauma injury to the median nerve at the wrist. It results from compression of the nerve when the flexor tendons in the area become swollen and press on the nerve as it passes through the carpal tunnel. Symptoms of carpal tunnel syndrome include pain and numbness, usually affecting the thumb and first two fingers. The condition can sometimes be prevented or treated by splinting or immobilizing the wrist during activities that cause excessive wrist flexion. In severe cases, treatment may include steroid injections or surgical intervention.

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Osteoarthritis
Osteoarthritis is degeneration of the normally smooth surfaces between joints. An inflammatory process, there is usually pain accompanied by a progressive loss of normal joint function. More commonly associated with the larger, weight-bearing joints of the body, osteoarthritis can develop anywhere in the body and may affect the hand or wrist as a result of an earlier injury or illness or for no known reason.
 
Osteoarthritis is a condition that may affect one or more joints, but does not affect other body tissues or organs, which is how it is differentiated from the systemic disease of rheumatoid arthritis. When osteoarthritis affects the hand or wrist, it may only affect the right or left side. A progressive disease causing degeneration of the joint, osteoarthritis may cause the affected joint or joints to become increasingly painful, less able to perform normal functions, and may even cause the joint to lose normal shape and alignment.

Numerous methods of treatment are now available to treat osteoarthritis, including medications and surgical options.

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Rheumatoid arthritis
Rheumatoid arthritis differs from osteoarthritis in that it is a systemic disease, affecting the whole body, individual organs and organ systems. In addition to the pain most people associate with osteoarthritis, rheumatoid arthritis also may produce other symptoms such as fatigue, weight loss, rashes, and generalized joint stiffness. Other abnormalities may be detected in blood tests, in the synovial fluid surrounding the body’s joints, and on the radiographic images of bone and cartilage.

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Wrist ganglion
A ganglion is a small cyst filled with the same synovial fluid that normally surrounds the body’s joints. When one develops on the wrist, it usually is seen on the back of the wrist.  A wrist ganglion is usually painless, but excessive use of the hand or pressure on the ganglion may cause discomfort. A ganglion may disappear without treatment, but also may return.

Often, no treatment is required unless the ganglion becomes painful or interferes with the normal function of the wrist. In some cases, your doctor may insert a needle into the cyst to aspi rate, or withdraw the fluid, or surgery may be required to remove the cyst if other treatments provide no lasting relief.

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Trigger Finger
Trigger finger is a name given to an inflammation in a tendon of one or more fingers. The name “trigger” derives from the appearance of an affected finger, which becomes difficult to straighten and has a slightly curled alignment. In many cases, there will be a “pop” or snap when the finger is stretched straight. The inflammation may be reduced by medication. However, surgery may be required to restore normal function.

If you feel you are suffering from any of these injuries, please call 1-888-563-KNEE(5633) to schedule an appointment with one of our orthopedic specialists.