Newton Wellesley Orthopedic Associates in Newton and Wellesley, MA addresses many conditions that cause wrist pain and hand pain, including carpal tunnel syndrome and arthritis.
Conditions Affecting the Hand and Wrist
Triangular Fibrocartilage Tear and Arthritis of the Wrist
The triangular fibrocartilage (TFC) is a meniscal cartilage at the end of the ulna bone in the wrist. This is very often injured along with fractures of the distal radius, but may be injured in isolation with sudden twisting or hyperextension of the wrist. Usually, the pain from a torn TFC resolves with rest, ice, anti-inflammatory medications, and time. A brace is used for comfort, and occasionally further treatment such as hand therapy, cortisone injections, or even arthroscopic surgery in chronic cases may be necessary to control the pain.
Carpal Tunnel Syndrome
Carpal tunnel syndrome is one of the most common causes of pain in the hand, wrist, and fingers. It is caused by compression of the median nerve in the wrist. Symptoms typically include burning, tingling, and numbness in the fingers and pain in the wrist shooting down into the fingers. The symptoms may be much worse at night or in the early morning hours and some patients wake up feeling like they need to “shake the hand out” in order to get the pain and numbness to improve.
Ganglion Cyst/Wrist Mass
Ganglion cysts are benign, fluid-filled masses that form on the tendons or joints of the wrists. These cysts are often small and painless. Most often, these cysts go away without treatment but occasionally may be drained or surgically removed if they are causing distress or discomfort to the patient.
Fractures of The Distal Radius (Colles Fracture)
A fracture of the distal radius refers to a fracture occurring at the lower end of the forearm (where the forearm meets the wrist). These are usually caused by a fall on an outstretched hand (palm of the hand hits the floor as the patient tries to break a fall). These are also the third most common large-bone fractures requiring surgical treatment by a hand surgeon (second to hip fractures and ankle fractures).
Nonsurgical (Cast) Treatment of Distal Radius Fractures
Treatment of fractures of the distal radius varies greatly depending on age of the patient. Children and young teenagers very seldom require surgery. Very frequently, the fracture may be very minimally displaced (a “buckle fracture”). These very often heal with a brace or a cast for 3 weeks and have no long-lasting problems. A significantly displaced wrist fracture in a child may require a closed reduction of the fracture (manually straightening the bone with the patient under anesthesia), application of a cast, and occasionally insertion of temporary pins to stabilize the fracture until the bone heals (typically 3-6 weeks depending on age of the patient). Treatment of the elderly patient who is not very physically active usually also involves cast application with or without closed reduction.
Fractures of The Scaphoid (Navicular)
The scaphoid is a small peanut-shaped bone that lies at the base of the thumb where it joins the wrist. Fractures of the scaphoid usually occur in younger patients after a fall on an outstretched hand. Pain and swelling are most pronounced in the “snuff box” at the base of the thumb. The great difficulties with scaphoid fractures is that many of them are non-displaced (e.g. a “hairline crack”) and are extremely difficult to detect on regular X-rays. Because of this, other studies (such as a CT scan or MRI) are sometimes necessary to diagnose these.
Arthritis of The Wrist
Osteoarthritis of the wrist is inflammation of one or more joints in the wrist, which causes the destruction of cartilage. When cartilage is gone, the bones rub together resulting in pain, stiffness and weakness.
Conditions Affecting the Hand
When the tendons in the fingers or thumbs become inflamed due to repetitive movements or force, it is called trigger finger. Pain at the base of the finger is a typically symptom and sometimes the finger may even lock in a bent or straight position. Splints may be used along with steroid injections to treat the condition.
Flexor/Extensor Tendon Laceration
Flexor tendons are in the palm side of the hand and extensor tendons are in the knuckle side of the hand. Lacerations to these tendons can cause difficulty or inability to bend or straighten the fingers, depending on the severity.
Infections in the hands have many causes from a tiny puncture wound to bacteria exposure. Pain and stiffness in the hands and fingers may be a sign of infection.
A lacerated nerve in the hand can cause pain, numbness or weakness and sometimes requires surgical repair. Like any wound, cuts to the hands should be cleansed and dressed properly to prevent infection.
The fingertips can be injured in many different ways including crushing and cutting. Fingertip injuries can affect the skin, bone, nail, nailbed, tendon and the fleshy part of the tip. Treatment depends on the type and severity of the injury.
Fractures of The Fingers
Fractures of the hand and fingers are the most common fracture leading to an emergency room visit. These are often caused by crush injuries, finger-twisting injuries, or axial loading (such as from punching an object). Many of these injuries do not require surgical treatment. These fractures are further divided into:
- Metacarpal Fractures
- Proximal and Middle Phalanx Fractures
- Distal Phalanx Fractures
Mallet finger, sometimes called baseball finger, is caused by injury to the tip of the finger in which the tendon that straightens the fingertip is damaged. If the fingertip will not straighten, medical treatment is needed to restore movement.
Dupuytren’s contracture is a condition in which the palmar fascia (the tough fibrous tissue just beneath the skin) contracts and tethers the skin, producing dimples, lumps, and cords in the palm of the hand and fingers. Occasionally this is seen on the soles of the feet, a condition known as Ledderhose’s Disease. The condition is benign (i.e. not a tumor) but the tissues can cause such severe contraction of the skin that the joints of the hand become curled and unable to straighten. Patients may notice difficulty placing the hand flat on a table, shaking hands, or sliding the hand into a glove or a pants pocket.
Arthritis of The Fingers and Thumb
Arthritis in the joints of the fingers and thumbs can be extremely painful and hinder a person’s ability to complete simple tasks. Finger and thumb arthritis may also cause deformities. Treatment includes heat application, exercise, anti-inflammatory medication and even surgery.