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Hand & Wrist

Normal Hand Anatomy

The human hand is an intricate instrument that is both tough and delicate. Its functions of sensation and motion allow us to experience and control the world around us.

Trigger Finger

The tendons of the thumb and each of the fingers pass through a sheath on the palm side of the hand. Certain diseases and overuse activities can cause a thickening of this sheath. As the tendon passes through a thickened sheath, the tendon eventually becomes irritated and swells. Pain, catching and eventually locking of the finger will occur. Early treatment consists of anti-inflammatory medication or Cortisone injection. If these fail to provide relief, the sheath is opened surgically through a small incision at the base of the finger.

Dupuytren’s Contracture

This is a disorder of thickened ligament in the palm, resulting in nodules on the ligament; which if severe enough can cause an inability to fully straighten the fingers. The ring and small fingers are most commonly affected.

The cause of this disorder is unknown. It is seen more commonly in men and is usually found in individuals of Northern European extraction.

If deformity is mild and there is no functional loss, no surgery is needed. If, however, there is significant contracture that interferes with full use of the hand, surgical removal of a portion of the ligament is the treatment of choice to improve function and to prevent further deformity.

De Quervain’s Tenosynovitis

Tendonitis on the thumb side of the wrist can be a very painful and disabling condition. Simple pinching and twisting activities can almost be impossible. The tendons to the thumb become inflamed as they pass under a ligament and the slightest motion of the wrist can cause pain.

Treatment consists of rest, medication and occasionally the use of a steroid injection. If these treatments do not provide relief over time, the tendons can be surgically released.

Carpal Tunnel Syndrome

Carpal tunnel syndrome is a common hand problem resulting from pressure on the median nerve at the wrist. Symptoms, which often get worse at night, consist of numbness and/or pain in the wrist and fingers. Eventually there is loss of strength, fine motor control and sensation.

Early treatment consists of splinting and anti-inflammatory medication. If symptoms do not improve, an outpatient surgical procedure to relieve the pressure on the nerve is suggested.

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Arthroscopic Wrist Surgery

Wrist is also called as carpus, a complex joint comprised of bones and joints, ligaments and tendons, nerves, blood vessels, and muscles that hold the bones together. A fibrous cartilage present between the radius and ulna (forearm bones of the hand) separates the radioulnar joint from the rest of the wrist. Wrist connects the forearm to the hand and allows it to move. Carpal tunnel is an opening in the wrist through which the nerves and blood vessels pass.

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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.

Flexor Tendon injuries

Tendons are the bands of fibrous connective tissue that connect muscles to bone. Tendons aid in movement of the fingers, hand and all other body parts.

There are two types of tendons present in the hand- extensor tendons and flexor tendons. The extensor tendons present on top of the hand help with straightening the fingers. While, the flexor tendons that lie on the palm side of the hand help in bending the fingers. The flexor tendons are smooth, flexible, thick tissue strands which bend the fingers.

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Wrist fractures

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.

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Finger fracture

Fingers are fine structures of the human body which assist in daily routine activities through coordinated movements. Any abnormality affecting the fingers can have a huge impact on quality of life of the patient. A finger fracture is usually a minor injury but if left untreated it may lead to major consequences due to interference with the specialized functions such as grasping or manipulating objects in the palm. A fracture of the finger may disrupt the alignment of whole hand and cause pain and stiffness.

Nail bed injuries

A nail is the hard covering at the end of the dorsal side of your fingers and toes. The nail is composed of a nail plate, nail matrix (a tissue that protects nails) and nail bed. The nail plate is a hard, translucent part of the nail composed of a protein called keratin. The nail bed is the skin that is present below the nail plate. Nail bed injuries are very commonly associated with hand injuries or fingertip injuries.

Distal radius fracture

The forearm consists of two bones, the radius and ulna. The radius is the larger of the two forearm bones, and the region towards the wrist is called the distal end. Fractures in this end are most common.

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Fractures and Trauma

The hand is one of the most flexible and useful parts of our body. In the wrist, many small bones are connected to each other and help you perform various activities. Because of overuse of hand in various activities hands are more prone to injuries and you may suffer from sprains and strains; fractures when lifting and carrying heavy objects, hand injury while operating machinery, bracing against a fall, or sports-related injuries.

Wrist Pain

The wrist is more prone to injuries and problems that include sprains and strains as well as fractures can occur with lifting and carrying heavy objects, wrist injury while operating machinery, bracing against a fall, or sports-related injuries. These injuries result in wrist pain.

Arthritis of Hand

Arthritis is an inflammatory condition of joints. There are several types of arthritis and the most common type is osteoarthritis or wear-and-tear arthritis. Arthritis affects various joints in the body and the arthritis in hand affects the joint at the base of the thumb.

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Hand Surgery

Hand surgery is performed to restore the structure and functionality of the fingers, wrist and hand secondary to a traumatic injury, medical condition, severe infection, or birth defect causing pain and/or deformity of the hand. It is performed by trained and certified plastic surgeons. The surgery is done either as an emergency procedure or as an elective procedure depending on the condition and its severity.

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Endoscopic carpal tunnel release surgery

Carpal tunnel syndrome can be treated with carpal tunnel release Surgery. Traditional surgery involves up to a 2- inch incision in the palm and wrist area, whereas endoscopic surgery involves one or two half-an-inch incisions and the use of an endoscope. During the surgery, the transverse carpal ligament will be dissected to release the pressure on the median nerve and enlarge the carpal tunnel. Your surgeon will decide which options are best for you based on your general and medical conditions.

Wrist joint replacement

Wrist Joint Replacement surgery, also called Total Wrist Arthroplasty, is used to treat the symptoms of arthritis that have not responded to non-surgical treatments such as medication or therapy. Arthritis is a general term covering numerous conditions where the joint surfaces wear out. The joint surface is covered by a smooth articular surface made of cartilage that allows pain free movement in the joint. This surface can wear out for a number of reasons. Often the definite cause is unknown.

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Wrist reconstructive surgery

Wrist reconstructive surgery is performed primarily to restore lost functions and relieve pain in cases of trauma, developmental deformities, or diseases.

Xiaflex for Dupuytren’s contracture

Dupuytren’s contracture is thickening of the fibrous tissue layer under the skin of palms, fingers, and hands which leads to curving of the finger. It is caused due to the excessive production of collagen which gets deposited under the skin. Hereditary factors, excessive alcohol consumption, diabetes, seizures, and increased age may increase the risk of developing the condition.

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Hand therapy

Hand Therapy is a rehabilitation technique recommended to improve the strength and restore functional activity of hands in patients with upper extremity injuries. Hand therapy also helps in preventing the injury.

Tendon transfer

Tendon transfer surgery is a surgery to restore the lost functions of the hand by shifting functioning tendon from its initial attachment to the new one.

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Microsurgery

The hand is considered one of the most complex structures in the human body due to its intricate anatomy. Your hands are a complex system of variousbones, joints, ligaments, tendons, muscles, nerves and blood vessels. Withoutthehealthy functioning of the hand we are unable to perform activities of daily living.

Rejuvenation of hand

Cosmetic enhancement is generally focused only on the face, while the hands portray some of the most prominent signs of aging. With age, the hands lose their firmness and plumpness and develop a bony and fragile. Hand rejuvenation is a treatment that gives you visibly younger, healthy, and firmer hands. If you want to diminish wrinkles, fight against the skin aging process, and improve the overall appearance of your hands, hand rejuvenation may be needed for you. Hand rejuvenation fights against the visible signs of aging through the use of invasive and non-invasive treatments.

Hand peripheral nerve surgery

The peripheral nerves are the nerve fibers that compose the area from head to toe, connecting the brain and spinal cord with the rest of the body parts. Nerves transmit electrical impulses and signals to and from the brain. Peripheral nervous system disorders interrupt the transmission of signals and weaken the sensory and motor nerve functions.

Click on the topics below to find out more from the Orthopaedic connection website ofAmerican Academy of Orthopaedic Surgeons.