Common Hand Injuries & Conditions

 Common Injuries of the Hand 

The hand is one of the most unique and complicated structures of the human anatomy, performing fine motor skills with agility and dexterity, but also tasks requiring strength and stability. The 19 bones of the hand are supported by ligaments, tendons and muscles, along with a rich supply of blood vessels and nerves that supply the brain with sensations such as touch, pain and temperature.

Aside from trauma to the thumbs and fingers (such as sprains, strains and fractures), the most common complaint is pain and numbness in the hand caused by Carpal Tunnel Syndrome (CTS). The carpal tunnel is the opening that allows the median nerve and flexor tendons to travel through the wrist to the hand. CTS symptoms arise when the opening is narrowed, or the tissues within the tunnel inflame and expand.

There are a number of causes and risk factors associated with CTS, including force (trauma to the wrist), posture, wrist alignment, stress from prolonged, repetitive movement (cashiers and typists), temperature and vibration. Other factors that may increase the likelihood of developing CTS include smoking, obesity and caffeine intake.

Effective treatment of Carpal Tunnel Syndrome requires a thorough physical examination and careful history of the condition. Non-operative treatments include bracing, physical therapy, occupational therapy and anti-inflammatory medication. Surgical intervention may be indicated if non-operative treatments fail or in the case of acute CTS.

Common Hand Injuries & Conditions

Basal Joint Osteoarthritis


Overview This condition is a degeneration of cartilage in the joints at the base of the thumb, collectively called the basal joint. The main component of the basal joint is the thumb carpometacarpal (CMC), joint. This joint, which allows the thumb to pivot and swivel, can wear out even early in life. Causes This condition is caused by aging, repetitive motions, and wear and tear that occurs during normal use of the hand. It typically results from weakness of the volar beak ligament, which normally helps maintain joint stability. When this ligament weakens, the thumb can begin to move abnormally and the joint becomes irritated and inflamed. Gradually, the cartilage that lines the joint degenerates, allowing bone to rub directly against bone. As the CMC joint degenerates, other articulations of the basal joint can become affected. Symptoms The most common symptom is pain at the base of the thumb, especially when gripping or pinching. A grinding sensation may be felt when the thumb is moved. The thumb may also become weak and stiff. As the condition worsens, the joint may become deformed, and a bump may form where the thumb meets the wrist. Diagnosis The doctor will order x-rays of the wrist and hand to diagnose this condition. MRI or CT scans are usually not required. Treatment Treatment options include cortisone injections, non-steroidal anti-inflammatory medications, use of a splint or brace, exercise, and modification of daily activities. Surgery may be needed.




Boxer's Fracture


Overview A boxer's fracture is a break of the metacarpal of the little finger. The metacarpals are the long bones in the hand that connect the fingers to the wrist. A boxer's fracture refers to a break at the end of the bone nearest the knuckle, which is called the metacarpal neck. Causes This type of fracture most commonly occurs when someone punches a hard surface (or another person) with a closed fist. Since most people punch in a roundhouse fashion, the first point of boney contact in a punch is the little finger metacarpal bone. The force concentrates at the metacarpal neck, leading to a fracture. Ironically, this is a rare injury in boxers because they are trained to punch with even force over the entire hand, maximizing force and minimizing injury. A boxer's fracture can also occur when a person stumbles and tries to break his fall with a closed fist to the ground. Occasionally, direct trauma to the hand can also cause this injury. Symptoms Common symptoms include pain, tenderness, and swelling around the knuckle of the little finger. Bruising and loss of knuckle contour are also common, and extending the finger may be difficult. In severely displaced fractures, the fingers may overlap (or scissor) when they are flexed. Treatment Most boxer's fractures can be treated with a cast or brace to stabilize the fracture while it heals. If the knuckle is severely deformed, a procedure called a closed reduction may be needed to push the fracture back into proper position before casting. For severe displacement, finger scissoring, or multiple metacarpal fractures, surgery may be recommended.




Carpal Tunnel Syndrome


Overview Pain, numbness and tingling in your hand may be from carpal tunnel syndrome. It happens when the area around the main nerve to your hand is too tight. The nerve is called the median nerve. And the small space in your wrist where it passes is called the carpal tunnel. Causes and Risk Factors Any crowding of the median nerve can cause this problem. Wrist injuries, diabetes and rheumatoid arthritis are causes. Pregnancy and conditions that cause your body to hold onto fluid may also cause it. Carpal tunnel syndrome is more common in women. You have a higher risk if your carpal tunnels are smaller than normal. Some think it's caused by repeated motions of the hand and fingers, especially a lot of typing at the computer. But evidence for that link is not clear. Symptoms Carpal tunnel syndrome can cause numbness or tingling in your hand. You may feel it in your thumb and in your index, middle and ring fingers. Your grip may be weak. Carpal tunnel syndrome may affect one or both hands. Treatment To get better, you may need to rest your hand and avoid doing the things that make your symptoms worse. Ice, wrist splints, medicine and injections may help. If they don't, surgery may be an option. Your healthcare provider can create a care plan that is right for your needs.




Colles Fractures


Overview Colles fracture is a break of one or both of the forearm bones (called the radius and ulna) that occurs just above the wrist. Although this type of injury can be caused by any strong force, Colles is most often associated with trying to break a forward fall. Breaking a Fall A person who falls forward will commonly try to break the fall by extending the hands and arms to reduce the impact of hitting the ground. The Fracture The combined pressure of hitting the ground and supporting a sudden load of body weight can cause the bones of the forearm to break just above the wrist. This is known as a buckle, or a Colles fracture. Symptoms Signs of a Colles fracture include pain and swelling just above the wrist and the inability to hold or lift heavy objects. Treatment Treatment ranges from simple immobilization to the use of a lightweight cast on the wrist. Recovery commonly lasts from six to twelve months. Severe fractures in which the bone is splintered or broken into many pieces may require pins or screws to hold the bones together while they heal.




Complex Regional Pain Syndrome (CRPS)


Overview This is a type of chronic, long-lasting, pain. In most cases, it develops in an arm or a leg that you have previously injured. With CRPS, you may have unexplained pain that won't go away. It may be severe, and it may spread. Causes We don't know the exact cause of CRPS. It's an abnormal response that your body has to being hurt. It seems to be a type of overreaction, almost like an allergy. It can develop after any kind of trauma, such as a sprain, a fracture, a burn or a medical procedure. CRPS may involve your immune system along with your nervous system. The genes you have inherited may also play a role. Symptoms If you have CRPS, you may feel burning pain, or pins and needles. The pain may spread. If you hurt your hand, for example, it may spread to your entire arm. It may even spread to your other arm. Your skin may change colors, and it may feel warm or cool. It may be so sensitive that even a light touch hurts. You may have other issues, such as abnormal sweating, a change in hair or nails, or problems moving your limb. Treatment Treatment for CRPS can involve physical therapy for your body and psychotherapy to help you deal with depression and anxiety. You may benefit from medications. A nerve block may help. You may benefit from a device such as a pump which can deliver medication directly into the fluid around your spinal cord as you need it. Your healthcare provider can create a plan that is right for you.




De Quervain’s Tenosynovitis


Overview This condition, also called stenosing tenosynovitis of the first dorsal compartment of the wrist, is an inflammation of the sheath that wraps around the tendons at the thumb side of the wrist. Causes This condition is caused by overuse, particularly from activities that require forceful gripping while flexing and extending the wrist. It is very common in new mothers (the result of grasping and lifting their babies) and from active gardeners who aggressively plant and weed. Occasionally, it is caused by direct trauma to the wrist. It is also more common in patients who have diabetes, rheumatoid arthritis, and other inflammatory conditions. Symptoms Symptoms can include pain and tenderness on the thumb side of the wrist when the wrist and thumb are moved. In some cases, a catching sensation may also occur. Gripping with the hand may be painful. Often, a firm nodule can be felt at the point of tenderness. Treatment Treatment options include rest, splinting of the wrist and thumb, and corticosteroid injections. Anti-inflammatory medications and a cold compress can also be used to relieve inflammation. If those treatment options are not successful, surgery may be needed.




Digital Mucous Cysts


Overview A mucous cyst is a small, fluid-filled sac that forms on the back of the finger near the base of the fingernail. It is a form of ganglion cyst that erupts from the capsule of the joint at the end of the finger, called the DIP joint. The cyst is attached to the joint capsule by a "stalk" that allows fluid to move into the cyst from the joint. Mucous cysts most commonly affect the index finger of the dominant hand. Cause Mucous cysts are caused by joint synovitis or arthritis at the DIP joint of the finger. It is believed that a weakness in the capsule leads to the formation of the cyst. Although cysts usually develop slowly, they can appear quite rapidly as well. Symptoms A mucous cyst appears as a visible bump under the skin. If it occurs near the nailbed, it may cause a groove to develop in the fingernail. A mucous cyst is typically not painful, but if it is repeatedly rubbed or bumped, the skin that covers the cyst may become irritated. Additionally, the arthritic or inflamed joint may cause discomfort. The skin that covers the cyst may become very thin and may rupture, resulting in drainage of a clear, jelly-like fluid. Because the cyst is connected to the joint, there is a risk of severe joint infection if the ruptured cyst becomes infected. Diagnosis Diagnosis of a mucous cyst involves x-rays, which are used to assess the condition of the joint and the severity of any underlying arthritis or synovitis. In many cases, bone spurs have formed on the top of the joint near the cyst. Treatment In many cases, mucous cysts do not need treatment. Small cysts that don't cause any problems may be treated with aspiration and a steroid medication. In more severe cases where the skin is thin and at risk of rupture, the cyst has become very large or painful, or the nail has become significantly deformed, surgical excision and joint debridement may be recommended.




Distal Radius Fracture (Broken Wrist)


Overview This condition is a break of the radius bone at the wrist. The radius is the larger of the two bones that connect the wrist to the elbow. The other bone is called the ulna. The radius supports the majority of forces at the wrist joint with its large joint surface. A fracture of the distal end of the radius - the end nearest the wrist -is one of the most common types of fractures. It may be part of a complex injury that involves other tissues, nerves and bones of the wrist. Causes A distal radius fracture is typically caused by direct trauma to the wrist. Common types of trauma include a fall on an outstretched hand, an automobile or bike accident, or a forceful blow to the wrist during a contact sport such as football. Symptoms Symptoms typically include pain, swelling, and tenderness at the wrist. The hand and wrist may be bruised and appear deformed. Moving the wrist may be difficult and painful. Mild numbness or tingling in the fingers may be present. Treatment Distal radius fractures can range from simple, clean breaks to severe fractures with multiple bone fragments. Treatment options, which vary depending on the type of injury, are designed to hold the broken radius in its correct position while it heals. If the fracture ends are out of alignment, the physician may need to perform a procedure called a closed reduction to realign them. The bones can then be stabilized with a cast, splint, or brace that may cover only the wrist and forearm or may extend to above the elbow. If the bones cannot be realigned with this method, surgery may be required.




Dupuytren's Disease


Overview This condition is a thickening of the fascia on the palm of the hand. The fascia is a connective tissue located just beneath the skin of the palm and fingers. This thickened fascia can form lumps or nodules under the skin, or long thick cords of tissue that extend from the palm to the fingers. Often, this thickened tissue contracts. This causes one or more fingers to curl toward the palm. This is called a flexion contracture. Dupuytren's Diathesis Dupuytren's diathesis is a more aggressive form of Dupuytren's disease that occurs before the age of 40. It is associated with a strong family history, and affects both hands. A person who has Dupuytren's diathesis also commonly has other diseases of the fascia, such as nodules and contractures in the soles of the feet (called Ledderhose's disease) and curvature of the penis (called Peyronie's disease). Causes The exact cause of Dupuytren's disease is unknown. It most commonly affects white males of Northern European and Scandinavian descent over the age of 60. It is more prevalent in patients with diabetes. Smoking, lung disease, alcoholism, and use of anticonvulsant medication have been associated with Dupuytren's disease, but the relationship is unclear. Trauma to the hand may also play a role in its development. Symptoms The first symptom is a painless, firm nodule under the skin of the palm, most commonly in line with the ring or little fingers. As the disease progresses, the normal fascial bands may further thicken. They may form a cord that extends to one or more fingers. As the cord contracts, affected fingers begin to curl. They may not be able to be fully straightened. Treatment There is no treatment to cure or prevent Dupuytren's disease or its progression, but treatment may be used to relieve severe finger contracture. Treatment options include surgical excision of the thickened fascial tissue or an in-office needle release of the contracture. It can also be treated with an injection of an enzyme called collagenase. This enzyme weakens the contracte




Finger Dislocation


Overview If your finger is dislocated, that means a bone has been forced out of its normal position. It's a common, painful injury, and one that needs proper treatment. Causes Finger dislocations occur when your finger is forcefully jammed or bent past its normal range of motion. That can happen if you fall and try to catch yourself, or if you get hurt playing sports. In the fingers, most dislocations happen at the middle joint. In the thumbs, it's usually the joint at the thumb's base. Symptoms A dislocation hurts. Your finger may be bent at an odd angle, and it may swell. In most cases, you won't be able to bend or straighten it. Sometimes it's hard to tell a dislocation from a broken bone. A doctor can take images to decide. Treatment In many cases, a doctor can treat your dislocation without surgery. The bone is moved back into position, and your finger is supported with a splint. But sometimes, the bone is blocked by soft tissues. Or, the dislocation may have caused tissue damage. If so, you may need surgery to prevent long-term problems. Your healthcare provider can create a plan that's right for you.




Finger Fracture


Overview If you've fractured a finger, you've broken one or more of the finger bones we call "phalanges." Each individual bone is called a "phalanx." You've got three in each finger, and two in each thumb. They are supported by a network of soft tissues that can also be damaged during a fracture. Causes You can fracture a finger in many ways. Bending, twisting and crushing injuries can all do it. With some breaks, the broken parts of the bone stay aligned with each other. But with others, they shift out of alignment. We call this a "displaced" fracture. Symptoms A finger fracture can cause pain and swelling. Your finger may be bent out of its normal position, and you may have trouble moving it. Your skin may bruise. Treatment Some fractures can be treated with a splint or a cast. But a severe fracture may need surgery. Your healthcare provider can create a plan that's right for you.




Flexor Tendon Injuries


Overview The flexor tendons of the hand are responsible for flexion of the fingers and thumb toward the palm. These long structures are connected to the flexor muscles in the forearm. An injury to one of these tendons can cause pain and inability to flex the finger or thumb and grasp with the hand. Common flexor tendon injuries include lacerations, ruptures and inflammation. Lacerations Cuts or penetrating trauma to the flexor tendons are frequently caused by accidents around the home or workplace. A laceration can sever a tendon, and can also injure other structures such as nerves and blood vessels that run parallel to the tendons. Commonly, a lacerated tendon retracts when severed, pulling away from the laceration site and slipping back through the tendon pulleys. Repairing a retracted tendon requires locating the ends and threading them back through the pulleys before they can be reattached. Ruptures Ruptures of the tendons are often caused by sports such as football or rugby, which require tackling. A common type of rupture, called a Jersey finger, is a rupture of the tendon at the fingertip. Inflammation Inflammation and spontaneous rupture of the flexor tendons can be caused by inflammatory conditions such as rheumatoid arthritis. Symptoms The most common symptoms for tendon laceration or rupture are pain and an inability to flex the finger. Swelling and bruising may also be present, but are less common. Symptoms for tendon inflammation can include pain, swelling, and limited range of motion. Treatment For flexor tendons that have been strained, treatment can include rest, anti-inflammatory medications, and often hand therapy. Tendons that have been cut or ruptured will require surgery to restore full use of the affected finger.