Hand and Wrist Injuries
The hand and wrist are made up of an intricate assortment of bones, ligaments, tendons and nerves. In addition, they are involved in almost every activity of daily living, and as such, they can be easily injured. Because of the complex biomechanics of the hand, many injuries are obvious, but some are so subtle that they can be easily missed on initial examination. Therefore it is important that careful diagnosis be made of all hand injuries so that proper rehabilitation can begin as early as possible. One of the most commonly seen wrist injuries is carpal tunnel syndrome. This is a condition where the median nerve which supplies the hand becomes compressed. Wrist pain, numbness and tingling are the usual signs of carpal tunnel syndrome. The primary causes are sprains, strains or fractures and repetitive use of the wrist. The condition is more common in women and diabetics. Therapeutic measures include splinting to rest the hands, stretching exercises and pain management. If these do not work, surgery may be necessary. This is then followed by physiotherapy to restore range of motion and strength. Another hand injury that is frequently seen in the clinic is De Quervain’s tenosynovitis. This is a condition that affects tennis, squash and badminton players as well as those who engage in canoing and ten- pin bowling. It can affect golfers as well. Symptoms are tenderness and swelling on the thumb side of the wrist, crepitus ( a creaking when the tendon moves) and a positive Finkelstein’s test (when the thumb is placed in the palm and the hand moved sideways toward the finger, pain is felt). Rehabilitation consists of rest and splinting if necessary, followed by pain management and stretching and strengthening exercises. Wrist fractures frequently occur, with a Colles’ fracture being one of the most common forms of wrist injury. This type of fracture, also known as a distal radius fracture, occurs at the wrist on the thumb side where the radius bone ends. If the other forearm bone the ulna breaks, the injury is called a distal ulna fracture. These wrist injuries can occur when someone falls on an outstretched hand, as in a bike, car or ski accident. Acute pain, swelling and tenderness are early symptoms and the wrist may hang in an odd way. Treatment for a Colles’ fracture depends on the severity of the injury and your surgeon’s preferences. If the bone is in good position, a plaster cast may be applied to allow the bone to heal. If there is deformity that could limit the future use of your arm, your doctor may choose to perform surgery. This may be either closed reduction – straightening the bone without an incision – or open reduction which is just the opposite. Following surgery, the bone will be allowed to heal in a cast. This is usually removed after six weeks, at which time intensive physiotherapy will begin to restore range-of-motion and function.