Common Finger, Hand Wrist and Elbow
Problems
WESTERN
MASSACHUSETTS SPRINGFIELD HOLYOKE
NORTHAMPTON
No matter what your age or occupation your
fingers,hands, wrists and elbows are always
working. Many common problems that interfere
with your daily activities can be diagnosed
and treated by your Hand and Upper extremity
specialist.
At the
Hand Center
of Western Massachusetts we are strong
proponents of patient education and
information. Please use this list as a
starting point. For more information refer
to the text and links below.
Ganglion Cysts
Ganglion cysts are the most
common mass or lump in the hand. They are
common in the back of the hand. These
fluid-filled cysts arise from the ligaments,
joint linings or tendon sheaths when they
are inflamed or irritated.
Carpal Tunnel Syndrome
Common symptoms of carpal tunnel syndrome
are numbness and tingling to the hand,
especially at night; pain with prolonged
gripping such as holding a steering wheel or
clumsiness in handling objects. Sometimes
the pain can go all the way up to the
shoulder.
Cubital Tunnel Syndrome
Like carpal tunnel syndrome,
this condition is due to compression or
pressure on a nerve but in this instance it
is at the elbow. Cubital Tunnel syndrome is associated with numbness or
tingling in your little and ring finger and at times
weakness in grip as well as increased
symptoms with bending of the elbow.
More recently it has been newly labeled
CELLPHONE ELBOW in the media.
Tendinitis of the Wrist
This is common in adult women between the
ages of 30 and 50. It is an irritation and
swelling of the tunnel which surround the
thumb tendons as they pass from the wrist to
the thumb. Pain when grasping or pinching
and tenderness over the tunnel are the most
common symptoms. If the hand is made into a
fist with the thumb tucked in and bent
towards the little finger, the pain gets
worse.
Arthritis of the Base of Thumb/Wrist
Wear and tear arthritis is very
common at the base of the thumb. Pain
localized to the base of the thumb is a very
common early symptom.
Arthritis of the MP joints (knuckles)
The large joints in the hand at the base of
each finger are known as the
metacarpophalangeal (MP, or MCP) joints.
They act as hinge joints and are important
for both power grip and pinch activities.
Most people refer to these joints as their
knuckles. The most common arthritic
condition affecting the MP joints is
rheumatoid arthritis. Gout, psoriasis, and
infection are other less common causes of MP
joint arthritis.
Hand Fractures
Some fractures will cause an obvious
deformity, such as a crooked finger, but
many fractures do not. Medical evaluation
and x-rays are usually needed so that your
doctor can tell if there is a fracture and
to help determine the treatment. Depending
upon the type of fracture, your hand surgeon
may recommend one of several treatment
methods.
Carpal Boss
The carpal boss is an osteoarthritic spur that develops at
the base of the second and/or third carpometacarpal joints. (figure 1) A firm,
bony, nonmobile, tender mass is visible and palpable at the base of the
carpometacarpal joints, especially when
the wrist is volar flexed.
Fingertip injuries/amputations
Children's fractures
Children have different bone
structure than adults. As a result there is
often concern regarding growth plate
injury. It is important to note that most
child hood fractures are growth plate
injuries. Growth plate fractures are
classified depending on the degree of damage
to the growth plate itself. Treatment
depends on the fracture type.
Forearm fractures in Children
Growth Plate Fractures
Distal phalanx fracture
Most pediatric hand
fractures can be treated by nonoperative
means with good results. However, a subset
of fractures requires prompt recognition and
surgical intervention. Several pediatric
phalangeal fracture types must be
recognized and treated appropriately to
minimize complications and disability. These
injuries defy the general conception that
pediatric fractures universally do well with
minimal intervention. This paper highlights
two important concepts: (1) phalangeal
fractures in children can differ
considerably from other pediatric fractures,
and (2) phalangeal fractures in children can
be very different from those in adults.
Pediatric Phalanx Fractures: Unique
Challenges and Pitfalls.
Trigger finger
Trigger finger is a condition
where the tendon in your palm and finger
doesn't have enough room to glide.
Symptoms may include locking of your
finger with activity, palm pain with grip or
even a finger that gets stuck in the palm
only in the morning.
Often an office injection can relieve the
symptoms of this problem.
Dupuytren's disease
Dupuytren's disease is an
abnormal thickening of the fascia (the
tissue just beneath the skin of the palm).
It often starts with firm lumps in the palm.
In some patients, firm cords will develop
beneath the skin, stretching from the palm
into the fingers Gradually, these cords may
cause the fingers to bend into the palm.
Although the skin may become involved in the
process, the deeper structures-such as the
tendons-are not directly involved.
Occasionally, the disease will cause
thickening on top of the finger knuckles
(knuckle pads), or nodules or cords within
the soles of the feet (plantar fibromatosis).
Osteoarthritis HANDReceiving a diagnosis of
arthritis doesn't mean that it is the
beginning of the end.
Symptoms of arthritis may be mild with
only pain with certain activities or severe
with chronic pain all the time.
Arthritis can affect any joint in the
body, but it is most noticeable when it
affects the hands and fingers.
Arthritis literally means "inflamed
joint." Normally a joint consists of two
smooth, cartilage-covered bone surfaces that
fit together as a matched set and that move
smoothly against one other. Arthritis
results when these smooth surfaces become
irregular and don't fit together well
anymore and essentially "wear out."
Treatment is designed to relieve pain and
restore function.
Hand Infections
Not all hand infections require surgery.
When seen early, in fact, many types of
infection can be treated with antibiotics
and local rest and soaking. At other times
surgery is neededif antibiotic treatment
fails or if the infection is severe enough
to warrant it.
Flexor Tendon injuries
Deep cuts on the palm side
of the wrist, hand, or fingers can injure
the flexor tendons and nearby nerves and
blood vessels. The injury may appear simple
on the outside, but is actually much more
complex on the inside. When a tendon is cut,
it acts like a rubber band, and its cut ends
pull away from each other
Extensor tendon injuries
Extensor tendons are just under the skin,
directly on the bone, on the back of the
hands and fingers. Because of their
location, they can be easily injured even by
a minor cut. Jamming a finger may cause
these thin tendons to rip apart from their
attachment to bone. After this type of
injury, you may have a hard time
straightening one or more joints. Treatment
is necessary to return use to the tendon.
At times splinting alone is used to treat
an extensor tendon injury. At other times
surgical repair is needed
Nerve Injuries
Nerves are fragile and can be
damaged by pressure, stretching, or cutting.
Pressure or stretching injuries can cause
the fibers carrying the information to break
and stop the nerve from working, without
disrupting the insulating cover. When a
nerve is cut, both the nerve and the
insulation are broken. Injury to a nerve can
stop the transmission of signals to and from
the brain, preventing muscles from working
and causing loss of feeling in the area
supplied by that nerve.
Wrist fractures
The most commonly broken bone
of the wrist is the radius.
Many people think that a fracture is
different from a break, but they are the
same. When the wrist is broken, there is
pain, swelling, and decreased use of the
hand and wrist. Often the wrist appears
crooked and deformed. Fractures of the small
wrist bones, such as the scaphoid, are
unlikely to appear deformed.
Distal Radius Fracture of the Wrist
When someone falls on their
outstretched hand, they sometimes get a
"broken wrist." The bone that is usually
broken is called the radius. It is the
larger bone on the upper side of the
photograph above. The end toward the wrist
is called the distal end. The medical term
for "broken bone" is fracture. Therefore,
the medical term for the most common type of
"broken wrist" is a distal radius fracture
(that is, the larger forearm bone is broken
near the wrist).
Scaphoid Fractures of the wrist
Fracture of the scaphoid
bone occurs most frequently from a fall onto
the outstretched hand. Typically there is
pain initially, but the pain may decrease
after days or weeks. Bruising is rare, and
swelling may be minimal. Since there is no
deformity, many people with this injury
mistakenly assume that they have just
sprained their wrist, leading to a delay in
seeking evaluation. It is common for people
who have fractured this bone to not become
aware of it until months or years after the
event.
Bite wounds of the Hand
Bites are extremely common and
can cause significant pain and other
problems, especially when associated with an
infection.
Early recognition of warning signs and
appropriate treatment are key in minimizing
potential problems from the bite.
Warts are common on the hands and
fingers. AS they are so common there
are many different treatment options.
Hand Surgeons typically do not perform
surgery for warts. However a variety
of treatments have been succeessful.
Nailbed Injury
Often nailbed injuries look worse than they
are and most of these are well taken care of
in the emergency room.
However, After being sutured in the
emergency room it is important to have
follow up so that the nail injury
can be assessed to see if further
definitive treatment needs to be done. Not
all nail injuries are the same though as
some are associated with fractures of the
underlying bone while others simply involve
the nail and the soft tissue of the
fingertip and nailbed. Children can have
different varieties of nailbed injuries
because of their unique underlying bone
anatomy
Tennis Elbow or Lateral Epicondylitis
Lateral epicondylitis, commonly
known as tennis elbow, is a painful
condition involving the tendons that attach
to the bone on the outside (lateral) part of
the elbow. The pain is located over the
outside aspect of the elbow, over the bone
region known as the lateral epicondyle. This
area becomes tender to touch. Pain is also
produced by any activity which places stress
on the tendon, such as gripping or lifting.
With activity, the pain usually starts at
the elbow and may travel down the forearm to
the hand. Occasionally, any motion of the
elbow can be painful.
Thumb sprains
These types of injuries are
common in sports and falls. The thumb is
jammed into another player, the ground, or
the ball. The thumb may be bent in an
extreme position, causing a sprain. The
thumb will usually swell and may show
bruising. It is usually very painful to
move. A sprain is an injury to a ligament.
Ligaments are the connective tissues that
connect bones to bones across a joint.
The most common ligament to be injured in
the thumb is the ulnar collateral ligament
Congenital Hand Differences
Babies born with hands that are
different than the normal hand have a
congenital hand difference. One in twenty
children is born with some difference from
normal, either major or minor.
The different groups of congenital hand
differences include missing parts of the arm
(failure of formation), webbed or fused
parts of the hand (failures of separation),
extra parts present in the hand
(duplication), undergrowth or overgrowth of
parts of the hand, or constriction band
syndrome.
ADDITIONAL RESOURCES
List of Hand Conditions from the
American Society of Surgery of the Hand
List of Hand Conditions from the
American Academy of Orthpedic Surgeons
List for Hand Conditions from the
American Society of Plastic Surgeons
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