Hand & Wrist

Wrist fractures often involve the distal radius, the larger of the two forearm bones. Treatment depends on the fracture's location, displacement and joint involvement. Symptoms include pain, swelling, bruising and possible deformity. X-ray and CT confirm the diagnosis.

Fractures that are not significantly displaced can be treated in a cast for four to six weeks while the bone heals. Displaced fractures, fractures with multiple fragments, or fractures involving the joint will likely require surgery with plates and screws to hold alignment during healing. Physical therapy follows to regain motion and strength.

Carpal tunnel syndrome is a common cause of numbness and tingling in the hand. It is more common in women than men and often affects people who do a lot of repetitive gripping, grasping, twisting and typing. The carpal tunnel is a narrow canal in the wrist through which the median nerve passes; the nerve provides sensation to the thumb, the index and middle fingers, and part of the ring finger.

Common symptoms include numbness in the hand, achiness around the wrist, nighttime pain and decreased grip strength. Diagnosis is confirmed by physical exam and nerve conduction studies.

Bracing and activity modification are usually first-line, along with anti-inflammatory medication, a cortisone injection and physical therapy. If symptoms continue, a surgical carpal tunnel release opens the ligament over the median nerve to relieve pressure.

De Quervain's tenosynovitis is inflammation of two tendons at the base of the thumb. It develops from overuse, and pain typically occurs when making a fist or gripping and grasping. Diagnosis is made by physical exam.

Treatment includes activity modification, bracing, and reducing inflammation with anti-inflammatory medication or a cortisone injection. Physical therapy is also an option. If symptoms persist, a surgical release of the tendon sheath gives the tendons more room to glide without pain.

Ganglion cysts are very common, most often in the hand and wrist. They are not dangerous and often resolve on their own. They can form after trauma or from overuse. Most are painless, but large cysts can be painful or restrict motion. Diagnosis is by physical exam, sometimes with MRI.

Treatment includes aspirating the cyst fluid and injecting a small amount of cortisone to help reduce recurrence. Recurrence is common; if the cyst returns, surgical removal of the entire cyst sac and stalk can be discussed.

Trigger finger affects the tendons of the fingers or thumb. Overuse can cause inflammation and thickening of the tendons, which then catch under their sheaths and lock the finger in a bent position. It can affect any finger, and more than one at a time. Diagnosis is made by physical exam.

Treatment focuses on reducing inflammation, best accomplished with a cortisone injection around the tendon. If symptoms persist, a surgical release of the tendon sheath can be performed.