Wrist and Hand Injuries

The wrist is a complex joint that connects your hand to your forearm.  Rather than one big joint, it is actually made up of multiple small joints.  This allows the hand to move in a variety of different planes. It is a commonly injured joint in sports, either from overuse or from trauma such as a fall.

The hand is one of the most sophisticated motor systems in the body.  It is intricately designed, combining a biomechanical and neural architecture that controls the coordination and force of finger movements.   As with the wrist, it can be injured from overuse or from trauma such as a fall or a direct blow.  

The Primary Function and Anatomy of the Wrist

The wrist joint allows movement along two axes, meaning hand flexion, extension, adduction, and abduction can all occur at the wrist.  It is the muscles of the forearm that control the movement of the wrist. The wrist joint is made of bones, cartilage, ligaments, and tendons.

• Bones:  The wrist joint includes the two bones of the forearm, the radius, and ulna, as well as the carpal bones of the hand.  
• Cartilage:  The ends of the bones are covered in a smooth, slippery substance called articular cartilage.  This helps allow the bones to glide against each other when moving the wrist. 
• Ligaments:  Bones connect to other bones through strong, fibrous tissues called ligaments.  The ligaments help maintain bones in proper position and provide stability for the joint.  
• Tendons:  Muscle attaches to bones through bands of strong tissue called tendons.  The tendons work in conjunction with the muscles to move the wrist in all directions. 

The Primary Function and Anatomy of the Hand

The hand and wrist have multiple small joints that work together to produce motion.  The hand is made of bones, cartilage, muscles, tendons, and ligaments that allow for a wide range of movement and dexterity.

• Bones:  There are three types of bones in the hand.  The carpal bones are 8 small bones that create the wrist.  The metacarpal bones are 5 bones that compose the middle part of the hand.  The phalanges are the bones found in the fingers of each hand. Each finger has 3 phalanges, except the thumb that has only 2. 
• Cartilage:  The ends of the bones are covered with cartilage.  This is a smooth substance that allows the bones to glide against each other when using the hand.
• Ligaments:  The ligaments are fibrous tissues that help bind together the joints of the hand and provide stability.  
• Tendons and Sheaths:  The sheaths are tubular structures that surround part of the fingers and permit the tendon to stretch while not adhering to the surrounding fascia.  Tendons are bands of connective tissue that attach the muscles to the bone and enable the muscles to move the bone.  

Common Types of Wrist and Hand Injuries Seen in Our Practice

• Tendonitis/Tendinosis:  Tendonitis is inflammation of the tendon that results from micro-tears that happen when the musculotendinous unit is overloaded.   Tendinosis is a degeneration of the tendon’s collagen response to chronic overuse when no time is given for the tendon to heal and rest.   Many injuries commonly presumed to be tendinitis are actually tendinosis.  DeQuervain’s tenosynovitis is a common type of wrist tendonitis.  Other common types of tendonitis in the hand and wrist include the wrist flexor and extensor tendons.
• Sprains and strains:  A strain is a muscle injury where the muscle is overstretched or torn.  A sprain is a tearing or stretching of a ligament, which is a fibrous tissue connecting two bones.
• Gymnast Wrist:  This is an overuse injury commonly occurring in up to 40 percent of adolescent gymnasts.  It involves irritation and inflammation of the growth plate at the end of the radius (forearm bone) where it connects to the hand.   
• Mallet Finger:  This is an injury to the tendon that straightens the ends of the fingers or thumb.  It results in a drooping finger deformity caused by the inability to extend the tip of the finger.
• Trigger Finger:  This is also known as stenosing tenosynovitis.  Along the tendon sheath, there are bands of tissue called “pulleys” which hold the flexor tendon.  With trigger finger, this pulley becomes inflamed and thickened, making it difficult for the tendon to glide normally.  This results in pain, stiffness, and a sensation of catching while bending and straightening the finger.

• Carpal Tunnel Syndrome:  A common condition where one of the major nerves in the hand is compressed as it travels through the wrist.  It results in pain, tingling, and numbness in the hand and arm.  

How are the Causes of Wrist and Hand Pain Diagnosed?

First and most important is a good thorough medical history intake and a physical exam. 

Imaging tests can also help with the diagnosis.

• X-Ray:  X-rays use radiation in the form of electromagnetic waves of high energy to pass to create pictures of the inside of your body.  X-rays show bones well and can help us identify things such as fractures. It is also very helpful in identifying things such as dislocations.  It can also help us identify signs of osteoarthritis.  
• MRI Scan: MRI scans use large magnets and radio waves to look at structures inside your body with great detail. It is a helpful imaging study to visualize soft tissues such as muscles and ligaments, as well as give an additional evaluation of bones. 
• CT Scan: A CT scan is an imaging tool that combines x-rays with computer technology to produce a detailed cross-sectional image of your body.  In our field, it is helpful sometimes for further evaluation of bony structures.
• Ultrasound: Ultrasound uses high-frequency sound waves that echo off the body.  It is a non-invasive study that does not use any radiation. It is used in-office to help with the diagnosis of some musculoskeletal conditions.

Treatment for Wrist and Hand Injuries

There are many treatment options for wrist and hand pain. However, the treatment option varies depending on multiple factors such as age, injury, medical history, etc.

• RICE therapy: RICE is a form of self-treatment or can be done under the guidance of trained physiotherapists. RICE stands for Rest, Ice, Compression, and Elevation. This therapy can help improve pain and swelling of many wrist and hand injuries. 
• Heat therapy:  Heat can help relax tense muscles and soothe stiff joints.  You can use a heated pad or hot water bottle. 
• Physical therapy: Manual therapy and a special exercise routine planned by a physiotherapist, keeping the condition of the patient in mind, can help strengthen the forearm and hand muscles and improve their flexibility.

• Medication:  Over the counter medications such as acetaminophen or ibuprofen can help ease the pain.  Stronger pain medications and muscle relaxers can also be of help temporarily.
• Steroid injections: Steroid injections, usually in conjunction with physical therapy, can be helpful to reduce inflammation and overall pain. 
• Surgery: If conservative treatment does not work, surgery may be needed.  Sometimes surgery needs to be considered sooner depending on the injury itself.

Stephen S. Chen, MD- Sports Medicine Doctor can help you evaluate and treat your wrist and hand injury and pain. Contact us using our phone number 925-934-3536 or email us at stephen.chen@eastbaysportsdoc.com to book an appointment.