YOUR HEALTH IS IN YOUR HANDS

A total of 27 bones constitute the basic skeleton of the wrist and hand. The hand is innervated by 3 nerves — the median, ulnar, and radial nerves — each of which has sensory and motor components.

The bones in the palm of the hand are called metacarpals. One metacarpal connects to each finger and thumb. Small bone shafts called phalanges line up to form each finger and thumb.

The main knuckle joint is formed by the connection of the phalanges to the metacarpals. This joint is called the MCP joint. This joint acts like a hinge when you bend and straighten your fingers and thumb.

The wrist meanwhile is a collection of many bones and joints. It is probably the most complex of all the joints in the body. There are 15 bones that form connections from the end of the forearm to the hand. The wrist itself contains eight small bones, called carpal bones.

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Arthritis of the Finger Joints

When you stop to think about how much you use your hands, it’s easy to see why the joints of the fingers are so important. Arthritis of the finger joints has many causes, and arthritic finger joints can make it hard to do daily activities due to pain and deformity. Unbearable pain or progressive deformity from arthritis may signal the need for surgical treatment.

Causes of Arthritis

  • Degenerative arthritis is a condition in which a joint wears out, or degenerates, usually slowly over a period of many years. The term arthritis means joint inflammation (pain, redness, heat, and swelling). The term degenerative arthritis means intermittent inflammation of a joint due to wear and tear. You may also hear the term degenerative arthrosis  Degenerative arthritis is usually called osteoarthritis.
  • Injury to a joint, such as a bad sprain or fracture, can cause damage to the articular cartilage. An injury to any of the joints of the fingers, even if it does not injure the articular cartilage directly, can alter how the joint works.
  • After a fracture, the bone fragments may heal in slightly different positions. This may make the joints line up differently. When an injury changes the way the joint lines up and moves, force can start to press against the surface of the articular cartilage. This is similar to how a machine that is out of balance wears out faster.

Over time, this imbalance in the joint can lead to damage to the articular surface. Since articular cartilage cannot heal itself very well, the damage adds up. Eventually, the joint can no longer compensate for the increasing damage, and symptoms begin. The damage in the joint starts well before the symptoms of arthritis appears.

Symptoms of Arthritis

  • Pain
  • The sensitive joint may feel enlarged and warm to the touch from inflammation.
  • Deformed fingers
  • Both forms of arthritis can cause enlarged areas over the back of the PIP joints. These areas tend to be sore and swollen. They are known as Bouchard’s nodes. Osteoarthritis causes similar enlargements over the DIP joints, called Heberden’s nodes.

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Carpal Tunnel Syndrome

(CTS) is a common problem affecting the hand and wrist. Symptoms begin when the median nerve gets squeezed inside the carpal tunnel of the wrist. Any condition that decreases the size of the carpal tunnel or enlarges the tissues inside the tunnel can produce the symptoms of CTS. This syndrome has received a lot of attention in recent years because of suggestions that it may be linked with occupations that require repeated use of the hands, such as typing on a computer keyboard or doing assembly work.

Causes of Carpal Tunnel Syndrome

Any condition that makes the area inside the carpal tunnel smaller or increases the size of the tissues within the tunnel can lead to symptoms of CTS. The carpal tunnel cannot expand so any condition that causes abnormal pressure in the tunnel can produce symptoms of CTS. And any increase in pressure within the carpal tunnel can reduce blood flow to the nerve, leading to loss of nerve function.
Various types of arthritis can cause swelling and pressure in the carpal tunnel. The way people do their tasks can put them at risk for problems of CTS. Some of these risks include

  • Force
    • Posture
    • Wrist alignment
  • Repetition
    • Temperature
    • Vibrations

One of these risks alone may not cause a problem. But doing a task that involves several factors may pose a greater risk. And the longer a person is exposed to one or more risks, the greater the possibility of having a problem with CTS.

Symptoms of Carpal Tunnel Syndrome

  • Pain
    • Episodic
    • Worse at night initially; Later during day dull ache also
    • Location: Arm, forearm, wrist, hand & fingers
    • Repetitive or sustained activity: Exacerbates pain
  • The hand may begin to feel like it’s asleep, especially in the early morning hours after a night’s rest.

Touching the pad of the thumb to the tips of the other fingers becomes difficult, making it hard to grasp items such as a steering wheel, newspaper, or telephone

Other Hand and Wrist Injuries that we treat

  • Claw hand (Dupuytren’s Contracture)
  • Triangular fibrocartilage complex (TFCC) injuries of the wrist

Hand and Wrist Injury Diagnosis

The diagnosis of degenerative Hand and Wrist Issues begins with a history of the problem. Details about any injuries that may have occurred to the hand are important and may suggest other reasons why the condition exists. Following the history, a physical examination of the hand and possibly other joints in the body will be done. Your doctor will need to see how the motion of each joint has been affected.

X-rays or MRI’s will be taken. These tests can help determine how bad the degenerative damage has become.

Hand and Wrist Injury Treatment

Treatment usually begins when the joint first becomes painful or stiff.

  • Reducing the activity, or changing from occupations that require heavy repetitive hand and finger motions may be necessary to help control the symptoms.
  • Soft tissue and special joint mobilisation techniques of the joints helps to restore their range of motion, reduce inflammation and pain
  • Clinical Pilates
  • Range-of-motion and stretching exercises are prescribed to improve your finger movement.
  • An injection of cortisone into the finger joint can give temporary relief