The Hand & Wrist

A scaphoid fracture, often resulting from a fall onto an outstretched wrist, is the most common fracture of the carpal bones. Diagnosis typically involves X-rays, with the possibility of a CT scan for further evaluation if necessary. However, scaphoid fractures can pose challenges due to the bone's blood supply pattern, which may impede proper healing. Treatment usually involves immobilization in a thumb spica cast for approximately three months, depending on the fracture's severity. In cases where cast immobilization is ineffective or the fracture is significantly displaced, surgical percutaneous screw fixation may be necessary. Ensuring proper healing of the scaphoid fracture is crucial for the long-term functionality and health of the wrist.

Carpal Tunnel Syndrome involves the compression of the median nerve in the wrist, leading to symptoms such as numbness and tingling in the thumb, index, and ring fingers, along with occasional nighttime pain and clumsiness. Treatment typically starts conservatively with night splinting using a wrist brace, along with anti-inflammatory medication and ergonomic adjustments to work setups. In some cases, a corticosteroid injection into the affected area may be recommended to alleviate symptoms. Further diagnostic evaluation, including nerve conduction studies, may also be advised. For patients who do not experience improvement with conservative measures or develop hand weakness, surgical carpal tunnel release may be suggested to relieve nerve compression.

De Quervain’s Tenosynovitis involves inflammation of the first dorsal compartment of the wrist, where three crucial tendons responsible for thumb movement are located. This condition often arises from repetitive thumb activity, resulting in pain on the radial side of the wrist that worsens with thumb movement. While commonly seen in postpartum women due to lifting newborns, it can affect anyone engaged in repetitive thumb use. Treatment typically begins with conservative measures, including the use of a thumb spica wrist brace, anti-inflammatory medication, activity modification, and occasionally corticosteroid injections into the affected area. In rare instances where symptoms persist despite conservative treatment, surgical release of the first dorsal compartment may be considered for relief.

The hand relies on a network of tendons to facilitate finger movements, including flexion, extension, and vertical motion. Tendon injuries can result from direct trauma, improper object handling, or cuts. Mallet finger, for instance, manifests when the tendon attaching to the distal phalanx is forcibly hyperextended, leading to its detachment from the bone. This condition impedes the extension of the finger's distal end and is typically diagnosed through physical examination and x-rays. Treatment may involve splinting for 6-8 weeks, with surgical intervention considered depending on the presence of associated fractures.

While mallet finger injuries are among the most prevalent tendon injuries in the hand, various other tendon-related issues can arise. Seeking prompt evaluation from a healthcare provider is crucial for accurate diagnosis and the preservation of optimal hand and finger function.

Arthritis, particularly osteoarthritis, often results from age-related changes and the cumulative effects of activity and daily use. Typically developing gradually over time, it is most prevalent among individuals aged 60 and above. The progressive deterioration of cartilage within the joints leads to discomfort and stiffness. While osteoarthritis can affect any joint, it frequently manifests in the wrist or the thumb's CMC joint. Symptoms usually emerge slowly, marked by subtle increases in pain or minor reductions in mobility. In some instances, an unrelated wrist injury may suddenly exacerbate underlying arthritis symptoms. Over time, these symptoms tend to intensify, particularly as individuals age, potentially resulting in significant motion loss and audible cracking sensations known as crepitus.

Diagnosis of CMC joint or wrist arthritis primarily relies on X-ray imaging, offering clarity on the extent of joint degeneration. Treatment approaches vary based on arthritis severity. For milder cases, maintaining range of motion and bolstering strength through physical therapy can be beneficial. Cortisone injections or anti-inflammatory medications may help alleviate significant pain flare-ups. In severe instances, surgical interventions, often performed by specialized hand surgeons, offer various options for managing the condition.