Wrist/Hand Conditions

About

Your hands are amazing tools made of many parts.  In fact there are more bones (27), joints (25), tendons (20), ligaments, muscles, nerves and arteries in the hand and wrists than any other part of the body!  So of course as with any complicated structure there are many things that can go wrong. And a problem can be extremely inconvenient since we use the hands for almost everything we do.  Sometimes it can keep us from working and can make simple routine tasks very difficult.  Fortunately almost all hand conditions are treatable, below are some of the most common problems we treat. 

Conditions

• Nerve problems: Sometimes the nerves in the wrist  or elbow are compressed causing numbness, tingling, and  pain in the hand and fingers   The most  common problem is called  carpal tunnel syndrome. 
• Tendon problems: Swollen and inflamed tendons  can cause the finger to get stuck (trigger finger) or cause pain with wrist movement (Dequervain's syndrome, ECU tendonitis)
• Joint problems: Joints can wear out due to loss of cartilage from wear and tear, injury, or aging and this can cause pain, swelling, and stiffness.  The most common joint affected is the basilar joint at the base of the thumb (CMC arthritis), the middle joints of the fingers (PIP arthritis). and the wrist.
• ligament strains and tears:  A common injury from skiing is a tear of the ulnar collateral ligament of the thumb (skiier's thumb).  In the wrist the scapholunate ligament and TFCC (triangular fibrocartilage complex) are often injured.  Partial ligament tears can often heal on there own but complete tears can cause significant problems down the road if left untreated.
• trauma: Fractures of the bones in the wrist and hand can cause long term problems if they don't heal correctly, especially if they involve the joint. Injuries that result in nerve and tendon lacerations can result in fingers that can't move properly and loss of feeling. 
• contractures and stiffness: Dupuytren's disease is a common inherited  condition that occurs mostly in men that causes cords and nodules in the hand and can result in contracture.  Stiffness is often a very common problem after any type of injury to the hand due to swelling and scarring and can lead to significant dysfunction.
• soft tissue tumors: There are many different benign soft tissue tumors in the hand but the most common soft tissue lump is caused by fluid leakage from a joint, called a ganglion cyst.
• medical conditions affecting the hand: Rheumatoid arthritis can cause damage to all the structures in the hand resulting in dysfunction.  Gout can cause joint swelling in the joints (especially the wrist) and crystal deposits under the skin
• Infections can affect many parts of the hand including the skin, pulp (pad of the finger) paronychia (fold at edge of the nail), tendons and joints. They can be serious if left untreated.  

Treatment

Treatment options depend on the diagnosis so the first thing to do is to figure out what the problem is.  The doctor will do a careful history and exam and sometimes order x rays or other tests if needed.  Once the diagnosis is made you and your doctor will work together to decide on a treatment plan that is best for you. The goal of treatment is to correct the problem with the least invasive method needed and provide the best outcome. 

Non operative treatment:
Problems can often be fixed without surgery.  Non operative treatments might include:

• activity modification (especially for overuse syndromes and tendonitis)
• splinting (to allow injured ligaments and tendons to heal, and for use at night for carpal tunnel syndrome)
• casting to hold fractured bones in place while they heal 
• hand therapy (to restore motion, strength and function)
• anti inflammatory medication (to relieve swelling and pain)
• cortisone injections (to relieve swelling and pain
• xiaflex (collagenase) injections and manipulation (for Dupuytren's contractures)
• biologic injections (PRP) for tendonopathies (tennis elbow)
• antibiotics for infection

Surgery: 
Often surgery is necessary, especially for injuries that result in fractures that involve one of the joints, tendon and nerve lacerations, and in situations where non operative treatment is not effective. Hand surgery is always done as an outpatient procedure and usually at Southwest Seattle ASC.  In most cases the procedures are done under local or regional anesthesia with sedation. These procedures include:

• carpal tunnel release
• cubital tunnel release
• proximal median nerve release
• denervectomy for chronic pain
• joint replacement for base of thumb and finger joint arthritis
• partial or complete fusions for wrist arthritis
• partial or complete removal of damaged bones for arthritis (excisional arthroplasty, styloidectomy)
• reconstruction and stabilization procedures
• re-alignment procedures for tendon problems
• tendon or nerve repair
• tendon transfers 
• fracture fixation 
• repair of scaphoid non-unions
• surgical treatment of Kienbock's disease (loss of blood supply to the lunate bone in the wrist)
• trigger finger release
• de Quervain's release
• wrist arthroscopy
• contracture release including Dupuytren's 
• scar tissue release and excision
• removal of cysts and tumors in soft tissue and bone

As you can see, because the hand and wrist are so complex there are many different problems and types of treatments.  And this is only a partial list!  But whatever the problem is we will make sure that you are involved in the treatment plan and we will do what is best for you so that your amazing hands are working properly again!