Hand & Wrist Pain
The hand and wrist are made up of different muscles, bones, and ligaments that enable a range of movements.
The wrist is formed where the two bones of the forearm meets the carpus. The radius bone, which is the larger bone on the thumb side of the arm; and the ulna, which, is the smaller bone along the pinky side. There are actually multiple joints in the wrist, where the bones of the arm and hand meet to allow movement.
The Carpus is formed from eight small bones, often called carpal bones. Carpal bones are bound in two groups of four bones.
– The pisiform, lunate, scaphoid, and triquetrum are located on the upper end of the wrist.
– The capitate, hamate, trapezium, and trapezoid are located on the lower side of the hand.
Other hand bones:
– The phalanges is 14 narrow bones that make all the fingers of each hand. The thumb has two phalanges and each finger has three.
Joints are formed wherever two or more these bones meet. Each finger has three joints.
– Proximal Interphalangeal joint (PIP): joint in the middle of the finger
– Metacarpophalangeal joint (MCP): joint at the base of the finger
– Distal Interphalangeal joint (DIP): joint closest to the fingertip
There is a layer of cartilage that covers the surfaces of the bones where they meet to form joints. This is what allows them to glide smoothly against one another as they move.
Ligaments & Tendons:
The ligament is a tough band of connective tissue that connects the bones to help support and keep the bones in place.
Some important ligaments are:
– Volar plate: ligament that connects the proximal phalanx to the middle phalanx on the palm side of the joint. When the joint in the finger is straightened, it tightens to keep the PIP joint from bending back.
– Volar Radiocarpal Ligaments: is a complex web of ligaments that support the palm side of the wrist.
– Collateral ligaments: a strong ligament on either side of the finger and thumb joints, which is what prevents a sideway movement of the joint.
– Radial and Ulnar Collateral Ligaments: Pair of ligaments, which are what bind the bones of the wrist to provide stability.
– Ulnocarpal and Radioulnar Ligaments: are two sets of ligaments that provide the main support of the wrist.
– Dorsal Radiocarpal Ligaments: the ligaments that support the back of the wrist.
Tendons are the connective tissue bands that attach the muscle to the bones in order to enable the muscles to move.
Main tendons are:
– Flexor Tendons: made of up 9 tendons that pass from the forearm through the carpal tunnel of the wrist. They spread along the palm, where two go into each finger and one in the thumb.
– Profundus Tendons: passes through the palm side of the hand and wrist, and attaches at the base of the distal phalanges. They are like superficialis tendons to flex the wrist and MCP and PIP joints and also flex the DP joints.
– Superficialis Tendons: passes through the palm side of the hand and wrist, and attaches at the base of the middle phalanges. They act with the profundus tendons to flex the wrist and MCP and PIP joints.
– Extensor Tendons: attach to the middle and distal phalanges and extend to the wrist, MCP, PIP, and DP joints of the fingers.
– Extenosr Pollicis Brevis and abductor Pollicis Longus: runs from the muscles at the top of the forearm and enables the movement for the thumb.
Pulleys are rings of connective tissue that hold the tendons of the fingers close the bone.
Hand & Wrist Injuries:
The connective tissues, small joints, and bones of the wrist and hands are prone to many different varieties of injuries.
Flexor Tendon Injuries: Most common causes are cuts and sports injuries. They may also rupture spontaneously in people whom suffer from Rheumatoid Arthritis
Extensor Tendon Injuries-
Boutonniere Deformity: in which the joint in the middle finger bends toward the palm and the joint that is closest to the nail bends upward. This can result from a cut or tear of the extensor tendon at the middle joint, a blow to the bent finger or damage from Rheumatoid Arthritis.
Mallet Finger: When an extensor tendon separates from the bone it causes a drooping at the end of the finger. This happens when the finger is cut or jammed and can also be known as, baseball finger.
Hand & Finger Injuries-
Finger Fractures: May result from a number of causes, jamming a finger, falling on it, or closing it in a car door. The result can be; Pain, swelling, inability to move the finger, and sometimes deformity.
Finger Dislocations: When a finger is bent back beyond its normal range of motion or hit, it can move the bones in a way where they are no longer properly aligned.
Wrist Fractures: Commonly caused by stopping a fall with outstretched arms. Many can fracture a wrist this way, however there is a greater risk in people whose bones are weakened due to osteoporosis.
They can be classified as Smith’s Fractures or Colles’ Fractures, both being a break of the radius near the wrist.
Smith’s Fracture: is sometimes called a reverse Colles’ Fracture, this occurs when the hand is flexed and the back of the hand is hit.
Colles’ Fracture: occurs when the bone is broken with the hand outstretched.
Some forms of non-surgical treatments are medications to ease with inflammation, pain, slow bone loss, or prevent joint damage.
The type of medication utilized to treat arthritis and other problems affecting the wrist and hands, depends on the form of arthritis or related condition that is diagnosed.
Commonly used Arthritis treatment:
– Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): More than a dozen different varieties of drugs, some of which are available over the counter. Used for all forms of arthritis to help ease the pain and inflammation caused by arthritis.
– Corticosteroids: A quick acting drug, similar to the cortisone made up by your own body, used to control the inflammation. When inflammation is due to a systematic inflammation, usually an oral corticosterioid is prescribed. However, if the inflammation is limited to one or few joints, the doctor may inject a corticosterioid directly into the joint.
– Analgesics: among the most common drugs for many forms of arthritis, unlike NSAIDs, that target both pain and inflammation, analgesics are designed purely for pain relief. Analgesics are usually used for people who are not able to take NSAIDs due to stomach problems or allergies.
– Disease Modifying Anti-Rheumatic Drugs (DMARDs): drugs that work in a slow manner to modify the course of inflammatory disease. DMARDs may be useful for multiple forms of arthritis like rheumatoid arthritis, lupus and psoriatic arthritis, all of which affect wrists and/or fingers.
– Gout Medications: Medications for gout are designed to reduce levels of uric acid in the blood in order to prevent future attacks of inflammation and joint pain. Others are made to relieve pain and inflammation of an acute attack; often time’s people with gout will take both medications.
– Biologic Response Modifiers: Newest category of medications being used for Rheumatoid Arthritis and some other forms of inflammatory forms of arthritis are the biologic agents. Currently, there are eight agents approved by the FDA. Each agent blocks a step in the inflammation process without suppressing the entire immune system.
– Osteoporosis Medications: Medications used to slow down the loss of bone, or help the body build a new bone. They are not specifically used to treat wrist and hand problems, but strong bones are less prone to fracture.