Wrist & Hand Pain

Elbow Pain

Shoulder Pain
Injuries to the wrist & hand range from acute traumatic fractures, such as falling or playing sport to overuse conditions, which occur in racquet sports, golf and rock climbing activities. Various occupational activities such as typing or manual work can also predispose to such injuries, including carpal tunnel syndrome.
Injuries to the wrist & hand range from acute traumatic fractures, such as falling or playing sport to overuse conditions, which occur in racquet sports, golf and rock climbing activities. Various occupational activities such as typing or manual work can also predispose to such injuries, including carpal tunnel syndrome.
Wrist Injuries
Fractures of the Radius / Ulna
Fracture of the Scaphoid
Post-Immobilisation Treatment and Rehabilitation
Chronic Wrist Pain
de Quervain’s Tenosynovitis
Treatment includes splinting, electrotherapy modalities and graduated stretching and strengthening exercises. An injection of corticosteroid and local anaesthetic into the tendon sheath will usually prove helpful. A recent study showed that, injection alone cured 83% of cases, injection and splinting cured 61% and splinting alone cured 14%. It is noteworthy that no patients gained symptom reduction from rest and anti-inflammatory medication.
Ganglions
Triangular Fibrocartilage Complex Tear
Treatment may include the wearing of protective bracing, electrotherapy modalities for pain relief and strengthening exercises. Should the symptoms persist, the onward referral to a hand / wrist surgeon is appropriate.
Kienbock’s Disease
Carpal Tunnel Syndrome
On examination, Tinel’s sign may be elicited by tapping over the volar aspect of the wrist. Nerve conduction studies can also confirm a diagnosis. Diabetes mellitus should be excluded as it is a risk factor for carpal tunel syndrome.
In terms of treatment, mild cases may be treated conservatively with anti-inflammatory medication and splinting. A corticosteroid injection may also provide relief but persistent cases require surgical intervention.
Hand and Finger Injuries
The mechanism of injury is the most important component of the history of acute hand injuries. A direct, severe blow to the fingers may result in a fracture, whereas a blow to the point of the finger may produce an interphalangeal dislocation, joint sprain or tendon avulsion. A punching injury often results in a fracture at the base of the first metacarpal or to the neck of one of the other metacarpals, usually the fifth. An avulsion of a flexor tendon, usually to the fourth finger, is suggested by a history of a patient grabbing an opponents clothing while attempting a tackle.
Investigations
All traumatic finger injuries should be x-rayed, including fractures and dislocations. Once a diagnosis has been established, the principles of treatment are initially to control inflammation and swelling. This can be achieved through splinting, compression, ice, elevation and electrotherapy modalities. Once this is stabilised, range of motion and strengthening exercises can be commenced.
If one of the flexor or extensor tendons are ruptures, then surgical intervention is required, followed by personalised splinting and a structured, progressive rehabilitation exercise programme.
Mallet Finger
Examination reveals tenderness and an inability to actively extend the DIP joint from its resting flexed position.
If left untreated, a chronic mallet finger deformity develops.
Such injuries may require surgery, but treatment of uncomplicated mallet finger involves splinting the DIP joint into slight hyperextension for a period of up to 8 weeks. The splint is then worn for an additional 6-8 weeks while engaging in sporting activity and at night.
Boutonniere Deformity
Treatment is to splint the finger with the PIP joint in full extension while allowing active flexion of the DIP joint for 6 weeks. On return to sport, protective splinting is continued for a further 6-8 weeks or until a pain-free range of flexion and extension is present. In longstanding injuries, there may be a fixed flexion deformity of the PIP joint. This can be treated with a dynamic splint but if this is unsuccessful, surgery is indicated.
Jersey Finger
Examination may reveal the finger assuming a position of extensionrelative to the other fingers. There is an inability to actively flex the DIP joint of the affected finger. A lump may be palpated more proximally in the finger corresponding to the avulsed tendon.
Treatment is urgent surgical repair with reattachment of the tendon to the distal phalanx. This must take place within 10 days of the injury as tendon ischaemia occurs when the tendon has retracted into the palm.
Trigger Finger
Potential Causes
Characteristic night pain at the wrist, with or without pins and needles sensation, is found in carpal tunnel syndrome. Finally, neck or elbow conditions can also refer pain to the wrist and hand.
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