Hand & Wrist
Arthritis of the Hand and Wrist
Arthritis is an inflammatory condition of the joints. There are several types of arthritis and the most common type is osteoarthritis or wear-and-tear arthritis. Arthritis affects various joints in the body and the arthritis in the hand affects the joint at the base of the thumb.
Carpal Tunnel Syndrome
Carpal tunnel syndrome is a common, painful, progressive condition that is caused by compression of the median nerve at the wrist area.
Trigger Finger
Inflammation in the tenosynovium leads to a condition called trigger finger, also known as stenosing tenosynovitis or flexor tendonitis, where one of the fingers or thumb of the hand is caught in a bent position.
Work Related Hand Injuries
The hand is one of the most flexible and useful parts of our body that assist us in most workplace activities. Hand injuries can range from minor cuts or burns to severe injuries.
Fractures of the Hand and Fingers
The hand is one of the most flexible and useful parts of our body. Because of overuse in various activities, the hands are more prone to injuries, such as sprains and strains, fractures and dislocations, lacerations and amputations while operating machinery, bracing against a fall and during sports.
Wrist Fracture
The wrist is comprised of two bones in the forearm, the radius and ulna, and eight tiny carpal bones in the palm. The bones meet to form multiple large and small joints. A wrist fracture refers to a break in one or more of these bones.
Arthritis of the Thumb
Arthritis is an inflammatory condition of the joints. There are several types of arthritis. The most common type is osteoarthritis or wear-and-tear arthritis that affects the joint at the base of the thumb.
Ganglion Cyst
Ganglion cysts are swellings that most commonly develop along the tendons or joints of wrists or hands. They can be found either at the top of the wrist, palm side of the wrist, end joint of a finger or at the base of a finger.
Wrist Sprain
Injuries caused due to stretching or tearing of the ligaments in the wrist are called wrist sprains. Sprains can range from mild to severe, based on the extent of injury to the ligament.
Finger Sprain
Injuries that involve tearing or stretching of the ligaments of your fingers are termed as sprains. Sprains in the fingers are most often caused from a fall when you extend your arms to reduce the impact of the fall, or from overuse or repetitive activity of the thumb such as with texting.
Thumb Fracture
A break or a crack in the bones of the thumb is known as a thumb fracture. Fractures may occur anywhere on the thumb, but a fracture at the base of the thumb, near the wrist, is considered the most serious.
Ulnar Nerve Compression in Guyon's Canal
Ulnar nerve compression in Guyon’s canal is a condition characterized by pain, numbness, weakness, and tingling sensation in the hand. The condition occurs when the ulnar nerve, the nerve that travels across the elbow from the shoulder to the hand, is compressed as it goes from the wrist into the hand through a space known as Guyon’s canal.
Flexor Tendon Injuries
Deep cuts on the under surface of the wrist, hand or fingers can cut and injure the tendon, and make it unable to bend one or more joints in a finger. When a tendon gets cut, the cut ends gets pulled away from each other like a rubber band.
Distal Radioulnar Joint (DRUJ) Arthritis
Distal radioulnar joint (DRUJ) arthritis is an inflammatory condition characterized by gradual wearing away of the cartilaginous surface of the radioulnar joint resulting in significant pain, swelling, stiffness, and interference in the functioning of the wrist and/or arm.
Mallet Finger
A mallet finger is a condition where the end of the finger is bent and does not straighten.
Scaphoid Fracture
The scaphoid bone is a small, boat-shaped bone in the wrist, which, along with 7 other bones, forms the wrist joint. It is present on the thumb side of the wrist, and is at a high risk for fractures. A scaphoid fracture is usually seen in young men aged 20 to 30 years. They can occur at two places: near the thumb or near the forearm.
Industrial Hand Trauma
The hand is one of the most flexible and useful parts of our body. Because of overuse in various activities, the hands are more prone to injuries, such as sprains and strains, fractures and dislocations, lacerations and amputations while operating machinery, bracing against a fall and during sports.
Finger Dislocation
Finger dislocation is a condition in which the bone of your finger has moved away from its normal position.
Adult Forearm Fractures
The forearm is made up of 2 bones, namely, the radius and ulna. The primary function of your forearm is rotation i.e., the ability to turn your palm up and down. The fracture of the forearm affects the ability to rotate your arm, as well as bend and straighten the wrist and elbow.
Forearm Fractures in Children
The radius (bone on the thumb side) and ulna (bone on the little-finger side) are the two bones of the forearm. Forearm fractures can occur near the wrist, near the elbow or in the middle of the forearm. Apart from this, the bones in children are prone to a unique injury known as a growth plate fracture.
Boutonniere Deformity
Tendons in your fingers connect the finger bones to finger muscles and help bend and straighten the finger at the joint when the muscles contract. Boutonnière deformity is a condition in which a tendon injury to the middle joint of the finger results in the inability to straighten the affected finger.
De Quervain's Tendinosis
Inflammation and swelling of the tendon sheaths put pressure on the adjacent nerves and leads to pain and numbness in the thumb side of the wrist. Strain on these tendons can cause swelling and irritation, and lead to a condition called De Quervain's tenosynovitis, which is characterized by inflammation.
Dupuytren's Contracture
Dupuytren’s contracture is a hand condition where thickening of the underlying fibrous tissues of the palm causes the fingers to bend inward. This makes it difficult to fully straighten the affected fingers. It commonly occurs in the ring finger and little finger.
Hand Infections
The hand becomes infected more frequently as it is one of the most commonly injured parts of our body.
Trapeziometacarpal (TMC) Arthritis
Trapeziometacarapal (TMC) joint arthritis, also known as carpometacarpal (CMC) joint arthritis or basilar thumb arthritis or rhizarthrosis, is a common form of arthritis that affects the first carpometacarpal (trapeziometacarpal) joint of the thumb.
Wrist Injuries
The wrist is a commonly injured joint in the body. Problems include sprains and strains as well as fractures that can occur with lifting and carrying heavy objects, while operating machinery, bracing against a fall, or from sports-related injuries.
Pediatric Forearm Fracture
The radius (bone on the thumb side) and ulna (bone on the little-finger side) are the two bones of the forearm. Forearm fractures can occur near the wrist, near the elbow or in the middle of the forearm. Apart from this, the bones in children are prone to a unique injury known as a growth plate fracture.
Carpal Instability
Carpal instability is the loss of alignment of the carpal bones and/or radioulnar joint. The wrist is a complex joint that connects the forearm to the hand and allows it to move. It consists of 8 small bones called carpals that articulate with two long bones of the forearm (radius and ulna).
Extensor Tendon Injuries
Tendons are bands of tissue connecting muscles to bones. The extensor tendon is a strong, smooth cord that connects finger bones to muscles in the hand. Extensor tendons are located just under the skin, directly on the bone, on the back of the hand and fingers. They allow you to open your hands and move or straighten your wrist, fingers, and thumb.
Fingertip Injuries
A fingertip injury is a wound or damage caused to the most distal portion of the finger. It can be a crush, a sharp cut, a tear or a combination of these, and can result in damage to the skin, nail or nailbed, tendon, pulp, bone, and nerve endings.
Distal Intersection Syndrome
Distal intersection syndrome also referred to as tenosynovitis of the radial wrist extensors is characterized by the radial wrist and forearm pain. Distal intersection syndrome is tenosynovitis of the third extensor compartment (extensor pollicis longus) where it crosses the second extensor compartment.
Wrist Ligament Tear and Instability
A ligament is a strong, flexible band of fibrous tissue. The wrist has many ligaments that help to keep the wrist bones in proper position providing stability to the joint. A torn ligament causes the wrist bones to move out of their position, which in turn leads to wrist instability as the sprained (torn) ligament can no longer support the wrist bones.
Finger Joint Dislocation and Volar Plate Injury
Finger dislocation is a condition where the bones of your finger have moved away from its normal anatomical position.
Triscaphoid Joint Arthritis
Arthritis is an inflammatory condition of one or more joints in your body. Triscaphoid joint arthritis is the localised pain and inflammation of the shared joint between the 3 carpal bones of your wrist.
Distal Radius Osteotomy to Correct Mal-Union (Crooked Painful Wrist)
The forearm consists of two bones, the radius, and the ulna. The radius is the larger of the two forearm bones, and the region closest to the wrist is called the distal end. A fracture or break in the distal end of the radius bone is known as a distal radius fracture.
Boxer's Fracture
A boxer’s fracture is a break in the neck of the fifth metacarpal bone of the hand (below the pinky finger) close to the knuckle. The hand is composed of 3 types of bones: carpal or wrist bones, metacarpals or long hand bones, and phalanges or finger bones. Metacarpals consist of five long bones that connect the carpal with the phalanges.
Bennett's Fracture
Bennet’s fracture is a break at the base of the first metacarpal bone (thumb bone) that meets the wrist at the first carpometacarpal (CMC) joint. The hand is composed of 3 types of bones: carpals or wrist bones, metacarpals or long hand bones, and phalanges or finger bones.
Kienbock's Disease
Kienbock's disease is a condition in which the lunate, one of the small bones of the wrist loses its blood supply leading to death of the bone. This results in pain, stiffness, and degenerative changes in the wrist joint.
Upper Limb (Arm) Artery Disease
Upper limb (arm) artery disease is a condition where an artery between the chest and the hand is blocked and does not supply blood to the arms. The narrowing or blockage of the artery may be caused due to atherosclerosis (hardening of the arteries due to plaque build-up).
Scapholunate Dissociation
Scapholunate dissociation is the abnormal orientation or movement of the small bones of your wrist: the scaphoid and lunate, in relation to one another.
Ulnar Carpal Impaction
The wrist is a complex joint made up of 8 carpal bones aligned in two rows, with four bones present in each row. The carpal bones are further connected to 5 metacarpal bones that form the palm of the hand. Each small bone forms a joint with the bone next to it. Thus, the wrist joint is made up of many small joints.
Malunion of a Fracture
Malunion of a fracture is a condition where the fractured ends of a bone heal in a misaligned position resulting in bone deformity. Malunions may occur in any bone fractures in the body often due to trauma.
Metacarpophalangeal Joint Arthritis
The bones of the hand are called metacarpals and the bones of the fingers are called phalanges. The metacarpophalangeal joint or MP joint, also known as the first knuckle, is the large joint in the hand where the finger bones meet the hand bones. The MCP joint acts as a hinge joint and is vital during gripping and pinching.
Extensor Carpi Ulnaris (ECU) Tendon Instability
ECU tendon instability can occur when the sheath covering and protecting the ECU tendon at the wrist is injured. This causes the tendon to move abnormally and occupy the wrong space within the sheath.
Wrist Arthroscopy
Wrist arthroscopy is a minimally invasive surgical procedure performed to view, diagnose and treat problems of your wrist joint.
Peripheral Nerve Repair
The peripheral nerves are the nerve fibers that compose the area from head to toe, connecting the brain and spinal cord with the rest of the body parts. Nerves transmit electrical impulses and signals to and from the brain. Peripheral nervous system disorders interrupt the transmission of signals and weaken the sensory and motor nerve functions.
Wrist Ligament Reconstruction
The human wrist is made up of small bones joined together by a band of tough fibrous tissue known as ligaments. Ligaments also join the bones in our wrist to the radius, ulna, and metacarpal bones, and aid in the proper functioning of our wrist.
Carpal Tunnel Release Surgery
Carpal tunnel syndrome is a common, painful, progressive condition that is caused by the compression of the median nerve at the wrist area.
Hand Fracture Surgery
The hand is one of the most flexible and useful parts of our body. Because of overuse in various activities, the hands are more prone to injuries, such as sprains and strains, fractures and dislocations, lacerations and amputations while operating machinery, bracing against a fall and sports-related injuries.
Surgery for Thumb and Digit Arthritis
Arthritis is an inflammatory condition of the joints. There are several types of arthritis; the most common type is osteoarthritis or wear-and-tear arthritis that affects the joint at the base of the thumb. Thumb arthritis is more common in women than men, and usually occurs after the age of 40 years.
Endoscopic Carpal Tunnel Surgery
The carpal tunnel is a narrow passageway on the palm side of your wrist. Small wrist bones known as carpals form the bottom and sides of the carpal tunnel and a strong band of connecting tissue, known as the transverse carpal ligament, covers the top of the carpal tunnel.
Microvascular Surgery
Microvascular surgery or microsurgery is a surgical technique for joining or repairing the damaged blood vessels and nerves during reconstructive surgery of body parts. Reconstructive surgery restores the functioning of the body parts by improving circulation.
Microsurgical Flap Procedure of the Hand
A microsurgical flap procedure of the hand is a surgery performed to cover a defect in an injured hand using skin along with the underlying healthy tissue of varying thickness harvested from adjacent tissue or another part of the body.
Elective Emergency Hand Surgery
Hand surgery is performed to restore the structure and functionality of the fingers, wrist and hand secondary to a traumatic injury, medical condition, severe infection, or birth defect causing pain and/or deformity of the hand. It is performed by trained and certified plastic surgeons.
Wrist Joint Replacement
Wrist joint replacement surgery, also referred to as total wrist arthroplasty, involves the replacement of a severe arthritic wrist joint with an artificial joint made of metal and plastic components. It relieves pain and restores function when conservative treatment fails to provide relief.
Nerve Transfers
A nerve transfer is a surgical procedure in which a portion of a healthy nerve is transferred to the site of a damaged nerve. This procedure is performed to restore normal function at the injured site. Healthy nerves that are near the site of injury and have a similar function to the injured nerve are ideally selected as donor's nerves to improve surgical outcomes.
Wrist Fracture Fixation
Wrist fractures are breaks in any of the bones that form your wrist joint.
Wrist Open Reduction and Internal Fixation
Open reduction and internal fixation of the wrist is a surgical technique employed for the treatment of severe wrist fractures to restore normal anatomy and improve range of motion and function.
Total Wrist Arthrodesis
The wrist joint is one of the most complex joints in the human body. Numerous joints and bones contribute to the strength and stability of the wrist. The wrist is made up of eight separate small bones called carpal bones. The carpal bones connect the two bones of the forearm, the radius and the ulna, to the bones of the hand.
ORIF of Distal Radius Fracture
The forearm consists of two bones, the radius and ulna. The radius is the larger of the two forearm bones, and the region towards the wrist is called the distal end. A fracture or break in the distal end of the radius bone is known as a distal radius fracture.
ORIF of the Forearm Fractures
Open reduction and internal fixation (ORIF) is a surgical technique employed for the treatment of a forearm fracture to restore normal anatomy and improve range of motion and function.
Distal Radioulnar Joint Arthroscopy
The distal radioulnar joint (DRUJ) is a pivot type synovial joint located between the radius and the ulna just proximal to the wrist joint and assists in pronation and supination of the forearm.
Sports Injury Management of Hand, Wrist and Elbow
Sports injuries are injuries that most commonly occur during sports and exercises. These injuries may result from accidents, poor training practices, and use of improper protective gear, lack of conditioning, and insufficient warm-up and stretching.
DRUJ Arthroscopy
The DRUJ is the joint formed by the radius and ulnar bones of the foreman in the wrist. DRUJ (Distal Radioulnar Joint) arthroscopy is a minimally invasive surgical procedure to diagnose and treat pathological problems in the DRUJ using an arthroscope, a thin, flexible scope with a camera on the end.
Hand Therapy
Hand therapy is a rehabilitation technique recommended to improve the strength and restore functional activity of hands in patients with upper extremity injuries. Hand therapy also helps in preventing injury.
Hand Rejuvenation
Cosmetic enhancement is generally focused only on the face, while the hands portray some of the most prominent signs of aging. With age, the hands lose their firmness and plumpness and can appear bony and fragile.
Non-Surgical Treatment of Hand and Wrist
The hand is one of the most flexible and useful parts of our body that enable us to perform many of our daily activities. The hands and wrists are prone to injuries or certain orthopedic conditions and can range from minor cuts or burns to severe arthritis or injuries of nerves, bones, and tendons.
Hand Anatomy
The human hand is made up of the wrist, palm, and fingers and consists of 27 bones, 27 joints, 34 muscles, over 100 ligaments and tendons, and many blood vessels and nerves.
The hands enable us to perform many of our daily activities such as driving, writing and cooking. It is important to understand the normal anatomy of the hand to learn more about diseases and conditions that can affect our hands.
Bones of the Hand
The wrist is comprised of 8 carpal bones. These wrist bones are attached to the radius and ulna of the forearm to form the wrist joint. They connect to 5 metacarpal bones that form the palm of the hand. Each metacarpal bone connects to one finger at a joint called the metacarpophalangeal joint (MCP joint). This joint is commonly referred to as the knuckle joint.
The bones in our fingers and thumb are called phalanges. Each finger has 3 phalanges separated by two interphalangeal joints, except for the thumb, which has only 2 phalanges and one interphalangeal joint.
The first joint close to the knuckle joint is called the proximal interphalangeal joint (PIP joint). The joint closest to the end of the finger is called the distal interphalangeal joint (DIP joint).
The MCP and PIP joint act like hinges when the fingers bend and straighten.
Soft Tissues of the Hand
Our hand bones are held in place and supported by various soft tissues. These include: articular cartilage, ligaments, muscles and tendons.
Articular cartilages are smooth material that act as shock absorbers and cushion the ends of bones at each of the 27 joints, allowing smooth movement of the hand.
Muscles and ligaments function to control the movement of the hand.
Ligaments are tough rope-like tissues that connect bones to other bones, holding them in place and providing stability to the joints. Each finger joint has two collateral ligaments on either side, which prevents the abnormal sideways bending of the joints. The volar plate is the strongest ligament in the hand. It joins the proximal and middle phalanx on the palm side of the joint and prevents backward bending of the PIP joint (hyperextension).
Muscles of the Hand
Muscles are fibrous tissues that help produce movement. They work by contracting.
There are two types of muscles in the hand:
- Intrinsic muscles are small muscles that originate in the wrist and hand. They are responsible for fine motor movements of the fingers during activities such as writing or playing the piano.
- Extrinsic muscles that originate in the forearm or elbow control the movement of the wrist and hand. These muscles are responsible for gross hand movements. They position the wrist and hand while the fingers perform fine motor movements.
Each finger has six muscles controlling its movement: three extrinsic and three intrinsic muscles. The index and little finger each have an extra extrinsic extensor.
Tendons of the Hand
Tendons are soft tissues that connect muscles to bones. When muscles contract, tendons pull the bones, causing the finger to move. The extrinsic muscles are attached to finger bones through long tendons that extend from the forearm through the wrist. Tendons located on the palm side help in bending the fingers and are called flexor tendons, while tendons on top of the hand called extensor tendons help in straightening the fingers.
Nerves of the Hand
Nerves of the hand carry electrical signals from the brain to the muscles in the forearm and hand, enabling movement. They also carry the senses of touch, pain and temperature back from the hands to the brain.
The three main nerves of the hand and wrist include:
- Ulnar nerve: The ulnar nerve crosses the wrist through an area called Guyon’s canal and branches to provide sensation to the little finger and half of the ring finger.
- Median nerve: The median nerve crosses the wrist through a tunnel called the carpal tunnel. The median nerve provides sensation to the palm, thumb, index finger, middle finger and part of the ring finger.
- Radial nerve: The radial nerve runs down the thumb side of the forearm and provides sensation to the back of the hand from the thumb to the middle finger.
All three nerves originate at the shoulder and travel down the arm to the hand. Each of these nerves has sensory and motor components.
Blood Vessels of the Hand
Blood vessels travel beside the nerves to supply blood to the hand. The main arteries are the ulnar and radial arteries, which supply blood to the front of the hand, fingers, and thumb. The ulnar artery travels next to the ulnar nerve through the Guyon’s canal in the wrist. The radial artery is the largest artery of the hand, traveling across the front of the wrist, near the thumb. Pulse is measured at the radial artery.
Other blood vessels travel across the back of the wrist to supply blood to the back of the hand, fingers and thumb.
Bursae of the Hand
Bursae are small fluid-filled sacs that decrease friction between tendons and bone or skin. They contain special cells called synovial cells that secrete a lubricating fluid.
