Your hand may hurt after an obvious injury or for no obvious reason at all. The majority of problems with the hand have a specific cause and can be treated either by a Specialist Hand Therapist or by a Specialist Hand Surgeon.
Common injuries include joint sprains, ligament tears and fractures of the bones in the hand or wrist. Many minor injuries will heal uneventfully, some will recover with hand therapy and some do need urgent surgery for optimal outcomes.
Joints in the hand can be affected by osteoarthritis or less commonly rheumatoid arthritis. Joints affected by osteo or rheumatoid arthritis can be stiff, deformed and are often painful. Surgery may be helpful in treating these joints. Finger joints may be fused solid in an optimal position ensuring a stable and pain free digit. Some finger joints are suitable for formal joint replacement. This operation if appropriate has the additional advantage of preserving movement.
Joints can also be affected by old injuries that then cause longer term problems; such as badly aligned distal radius fractures or scaphoid breaks that never healed. The scaphoid bone is the most commonly injured of the wrist bones and has a relatively high complication rate in terms of missed diagnosis and non-healing. It is often an injury seen in young people. If the scaphoid fracture does not heal and goes onto form a non-union, the mechanics of the wrist are changed. If this happens, post-traumatic arthritis of the wrist is common.
Other causes of pain in the hand also include:
- Trigger finger or thumb
- Carpal tunnel syndrome, compression of the large median nerve as it comes into the hand causing pain and numbness
- Tendonitis, particularly around the thumb side of the wrist (De Quervain’s tendonitis)
- Painful lumps and bumps in the hand include ganglions, giant cell tumours and others
One cause for a painful wrist is a badly aligned old distal radius fracture. Distal radius fractures are very common injuries. Approximately a quarter of distal radius fractures treated without surgery end with a degree of malunion. i.e. they are imperfectly aligned. When fractures have malunited, patients can experience various levels of disability. The Edinburgh Group have recently published their outcomes in a large group of patients undergoing correction of a malunion. The results were published in the Bone and Joint Journal in November. Their conclusion was that corrective osteotomy for a malunited distal radius can result in good functional outcomes and high levels of patient satisfaction.
Below is an example of a patient specific corrective osteotomy. This example uses the information from a preoperative CT scan of the radial malunion to make what can be a demanding procedure a little easier. The information is used to carry out a perfect virtual osteotomy using computer aided design techniques. A 3D printed cutting guide is then produced to allow accurate placing of the bone cut. The bone is then perfectly aligned and fixed back together using a 3D printed plate.
Your hand can be a problem after an injury. It takes a good deal of time to recover after an injury; typically, a finger joint sprain can take months to settle down. The vast majority of these types of injury will settle down with specialist hand therapy.
Just the same as with the distal radius, imperfectly aligned broken bones in the hand can lead to ongoing disfunction. This is especially a problem if this occurs in a joint as it can lead to post traumatic arthritis. The other big problem with phalangeal or metacarpal malunions is if the fracture has healed in a rotated position. This can lead the fingers to overlap when attempting to form a fist. Should this be the case, the broken bone can be surgically realigned, as in the example below.
I have covered a couple of not so common causes of pain in the hand and wrist. We can now look at a very common cause of pain in the hand and wrist – osteoarthritis.
Osteoarthritis can affect any of the joints in the hand and wrist. Osteoarthritis in the hands is extremely common, as we get older. It does not always cause significant pain but certainly can be very painful in some people. It is also often associated with stiffness and deformity.
Osteoarthritis is caused by the degeneration of the bearing surface (cartilage) of the joint; this cannot yet be routinely repaired. All osteoarthritic conditions can be eased by reducing the symptoms. This can be with analgesics or by using non-surgical treatments administered by a Hand Therapist.
The distal interphalangeal joint (DIPJ, the one closest to the tip of the finger) is mainly used to apply pressure. These joints need to be stable, well aligned and pain free for optional use. As such, fusion of the DIPJ is a good option. This involves removing the degenerative part of the joint and encouraging the two bones to join. As such, instead of two bones with a degenerative, stiff painful joint between them, the bones are fused to produce one bone. This is usually accomplished using a specifically designed screw and is extremely successful.
The next joint back from the tip of the finger, the proximal interphalangeal joint, can also undergo arthritic change. Most of the time this joint functions better if it can bend. Fusion can be an option here but joint replacement can also be carried out. Joint replacement reliably helps with pain and can keep movement. There are different types of joint replacement on the market and your surgeon can discuss the advantages of the implants.
To learn more on all hand and wrist procedures carried out at One Ashford Hospital by Mr Andrew Smith, click here
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