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Hand & Wrist

Foreman/Wrist/Hand

Injuries or the hand or wrist are important to treat to reverse or address significant issues of movement.  Pomeroy & Rhoads can help diagnose and treat your specific problem and provide the best solution for you.

Carpal Tunnel Syndrome

Carpal tunnel syndrome is a common condition that causes pain, numbness, and tingling in the hand and arm. The condition occurs when one of the major nerves to the hand — the median nerve — is squeezed or compressed as it travels through the wrist. 

In most patients, carpal tunnel syndrome gets worse over time, so early diagnosis and treatment are important. Early on, symptoms can often be relieved with simple measures like wearing a wrist splint or avoiding certain activities.

If pressure on the median nerve continues, however, it can lead to nerve damage and worsening symptoms. To prevent permanent damage, surgery to take pressure off the median nerve may be recommended for some patients.

Anatomy

The carpal tunnel is a narrow passageway in the wrist, about an inch wide. The floor and sides of the tunnel are formed by small wrist bones called carpal bones.

Hand

The carpal tunnel protects the median nerve and flexor tendons that bend the fingers and thumb.  The roof of the tunnel is a strong band of connective tissue called the transverse carpal ligament. Because these boundaries are very rigid, the carpal tunnel has little capacity to “stretch” or increase in size.

The median nerve is one of the main nerves in the hand. It originates as a group of nerve roots in the neck. These roots come together to form a single nerve in the arm. The median nerve goes down the arm and forearm, passes through the carpal tunnel at the wrist, and goes into the hand. The nerve provides feeling in the thumb and index, middle, and ring fingers. The nerve also controls the muscles around the base of the thumb.

The nine tendons that bend the fingers and thumb also travel through the carpal tunnel. These tendons are called flexor tendons.

Description

Carpal tunnel syndrome occurs when the tunnel becomes narrowed or when tissues surrounding the flexor tendons swell, putting pressure on the median nerve. These tissues are called the synovium. Normally, the synovium lubricates the tendons, making it easier to move your fingers.

When the synovium swells, it takes up space in the carpal tunnel and, over time, crowds the nerve. This abnormal pressure on the nerve can result in pain, numbness, tingling, and weakness in the hand. 

Carpal tunnel syndrome is caused by pressure on the median nerve as it travels through the carpal tunnel. Most cases of carpal tunnel syndrome are caused by a combination of  factors. Studies show that women and older people are more likely to develop the condition.

Other risk factors for carpal tunnel syndrome include:

 

  • Heredity. This is likely an important factor. The carpal tunnel may be smaller in some people or there may be anatomic differences that change the amount of space for the nerve—and these traits can run in families.
  • Repetitive hand use. Repeating the same hand and wrist motions or activities over a prolonged period of time may aggravate the tendons in the wrist, causing swelling that puts pressure on the nerve.
  • Hand and wrist position. Doing activities that involve extreme flexion or extension of the hand and wrist for a prolonged period of time can increase pressure on the nerve.
  • Pregnancy. Hormonal changes during pregnancy can cause swelling.
  • Health conditions. Diabetes, rheumatoid arthritis, and thyroid gland imbalance are conditions that are associated with carpal tunnel syndrome.

Symptoms

Symptoms of carpal tunnel syndrome may include:

  • Numbness, tingling, burning, and pain—primarily in the thumb and index, middle, and ring fingers
  • Occasional shock-like sensations that radiate to the thumb and index, middle, and ring fingers
  • Pain or tingling that may travel up the forearm toward the shoulder
  • Weakness and clumsiness in the hand—this may make it difficult to perform fine movements such as buttoning your clothes
  • Dropping things—due to weakness, numbness, or a loss of proprioception (awareness of where your hand is in space)

In most cases, the symptoms of carpal tunnel syndrome begin gradually—without a specific injury. Many patients find that their symptoms come and go at first. However, as the condition worsens, symptoms may occur more frequently or may persist for longer periods of time.

Night-time symptoms are very common. Because many people sleep with their wrists bent, symptoms may awaken you from sleep. During the day, symptoms often occur when holding something for a prolonged period of time with the wrist bent forward or backward, such as when using a phone, driving, or reading a book.

Many patients find that moving or shaking their hands helps relieve their symptoms.

Distal Radius Fractures (Broken Wrist)

The radius is the larger of the two bones of the forearm. The end toward the wrist is called the distal end. A fracture of the distal radius occurs when the area of the radius near the wrist breaks.

Distal radius fractures are very common. In fact, the radius is the most commonly broken bone in the arm.

Description

A Colles fracture occurs when the broken end of the radius tilts upward.

A distal radius fracture almost always occurs about 1 inch from the end of the bone. The break can occur in many different ways, however.

One of the most common distal radius fractures is a Colles fracture, in which the broken fragment of the radius tilts upward. This fracture was first described in 1814 by an Irish surgeon and anatomist, Abraham Colles — hence the name “Colles” fracture.

Other ways the distal radius can break include:

 

  • Intra-articular fracture. A fracture that extends into the wrist joint. (“Articular” means “joint.”)
  • Extra-articular fracture. A fracture that does not extend into the joint is called an extra-articular fracture.
  • Open fracture. When a fractured bone breaks the skin, it is called an open fracture. These types of fractures require immediate medical attention because of the risk for infection.
  • Comminuted fracture. When a bone is broken into more than two pieces, it is called a comminuted fracture.

It is important to classify the type of fracture, because some fractures are more difficult to treat than others. Intra-articular fractures, open fractures, comminuted fractures, and displaced fractures (when the broken pieces of bone do not line up straight).are more difficult to treat, for example.

Sometimes, the other bone of the forearm (the ulna) is also broken. This is called a distal ulna fracture.

This illustration shows some of the types of distal radius fractures.

Cause

The most common cause of a distal radius fracture is a fall onto an outstretched arm.

Osteoporosis (a disorder in which bones become very fragile and more likely to break) can make a relatively minor fall result in a broken wrist. Many distal radius fractures in people older than 60 years of age are caused by a fall from a standing position.

A broken wrist can happen even in healthy bones, if the force of the trauma is severe enough. For example, a car accident or a fall off a bike may generate enough force to break a wrist.

Good bone health remains an important prevention option. Wrist guards may help to prevent some fractures, but they will not prevent them all.

Symptoms

A broken wrist usually causes immediate pain, tenderness, bruising, and swelling. In many cases, the wrist hangs in an odd or bent way (deformity).

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Arthritis of the Wrist

Arthritis involves inflammation of one or more of your joints. Pain and stiffness are common symptoms of arthritis, and when these occur in your wrist, simple daily activities can become more difficult.

There are many types of arthritis, and most of these can affect the wrist. Although the severity of symptoms related to arthritis can vary, most arthritis-related diseases are chronic. This means that they are long-lasting—even permanent—and can eventually cause serious joint damage.

Your wrist is a complex joint—it is actually made up of multiple small joints. When healthy, the bones glide easily over each other during movement, protected by smooth cartilage that coats the joint surfaces. Arthritis damages this cartilage. As the disease progresses, there is a gradual loss of cartilage. Without a smooth joint surface, the bones rub against each other, leading to joint damage that cannot be repaired.

Although there is no cure for arthritis today, there are many treatment options available to help relieve your symptoms. Some options may also slow the progression of joint damage. With proper treatment, many people are able to manage their symptoms and stay active.

Suspect a fracture or broken bone?  Contact us today.