The hand and wrist are prone to injury due to their structure wherein there is an intricate assortment of bones, ligaments, tendons, and nerves. Moreover, due to the nature of human anatomy wherein the hand and wrist are also involved in almost every activity of daily living thereby adding to the likelihood of hand and wrist injuries. Due to the complex biomechanics of the hand, many injuries are common whereas some other are so subtle that they are easily missed or ignored which leads to future complications. It is vital to carefully diagnose all hand and wrist injuries so that an effective rehabilitation therapy can begin as early as possible.
Some Common Hand and Wrist Injuries Include:
- Carpal Tunnel Syndrome: This is caused by the Median nerve that supplies the hand is compressed as it passes through the carpal tunnel at the wrist.
- de Quervain's Tenosynovitis: This is an overuse injury of one of the tendons on the thumb side of the wrist.
- Wrist Fractures: Most Common types of fractures are the distal Radius (a ‘Colles Fracture’), Ulna and Scaphoid.
- Dislocated finger
- Wrist sprain: The ligaments and connective tissue of the wrist can be overstretched or torn
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Hand and Wrist Injuries Experienced by Some Athletes and Workers
Sprains are damage to ligaments. A ligament is a type of tissue that connects bone to each other. Sprains are graded from a minor tear to a complete rupture. The Treatment and recovery time depends on the grade of sprain.
This is caused by a ulnar collateral ligament which may be sprained as this ligament acts like a hinge and helps your thumb to function properly. Grasping power of the hand is severely impacted due to thumb sprain. Such painful thumb injury may happen while breaking a fall with the palm of the hand or taking a spill on the slopes with your hand strapped to a ski pole.
This type of injury happens in activities when direct pressure and weight is applied on the palm thereby bending the wrist backward and possibly stretching or tearing the ligaments connecting the bones in the wrist. This type of injury is experienced during a forward fall to which the natural response of the body is to put the hands out in front which bear the weight and impact the wrist.
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Bones can be fractured and dislocated. A fracture is a crack or a break in a bone. It is commonly referred to as broken bone. A dislocation is when a bone is pushed out of place so that they no longer line up correctly at the joint. This can impact the ability to move due to pain.
Fractures of the metacarpals (the bones in the hand just before the knuckles) and phalanges (the bones between the joints of fingers) are also common injuries.
The most common fracture of the metacarpals is a boxer's fracture. A boxer's fracture usually occurs when you strike an object with your closed fist. With a boxer's fracture, the fifth metacarpal joint (the one at the base of your littlest finger) is depressed and the surrounding tissue is tender and swollen.
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The scaphoid bone is one of eight small bones that make up the wrist and fracture of the scaphoid bone accounts for most of the wrist fractures.
These are quite common in sports, work, and motor vehicle accidents. The break usually occurs during a fall on the outstretched wrist. The angle at which the wrist hits the ground may determine the type of injury. The more the wrist is bent back (extension), the more likely the scaphoid bone will break. With less wrist extension it is more likely the lower arm bone (radius) will break.
Scaphoid fractures may not be immediately obvious. Such fractures are sometimes disguised as sprained wrist instead of a broken bone because there is no obvious deformity and very little swelling.
PIP Joint Dislocations
One of the most common injuries to a hand is an injury to the joint above the knuckle, the proximal interphalangeal (PIP) joint. Injuries to the PIP joint occur when the finger is either hyper extended (forced backward) or forced into flexion (downward into a bent position). Injuries to the PIP joint may include fractures, dislocations, and fracture dislocations.
Soft Tissue and Closed Tendon Injuries
Tendons are connective tissues that attach muscle to bone. Tendonitis is a common injury of the tendon which causes an irritation of the tissue.
de Quervain's Syndrome
de Quervain's syndrome is a common injury with people who use a lot of wrist motion, especially repetitive rotating and gripping generally caused by overuse of hand which causes irritation of the tendons found along the thumb side of the wrist. This irritation impacts the lining around the tendon which swells and severely impacts the movement of the tendons.
Extensor Carpi Ulnaris (ECU) tendonitis is another common closed tendon injury. ECU tendonitis is an inflammation of the tendon that runs along the back of the wrist and is caused by repetitive twisting and backward flexion of the wrist. It is most commonly seen in basketball players and those playing racquet sports.
Baseball finger (or mallet finger) is an injury that commonly occurs at the beginning of the baseball season. It occurs when a ball hits the tip of the finger, bending it down. Normally, the tip of the finger can bend toward the palm of the hand by about 60-70 degrees. However, adding the force of a ball that has been batted through the air, the force of the moving ball can push the finger beyond that limit, tearing the extensor tendon that controls muscle movement in the affected finger. If the force is great enough, it may even pull tiny pieces of bone away thereby complicating the injury.
Jersey finger is the opposite of mallet finger and occurs when the fingertip, usually the ring finger, is forcibly extended, such as if the finger gets caught in machinery. This causes the flexor tendon, which bends the fingertip, to be pulled away from the bone due to which the individual will be unable to bend the finger without assistance.
Boutonnière deformity is an injury to the tendons that straighten the fingers. It occurs when the finger receives a forceful blow when it is bent. Several tendons, running along the side and top of the finger, work together to straighten the finger. If the tendon on the top that attaches to the middle bone of the finger (the central slip of tendon) is injured by a forceful blow, it can sever the central slip from its attachment to the bone, in some cases, even popping the bone through the opening. The tear looks like a buttonhole ("boutonnière" in French). In case of a boutonnière deformity, the middle joint of the finger will bend downward and the fingertip end joint bends back. People with a boutonnière deformity cannot fully straighten their finger.
Preventing Hand and Wrist Injuries
The following methods are suggested to prevent hand injuries, wrist injuries, and upper extremity injuries:
- Wrist guards: Wrist guards may help protect an individual from bone fractures and hand scrapes in case of a fall or slide.
- Gloves: The gloves will help protect the hands if the palm suffers a direct blow. In addition to protecting the hand nerves; the gloves will also protect the skin from direct wounds and cuts by acting as a shield.
- Warm-up: It is recommended to include a warm-up before playing sports or working an eight-hour physically-intense work shift with focus on stretching and improving flexibility.
Exercises for Hand and Wrist Injuries
There are exercises for rehabilitation of hand and wrist injuries such as Carpal Tunnel Syndrome. We also have general wrist and hand exercises below.
- Assisted Supinator Stretch - This stretch requires the help of a partner or physiotherapist to stretch the muscles which supinate the wrist (turn the hand over).
- Putty Exercises (Various) - Putty can be used to strengthen the small muscles of the wrist and hand. This is useful after injuries such as a fracture to any of the small bones in the hand or a wrist, thumb or finger sprain.
- Prolonged Wrist Stretches - This exercise aims to increase the range of motion into pronation and supination. Pronation is the movement of turning the hand so the palm faces downwards. Supination is the opposite movements so the palm ends facing upwards.
- Ulna & Radial Deviation - Ulna and radial deviation are the movements of tilting the wrist from one side to the other. Radial deviation is to move the thumb side of the hand down towards the wrist and ulnar deviation is moving the little finger side down.
- Wrist Flexion - This wrist flexion exercise can be performed with a dumbbell, or with a resistance band. It is great for strengthening the wrist flexor muscles of the forearm after wrist and elbow injuries.
- Wrist Extension - Wrist extension exercises are rarely used in weight training programs, although it is a great exercise for rehabilitation of injuries such as tennis elbow and sprains/fractures of the wrist.
- Finger Exercises with Rubber Band - Rubber band exercises are a great way for strengthening the finger extensors and are commonly used in treating tennis elbow injuries as the same muscles causing pain at the elbow, also control finger extension.
Physiotherapy Treatment for Hand & Wrist Injuries
Physiotherapy treatment becomes important following a hand or wrist injury to restore optimal function of the organ thereby, allowing the patient to participate in all the daily activities without pain, limitation or weakness.
The treatment of such injuries includes a detailed assessment of the patient for development of an individual treatment plan to reduce pain, regain the range of movement, function, and strength. The physiotherapist may also recommend further investigations like an X-ray, ultrasound, MRI, CT scan or nerve conduction studies to confirm a hand and wrist pain diagnosis and rule out other more serious conditions.