+ Wrist Fractures (Distal Radius and Ulna Fractures)

Wrist fractures are the most common orthopedic injury and can encompass either a distal ulna fracture or, more commonly, a distal radius fracture. These can occur in any age group and typically are due to a fall on an outstretched wrist. The extent of the fracture can be evaluated on an X-ray. Treatment of wrist fractures is based on the fracture pattern. Simple nondisplaced fractures are more commonly treated in a cast for around 6 weeks. Fractures with a more complex or unstable pattern may require either a closed reduction or surgical fixation.

Symptoms of a fracture include immediate pain, swelling, and decreased range of motion after an injury. Diagnosis is based on a physical exam and, most importantly, X-rays are taken to evaluate the extent of a fracture.

Treatment of elbow fractures varies greatly depending on the severity of the fracture and should be evaluated by your provider. Non-surgical treatment can involve immobilization in a splint and sling and is typically followed by early range of motion exercises with the help of a physical therapist. Surgical treatment will often involve placing a combination of plates and screws at the site of the fracture in order to stabilize the bone and allow for good future outcomes and function.

+ Scaphoid Fracture

The scaphoid is the most frequently fractured carpal bone, commonly occurring from a fall on an outstretched wrist. Like most fractures, the extent of the fracture can be evaluated on X-ray and occasionally a CT if needed. Unfortunately, scaphoid fractures can be complex due to the pattern of blood supply in the bone creating an environment that is poor for fracture healing. Depending on the fracture pattern, most are treated in a thumb spica cast for approximately 3 months. Those that do not heal after cast immobilization or are too displaced to begin with are treated with surgical percutaneous screw fixation. Proper healing of this fracture is important for the long term efficacy and health of the wrist.

+ Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is a syndrome characterized by compression of the median nerve in the wrist. Symptoms include numbness and tingling in the thumb, index, and ring finger as well as clumsiness and, occasionally, pain at night. Treatment for carpal tunnel begins conservatively with night splinting in a wrist brace, anti-inflammatories, ergonomic work setups, and, occasionally, a corticosteroid injection into the area. Nerve conduction studies may be recommended for further diagnostic purposes. For those patients who are not improving or are experiencing weakness in the hand, a surgical nerve carpal tunnel release may be recommended.

+ De Quervain’s Tenosynovitis

De Quervain’s Tenosynovitis is an inflammation of the first dorsal compartment of the wrist. This compartment is where three of the tendons that are important for movement of the thumb are located. This is an overuse injury that typically occurs when patients are doing repetitive activity with the thumb and can cause pain on the radial side of the wrist that is worse with movement of the thumb. Commonly this occurs in postpartum women who are lifting their newborns, but can occur in anyone. Treatment for De Quervain’s begins conservatively with a thumb spica wrist brace, anti-inflammatories, activity modification, and occasionally a corticosteroid injection into the area. Although rare, for severe refractory cases a surgical release of the first dorsal compartment in the wrist can be done.

+Mallet Finger and Other Tendon Injuries

The hand encompasses many tendons that all work together to aid in flexion, extension, and vertical movement of the fingers. Injuries to tendons can occur from a direct impact to the hand, catching something incorrectly, or a laceration. Mallet finger occurs when the tendon that attaches to the distal phalanx is hyperextended and avulses off the bone. This can cause inability to extend the distal end of the finger, and is diagnosed on physical exam and with x-rays. Treatment can change based on if there is a fracture involved as well, but typically involves extension splinting for 6-8 weeks. Depending on the injury surgical fixation may also be an option.

Although mallet finger injuries are some of the most common tendon injuries of the hand, there are many other tendon injuries that can also occur. Immediate careful evaluation from a provider is recommended to properly diagnose an injury and maintain full function of the hand and fingers.

+Arthritis

Osteoarthritis is usually caused by age along with wear and tear from activity and work. As such, it usually develops slowly over time and is most common in patients over 60 years of age. Progressive loss of cartilage leads to pain and joint stiffness. Osteoarthritis can occur in any joint, but most commonly occurs in the wrist joint or the CMC joint of the thumb. Symptoms usually begin very gradually with only a slight increase in pain or subtle loss of motion. Sometimes an unrelated injury in the wrist can make underlying arthritis suddenly symptomatic. These symptoms tend to worsen over time especially as a person gets older. More severe arthritis can be associated with significant loss of motion as well as catching or cracking noises known as crepitus.

CMC joint or wrist arthritis is diagnosed primarily on X-ray, as this best shows the extent to which the joint has worn out. Once diagnosed, treatment for arthritis depends on its severity. For more mild cases, preservation of range of motion and strengthening with physical therapy is very helpful. Significant flares of pain can sometimes also be controlled with cortisone injections or anti-inflammatories. In severe cases, there are various surgical procedures available that are most commonly performed by hand specialists.