THE STRUCTURES OF THE WRIST JOINT
The hand comprises of 8 small carpal bones lined in two rows,5 metacarpal bones in the palm and dorsal of the hand and 14 phalanx bones.The wrist joint comprises of distal ends of the ulna and radius,8 carpal bones and proximal portions of the 5 metacarpal bones.The majority of the muscles that produce the functional motion of the wrist origin from the forearm and and their tendons form the muscles of the hand.The radial,ulnar and median nerves lead the complex and fine motor movements of the hand.
CAUSES OF HAND AND WRIST INJURIES
Wrist injuries ocur frequently from instantaneous and forced travma,nerve entrapments in the elbow and wrist,Daily rhytmic and forced activities and rheumatoid diseases.
WHO SUFFERS MOSTLY FROM HAND AND WRİST INJURIES?
Because the hand is comprised of complex anatomical structure and we use fine and multi-motor activities in daily life,we face forced movements and sprains.The wrist and hand pathologies can be congenital or may be seen in profession groups (carpenters,electricians,house wives etc)who use repetitive and forced movements,computer users and athletes (golf,billiard players). It can ocur in every age group and gender.
Physical examination and evaluation
For definitive diagnosis; X-Ray,MR,CT,EMG,Scintigraphie scans are used.
WHAT ARE THE MOST COMMON HAND AND WRIST DISORORDERS?
-Carpal Tunnel Syndrome
-De Quervain Tenosynovitis
CARPAL TUNNEL SYNDROME(Entrapment of Median Nerve)
CTS is the entrapment of the median nerve; which is one the 3 nerves in the arm;in the wrist ,where it runs through a small space called The Carpal Tunnel.The Median nerve controls fine movements of the fingers and feeling of thumb and first three fingers.
Pressure of the nerve in the tunnel for a prolonged time will cause the syndrome.Wrist traumas,swelling of the tendons,fractures or diseases such as hypothyroidsm,Rheumatoid Arthritis, Diabetes and pregnancy where the body holds fluid,are some of the reasons.
CTS can cause tingling,numbness or pain in the thumb,index finger,middle finger and half of the ring finger.At the beginning there is weakness and fatigue in the hand,in the advanced period,there is severe pain and numbness especially at night.The patient has to shake her/his hand to alleviate the symptoms.It gets harder to touch the thumb with the other fingers.
-First of all the patient is advised not to perform activities that increase the symptoms.
-Splint is advised to relieve the painand pressure on the nerve.
-Medical care; analgesics and nonsteroid antiinflammatory, oedema reducing drugs.
-Cortisone injection when necessary.
-Physical Therapy agents (TENS,Ultrasound,Cold Pack,JOBS etc.)
-Stretching and strengthening exersises
If these treatments modalities don’t relieve the symptoms, surgical intervention must be considered.
Because of the complex anatomical structure and multidirectional motions in daily life, our hand and wrist are subjected to multiple traumas.The most prominent symptoms are severe pain and edema.The patient cannot move his/her hand and holds it in a fixed position.In more serious traumatic fractures there will be a significant difference in the alignment of the bones.
For definitive diagnosis physical examination and X-Ray must be obtained.Occasionally MR,CT,Syntigraphie scan may be needed to get better detail.
In the early stage a cast or splint must be used to hold the fracture that has been set.In some instances surgery may be beneficial to put the broken bones back together.After the bone union following cast or post-op,physical therapy program is recommended to relieve pain and swelling;
Cold/Hot Pack fomentations,
Various electrical currents (TENS,Compex)
Stretching and strenghtening exercises.
De Quervain Tenosynovitis
It is a non-inflammatory process where the tendons and tendon sheats pass the first dorsal compartment at the wrist to the thumb.It causes pain during thumb motions.There is irregularity between tendon and tendon sheat and the lubricity and motion is limited.
The most prominent symptom is pain at the thumb and radial side of the wrist.In the later stages there is pain, swelling and burning sensation on the thumb.There is difficulty in gripping and rotational movements of the thumb.
Repetitive activities where the thumb is held in abduction and extension.
Fracture,trauma history or excessive weight-bearing exercises.
In the early stage,splinting the thumb and wrist is essential for immobilisation.
Medical treatment(for pain and inflammation),steroid injections,physical therapy agents (col pack,laser,TENS etc.) can be of benefit.
In case of failure to palliative measures,surgery must be considered.