Hand and Wrist

The hand and wrist comprises of several small joints, and therefore this area can have several different injury presentations. Most hand and wrist problems arise either due to trauma such as falling on an outstretched hand or a repetitive strain, like typing.

Your GP, Advanced Practitioner or Physiotherapist might have given you a diagnosis already, and directed you here.

Below you will find some of the more common presentations of hand and wrist injuries.

Whether you are undergoing treatment, or waiting to be seen, you might find some helpful resources below to get you started on your journey to improving your hand and wrist pain.

If you would like a more in depth understanding of the anatomy of the hand or wrist, visit AnatomyZone – Your Guide to Human Anatomy and search ‘hand’ or ‘wrist’.

Accordion

What are they?

Mostly caused by falling onto an outstretched hand, or excessive force on the fingers – leading to tendon or ligament ruptures. The leaflets below give specific information on common acute hand and wrist injuries.

Will a scan help?

Yes, X-Rays where fractures are suspected. Ultrasound and MRI for confirming soft tissue ruptures.

What are the pathways?

  1. Immobilisation in a cast or brace to allow healing then Physiotherapy for return to function
  2. Surgery for fixation of bones or repair of tendons then Physiotherapy

Self help and resources

What is it?

A very common hand and wrist complaint. The carpal tunnel in the wrist can become pressurised and compresses the median nerve. Characterised by tingling in the thumb, index and middle fingers for most, and often experienced at night. Occasionally the whole hand is affected.

Will a scan help?

Most CTS diagnoses are made clinically, with the help of the below CTS scoring questionnaire. Nerve conduction studies may be useful to differentiate between other sources of hand symptoms.

What are the pathways?

  • Patients with mild to moderate CTS are advised to wear night splints for 12 weeks before referral to MSK (ask your GP for one, or search for ‘CTS splint’ online, example below)
Carpal Tunnel Syndrome night splint

Carpal Tunnel Syndrome night splint

  • Hand/nerve exercises can be found below
  • A single Injection of corticosteroid can be useful if the above does not help
  • Finally, surgery has also shown to be successful for more persistent or severe cases – decompressing the carpal tunnel

Self help and resources

What is it?

De Quervain’s is a painful condition that affects tendons where they run through a tunnel on the thumb side of the wrist. Commonly can affect new mums, and is generally aggravated by use of the hand at home, work or in the garden.

Will a scan help?

Not routinely. The diagnosis is made by the clinician.

What are the pathways?

  1. Physiotherapy can advise on modifying activities and using a thumb/wrist support
  2. Injections relieve pain in up to 70% of occasions
  3. Less commonly, surgical decompression of the tendon tunnel may be offered

Self help and resources

Accordion

What is it?

Dupuytren’s contracture (also referred to as Dupuytren’s disease) is a common condition that usually arises in middle age or later and is more common in men than women. Firm nodules appear in the fascia just beneath the skin of the palm of the hand, and in some cases they extend to form cords that can prevent the finger straightening completely.

Will a scan help?

Not routinely. The diagnosis is made by the clinician.

What are the pathways?

  1. Self-manage – after your diagnosis, you may wish to continue until it becomes more of an impact to you
  2. Surgery – fasciectomy is considered when contractures are >30 degrees or impairing function
  3. Physiotherapy will guide further splinting and scar management after surgery.

Self help and resources

What is it?

The joint at the base of the thumb, between the 1st metacarpal and trapezium bone, often becomes arthritic as people get older. Arthritis of the basal joint of the thumb is common in women and rather less common in men.

Will a scan help?

Yes, but a clinical diagnosis can also be made (by physical examination). X-rays show it is present in about 25% of women over the age of 55, but many people with arthritis of this joint have no significant pain.

What are the pathways?

  1. Physiotherapy – thumb supports and adaptive equipment place less pressure through the joint, and exercises can improve function and reduce pain
  2. Steroid injections can relieve pain for short to medium term
  3. A “Trapeziectomy” is the surgical option when other options have failed

Self help and resources

 

What is it?

Trigger finger is a painful condition in which a finger or thumb clicks or locks as it is bent towards the palm. Thickening of a tendon tunnel or formation of a tendon nodule leads to the tendon then catching in the tunnel mouth – creating the triggering.

Will a scan help?

Not routinely. The diagnosis is made by the clinician.

What are the pathways?

  1. A small finger or thumb or thumb splint at night keeps the nodule in the tunnel and can prevent sleep disturbance and morning symptoms
  2. Steroid injections are successful for pain and triggering in the majority of cases
  3. Release of the tendon tunnel with a needle (percutaneous) or via a small incision (surgical) is the final option, or if injection is unsuccessful or inappropriate

Self help and resources