Hand injury

Last updated
Hand injury
Specialty Plastic surgery

The hand is a very complex organ with multiple joints, different types of ligament, tendons and nerves. Hand disease injuries are common in society and can result from excessive use, degenerative disorders or trauma.

Contents

Trauma to the finger or the hand is quite common in society. In some particular cases, the entire finger may be subject to amputation. The majority of traumatic injuries are work-related. Today, skilled hand surgeons can sometimes reattach the finger or thumb using microsurgery. Sometimes, traumatic injuries may result in loss of skin, and plastic surgeons may place skin and muscle grafts. [1]

Types

3D medical animation still showing Arthritis infected hand. Rheumatoid arthritis - Swollen finger joint.jpg
3D medical animation still showing Arthritis infected hand.

Arthritis of the hand is common in females. Osteoarthritis of the hand joints is much less common than rheumatoid arthritis. As the arthritis progresses, the finger gets deformed and lose its functions. Moreover, many patients with rheumatoid arthritis have this dysfunction present in both hands and become disabled due to chronic pain. Osteoarthritis is most common at the base of thumb and is usually treated with pain pills, splinting or steroid injections. [2]

Carpal tunnel syndrome is a common disorder of the hand. This disorder results from compression of the median nerve in the wrist. Disorders like diabetes mellitus, thyroid or rheumatoid arthritis can narrow the tunnel and cause impingement of the nerve. Carpal tunnel syndrome also occurs in people who overuse their hand or perform repetitive actions like using a computer key board, a cashiers machine or a musical instrument. When the nerve is compressed, it can result in disabling symptoms like numbness, tingling, or pain in the middle three fingers. As the condition progresses, it can lead to muscle weakness and inability to hold objects. The pain frequently occurs at night and can even radiate to the shoulder. Even though the diagnosis is straightforward, the treatment is surgical decompression of the median nerve after deroofing of the carpal tunnel. [3]

Dupuytren's contracture is another disorder of the fingers that is due to thickening of the underlying skin tissues of the palm. The disorder results in a deformed finger which appears thin and has small bumps on the surface. Dupuytren's contracture does run in families, but is also associated with diabetes, smoking, seizure recurrence and other vascular disorders. Dupuytren's does not need any treatment as the condition can resolve on its own. However, if finger function is compromised, then surgery may be required.

Ganglion cysts are soft globular structures that occur on the back of the hand usually near the junction of the wrist joint. These small swellings are usually painless when small but can affect hand motion when they become large. The cysts contain a jelly like substance and usually do disappear on their own. If the ganglion cyst is not bothersome, it should be left alone. Just removing the fluid from the cyst is not curative because fluid will come back in less than a week. Surgery is often done for large cysts but the results are poor. Recurrences are common, and there is always the possibility of nerve or joint damage.

Inflamed tendons of the hand. Tendinitis.jpg
Inflamed tendons of the hand.

Tendinitis is disorder when tendons of the hands become inflamed. Tendons are thick fibrous cords that attach small muscles of the hand to bones. A Tendon is useful for generation of power to bend or extend the finger. When repetitive action is performed, tendons often get inflamed and present with pain and difficulty for moving the finger. In most cases, tendinitis can be treated with rest, ice and wearing splints. In some cases, an injection of corticosteroid may help. Tendinitis is primarily a disorder from overuse but if not treated properly, can become chronic. Severe cases need surgical decompression.

Trigger finger is a common disorder which occurs when the sheath through which tendons pass, become swollen or irritated. Initially, the finger may catch during movement but symptoms like pain, swelling and a snap may occur with time. The finger often gets locked in one position and it may be difficult to straighten or bend the finger. Trigger finger has been found to be associated with diabetes, gout and rheumatoid arthritis.

Causes

Fractures of the fingers occur when the finger or hands hit a solid object. Fractures are most common at the base of the little finger (boxer's fracture). Nerve injuries occur as a result of trauma, compression or over-stretching. Nerves send impulses to the brain about sensation and also play an important role in finger movement. When nerves are injured, one can lose ability to move fingers, lose sensation and develop a contracture. Any nerve injury of the hand can be disabling and results in loss of hand function. Thus it is vital to seek medical help as soon as possible after any hand injury. [4]

Sprains result from forcing a joint to perform against its normal range of motion. Finger sprains occur when the ligaments which are attached to the bone are overstretched and this results in pain, swelling, and difficulty for moving the finger. Common examples of a sprain are jammed or twisted fingers. These injuries are common among ball players but can also occur in laborers and handy men. When finger sprains are not treated on time, prolonged disability can result. [5]

Diagnosis

Fracture of the tuft of the finger Tuffedfracture.png
Fracture of the tuft of the finger

Finger injuries are usually diagnosed with x-ray and can get to be considerably painful. The majority of finger injuries can be dealt with conservative care and splints. However, if the bone presents an abnormal angularity or if it is displaced, one may need surgery and pins to hold the bones in place.

Treatment

Most hand injuries are minor and can heal without difficulty. However, any time the hand or finger is cut, crushed or the pain is ongoing, it is best to see a physician. Hand injuries when not treated on time can result in long term morbidity. [6]

Simple hand injuries do not typically require antibiotics as they do not change the chance of infection. [7]

Many hand injuries need surgery, but the time from injury to surgery (delays of up to 4 days) doesn't increase the chance of infection [8]

Epidemiology

About 1.8 million people go to the emergency department each year due to hand injuries. [7]

Related Research Articles

<span class="mw-page-title-main">Repetitive strain injury</span> Muscular, skeletal, or nerve injury due to repetitive actions

A repetitive strain injury (RSI) is an injury to part of the musculoskeletal or nervous system caused by repetitive use, vibrations, compression or long periods in a fixed position. Other common names include repetitive stress injury, repetitive stress disorders, cumulative trauma disorders (CTDs), and overuse syndrome.

<span class="mw-page-title-main">Carpal tunnel syndrome</span> Compression of the median nerve in the wrist

Carpal tunnel syndrome (CTS) is a nerve compression syndrome associated with the collected signs and symptoms of compression of the median nerve at the carpal tunnel in the wrist. Carpal tunnel syndrome is an idiopathic syndrome but there are environmental, and medical risk factors associated with the condition. CTS can affect both wrists.

<span class="mw-page-title-main">Wrist drop</span> Medical condition

Wrist drop is a medical condition in which the wrist and the fingers cannot extend at the metacarpophalangeal joints. The wrist remains partially flexed due to an opposing action of flexor muscles of the forearm. As a result, the extensor muscles in the posterior compartment remain paralyzed.

<span class="mw-page-title-main">Dupuytren's contracture</span> Gradual bending of the fingers due to scar tissue buildup within the palms

Dupuytren's contracture is a condition in which one or more fingers become permanently bent in a flexed position. It is named after Guillaume Dupuytren, who first described the underlying mechanism of action, followed by the first successful operation in 1831 and publication of the results in The Lancet in 1834. It usually begins as small, hard nodules just under the skin of the palm, then worsens over time until the fingers can no longer be fully straightened. While typically not painful, some aching or itching, or pain, may be present. The ring finger followed by the little and middle fingers are most commonly affected. It can affect one or both hands. The condition can interfere with activities such as preparing food, writing, putting the hand in a tight pocket, putting on gloves, or shaking hands.

A soft tissue injury is the damage of muscles, ligaments and tendons throughout the body. Common soft tissue injuries usually occur from a sprain, strain, a one-off blow resulting in a contusion or overuse of a particular part of the body. Soft tissue injuries can result in pain, swelling, bruising and loss of function.

<span class="mw-page-title-main">Distal radius fracture</span> Fracture of the radius bone near the wrist

A distal radius fracture, also known as wrist fracture, is a break of the part of the radius bone which is close to the wrist. Symptoms include pain, bruising, and rapid-onset swelling. The ulna bone may also be broken.

<span class="mw-page-title-main">Nintendo thumb</span> Injury caused by video games

Nintendo thumb, also known as gamer's thumb and similar names, is a form of repetitive strain injury (RSI) caused by excessive playing of video games with the traditional Nintendo controller. This injury mainly occurs due to repeated thumb movements while playing video games. The symptoms can include blistering, paraesthesia, as well as swelling of the thumbs, though any finger can be affected. This can lead to stress on tendons, nerves, and ligaments in the hands, and further onto lateral epicondylitis, tendinitis, bursitis, and carpal tunnel syndrome. Similar injuries can occur with other gaming systems, such as PlayStation thumb from playing Sony PlayStation. The general recommendation for the treatment is to rest and stop the repetitive motion of the affected finger. In more severe and painful cases, using NSAIDs is also recommended.

<span class="mw-page-title-main">Tarsal tunnel syndrome</span> Compression of the tibial nerve in the foot

Tarsal tunnel syndrome (TTS) is a nerve compression syndrome or nerve entrapment syndrome causing a painful foot condition in which the tibial nerve is entrapped as it travels through the tarsal tunnel. The tarsal tunnel is found along the inner leg behind the medial malleolus. The posterior tibial artery, tibial nerve, and tendons of the tibialis posterior, flexor digitorum longus, and flexor hallucis longus muscles travel in a bundle through the tarsal tunnel. Inside the tunnel, the nerve splits into three segments. One nerve (calcaneal) continues to the heel, the other two continue on to the bottom of the foot. The tarsal tunnel is delineated by bone on the inside and the flexor retinaculum on the outside.

Hand surgery deals with both surgical and non-surgical treatment of conditions and problems that may take place in the hand or upper extremity including injury and infection. Hand surgery may be practiced by post graduates of orthopedic surgery and plastic surgery and MCh Hand surgery.

<span class="mw-page-title-main">Carpal tunnel</span> Structure of human wrist

In the human body, the carpal tunnel or carpal canal is a flattened body cavity on the flexor (palmar/volar) side of the wrist, bounded by the carpal bones and flexor retinaculum. It forms the passageway that transmits the median nerve and the tendons of the extrinsic flexor muscles of the hand from the forearm to the hand. The median artery is an anatomical variant. When present it lies between the radial artery, and the ulnar artery and runs with the median nerve supplying the same structures innervated.

<span class="mw-page-title-main">Jammed finger</span> Medical condition

Jammed finger is a colloquialism referring to a variety of injuries to the joints of the fingers, resulting from axial loading beyond that which the ligaments can withstand. Common parts of the finger susceptible to this type of injury are ligaments, joints, and bones. The severity of the damage to the finger increases with the magnitude of the force exerted by the external object on the fingertip. Toes may become jammed as well, with similar results.

<span class="mw-page-title-main">Musculoskeletal injury</span> Damage of muscular or skeletal systems

Musculoskeletal injury refers to damage of muscular or skeletal systems, which is usually due to a strenuous activity and includes damage to skeletal muscles, bones, tendons, joints, ligaments, and other affected soft tissues. In one study, roughly 25% of approximately 6300 adults received a musculoskeletal injury of some sort within 12 months—of which 83% were activity-related. Musculoskeletal injury spans into a large variety of medical specialties including orthopedic surgery, sports medicine, emergency medicine and rheumatology.

<span class="mw-page-title-main">Wrist pain</span>

Wrist pain or open wrist is a syndrome inhibiting use of a hand due to pain in anatomical structures of the wrist. It most commonly results from an injury to a ligament. The pain may be sharp from a traumatic injury or from chronic repetitive wrist activities.

<span class="mw-page-title-main">Dynasplint Systems</span>

Dynasplint Systems, Incorporated (DSI) is a company that designs, manufactures and sells dynamic splints that are used for range of motion rehabilitation. The corporate headquarters are located in Severna Park, Maryland and it is considered a major employer in Anne Arundel County. Products are Made in the US in Stevensville, Maryland. There is a national sales force throughout the US as well as a presence in Canada and Europe.

<span class="mw-page-title-main">Median nerve palsy</span> Medical condition

Injuries to the arm, forearm or wrist area can lead to various nerve disorders. One such disorder is median nerve palsy. The median nerve controls the majority of the muscles in the forearm. It controls abduction of the thumb, flexion of hand at wrist, flexion of digital phalanx of the fingers, is the sensory nerve for the first three fingers, etc. Because of this major role of the median nerve, it is also called the eye of the hand. If the median nerve is damaged, the ability to abduct and oppose the thumb may be lost due to paralysis of the thenar muscles. Various other symptoms can occur which may be repaired through surgery and tendon transfers. Tendon transfers have been very successful in restoring motor function and improving functional outcomes in patients with median nerve palsy.

Injuries in rock climbing may occur due to overuse or falls. However, injuries due to falls are relatively uncommon; the vast majority of injuries result from overuse, most often occurring in the fingers, elbows, and shoulders. Such injuries are often no worse than torn calluses, cuts, burns and bruises. But overuse symptoms, if ignored, may lead to permanent damage.

<span class="mw-page-title-main">Ankle problems</span> Medical condition

Ankle problems occur frequently, having symptoms of pain or discomfort in the ankles.

<span class="mw-page-title-main">Broken finger</span> Medical condition

A broken finger or finger fracture is a common type of bone fracture, affecting a finger. Symptoms may include pain, swelling, tenderness, bruising, deformity and reduced ability to move the finger. Although most finger fractures are easy to treat, failing to deal with a fracture appropriately may result in long-term pain and disability.

Acquired hand deformity refers to the structural or functional abnormalities that develop in the hand. There are multiple varying causes of acquired hand deformity, triggering significant consequences and complications. Trauma, including blunt force, penetrating injuries, burns, and sports-related incidents, is a primary cause of acquired hand deformities. Inflammatory conditions such as rheumatoid arthritis, gouty arthritis, and systemic lupus erythematosus can also contribute to hand deformities by affecting the joints. Degenerative arthritis, specifically osteoarthritis, functions to evoke impaired hand function due to the gradual deterioration of cartilage. Neurological disorders like cerebral palsy can result in hand contractures due to increased muscle tone and stiffness. There are different types of acquired hand deformities, each with distinct characteristics and underlying causes, such as boutonnière deformity, Dupuytren's contracture, gamekeeper's thumb, hand osteoarthritis deformity, mallet finger, swan-neck deformity, ulnar claw hand, among many others.

References

  1. Common Hand Problems Eaton Hand Surgery. Retrieved on 2010-01-20
  2. Hand Pain And Problems Archived 2010-01-24 at the Wayback Machine University of Maryland Medical Center. Retrieved on 2010-01-20
  3. Hand Injuries UeMedicine Health. Retrieved on 2010-01-20
  4. Hand Injuries and Disorders Medline Plus. Retrieved on 2010-01-20
  5. Common Orthopedic Hand and Wrist Injuries Archived 2011-05-20 at the Wayback Machine EmedMag. Retrieved on 2010-01-20
  6. Hand and Wrist Injuries American Academy of Family Physicians. Retrieved on 2010-01-20
  7. 1 2 Murphy, GR; Gardiner, MD; Glass, GE; Kreis, IA; Jain, A; Hettiaratchy, S (April 2016). "Meta-analysis of antibiotics for simple hand injuries requiring surgery". The British Journal of Surgery. 103 (5): 487–92. doi:10.1002/bjs.10111. PMID   26928808. S2CID   205507679.
  8. Davies, James; Roberts, Tobias; Limb, Richard; Mather, David; Thornton, Daniel; Wade, Ryckie (2020). "Time to surgery for open hand injuries and the risk of surgical site infection: a prospective multicentre cohort study" (PDF). Journal of Hand Surgery (European Volume). 45 (6): 622–628. doi:10.1177/1753193420905205. PMID   32065001. S2CID   211136445.