Common Problems of the Hand and Wrist

Painful numbness and tingling in the hand

One of the most common reasons patients seek evaluation by an Orthopedic surgeon is for painful numbness and tingling in the hand.  Two of the frequent causes are carpal tunnel syndrome or cubital tunnel syndrome.

Carpal Tunnel Sydrome is essentially a pinched nerve at the wrist.  The carpal tunnel is a space at the wrist where the median nerve passes in order to reach the hand.  If excessive pressure is placed on this nerve, patients may start to experience painful numbness and tingling that radiates to the tips of the thumb, index, middle, and ring fingers.

Cubital Tunnel Syndrome is essentially a pinched nerve at the elbow. The cubital tunnel is a space along the inner side of the elbow where the ulnar nerve passes through on its way to the hand.  If excessive pressure or strain is placed on this nerve, patients may start to experience painful numbness and tingling that radiates to the tips of the small and ring fingers.

Wrist pain

Pain or injury to the wrist effects patients of all ages and activity level. The wrist is a finely tuned joint comprised of several bones, ligaments, and tendons that elevates our ability to perform routine activities at home as well as participate in recreational sports such as tennis, golf, and swimming.

De Quervain’s tenosynovitis is a form of repetitive tendon injury involving two of the tendons that travel along the radial side of the wrist. Patients often express considerable discomfort with wrist and thumb motion. Two of the tendons that help in moving the thumb develop frictional degeneration as they pass back and forth through a small tunnel.

Ulnocarpal abutment syndrome is a mechanical impaction that results when the ulnar bone contacting the small bones of the wrist joint.  This can result in wrist pain lifting, grasping, and pushing activities such as while playing tennis, exercising, or occupational demands.

Distal radius fractures is the larger of the two forearm bones near the wrist joint.  It is one of the most commonly broken bones in the entire body.  This fracture can occur in patients of all age groups and activity level.

Hand or Finger pain

Discomfort in the hand or fingers can occur abruptly or can gradually progress over time.  Based on the location, type of pain, and time of onset, many times patients’ symptoms can be improved upon with simple yet effective treatment.

Thumb CMC arthritis (carpal metacarpal) arthritis or base of the thumb joint arthritis remains one of the most common locations of arthritis in the hand that leads to considerable disability.  The joint at the base of the thumb is predisposed to degenerative arthritis as a result of its unique anatomy and load.  Over time, some patients may wear down the cartilage of the joint leading to pain and loss of function.  When symptomatic, patients often complain of focal pain and difficulty with grabbing, grasping, and pinching activities.

Trigger fingers results from tethering of the tendon that bends our finger.  This leads to catching or locking of the finger while attempting to flex the digit.  The thumb and ring finger are thought to be the two most common digits affected.  Some patients describe having to use their contralateral hand to passively extend the affected finger that is stuck in a bent position.

Hand and finger trauma – Our hands and fingers are frequently injured as a result of trauma.  Accidental injuries can result in finger fractures or nerve lacerations.  Patients’ often present with abrupt onset of loss of normal motion, sensation, or function of the hand or finger.

Lumps and Bumps

It is common for patients to notice different types of lumps and bumps on their hands.  Although they can be many times the bumps are not painful.  Some are small while others can gradually increase in size.

Ganglion cyst is a fluid or gel filled appearing lump that is common around the joints and tendons of the hand and wrist.  They can appear abruptly without any prior trauma or injury.  One of the most common locations for them to appear is over the back of the wrist.  They are often firm and immobile.  Patients may experience some discomfort in the vicinity of the cyst.   Depending on the characteristics of the cyst, some can resolve on their own.

Mucous cyst is a fluid filled bump that appears just proximal to the fingernail.  They usually originate from an arthritic finger knuckle joint.  Sometimes they are associated with nail deformities.  At times, mucous cysts can drain unexpectantly.