Common Hand Problems

Common Finger, Hand Wrist and Elbow Problems
No matter what your age or occupation your fingers,hands, wrists and elbows are always working. Many common problems that interfere with your daily activities can be diagnosed and treated by your Hand and Upper extremity specialist.

At the Hand Cemter of Western Massachusetts we are strong proponents of patient education and information. Please use this list as a starting point. For more information refer to the text and links below.

Ganglion Cysts
Ganglion cysts are the most common mass or lump in the hand. They are common in the back of the hand. These fluid-filled cysts arise from the ligaments, joint linings or tendon sheaths when they are inflamed or irritated.

Carpal Tunnel Syndrome
Common symptoms of carpal tunnel syndrome are numbness and tingling to the hand, especially at night; pain with prolonged gripping such as holding a steering wheel or clumsiness in handling objects. Sometimes the pain can go all the way up to the shoulder.

Cubital Tunnel Syndrome
Like carpal tunnel syndrome, this condition is due to compression or pressure on a nerve but in this instance it is at the elbow.   It is associated with numbness or tingling in your little finger and at times weakness in grip as well as increased symptoms with bending of the elbow. More recently it has been newly labeled CELLPHONE ELBOW in the media.

Tendinitis of the Wrist
This is common in adult women between the ages of 30 and 50. It is an irritation and swelling of the tunnel which surround the thumb tendons as they pass from the wrist to the thumb. Pain when grasping or pinching and tenderness over the tunnel are the most common symptoms. If the hand is made into a fist with the thumb tucked in and bent towards the little finger, the pain gets worse.

Arthritis of the Base of Thumb
Wear and tear arthritis is very common at the base of the thumb. Pain localized to the base of the thumb is a very common early symptom.

Arthritis of the MP joints (knuckles)
The large joints in the hand at the base of each finger are known as the metacarpophalangeal (MP, or MCP) joints.  They act as hinge joints and are important for both power grip and pinch activities.  Most people refer to these joints as their knuckles. The most common arthritic condition affecting the MP joints is rheumatoid arthritis. Gout, psoriasis, and infection are other less common causes of MP joint arthritis.

Hand Fractures
Some fractures will cause an obvious deformity, such as a crooked finger, but many fractures do not. Medical evaluation and x-rays are usually needed so that your doctor can tell if there is a fracture and to help determine the treatment. Depending upon the type of fracture, your hand surgeon may recommend one of several treatment methods.

Carpal Boss
The carpal boss is an osteoarthritic spur that develops at the base of the second and/or third carpometacarpal joints. The boss is more common in women (2:1), in the right hand (2:1), and between the third and fourth decades. The mass may be asymptomatic, but the patient may complain of considerable pain and aching. A small ganglion is associated with the carpal boss in 30 percent of cases, adding to its confusion with the more common dorsal wrist ganglion.

Children's Fractures
Children have different bone structure than adults. As a result there is often concern regarding growth plate injury.  It is important to note that most child hood fractures are growth plate injuries. Growth plate fractures are classified depending on the degree of damage to the growth plate itself. Treatment depends on the fracture type.

Forearm Fractures in Children
Children love to run, hop, skip, jump and tumble. But if they fall onto an outstretched arm, they could break one or both of the bones in the forearm.

Growth Plate Fractures
The bones of children and adults share many of the same risks for injury. However, a child's bones are also subject to a unique injury called a growth plate fracture.

Distal Phalanx Fracture
Most pediatric hand fractures can be treated by nonoperative means with good results. However, a subset of fractures requires prompt recognition and surgical intervention. Several pediatric phalangeal fracture types  must be recognized and treated appropriately to minimize complications and disability. These injuries defy the general conception that pediatric fractures universally do well with minimal intervention. This paper highlights two important concepts: (1) phalangeal fractures in children can differ considerably from other pediatric fractures, and (2) phalangeal fractures in children can be very different from those in adults.

Diatric Phalanx Fractures
Most pediatric hand fractures can be treated by nonoperative means with good results. However, a subset of fractures requires prompt recognition and surgical intervention. Several pediatric phalangeal fracture types must be recognized and treated appropriately to minimize complications and disability. These injuries defy the general conception that pediatric fractures universally do well with minimal intervention. This paper highlights two important concepts: (1) phalangeal fractures in children can differ considerably from other pediatric fractures, and (2) phalangeal fractures in children can be very different from those in adults.

Trigger Finger
Trigger finger is a condition where the tendon in your palm and finger doesn't have enough room to glide.  Symptoms may include locking of your finger with activity, palm pain with grip or even a finger that gets stuck in the palm only in the morning.  Often an office injection can relieve the symptoms of this problem.

Dupuytren's Disease
Dupuytren's disease is an abnormal thickening of the fascia (the tissue just beneath the skin of the palm). It often starts with firm lumps in the palm. In some patients, firm cords will develop beneath the skin, stretching from the palm into the fingers Gradually, these cords may cause the fingers to bend into the palm. Although the skin may become involved in the process, the deeper structures-such as the tendons-are not directly involved. Occasionally, the disease will cause thickening on top of the finger knuckles (knuckle pads), or nodules or cords within the soles of the feet (plantar fibromatosis).

Osteoarthritis
Receiving a diagnosis of arthritis doesn't mean that it is the beginning of the end.  Symptoms of arthritis may be mild with only pain with certain activities or severe with chronic pain all the time.  Arthritis can affect any joint in the body, but it is most noticeable when it affects the hands and fingers.  Arthritis literally means "inflamed joint." Normally a joint consists of two smooth, cartilage-covered bone surfaces that fit together as a matched set and that move smoothly against one other. Arthritis results when these smooth surfaces become irregular and don't fit together well anymore and essentially "wear out." Treatment is designed to relieve pain and restore function.

Hand Infections
Not all hand infections require surgery.  When seen early, in fact, many  types of infection can be treated with antibiotics and local rest and soaking.  At other times surgery is neededif antibiotic treatment fails or if the infection is severe enough to warrant it. 

Flexor Tendon Injuries
Deep cuts on the palm side of the wrist, hand, or fingers can injure the flexor tendons and nearby nerves and blood vessels. The injury may appear simple on the outside, but is actually much more complex on the inside. When a tendon is cut, it acts like a rubber band, and its cut ends pull away from each other.

Extensor Tendon Injuries
Extensor tendons are just under the skin, directly on the bone, on the back of the hands and fingers. Because of their location, they can be easily injured even by a minor cut. Jamming a finger may cause these thin tendons to rip apart from their attachment to bone. After this type of injury, you may have a hard time straightening one or more joints. Treatment is necessary to return use to the tendon.  At times splinting alone is used to treat an extensor tendon injury.  At other times surgical repair is needed.

Nerve Injuries
Nerves are fragile and can be damaged by pressure, stretching, or cutting. Pressure or stretching injuries can cause the fibers carrying the information to break and stop the nerve from working, without disrupting the insulating cover. When a nerve is cut, both the nerve and the insulation are broken. Injury to a nerve can stop the transmission of signals to and from the brain, preventing muscles from working and causing loss of feeling in the area supplied by that nerve.

Wrist Fractures
The most commonly broken bone of the wrist is the radius.  Many people think that a fracture is different from a break, but they are the same.  When the wrist is broken, there is pain, swelling, and decreased use of the hand and wrist.  Often the wrist appears crooked and deformed. Fractures of the small wrist bones, such as the scaphoid, are unlikely to appear deformed.

Distal Radius Fracture of the Wrist
When someone falls on their outstretched hand, they sometimes get a "broken wrist." The bone that is usually broken is called the radius. It is the larger bone on the upper side of the photograph above. The end toward the wrist is called the distal end. The medical term for "broken bone" is fracture. Therefore, the medical term for the most common type of "broken wrist" is a distal radius fracture (that is, the larger forearm bone is broken near the wrist).

Scaphoid Fractures of the Wrist
Fracture of the scaphoid bone occurs most frequently from a fall onto the outstretched hand. Typically there is pain initially, but the pain may decrease after days or weeks.  Bruising is rare, and swelling may be minimal. Since there is no deformity, many people with this injury mistakenly assume that they have just sprained their wrist, leading to a delay in seeking evaluation.  It is common for people who have fractured this bone to not become aware of it until months or years after the event.

Bite Wounds of the Hand
Bites are extremely common and can cause significant pain and other problems, especially when associated with an infection. Early recognition of warning signs and appropriate treatment are key in minimizing potential problems from the bite.

Nailbed Injury
Often nailbed injuries look worse than they are and most of these are well taken care of in the emergency room. However,  after being sutured in the emergency room it is important to have follow up so that the nail injury can be assessed to see if further definitive treatment needs to be done.  Not all nail injuries are the same though as some are associated with fractures of the underlying bone while others simply involve the nail and the soft tissue of the fingertip and nailbed.  Children can have different varieties of nailbed injuries because of their unique underlying bone anatomy.

Tennis Elbow or Lateral Epicondylitis
Lateral epicondylitis, commonly known as tennis elbow, is a painful condition involving the tendons that attach to the bone on the outside (lateral) part of the elbow.  The pain is located over the outside aspect of the elbow, over the bone region known as the lateral epicondyle. This area becomes tender to touch. Pain is also produced by any activity which places stress on the tendon, such as gripping or lifting. With activity, the pain usually starts at the elbow and may travel down the forearm to the hand. Occasionally, any motion of the elbow can be painful.

Thumb Sprains
These types of injuries are common in sports and falls. The thumb is jammed into another player, the ground, or the ball. The thumb may be bent in an extreme position, causing a sprain. The thumb will usually swell and may show bruising. It is usually very painful to move. A sprain is an injury to a ligament. Ligaments are the connective tissues that connect bones to bones across a joint.  The most common ligament to be injured in the thumb is the ulnar collateral ligament.

Congenital Hand Differences
Babies born with hands that are different than the normal hand have a congenital hand difference. One in twenty children is born with some difference from normal, either major or minor.

The different groups of congenital hand differences include missing parts of the arm (failure of formation), webbed or fused parts of the hand (failures of separation), extra parts present in the hand (duplication), undergrowth or overgrowth of parts of the hand, or constriction band syndrome.

ADDITIONAL RESOURCES

List of Hand Conditions from the American Society of Surgery of the Hand


List of Hand Conditions from the American Academy of Orthpedic Surgeons


List for Hand Conditions from the American Society of Plastic Surgeons