Hand and Wrist

Anatomy of the hand

The hand is made up of many different bones, muscles, and ligaments that allow for a large amount of movement and dexterity. There are three major types of bones in the hand itself, including:

• Phalanges. The 14 bones that are found in the fingers of each hand and also in the toes of each foot. Each finger has 3 phalanges (the distal, middle, and proximal). Only the thumb has 2 phalanges.

• Metacarpal bones. The 5 bones that make up the middle part of the hand.

• Carpal bones. The 8 bones that create the wrist. The carpal bones are connected to 2 bones of the arm: the ulnar bone and the radius bone.

Many muscles, ligaments, and sheaths can be found within the hand. The muscles are the structures that can contract, allowing movement of the bones in the hand. The ligaments are fibrous tissues that help bind together the joints in the hand. The sheaths are tubular structures that surround part of the fingers.

What are common hand problems?

There are many common hand problems that can interfere with activities of daily living. They include:

Arthritis

Arthritis is loss of joint cartilage, often with inflammation, pain, and stiffness. It can occur in many areas of the hand and wrist. Arthritis of the hand can be very painful.

Osteoarthritis

Osteoarthritis is one of the most common forms of arthritis in the hands. It may be caused by normal use of the hand. Or it may develop after an injury. Osteoarthritis often develops in one of three places: the base of the thumb, at the end joint closest to the fingertip, or at the middle joint of a finger.

Symptoms of osteoarthritis include: 

• Stiffness.

• Swelling and pain.

• Bony nodules at the middle or end joints of the finger.

• Pain and possibly swelling at the base of the thumb.

• Loss of strength in the fingers and the grip of the hand.

Treatment for osteoarthritis includes:

• Over-the-counter pain and fever medicines (NSAIDs or nonsteroidal anti-inflammatory drugs).

• Resting the affected hand.

• Wearing splints at night.

• Using heat to soothe the pain.

• Using ice to reduce swelling.

• Possible cortisone injections.

• Possible surgery when no other treatments work. 

Carpal tunnel syndrome

With this condition, the median nerve is squeezed or compressed as it passes through the carpal tunnel in the wrist, a narrow, confined space. Since the median nerve provides sensory and motor functions to the thumb and 3 middle fingers, many symptoms may result. Each person’s symptoms may be different. Symptoms may include:

• Trouble gripping objects with the hand.

• Pain or numbness in the hand.

• "Pins and needles" feeling in the fingers.

• Swollen feeling in the fingers.

• Burning or tingling in the fingers, especially the thumb and the index and middle fingers.

The symptoms of carpal tunnel syndrome may look like other conditions, such as tendonitis, bursitis, or rheumatoid arthritis. Always see your doctor for a diagnosis.

Treatment may include:

• Splinting the hand.  This is done to help prevent wrist movement and decrease the compression of the nerves inside the tunnel.

• Medicines to reduce swelling.  Anti-inflammatory medicines can be taken by mouth (oral) or injected.

• Ergonomic changes.  Making changes to your work environment, such as changing the position of a computer keyboard.

• Surgery. This is done to relieve compression on the nerves in the carpal tunnel.

Ganglion cysts

Soft, fluid-filled cysts can develop on the front or back of the hand for no apparent reason. These are called ganglion cysts. They are the most common noncancer, soft-tissue tumor of the hand and wrist.

The most common symptoms for ganglion cysts include:

• Wrist pain that gets worse with repeated use or irritation.

• A slow growing, localized swelling, with mild aching and weakness in the wrist.

• An apparent cyst that is smooth, firm, rounded, or tender.

The symptoms of ganglion cysts may look like other health conditions or problems. Always see your doctor for a diagnosis.

At first, when the cyst is small and painless, treatment is usually not needed. Only when the cyst begins to grow and hand function is affected is treatment usually necessary. Treatment may include:

• Rest.

• Splinting.

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen.

• Aspiration.

• Cortisone injections.

• Surgery.

Tendon problems

Tendons are the tough cords of tissue that connect muscles to bones. Two major problems linked to tendons are tendonitis and tenosynovitis. Tendonitis is inflammation of a tendon. It can affect any tendon. But it's most often seen in the wrist and fingers. When the tendons become irritated, swelling, pain, and discomfort will occur.

Tenosynovitis is the inflammation of the lining of the tendon sheaths that enclose the tendons. The tendon sheath is often the site which becomes inflamed. But both the sheath and the tendon can become inflamed at the same time. The cause of tenosynovitis is often unknown. But usually strain, overuse, injury, or excessive exercise may be a factor. Tendonitis may also be linked to disease, such as diabetes or rheumatoid arthritis.

Common tendon disorders include:

• Tennis elbow (lateral epicondylitis). There is pain in the outside of the elbow and forearm. The pain is along the thumb side when the arm is next to the body with the thumb turned away. The pain is caused by damage to the tendons that bend the wrist backward away from the palm.

• Golfer’s or baseball elbow (medial epicondylitis). Pain goes from the elbow to the wrist on the inside of the forearm. The pain is caused by damage to the tendons that bend the wrist toward the palm.

• Rotator cuff tendonitis. A shoulder disorder with inflammation of the shoulder capsule and related tendons.

• De Quervain's tenosynovitis. The most common type of tenosynovitis disorder. There is tendon sheath swelling in the tendons of the thumb.

• Trigger finger or trigger thumb. A tenosynovitis condition in which the tendon sheath becomes inflamed and thickened. This prevents the smooth extension or flexion of the finger or thumb. The finger or thumb may lock or "trigger" suddenly.

Treatment for most tendon problems may include:

• Reducing your activity level.

• Ice.

• Splinting or immobilization.

• Steroid injections.

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen.

• Surgery.

Carpal tunnel syndrome

What is carpal tunnel syndrome?

Carpal tunnel syndrome is when the median nerve is squeezed (compressed) as it passes through the carpal tunnel. The carpal tunnel is an opening in your wrist that is formed by the carpal (wrist) bones underneath the median nerve and the transverse carpal ligament across the top of the median nerve. The median nerve provides sensory and motor functions to the thumb and 3 middle fingers. If it gets compressed or irritated, you may have symptoms.

What causes carpal tunnel syndrome?

Most cases of carpal tunnel syndrome have no specific cause. But any or all of the following may be part of the cause:

• Frequent, repetitive, small movements with the hands such as with typing or using a keyboard
• Frequent, repetitive, grasping movements with the hands, such as with sports and certain physical activities
• Joint or bone disease. For example, arthritis, osteoarthritis, or rheumatoid arthritis.
• Hormonal or metabolic changes. For example, menopause, pregnancy, or thyroid imbalance.
• Changes in blood sugar levels. For example, with type 2 diabetes.
• Other conditions or injuries of the wrist. For example, strain, sprain, dislocation, break, or swelling and inflammation.
• Family history of carpal tunnel syndrome

Who is at risk for carpal tunnel syndrome?

Women get carpal tunnel syndrome 3 times more often than men. The risk to women increases during pregnancy. It generally occurs only in adults. You may be at risk if you have an underlying health problem, such as diabetes or kidney failure. These conditions put you at risk for nerve compression, including carpal tunnel syndrome.

What are the symptoms of carpal tunnel syndrome?

These are the most common symptoms:

• Weakness when gripping objects with one or both hands
• Pain or numbness in one or both hands
• "Pins and needles" feeling in the fingers
• Swollen feeling in the fingers
• Burning or tingling in the fingers, especially the thumb and the index and middle fingers
• Pain or numbness that is worse at night, interrupting sleep

The symptoms of carpal tunnel syndrome may seem like other health conditions or problems. Always see your healthcare provider for a diagnosis.

How is carpal tunnel syndrome diagnosed?

Your provider will check your health history and give you a physical exam. They may advise electrodiagnostic tests on your nerves. These tests, also known as nerve conduction studies and electromyography, are the best way to diagnose carpal tunnel syndrome. Electrodiagnostic tests stimulate the muscles and nerves in your hand to see how well they work.

How is carpal tunnel syndrome treated?

Your healthcare provider will discuss different treatment choices with you. Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

Treatment may include:

• Splinting your hand. This helps keep your wrist from moving. It also eases the compression of the nerves inside the tunnel.
• Anti-inflammatory medicines. These are taken by mouth (oral) or injected into the carpal tunnel space. These ease the swelling.
• Worksite changes. Changing the position of your computer keyboard or making other ergonomic changes can help ease symptoms.
• Exercise. Stretching and strengthening exercises can help when your symptoms are better. A physical or occupational therapist may watch you do the exercises. Yoga can also help some.
• Surgery. You may need surgery if the condition doesn’t get better with other treatments or go away on its own. This surgery is called carpal tunnel release. This eases compression on the nerves in the carpal tunnel.

Key points about carpal tunnel syndrome

• Carpal tunnel syndrome is when the median nerve is squeezed (compressed) as it passes through the carpal tunnel in the wrist.
• Women get carpal tunnel syndrome 3 times more often than men. It generally occurs only in adults.
• Symptoms include weakness when gripping objects, pain or numbness in hands, and a “pins and needles” feeling in the fingers.
• To diagnose carpal tunnel syndrome, you may have electrodiagnostic tests. These tests stimulate the muscles and nerves in your hand to see how well they work.
• Treatment may include splinting your hand, medicines, worksite changes, exercise, or surgery.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new directions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your healthcare provider if you have questions, especially after office hours or on weekends.