Hand and Wrist Injuries

The hand is made up of 27 bones, so with the joints, ligaments and muscles it is no surprise that hand and wrist injuries are both quite common and extremely painful. Osteoarthritis is also very common in the hand and wrist, a condition that Mr Durrant has a wealth of experience in diagnosing and treating, using both surgical and non surgical methods.

Another common complaint in the hand is carpal tunnel syndrome. Symptoms of carpal tunnel syndrome include numbness, tingling, and weakness in the thumb, first and second finger, and part of the ring finger, as well as part of the palm of the hand. Mr Durrant specialises in both surgical and non surgical treatments for carpal tunnel. A carpal tunnel release procedure is one of Mr Durrants most common operations performed.

Hand and Wrist Arthritis

Arthritis of the hand and wrist is relatively common, especially osteoarthritis. As we age the joints in our hands, wrists, and fingers suffer wear and tear from constant use over the years. Often it is in the joints of the fingers and hands and it is here that most people first experience the first signs and symptoms of arthritis.

When we talk about arthritis, we usually refer to osteoarthritis which is a condition relating to wear and tear on the joints. The other common form of arthritis of the hands and wrists is rheumatoid arthritis. Rheumatoid arthritis is not related to ageing. Instead it is a disease of the immune system where the body attacks the healthy tissue of the joints. In osteoarthritis the protective covering over the ends of bones, called cartilage, begins to wear away. As this cartilage wears away the bones begin to rub together. There are 29 bones that make up the hand and wrist and arthritis in any of these joints can cause significant pain and disability.

Mr. Durrant is able to accurately diagnose arthritis by considering the described symptoms as well as taking x-rays of the affected joints. Blood tests may also be recommended in order to rule out rheumatoid arthritis.

Symptoms

The symptoms of hand and wrist arthritis include:

  • burning, aching, or grating type of pain in the joints
  • swelling, stiffness
  • limited range of motion
  • weakness in the hands
  • redness and warmth over the joints

Small cysts can also form over the finger joints, especially over the end knuckles of the fingers. Pain and stiffness in the joints experienced in the morning is common, and the base thumb joint, where the thumb joins into the wrist, is one of the most common joints to be affected by arthritis.

Treatment

Treatment of hand and wrist arthritis can include surgical and non surgical means. The aim of treatment is to relieve pain and maintain function and use of the affected joint.

Non Surgical

Anti inflammatory tablets have been found to offer relief from the symptoms of pain and swelling in arthritic joints. Sometimes splinting the joint can offer relief from painful symptoms and allow the joint to rest and the inflammation to subside.

Resting the joints is often helpful when the arthritis symptoms flare up, and introducing changes to some daily activities can help to reduce the frequency of painful symptoms. Regular and gentle physical therapy exercises will help to keep joints as mobile as possible and maintain the strength and flexibility within the joints. If the joint deterioration is extensive and causing immobility, then steroid injections can offer relief of painful symptoms.

Surgical

When joint deterioration becomes too severe then surgery is generally the only option. Some of the damaged bone may be removed which enables relief from pain while still maintaining some mobility of the joints. Bones can be fused together using pins and plates to stop them rubbing and causing pain. This relieves pain but can limit movement of the hands and wrists. Or joints may be replaced with artificial ones. The aim is to remove the painful symptoms of arthritis while still allowing movement and flexibility of the replaced joint.

Recovery from hand or wrist surgery takes a few months, and involves physical therapy in order to regain as much movement in the hand as possible. For the first few weeks it is important to adequately rest the hand in order to allow the swelling to reduce. And physical therapy may need to continue for up to three months post surgery.

Mr. Durrant has taken a special interest in arthroscopic surgery, particularly of the wrist and hand. Mr. Durrant is able to expertly diagnose and offer an appropriate treatment plan for your wrist or hand arthritis.

Contact Mr. Adam Durrant for more information on hand and wrist arthritis
or for additional resources on other hand related injuries.

Carpal Tunnel Syndrome

Carpal tunnel syndrome occurs when the median nerve becomes squashed, or compressed at the wrist. The median nerve runs down the inside of the forearm and into the wrist. It supplies feeling to part of the palm, the thumb, the first two fingers, and the inside half of the ring finger. It also supplies motor function to part of the thumb. Carpal tunnel syndrome can cause numbness, tingling and weakness in the affected hand.

The point at which the nerve passes through the wrist from the forearm is called the carpal tunnel. This tunnel space is very narrow, and can often become narrower if even the slightest amount of swelling occurs. This then causes the nerve to be compressed, causing the symptoms of carpal tunnel syndrome.

Carpal tunnel syndrome occurs when the median nerve becomes squashed, or compressed at the wrist. The median nerve runs down the inside of the forearm and into the wrist. It supplies feeling to part of the palm, the thumb, the first two fingers, and the inside half of the ring finger. It also supplies motor function to part of the thumb. Carpal tunnel syndrome can cause numbness, tingling and weakness in the affected hand.

The point at which the nerve passes through the wrist from the forearm is called the carpal tunnel. This tunnel space is very narrow, and can often become narrower if even the slightest amount of swelling occurs. This then causes the nerve to be compressed, causing the symptoms of carpal tunnel syndrome.

Causes

Repetitive movements of the wrist, such as typing, writing, painting, sewing, playing certain musical instruments, or certain racquet sports can all cause the carpal tunnel to become inflamed. Other causes of carpal tunnel syndrome may include diabetes, excessive weight gain, arthritis, pregnancy, or an injury to the wrist or forearm.

Symptoms

The most significant symptom of carpal tunnel syndrome is numbness and tingling in the affected area of the hand. Usually this numbness is intermittent, and often occurs during the night while sleeping, or after repetitive use of the wrist. It generally does not cause significant pain, only discomfort from having a numb hand. However sometimes people do experience some pain in their wrist, or up into their forearm and elbow.

Other symptoms include:

  • a burning sensation in the affected area,
  • weakness of the hand, especially when trying to grip something with any strength.
  • problems with coordination and fine movement of the fingers

In chronic long term carpal tunnel syndrome muscle wasting in the thumb half of the hand, due to lack of use, may be experienced.

Treatment

Non Surgical

Wearing a splint to support the wrist and stop flexion of the wrist can ease the condition. Ideally the splint should be worn at night and when performing the movements that caused the problem initially. Mr. Durrant may suggest the use of hot and cold packs to offer relief. Making changes to the movements that are the cause of the syndrome are also important to ensure the problem does not become chronic. Changes may include using a wrist support when typing on a keyboard or using a mouse. Non Steroidal Anti-Inflammatory Drugs (NSAID’s) such as ibuprofen may work to reduce swelling around the nerve. If these do not work, then a steroid injection may provide relieve from symptoms for a few months.

Surgical

Carpal tunnel surgery is relatively straight forward and can be performed either endoscopically, where a small camera is inserted into a small incision, or open, which involves making a small incision about two or three centimetres in length into the wrist. The ligament that creates the carpal tunnel space is then divided in order to release the pressure on the nerve and increase the tunnel space. For the majority of patients surgery is successful in treating carpal tunnel syndrome. Carpal tunnel surgery is very common and is usually performed in a day-surgery unit, where there is no need for any overnight stay in a hospital.

Often patients can experience relief from their symptoms immediately. However care needs to be taken for a few weeks post surgery in order to give the wrist time to heal properly. Physical therapy for the weeks following surgery will ensure the wrist regains full strength and range of motion. The chances of carpal tunnel syndrome recurring after surgical treatment are rare, and the majority of patients make a full and complete recovery within a short period of time.

Carpal tunnel syndrome is a very common condition. Mr. Adam Durrant offers experience and expertise in accurately diagnosing and effectively treating carpal tunnel syndrome. Mr. Durrant will be able to offer the best course of treatment for your condition, whether surgical or non-surgical in order to provide relief from the symptoms you experience.

Contact Mr. Adam Durrant for more information on carpal tunnel syndrome
or for additional resources on other hand and wrist related injuries.

DRUL Instability

DRUJ instability refers to the Distal Radio-Ulna Joint which is situated in your wrist. The two bones in your forearm, the radius and the ulna, both come together and meet at the wrist joint. In a normal wrist these two bones should fit together in a type of ball and socket joint. With DRUJ instability these two bones rub against each other and do not glide smoothly together. This causes pain and instability within the wrist joint.

DRUJ instability is most commonly caused by an injury to the wrist, but may also be caused by arthritis of the wrist. There is a group of ligaments that sit around this joint, called the Triangular Fibro-Cartilaginous Complex (TFCC) that give stability during movement of the forearm and wrist as the joints bend, flex and rotate as we move. If these ligaments become damaged, stretched or torn then the joint becomes loose and instability is likely to occur. Instability may also occur if the two forearm bones do not align correctly.

DRUJ instability refers to the Distal Radio-Ulna Joint which is situated in your wrist. The two bones in your forearm, the radius and the ulna, both come together and meet at the wrist joint. In a normal wrist these two bones should fit together in a type of ball and socket joint. With DRUJ instability these two bones rub against each other and do not glide smoothly together. This causes pain and instability within the wrist joint.

DRUJ instability is most commonly caused by an injury to the wrist, but may also be caused by arthritis of the wrist. There is a group of ligaments that sit around this joint, called the Triangular Fibro-Cartilaginous Complex (TFCC) that give stability during movement of the forearm and wrist as the joints bend, flex and rotate as we move. If these ligaments become damaged, stretched or torn then the joint becomes loose and instability is likely to occur. Instability may also occur if the two forearm bones do not align correctly.

Symptoms

Symptoms of DRUJ instability include pain in the wrist, a loss of strength, especially when trying to grip or pick up something of any weight. Dislocation of this DRUJ joint can also occur.

Treatment

Treatment of DRUJ instability generally involves a surgical procedure in order to either tighten up the TFCC ligament group or try to realign the bones of the DRUJ joint. However non-surgical treatment will often be given prior to surgery. The use of anti-inflammatory medication may help to ease the pain felt in the joint. A wrist splint may also offer relief and give the joint a chance to rest. Physical therapy exercises may be able to increase the strength of the joint and offer more stabilization.

Surgery may either involve reconstructing the ligaments in order to tighten them and give the joint more strength. Mr. Durrant may remove a small portion of the ulna bone to shorten it. Once this is removed the bones will be secured into place using plates and screws.

If you are experiencing pain, weakness, or loss of movement in your wrist, then Mr. Durrant will be able to accurately diagnose the problems and offer an effective course of treatment.

Contact Mr. Adam Durrant for more information on DRUJ instability
or for additional resources on other hand and wrist related injuries.

DRUL Instability

The TFCC, or the Triangular Fibro-Cartilaginous Complex, is made up of a cartilage disc that sits over the end of the ulna (the bone in the arm). This provides a smooth surface between the radius and ulna, and a group of ligaments that hold the radius and ulna together, or the Distal Radio-Ulna Joint (DRUJ). The TFCC is what stabilises the radius and ulna joint within the wrist.

A TFCC tear can occur as a result of an injury to the wrist, such as a fall onto an outstretched hand, or from everyday wear and tear to the joint. Damage to the TFCC is quite common due to the wrist being a very complex mechanism with an extensive range of movement.

The TFCC, or the Triangular Fibro-Cartilaginous Complex, is made up of a cartilage disc that sits over the end of the ulna (the bone in the arm). This provides a smooth surface between the radius and ulna, and a group of ligaments that hold the radius and ulna together, or the Distal Radio-Ulna Joint (DRUJ). The TFCC is what stabilises the radius and ulna joint within the wrist.

A TFCC tear can occur as a result of an injury to the wrist, such as a fall onto an outstretched hand, or from everyday wear and tear to the joint. Damage to the TFCC is quite common due to the wrist being a very complex mechanism with an extensive range of movement.

Symptoms

The symptoms of a TFCC tear include pain mainly on the outside of the wrist, over the prominent ulna bone, although pain may also radiate through the wrist. The pain is commonly experienced when the joint is used often, and resting will usually ease the painful symptoms. Rotating the wrist or moving the wrist outwards is also likely to cause pain. There may also be swelling around the outside of the wrist and patients often report a loss of strength in the wrist, especially when trying to perform twisting or gripping actions. Clicking, cracking, or grating sounds within may also be apparent upon movement of a wrist with a TFCC tear.

Treatment

Non Surgical

If a TFCC tear is present but there is no instability of the radio-ulna joint, then non-surgical treatment will be attempted. A splint may be worn, sometimes for four to six weeks. This keeps the joint immobile and allows the wrist time to rest and repair itself. Anti-inflammatory drugs may also be prescribed to help reduce any swelling and ease pain in the joint. Steroid injections may also be required to ease painful symptoms.

Surgical

If conservative treatment is unsuccessful, then surgery may be required. Surgery may involve an arthroscopic procedure. Mr Durrant inserts a narrow camera through a small incision into the wrist, and any torn and damaged cartilage or frayed ligament tissue is removed. The torn ligament may also be repaired by using sutures to close up the tear. If the damaged ligaments are unable to be joined together with sutures, a reconstruction of the ligament may be necessary. To prevent the injury occurring again Mr Durrant may shorten the ulna by taking a small piece of bone out to “decompress” the wrist joint.

Contact Mr. Adam Durrant for more information on TFCC tears
or for additional resources on other wrist related injuries.