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Wrist & Thumb Injuries

Wrist & Thumb Injuries

Hand and wrist injuries are a common cause of complaint, not only for people involved in sports and exercise. Injuries can be caused by repetitive actions carried out daily, such as typing, or slips, trips and falls, which may result in sprains and breaks of the wrist and hand.

In sports and exercise, the repetitive action at the wrist during racquet sports can cause injury. In addition to this, physiological and mechanical changes around the wrist joint can cause abnormal sensations at the base of the palm and thumb.

About the Wrist & Thumb

The wrist and hands consist of 27 bones. Eight carpal bones, arranged in two irregular rows of four, form the wrist. The carpal bones and connective tissue form the carpal tunnel, several tendons pass through the carpal tunnel, as does the median nerve. There are five bones that make up the palm of the hand, these are the metacarpals.

Each finger consists of three bones called the phalanges, except the thumb that only has two. Movement of the wrist and hand is controlled by extrinsic and intrinsic hand muscle groups. The extrinsic muscles are located on the forearm and control the flexion and extension of the hand and fingers. Finer movements of the fingers are controlled by muscles located within the hand; these are known as the intrinsic hand muscles, of which there are more than 60.

As with all sprains and strains protection, rest, ice, compression and elevation are advised. If you are in severe pain or if it doesn’t ease up after a few days you should visit your GP.

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Types of Wrist & Thumb Injuries

Some of the injuries that affect the wrist and hand include:

Carpal Tunnel Syndrome

Causes

Carpal tunnel syndrome is a condition that is suffered by a substantial number of the population. It is generally more prolific in women, with around five in every 100 women affected during their life compared with three in every 100 men. The root cause of the issue is where pressure is applied to the nerves within the carpal tunnel.

There are a host of reasons why you may experience an increased risk in the onset of CTS, whether this is injury based, linked to other health conditions or even as a result of something hereditary. In general, medical professionals are unsure as to the root cause of the condition.

Injury to the Wrist: Some injuries, such as crushing, fractures or sprains can cause swelling or structural changes to the hand and wrist. Where these compress the median nerve, CTS may develop.

Preexisting Health Conditions: It is known that a number of health conditions, such as type 1 or type 2 diabetes, oedema, rheumatoid arthritis, gout, obesity and hyperthyroidism can contribute to the development of CTS. More rarely, CTS can develop as a result of growths or cysts on the tendons and blood vessels within the carpal tunnel. It can also arise where there is an abnormal wrist structure.

Pregnancy and menopause: For reasons that remain unclear to the medical profession, carpal tunnel syndrome can be more common in pregnancy. Luckily, most cases will improve or completely resolve about six to 12 weeks following the birth of the baby. In addition, CTS can occur more frequently during the menopause and among some women being treated for breast cancer.

Family history: Although scientists are unsure as to how or why CTS can be passed on, research has suggested a possible genetic link. Therefore, individuals with family members who have, or have had CTS may be at a slightly increased risk of developing the condition. Approximately 25% of sufferers report a parent, brother, sister or another close relative with carpal tunnel syndrome.

Certain Activities: Some activities may prompt CTS to develop. Typically those activities requiring repetitive movement, strenuous grip or exposure to prolonged vibration can trigger symptoms of CTS.

Symptoms

The main symptoms of carpal tunnel syndrome, also known by the abbreviation CTS, are as a result of injury to the median nerve. This nerve passes through the tunnel in the wrist and is responsible for the control of the movement of the thumb, as well as providing the sensation to the thumb and the fingers to the side. CTS symptoms generally develop gradually, building up over time and sufferers feel these symptoms more acutely early in the morning, or at night.

Symptoms typically include pain, numbness and tingling and these sensations can occur in the half of the ring finger, the middle finger, index finger or thumb. It is possible that in the case of more severe CTS that tingling, pain and numbness will be felt beyond the localised areas. Symptoms can be present in a single hand or in both and generally will affect both hands after an extended period of time.

For more information on carpal tunnel syndrome Arthritis Research UK have put together a downloadable booklet with all the information you may need.

Symptoms often worsen after using the affected hand, and a wrist support or brace may be needed to ease the pain. Repetitive actions may increase the severity of the symptoms, and although many sufferers initially believe that keeping the hand or arm in the same position for an extended period of time may reduce carpal tunnel syndrome, the opposite is in fact true. In severe cases pain may run all the way from your hand up your forearm and reaching your elbow.

In addition to the more common symptoms there are further symptoms that may indicate CTS, and these include the atrophy of muscles in the thumb, or weakness in this digit when a sufferer tries to bend it at a 90 degree angle away from the palm of the hand. Discomfort in the upper arm, forearm or the hand may be experienced and a dull ache may be frequently felt. Paraesthesia, a sensation similar to pins and needles may be felt in the hand or dry skin. Changes in the colour of the hand or swelling may also occur. Sufferers of CTS may become less sensitive to touch, a condition also known as hypoesthesia.

Those with the condition may find that their hands become weak and that they struggle to grip or hold on to certain objects. The dexterity of a hand may also be affected and impaired by carpal tunnel syndrome. Sufferers often struggle with basic tasks such as fastening buttons or typing and a wrist support may be needed to ensure that the hand is held in the correct place and the ailment treated or limb rested accordingly. CTS can be a minor or a major ailment, and if symptoms appear they are best addressed quickly in order to minimise the impact on a sufferer’s activities and daily life.

Diagnosis

There are a number of ways in which CTS can be diagnosed but typically this can be done by your GP. He may conduct a number of physical tests as well as asking about the symptoms you are experiencing and how this might be affecting your mobility.

Physical Assessment: A GP's physical assessment will check for any tingling sensations or numbness around your fingers by tapping gently on your wrist. They might also ask you to perform certain movements and positions for one minute to see if this causes you any pain, tingling or numbness. This can involve keeping your wrist held over your head or moving your wrist around. If these tests prove to be positive, then a diagnosis of carpal tunnel syndrome can be easily made.

Other Tests: Generally, a physical examination by your GP is enough to diagnose carpal tunnel syndrome. However, there are other tests that can be used if your GP is not completely sure of the cause of your problems. These can be used to indicate or eliminate other conditions.

Blood Tests: By testing your blood, other conditions that are related to carpal tunnel syndrome can be diagnosed. These include rheumatoid arthritis, diabetes and an underactive thyroid.

Nerve Conduction Test: This test is used to show how quickly signals pass through the nerves. During the test, electrodes are attached to the wrist and hand and the nerves are stimulated by passing a current through them. This can indicate any damage that has occurred to the nerves.

Electromyography: An electromyography (EMG) can also be carried out to show up damage to the nerves. In this test, thin needles are put into the muscles and these will then show any electrical activity that occurs naturally in them. This type of test is not used very often in the UK, as a nerve conduction test is usually sufficient for a diagnosis.

Imaging Tests: If there is the possibility of fractures in the wrist or the presence of a condition such as rheumatoid arthritis, your GP might ask for an X-ray. They might also use an ultrasound scan to check the median nerve. Both of these produce images of what is inside your body. They can be used along with the other tests and examinations to determine if you have carpal tunnel syndrome. Following a diagnosis, you might need to wear a wrist support or do certain exercises and movements to help alleviate the symptoms.

Management

The treatment options available to you will be largely determined by the severity of the condition. Non-invasive treatments may be offered for mild to moderate symptoms in the form of a wrist support though at the same time medication or corticosteroid injections may also be offered. For serious cases of CTS then surgery may be offered to relieve pressure on the median nerve.

Wrist Support: All but the most severe cases of carpal tunnel syndrome benefit from the use of a suitable wrist support. Choose a well-made wrist support that is comfortable enough to be worn through the night as this will help to keep the wrist still enough to avoid aggravating the median nerve and triggering pain. An improvement in the condition can often be felt within four weeks of using wrist support.

Non-steroidal anti-inflammatory drugs (NSAIDs): Those such as ibuprofen are not particularly helpful in managing the pain of carpal tunnel syndrome and are usually rejected in favour of corticosteroid treatment. This can be given in tablet form but is more frequently delivered to the site of the problem through an injection. Sometimes further injections may be necessary to get the condition under control.

Surgery: CTS is considered to be severe when symptoms have lasted for longer than six months and / or when other treatments have failed to make an impact on the disorder. Sometimes known as ‘decompression’ or ‘release’ surgery, this is undertaken under local anaesthetic and does not usually require a stay in hospital. Surgery is undertaken either through the traditional form of open cut or occasionally as keyhole surgery accessed through the wrist and palm. Because it is less invasive with minimal scarring, keyhole surgery usually results in a quicker recovery time, but the long term prognosis for both types of surgery is the same.

After surgery the hand is bandaged and usually kept in a raised position in a sling for the first couple of days as this helps to relieve post-operative stiffness and swelling. You will be provided with exercises to aid healing which should be commenced after the operation or as advised by your medical practitioner.

All surgery carries a degree of risk and in the case of CTS surgery there are a number of potential complications which should be given due consideration before undergoing the operation to release the median nerve. These include failure to release the nerve successfully, possible nerve injury, post-operative bleeding and scarring.

An NHS survey into 6,000 patients who underwent CTS surgery indicated that 75% of respondents believed their symptoms had improved, with over half of the people in the study reporting that the operation had completely resolved the problem.

In many cases of carpal tunnel syndrome there will be no need for surgery, and many patients find that they can successfully bring the annoying and painful symptoms under control with the use of gentle exercise and appropriate wrist support.

Surgery can be an extremely effective way of treating CTS but it is important to manage your recovery well to ensure that it is as quick and effective as possible.

This rehabilitation after a carpal tunnel syndrome operation can include doing exercises to improve movement, reduce stiffness and regain strength, and wearing a wrist support to protect the area from further damage and aid recovery.

Recovery: You can start doing small exercises on the day of your surgery simply by bending and extending your fingers regularly and moving your shoulders and elbow, although it is advisable to keep your arm elevated for the first 48-hours after your operation. This will help reduce swelling and is particularly important at night.

How long it will take you to fully recover after carpal tunnel surgery will largely depend on the type of operation you have had. You may recover slightly quicker from keyhole surgery, for example, than you will from open release surgery. Both methods have been proven to be just as effective for treating carpal tunnel syndrome, but there can be several weeks' difference in recovery times.

It will probably take around six weeks for your hand to heal after open release surgery. When you can return to work will depend on your own recovery and the type of work you do. If your job involves a lot of repetitive movements with your affected hand, you may need to have the whole six weeks off. If your work does not put too much pressure on your injured hand, however, you may be able to return in as little as a fortnight. A wrist brace or support may be useful in these circumstances to prevent against accidental stresses and to help your hand heal as quickly as possible.

If you had keyhole surgery on the hand that is not your dominant one and you do not do a job that requires repetitive movements, you may be able to get back to work after just a day. Conversely, if you have to do repeated movements with your affected hand, you may have to stay away from your job for around four weeks.

Prevention: If you do not want a recurrence of the syndrome in either your affected hand or in the other one, you may want to consider wearing a wrist brace or support. This is particularly important if you do a job involving repetitive activities. If you do suffer from carpal tunnel syndrome symptoms, wearing a wrist support or splint can reduce the effects by stopping the wrist from bending and putting pressure on your median nerve. This treatment can see benefits within just four weeks.

You may also wish to consider lifestyle changes to help alleviate the issues seen with CTS, whether this is in eating healthy, looking at exercises like yoga which work on stretching and strengthening or if it is a workplace-related source, simply speak with your line manager.

The BUPA website has a number of FAQs in relation to suffering from carpal tunnel syndrome. To view them click here.

Sprained Thumb (Skier’s Thumb)

Causes

A sprained thumb is often referred to as skier's thumb or gamekeeper's thumb, although medically it is known as an ulnar collateral ligament injury that resides on the metacarpophalangeal joint. It occurs when force is applied to the thumb in the direction away from the hand.

It was initially defined as a gamekeeping-related injury, having been officially noted in 1955, following a number of cases from Scottish gamekeepers where the repeated motion of twisting a hare’s neck led to the onset of the condition. Since then the condition has been associated with other activities and referred to by other names.

Symptoms

Skier's thumb normally results in pain and swelling over the ulnar collateral ligament. In some cases, bruising may show up after a few days. Severe cases may reveal a constant thickening of the thumb joint accompanied by painful swelling. The joint between the metacarpal and thumb bone may feel unstable, which can make it very difficult to grip small objects using the thumb and index finger.

Thumb injuries should be given immediate medical attention to ensure correct diagnosis and treatment. A skier's thumb is usually diagnosed on the basis of the symptoms and how it occurred, as well as a physical examination. An X-ray may also be taken in order to support the diagnosis.

Diagnosis

If you suspect you have suffered from a thumb related injury that could later diagnosed as skier’s thumb then you should seek medical attention. Your local walk-in centre or A&E will have the facilities in place to X-ray and identify the root cause of the issue.

On arrival, you may be asked a series of questions by doctors in to understand more about the condition, such as when the injury took place, how the hand and thumb were positioned at the time of the injury occurring, how long after the injury did you start to feel pain and experience swelling and whether the range of motion has been compromised.

Management

Treatment for a sprained thumb can vary, particularly depending on the severity of the symptoms. Immediately following thumb injuries, ice packs and compression should be applied to help reduce swelling. Sometimes anti-inflammatory drugs or gel are also given to reduce inflammation and pain.

Thumb support products, such as taping or a thumb brace, can also be beneficial, as can physiotherapy and massage treatments to assist with repairing the ligament and improving thumb mobility. Thumb support products that improve grip, strength and dexterity, such as hand therapy balls and therapeutic putty are also highly regarded in treating a sprained thumb.

Skier's thumb usually takes around a month to six weeks to heal. In more severe cases, it can take longer. A total rupture of the ulnar collateral ligament often requires surgery, especially if a scenario called Stener lesion (where the ligament becomes entangled in the tissue of the base of the thumb) occurs. If a rupture does result without Stener lesions, doctors often follow a wait and see procedure, using a plaster cast (or a thumb spica), to see if the thumb will heal without the need for surgical intervention. Sometimes, a sprained thumb can be accompanied by a small bone fracture of the metacarpal of the thumb. Often this will heal itself, but it may require surgery in some cases.

Many thumb injuries, such as a sprained thumb, can be prevented in people who may be susceptible to injury, by wearing a thumb support product. Taping and a thumb brace, for instance, can help to improve thumb joint stability. A thumb stabiliser can also offer protection to the ligament, without compromising thumb mobility when doing sports. Skiers are advised to avoid putting their hands inside the ski pole, as this can increase the risk of a skier's thumb accident.

In the majority of cases, you will see full functionality return to the thumb. A period of physiotherapy will help to strengthen the ligament and minimise the risk of subsequent injury in the future. There are cases where a patient may experience a weakening in the thumb and reduced mobility and, in these cases, further surgery may be required in order to remedy the issue.

For more information on sprained thumbs, visit the Heathline site.

Dislocated Thumb

Causes

A Bennett’s fracture is a break and dislocation of the joint in the thumb. It's common among sportspeople of all kinds. Seen in rugby players, footballers and boxers as well as a range of other individuals, it is a fracture that can cause serious issues because of the dual nature of the damage caused.

The fracture occurs at the base of the metacarpal bone of the thumb, which usually fractures at the surface of the joint between this and the carpal bones of the wrist. This joint, known as the carpometacarpal connection or CMC joint, is usually supported and stabilised by a ligament known as the deep ulnar. In instances of injury in this area, not only does the metacarpal bone fracture, but there is also a level of disconnection caused between this particular ligament and the surrounding bones, leading to a dislocated thumb.

Thumb injuries can be due to a range of movements, most of which include a traumatic force passing the length of the bone whilst the CMC joint is in a semi-bent position. This would be the case in a punching motion, which is why the injury is common in boxers, but it also can occur during other activities or even through a hard fall where the thumb connects with the ground at the wrong angle. It was named Bennett’s fracture in the late nineteenth century when Dr Bennett described his injury after an accident whilst horse riding. Today, wearing a thumb spica can help with rehabilitation and compression, though the injury itself remains common in people of all walks of life.

Symptoms

Symptoms of a Bennett’s fracture generally manifest as a serious pain in the area around the bottom of the thumb where it connects to the hand, alongside very rapid swelling and tenderness around the thumb and into the wrist. This limits movement and use of the limb, as any attempts to carry out normal activities are met with severe discomfort.

Diagnosis

To confirm the presence of this injury, an X-ray would need to be taken by a qualified professional, who would then be able to help with treatment and support.

Management

These kinds of thumb injuries need to be carefully managed to avoid future instances of arthritic degeneration. A detachment of the ligament can cause weakening in the joint, so thumb injuries that are not properly treated can have significant consequences later in life. After consulting with a healthcare provider, several options can become available. Use of a wrist support with a thumb spica is usually one of the first routes. It helps to hold the thumb in the correct position whilst the fracture is repaired and tissues redevelop. During healing the use of anti-inflammatory gels and heat treatments can also be very soothing for thumb injuries, helping to ease discomfort.

Wrist Arthritis

Causes

Arthritis in your wrist is better known as osteoarthritis. It's not as common as rheumatoid arthritis, but it can be very painful.

If you have osteoarthritis of the wrist you are likely to have pain and stiffness in the joint, and you will notice that your range of motion is limited. This can be quite debilitating as it can have an impact on the type of everyday activities you can carry out. It is generally found in people over the age of 45 but can also be caused by a broken or sprained wrist.

Osteoarthritis is generally referred to as a ‘wear and tear’ condition, hence being prevalent in older individuals or those where a previous injury exists.

Symptoms

Wrist arthritis can be exacerbated by playing sports like tennis or golf, which require a grip, and you may notice wrist pain when you are opening a door, or taking a lid off a jar. The symptoms are often worsened by these activities, and you may notice a sudden flare-up of wrist pain. This will usually settle given some rest and you may benefit from some anti-inflammatories to help reduce the swelling.

You can also apply ice packs to the affected area to try to settle any inflammation. Try applying for 20 minutes at a time every few hours - just make sure you wrap the ice in a towel and never apply it directly to your skin.

Depending on the severity of your symptoms, you may have a long time in between flare-ups, or you may get another quite soon after. This is when resting will no longer have any positive impact on your condition and instead of alleviating the symptoms resting can actually bring them about.

Diagnosis

Following a referral from your doctor, you will need to see a specialist who can pinpoint your problem after taking X-rays and MRI scans. Once they have identified the specific areas affected by arthritis they can recommend treatment. This could involve lifestyle changes such as buying cutlery, tools or sporting racquets with larger grips, which can relieve the pressure on your wrist.

Management

You can help prevent wrist injuries by avoiding repetitive movements during work or sport, and take regular breaks from the computer to avoid too much pressure on your wrists.

Physiotherapy can also help to keep your wrist mobile, as can corticosteroid injections. You may also be suitable for wrist fusion surgery, which should relieve the wrist pain. Wearing a wrist brace is essential following surgery as this will help to heal and strengthen your wrist. You will need to wear this for about six weeks then after around three months, you will be able to resume your normal activities, including a gradual return to sport.

For more information on wrist arthritis, visit the Arthritis Care page.

Broken Arm or Wrist

Types

There are three different types of broken wrist that are determined by the type of break sustained:

  • Capitate fracture: A fracture known as a capitate wrist fracture accounts for a very small percentage of all wrist fractures, and although only a small percentage of people suffer from this particular type of broken wrist, it is one of the more severe and complicated types of break. ‘Capitate’ is the name given to one of the eight smaller bones that form the wrist complex, and these small bones can snap without warning when under too much pressure. An isolated capitate wrist fracture can occur, but generally, these types of fractures occur together with the fracture of another carpal bone known as the scaphoid. This type of broken wrist has a long recovery period and a wrist support may be required during the healing time and for longer, in some cases. A wrist support allows protects the area, while ensuring a degree of freedom of movement.

  • Colles fracture: The technical-sounding Colles fracture is simply one affecting the radius bone just above your wrist in your forearm. This is more commonly called a broken wrist and will almost always cause intense pain and the need for rehabilitation and wrist support. The complex name derives from Abraham Colles, the Dublin doctor who was the first to describe the injury in 1814. Since then, advances in modern technology and equipment continue to make diagnosing and treating the condition easier and more effective.

  • Scaphoid fracture: The scaphoid is one of the eight small carpal bones in the wrist joint and, in the event of a fracture, is one of the most common bones to be broken.

Causes

Falling heavily onto an outstretched arm can, if you’re unlucky, result in a broken arm or wrist. Don’t panic though, as most breaks of this kind heal within eight weeks in adults, and children recover even faster. When you go to your doctor, they might refer to the break as a fracture, as this is the general medical term for a break or a crack in a bone.

Symptoms

If you have a broken wrist or arm then it will be very painful, with swelling, tenderness and possibly bleeding around the affected area. You might also get these symptoms with a sprain or a strain, so it’s important to have an X-ray to confirm whether you have a broken wrist or not. This is done at the hospital, so you need to make sure not to eat or drink anything before you go, just in case you need a general anaesthetic. It’s also a good idea to have some kind of wrist support or sling to stabilise your arm. You can also try applying ice, which may reduce the swelling and lessen the pain.

Diagnosis

Depending on how severe your injury is, you’ll usually be given some painkillers as soon as you arrive at the hospital, before being taken for an X-ray. If you have a simple fracture, you can probably just have a plaster cast, which will hold your bones together as they heal. From here, you’ll be sent home with information on looking after your cast and some more painkillers. You’ll also need to attend a fracture clinic so doctors can monitor your progress.

With a more serious broken wrist or arm, your bones may have become misaligned so they need to be put back into the right position. You’ll be given anaesthetic, and the doctors will pull your bones back together, before giving you a plaster cast.

Some extreme cases need surgery to realign and fix the bones using plates, wires, rods and screws, with the metalwork kept in place for as long as possible to help your bones to heal. Having a broken limb can be extremely painful and inconvenient, as you won’t be able to drive and are likely to need some time off work.

Management

It is important to wear a wrist support even for a while after having your cast removed, and you may benefit from some physiotherapy too. Your arm and wrist can become weakened from being in a cast, so you need to restore strength in your muscles. Once you’ve had the plaster cast removed, be aware that your chances of cracking your bones again are higher (even more so in children) so try to avoid any activities that could cause you to fall for at least a couple more weeks, lessening your likelihood of another broken wrist or arm.

For more information on broken wrists, visit the NHS website.

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