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Our Treatments / Fracture fixation

Carpal tunnel syndrome – a condition caused by pressure to the median nerve within the wrist, or carpal tunnel. You might feel pain, a tingling sensation, numbness of the fingers, weakness or aching. Carpal tunnel syndrome is associated with multiple conditions including: repetitive motion or overuse, fluid retention during pregnancy, injury to the nerve in the carpal tunnel or rheumatoid arthritis.

Rheumatoid arthritis - a disabling disease that can cause severe inflammation in any joint of the body. In the hand, it can deform fingers and impair movement.

Dupuytrens contracture - a disabling hand disorder in which thick, scar-like tissue bands form within the palm and may extend into the fingers. It can cause restricted movement, bending the fingers into an abnormal position.

Tenosynovitis (trigger finger)

Tenosynovitis affects the tendons and is most prevalent in the hand and wrist.

The tendons move through a tunnel of tissue and when the tendons get inflamed they can start to catch on the inside of their tunnel causing which prevents the fingers, for instance, moving smoothly and can cause the finger to lock into one position.

Ganglion cysts : are small sacs (cysts) filled with clear, jellylike fluid that often appear as bumps on the hands and wrists but can also develop on feet, ankles, knees, or shoulders. See a picture of ab

Problems from medical conditions

  • Tingling or pain in the fingers or hand (especially the left hand) may be signs of a heart attack.
  • Diabetes may change how the hands normally feel or sense touch. Decreased feeling in the hands is common because of decreased blood flow to the hands or damage to nerves of the hand.
  • Pregnancy may cause redness, itching, swelling, numbness, or tingling that often goes away after delivery.
  • Osteoarthritis is the progressive breakdown of the tissue that protects and cushions joints (cartilage). It may cause stiffness and pain with movement.
  • Rheumatoid arthritis may cause stiffness and pain with movement. Over time, deformity of the fingers may occur. See a picture of rheumatoid arthritis.
  • Lupus is a long-lasting autoimmune disease in which the immune system attacks normal body tissues as though they were foreign substances. It may cause joint pain.
  • Gout is an inflammatory joint disease that causes acute pain and swelling. It is a form of arthritis that develops when uric acid crystals form in and around the joints, commonly affecting the big toe joint.
  • Raynaud’s phenomenon is a condition in which some areas of the body, usually the fingers or toes, have an extreme response to cold temperature or emotional stress. During an attack of Raynaud’s, the blood vessels in the affected areas tighten, severely limiting the flow of blood to the skin, causing numbness, tingling, swelling, pain, and pale colour.
  • Infection can cause pain, redness, and swelling that occur with red streaking, heat, fever, or the drainage of pus. An infection often causes tenderness to the touch or pain with movement at the site of the infection.

Distal Radius Fractures (Broken Wrist)

  • The radius is the larger of the two bones of the forearm. The end toward the wrist is called the distal end. A fracture of the distal radius occurs when the area of the radius near the wrist breaks.
  • Distal radius fractures are very common. In fact, the radius is the most commonly broken bone in the arm.

Description

  • A distal radius fracture almost always occurs about 1 inch from the end of the bone. The break can occur in many different ways, however.
  • One of the most common distal radius fractures is a Colles fracture, in which the broken fragment of the radius tilts upward. This fracture was first described in 1814 by an Irish surgeon and anatomist, Abraham Colles - hence the name "Colles" fracture.
  • A Colles fracture occurs when the broken end of the radius tilts upward.

Other ways the distal radius can break include:

  • Intra-articular fracture. A fracture that extends into the wrist joint. ("Articular" means "joint.")
  • Extra-articular fracture. A fracture that does not extend into the joint is called an extra-articular fracture.
  • Open fracture. When a fractured bone breaks the skin, it is called an open fracture. These types of fractures require immediate medical attention because of the risk for infection.
  • Comminuted fracture. When a bone is broken into more than two pieces, it is called a comminuted fracture.

It is important to classify the type of fracture, because some fractures are more difficult to treat than others. Intra-articular fractures, open fractures, comminuted fractures, and displaced fractures (when the broken pieces of bone do not line up straight).are more difficult to treat, for example.

Sometimes, the other bone of the forearm (the ulna) is also broken. This is called a distal ulna fracture.

This illustration shows some of the types of distal radius fractures.

Reproduced with permission from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.

Cause

  • The most common cause of a distal radius fracture is a fall onto an outstretched arm.
  • Osteoporosis (a disorder in which bones become very fragile and more likely to break) can make a relatively minor fall result in a broken wrist.
  • Many distal radius fractures in people older than 60 years of age are caused by a fall from a standing position.
  • A broken wrist can happen even in healthy bones, if the force of the trauma is severe enough. For example, a car accident or a fall off a bike may generate enough force to break a wrist.
  • Good bone health remains an important prevention option. Wrist guards may help to prevent some fractures, but they will not prevent them all.

Symptoms

A broken wrist usually causes immediate pain, tenderness, bruising, and swelling. In many cases, the wrist hangs in an odd or bent way (deformity).

Doctor Examination

If the injury is not very painful and the wrist is not deformed, it may be possible to wait until the next day to see a doctor. The wrist may be protected with a splint. An ice pack can be applied to the wrist and the wrist can be elevated until a doctor is able to examine it.

If the injury is very painful, if the wrist is deformed or numb, or the fingers are not pink, it is necessary to go to the emergency room.

To confirm the diagnosis, the doctor will order x-rays of the wrist. X-rays are the most common and widely available diagnostic imaging technique. X-rays can show if the bone is broken and whether there is displacement (a gap between broken bones). They can also show how many pieces of broken bone there are.

(Left) An x-ray of a normal wrist. (Right) The white arrows point to a distal radius fracture.

Hand Fractures

Fractures of the hand can occur in either the small bones of the fingers (phalanges) or the long bones (metacarpals). They can result from a twisting injury, a fall, a crush injury, or direct contact in sports.

Symptoms

This X-ray shows a fracture in the middle of one of the bones of the finger.

Reproduced with permission from Kozin SH, Thoder JJ, Lieberman G: Operative Treatment of Metacarpal and Phalangeal Shaft Fractures. J Am Acad Orthop Surg 2000;8:111-121.

Signs and symptoms of a broken bone in the hand include:

  • Swelling
  • Tenderness
  • Deformity
  • Inability to move the finger
  • Shortened finger
  • Finger crosses over its neighbor when making a partial fist
  • Depressed knuckle

A depressed knuckle is often seen in a “boxer’s fracture.” This is a fracture of the fifth metacarpal, the long bone below the little finger.

Diagnosis

A physical examination is done to check the position of the fingers and the condition of the skin. The examination may include some range of motion tests and an assessment of feeling in the fingers. This will ensure that there is no damage to the nerves. X-rays identify the location and extent of the fracture.

Fractures are seen in the phalanges of two fingers (left). The image on the right shows how the fractures are repaired with screws. Reproduced with permission from Kozin SH, Thoder JJ, Lieberman G: Operative Treatment of Metacarpal and Phalangeal Shaft Fractures. J Am Acad Orthop Surg 2000;8:111-121.

 

 

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