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Your hands and wrists are essential tools that allow you to work, play and perform everyday activities. In fact, how well the hand and wrist interact depends on the integrity and function of the related ligaments, tendons, muscles, joints and bones. Problems in any of these can affect upper extremity function causing major disruptions at home and at work and negatively impacting quality of life.

The human hand itself is very complex and delicate in structure. Hand surgery requires a totally different surgical approach whether treating fractures, arthritis or deformities. Hand surgery traditionally includes treatment of the entire hand, wrist and forearm. Again, this whole region works as a single unit, and the dysfunction of a single part needs consideration of the whole. An additional year of training is required for those orthopaedic surgeons seeking certification in hand surgery.

Rothman Institute takes a team approach to hand treatment, combining the expertise of hand and wrist surgeons and therapists. Rothman Institute specialists perform more than 1,000 procedures a year and have more than 15 years of clinical experience treating problems of the hand and wrist including carpal tunnel syndrome, trigger finger, tendonitis, arthritis, fractures, nerve compression, peripheral nerve damage, brachial plexus injuries, thoracic outlet syndrome, chronic regional pain syndromes, athletic injuries, trauma, and elective surgeries, among other conditions.

All of the surgeons of the Rothman Institute hand and wrist team are specially trained, experienced, and skilled in hand and wrist diagnoses, treatment and surgery along with plastic reconstruction. In addition to their extensive residency training, each physician has undergone advanced subspecialty training and acquisition of skills in programs known as fellowships. Thus providing each with superior knowledge and expertise in this chosen area of subspecialization.

Anatomy of the hand

Humans rely on the complex and intricate structure of the hands to survive. These specialized appendages not only help us to eat and work but also to express our thoughts through gestures and sign language. The skin of the hand, the fingers, and the small muscles of the hand are the primary structures for these functions. The carpal and metacarpal bones and phalanges comprise the skeleton of the hand. These bony structures are joined to each other via different types of joints. Additionally, long and short muscles of the hand insert onto the bones to provide unique movement of the fingers and hand. Finally, hands are covered by skin that is different from the skin covering other parts of the body. The hand has rich vascular and neural structures to manage its unique functions.

Three main groups of bones constitute the skeleton of the hand. From proximal to distal, these include the carpal bones, metacarpal bones, and the phalanges . Additionally, the hand also contains some small bony structures termed sesamoid bones.

Anatomy of the wrist

The anatomy of the wrist joint is extremely complex--probably the most complex of all the joints in the body. The wrist is actually a collection of many joints and many bones. These joints and bones let us use our hands in many ways. The wrist must be extremely mobile to give our hands a full range of motion. At the same time, the wrist must provide the strength for heavy gripping.

The wrist is made up of eight separate small bones, called the carpal bones. The carpal bones connect the two bones of the forearm, the radius and the ulna, to the bones of the hand. The metacarpal bones are the long bones that lie underneath the palm. The metacarpals attach to the phalanges, which are the bones in the fingers and thumb.

One reason that the wrist is so complicated is because every small bone forms a joint with the bone next to it. This means that what we call the wrist joint is actually made up of many small joints. Ligaments connect all the small bones to each other. Ligaments also connect the bones of the wrist with the radius, ulna, and metacarpal bones.

Articular cartilage is the smooth, rubbery material that covers the bone surfaces in most joints. It protects the bone ends from friction when they rub together as the joint moves. Articular cartilage also acts sort of like a shock absorber. Damage to the articular cartilage eventually leads to osteoarthritis.

When to seek an evaluation

At one time or another, everyone has had a minor injury to a finger, hand, or wrist that caused pain or swelling. Most of the time our body movements do not cause problems, but it's not surprising that symptoms develop from everyday wear and tear, overuse, or an injury.

Finger, hand, or wrist injuries most commonly occur during:

• Sports or recreational activities.
• Work-related tasks.
• Work or projects around the home, especially if using machinery such as lawn mowers, snow blowers, or hand tools.
• Accidental falls.
• Fistfights.

The risk of finger, hand, or wrist injury is higher in contact sports, such as wrestling, football, or soccer, and in high-speed sports, such as biking, in-line skating, skiing, snowboarding, and skateboarding. Sports that require weight-bearing on the hands and arms, such as gymnastics, can increase the risk for injury. Sports that use hand equipment such as ski poles, hockey or lacrosse sticks, or racquets also increase the risk of injury.

In children, most finger, hand, or wrist injuries occur during sports or play or from accidental falls. Any injury occurring at the end of a long bone near a joint may injure the growth plate (physis) and needs to be evaluated.

Older adults are at higher risk for injuries and fractures because they lose muscle mass and bone strength (osteopenia) as they age. They also have more problems with vision and balance, which increases their risk of accidental injury.

Most minor injuries will heal on their own, and home treatment is usually all that is needed to relieve symptoms and promote healing.

Sudden (acute) injury

An acute injury may occur from a direct blow, a penetrating injury, a fall, or from twisting, jerking, jamming, or bending a limb abnormally. Pain may be sudden and severe. Bruising and swelling may develop soon after the injury. Acute injuries include:

• Bruises. After a wrist or hand injury, bruising may extend to the fingers from the effects of gravity.
• Injuries to ligaments, such as skier's thumb.
• Injuries to tendons, such as mallet finger.
• Injuries to joints (sprains).
• Pulled muscles (strains).
• Broken bones (fractures), such as a wrist fracture.
• Dislocations.
• Crushing injury, which can lead to compartment syndrome.

Overuse injuries occur when too much stress is placed on a joint or other tissue, often by "overdoing" an activity or repeating the same activity. Overuse injuries include the following:
• Carpal tunnel syndrome is caused by pressure on a nerve (median nerve) in the wrist. The symptoms include tingling, numbness, weakness, or pain of the fingers and hand.
• Tendon pain is actually a symptom of tendinosis, a series of microtears in the connective tissue in or around the tendon. In addition to pain and tenderness, common symptoms of tendon microinjury include decreased strength and movement in the affected area.
• De Quervain’s disease

can occur in the hand when tendons and the tendon sheath on the thumb side of the wrist swell and become inflamed.

Do you have any of the following symptoms that require emergency treatment? Call 911 or other emergency services immediately.
*Signs of shock occur:
-In children.
-In adults and older children.
• Severe bleeding does not slow during the first 15 minutes of steady, direct pressure.
• Any part of your hand is partially or completely amputated..
• Pieces of bone are visible in a wound, or a bone is sticking through the skin. Note: Do not try to push the bone back into the skin. Cover the area with a clean bandage.
• Injection of a substance under high pressure into the hand, such as paint from a high-pressure paint sprayer or a nail from a powered nail gun.
• Severe pain with pale, white, blue, or cold fingers or hand

Check your symptoms

Review health risks that may increase the seriousness of your symptoms.

If you have any of the following symptoms, evaluate those symptoms first.

• Bleeding
• Puncture wound or injection of a foreign body under high pressure
• A finger, hand, or wrist problem not related to an injury
• Injury from cold exposure
• A burn to a finger, hand, or wrist
• A bite to a finger, hand, or wrist
• A fingernail problem or blood under a nail

Is your finger, hand, or wrist twisted, bent out of shape, or out of its normal position?

Do you have pain or tenderness in your finger, hand, or wrist?

Are your fingers or hands pale, white, blue, or cold?

Do you have numbness or tingling in an injured finger, hand, or wrist?

Are you unable to move your fingers, hand, or wrist normally?

Is your finger, hand, or wrist swollen after an injury?

Did you feel or hear a snap, pop, or grating in your finger, hand, or wrist?

Are you unable to free trapped finger or hand from an object such as a toy, bottle, or jar?

Do you have signs of infection in your finger, hand, or wrist?

Is an object, such as a nail, embedded in your finger or hand?

Are you concerned an injury may have been caused by abuse of a child or vulnerable adult?

Do you have bruising of your finger, hand, or wrist?

Do you need a tetanus shot?

If you answered yes to any of the above questions, seek professional help immediately.

Tips for healthy hands and wrists

We use our hands and wrists for a vast majority of activities during the day that you normally wouldn't think about. But if you suffer from arthritis, carpel tunnel syndrome, trigger-finger or any other of the several ailments that can include the wrist and hand, you would know just how important they are to daily tasks. The hand and wrist are one of the most intricate and most vulnerable areas to injury in the human body. By taking simple preventative measures you might be able to keep your hand and wrist in good shape.

There are mainly two types of injuries physical therapists treat in the hand and wrist. These are traumatic injuries, such as fractures or lacerations which require immediate care, and repetitive motion injuries. Repetitive motion injuries happen over time due to working the hand and wrist in a repeating motion such as computer work, meat cutters or assembly line work

Most repetitive motion exercises can be avoided through rest breaks, exercise, proper posture, proper technique, use of protective equipment, and properly designed work stations. Take rest breaks every hour for a few minutes away from the repetitive activity that you are performing. Exercise regularly to build strength, endurance and flexibility. Simple exercises such as: waving the hand, opening and closing of the hand, squeezing a soft-ball, and stretching the wrist all help. Practice proper posture while at work and play. This is essential to healthy, harmonious functioning of the wrist and hand. Have your workstation and tools redesigned by a qualified physical therapist.

The main way to minimize your risk for traumatic injuries is to play it safe! Wear protective gear when roller-blading and biking. Keep air in your tires. Wear reflective gear as needed and try to limit your activity to daylight hours. Don't wear old worn out shoes when walking that may cause you to fall. Check them regularly and get new ones often. Drink plenty of fluids and avoid direct sunlight if possible.

A little bit of planning can mean the difference between many hours in a physical therapist's office and many hours zipping around town at work or at play.