HAND AND WRIST OWNER S MANUAL

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Albert Booth
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1 HAND AND WRIST OWNER S MANUAL Treatment for Common Hand and Wrist Problems

Problems with the Hand and Wrist You depend on your hands and wrists every day. But an injury can make even simple tasks painful and difficult. Fortunately, the right treatment can reduce pain.

2 Problems with the Hand and Wrist You depend on your hands and wrists every day. But an injury can make even simple tasks painful and difficult. Fortunately, the right treatment can reduce pain. It can also help you regain full use of your hand and wrist. Before treatment can begin, you ll first need a medical evaluation. This helps your doctor learn more about your problem and how best to treat it. Your Evaluation The evaluation may be done by your primary care doctor or a specialist, such as an orthopaedic surgeon. Once the evaluation is complete, your doctor will talk with you about treatment options. Medical History and Physical Exam You ll be asked about your symptoms and any previous hand or wrist injuries. Be sure to mention when your symptoms started and whether certain movements make them worse. Your hand, wrist, and forearm are then examined. This includes checking your range of motion (how well you can move your fingers and hand in different directions). Some movements may be uncomfortable, but they help your doctor pinpoint the cause of the problem. Diagnostic Tests Certain tests can help find problems not visible during the exam. You may have one or more of the tests below: X-rays can show broken (fractured) bones, dislocations, and arthritis. MRI (magnetic resonance imaging) provides detailed images of soft tissues. CT scan (computed tomography scan) is a special type of x-ray that provides 3-dimensional images of bones and joints. Electrodiagnostic tests use a mild electric current to check for nerve and muscle problems. 2

Reducing Pain and Swelling There are many ways to treat hand and wrist problems. But the first step is almost always the same reducing pain and swelling. This is done using rest, ice, and elevation.

3 Reducing Pain and Swelling There are many ways to treat hand and wrist problems. But the first step is almost always the same reducing pain and swelling. This is done using rest, ice, and elevation. Your doctor may also prescribe pain or anti-inflammatory medications. Be sure to take these as directed. Rest Resting an injured area gives it time to heal. Your doctor is likely to suggest wearing a splint or brace. This helps keep the hand and wrist stable. Ice Icing is a great way to reduce pain and swelling. Apply an ice pack or bag of frozen vegetables for 10 to 15 minutes, 3 to 5 times a day. Keep a thin towel between the ice and your skin. Elevation Keeping your hand elevated helps control swelling and throbbing. For best results, rest with the injured area above heart level. If needed, use pillows for support. 3

4 Inside the Hand and Wrist The hands and wrists are amazing structures. Bones, muscles, and other tissues give them strength. Nerves provide the sense of touch, and an array of joints makes them extremely flexible. A Strong Foundation Bones give your hand and wrist shape and stability. They provide a strong foundation for tissues that control hand movement. Inside Your Fingers Fingers are the most flexible parts of your hand. They also have the greatest sensitivity to touch. Finger function is controlled by nerves and other tissues. Metacarpals are the bones in the body of the hand. Carpals are the wrist bones. Collateral ligaments keep the finger joints stable. Back of left hand Phalanges are the finger bones. The ulna is the smaller forearm bone. Nerves send and receive messages that allow you to feel and control movement. Ligaments are tough, fibrous tissues that connect bone to bone. The radius is the larger forearm bone. Joints are places where bones fit together, allowing movement. Synovial lining produces fluid that lubricates the joints. Extensor tendons straighten the fingers. Volar plates are tough tissues that keep fingers from bending too far backward. Flexor tendons bend the fingers. 4

The Hand in Motion The movements of your hand and wrist are controlled by many tissues working together. Nerves carry messages between the brain and the muscles.

These help form the joints that move the wrist. They also form part of the carpal tunnel.

5 The Hand in Motion The movements of your hand and wrist are controlled by many tissues working together. Nerves carry messages between the brain and the muscles. Signals tell the muscles to tighten or relax. As the muscles move, they pull on tendons that connect to your bones. Inside Your Wrist There are 8 carpal bones in the wrist. These help form the joints that move the wrist. They also form part of the carpal tunnel. This is a space inside the wrist that allows tendons, blood vessels, and the median nerve to pass between the forearm and hand. Back of left hand Nerves allow you to feel and coordinate movement. The median nerve is a major nerve that runs through the carpal tunnel. Tendon sheaths are fluid-filled tubes that surround and lubricate tendons. The carpal bones are a U-shaped group of bones that form the floor and sides of the carpal tunnel. Tendons are cordlike tissues that connect muscles to bones. Muscles are soft tissues that contract (tighten) and relax to move your hand. The transverse carpal ligament forms the roof of the carpal tunnel. Tendon sheaths surround the tendons in the wrist. 5

6 Fractures A fall or blow can fracture (break) bones in the wrist or hand. Fractures can range from a tiny hairline crack to breaks in many places. These injuries often cause severe pain, swelling, and bruising. Hand and finger motion can also be limited. In some cases, the injured area looks misshapen or bent. Common Fractures Fractures can occur in any bone of the hand or wrist. You can also have more than one fracture at a time. The most common types of fractures are shown below. Back of left hand Joint fractures occur when the bony knobs on the ends of the finger bones break or chip. This can be caused by jamming the fingers against a solid object. Metacarpal fractures occur when a bone in the body of the hand is broken. This can be caused by a crushing blow to the hand. Carpal fractures occur when a bone in the wrist is broken. This can be caused by a fall or direct blow to the wrist. The most common carpal fracture occurs in the scaphoid bone, which forms a joint with the radius and other carpal bones. Finger fractures occur when any of the three bones in the finger are broken. This can be caused by a direct blow, or by trapping and twisting a finger. Bennett fractures occur when the metacarpal at the base of the thumb is broken. This can result from a hard fall or the thumb being forced backward. This injury also damages the joint where the thumb meets the wrist. Radius fractures (often called Colles fractures) occur when the larger bone in the forearm is broken. This is often caused by falling on an outstretched hand. The ulna may also break. 6

$How Fractures Are Treated Treatment for a fracture depends on its location and how badly the bone is broken. First, the bone may need to be reduced (put back into place).$ $An open reduction means the fracture is treated with surgery. This may include using pins, plates, or screws to hold the bones together.$

7 How Fractures Are Treated Treatment for a fracture depends on its location and how badly the bone is broken. First, the bone may need to be reduced (put back into place). A splint or cast is used to stabilize the bone while it heals. Reducing the Fracture A closed reduction means the bones are set in place without surgery. An open reduction means the fracture is treated with surgery. This may include using pins, plates, or screws to hold the bones together. Putting On a Splint or Cast A splint is a firm device that supports the fracture. It s often used for a broken finger. Fingers may also be splinted by taping them together. A cast is made of hard material that surrounds the broken bones. It s often used for a hand or wrist fracture. As You Recover Fractures often take 4 to 6 weeks to heal. Use rest, icing, and elevation to reduce pain and swelling (see page 3). Your doctor may also prescribe pain medications. Keep your cast dry. Place a plastic bag over it when bathing. Never stick things inside your cast or try to remove the cast yourself. When to Call Your Surgeon During recovery, call your doctor if you have any of the following: Screw Fracture Plate Sharp or increasing pain Hand or fingers that feel numb or very cold, turn blue or gray, or swell A cast or splint that is damaged or feels too tight or too loose A broken finger may be splinted by buddy taping it to an adjacent finger. 7

Sprains and Dislocations A sharp blow or fall on the hand can stretch or tear ligaments that connect the bones. This may result in a sprain or dislocation.

8 Sprains and Dislocations A sharp blow or fall on the hand can stretch or tear ligaments that connect the bones. This may result in a sprain or dislocation. To keep the injury stable, a splint or cast is often needed. Rest, icing, and elevation will help reduce pain and swelling (see page 3). Finger Dislocation A forceful twist or pull on a finger can tear ligaments and dislocate a joint. It can also injure the volar plate, causing painful swelling and bruising. The joint must be put back in place by your doctor. A splint is then used to keep the joint from moving out of place. For severe dislocations, surgery may be needed. Collateral Ligament Tear A fall on an outstretched thumb can stretch or tear the ligament at the base of the thumb. This is sometimes called skier s thumb. The ligament and nearby tissues swell, making thumb movement painful and difficult. A splint or cast is worn for several weeks to keep the thumb from moving. Severe tears may require surgery to reattach the ligament. Wrist Sprain Torn ligament in thumb A forceful fall on the hand can stretch or tear ligaments in your wrist. This causes painful swelling and bruising. Wrist movement may also be difficult. Minor sprains can be treated with a splint. For severe sprains, a cast or splint may be worn for several weeks. This keeps the wrist stable while the ligaments and other tissues heal. Torn ligament 8

Tendon Cuts and Tears Tendon cuts (lacerations) are often caused by accidents in the workshop or kitchen.

If a tendon is cut all the way through, surgery is needed to reconnect the tendon. You ll also need therapy to restore proper finger function.

Your symptoms depend on which tendon is injured. A flexor tendon injury can prevent you from bending your finger to form a fist.

What comes next depends on your injury. Partial tendon cuts may heal by themselves.

9 Tendon Cuts and Tears Tendon cuts (lacerations) are often caused by accidents in the workshop or kitchen. Tendons can also be torn if the fingers are forcefully yanked or jerked. If a tendon is cut all the way through, surgery is needed to reconnect the tendon. You ll also need therapy to restore proper finger function. Flexor and Extensor Tendons The flexor and extensor tendons are cordlike fibers that help control movement in your fingers. Your symptoms depend on which tendon is injured. A flexor tendon injury can prevent you from bending your finger to form a fist. An extensor tendon injury can prevent you from straightening your finger. How Cuts Are Treated The wound is first cleaned. What comes next depends on your injury. Partial tendon cuts may heal by themselves. If the tendon is cut badly or completely severed, surgery is used to repair the damage. Sutures may be used to rejoin the ends of the tendon. After the tendon cut is cleaned or repaired, the hand is placed in a splint to heal. You ll need rehabilitation (see page 14) to help restore finger function and strength. Without rehabilitation, your finger may become permanently stiff. Completely severed tendon Sutures 9

$Crushing Injuries Crushing injuries can result in moderate to severe damage. In some cases, just the nail is affected. In other cases, the blow fractures bones or causes deep cuts in the finger.$ Because blood under the nail appears dark purple or black, it may be called a black nail. If the pain is severe, your doctor will make a small hole in the nail to drain blood and relieve pressure.

Because blood under the nail appears dark purple or black, it may be called a black nail. If the pain is severe, your doctor will make a small hole in the nail to drain blood and relieve pressure.

$Crushed or Cut Fingertips A severe blow to a fingertip can fracture the bone in many places. It can also cause deep cuts or lift the nail off the fingertip.$

10 Crushing Injuries Crushing injuries can result in moderate to severe damage. In some cases, just the nail is affected. In other cases, the blow fractures bones or causes deep cuts in the finger. If nerves and tendons are injured, rehabilitation is needed to restore proper function. Black Nail A hard blow to the fingernail can cause bleeding beneath the nail (subungual hematoma). Because blood under the nail appears dark purple or black, it may be called a black nail. If the pain is severe, your doctor will make a small hole in the nail to drain blood and relieve pressure. Otherwise, the problem heals on its own as a new fingernail grows in to replace the damaged one. Be aware that it takes several months for a new nail to grow in. Crushed or Cut Fingertips A severe blow to a fingertip can fracture the bone in many places. It can also cause deep cuts or lift the nail off the fingertip. Treatment depends on what injuries you have. The wound is cleaned. Deep cuts are sutured (stitched). In some cases, a skin graft may be needed to replace severely damaged skin. If bone was fractured, surgery may be done to move fragments back into place. The bone is then held with pins or screws. A splint is worn while the injury heals. Sutures Hole to drain blood 10

Other Problems Aging or injuries can result in other common hand problems. These include arthritis and ganglion cysts. Treatment for these problems depends on the severity of your symptoms.

Common symptoms include pain, stiffness, and trouble grasping objects. For moderate symptoms, your doctor may prescribe anti-inflammatory medications. This can include injections of cortisone.

11 Other Problems Aging or injuries can result in other common hand problems. These include arthritis and ganglion cysts. Treatment for these problems depends on the severity of your symptoms. Arthritis Over time, wear and tear can break down the tissues that cushion your hand joints. This is called osteoarthritis. Most often, arthritis affects the basal joint at the base of the thumb. Common symptoms include pain, stiffness, and trouble grasping objects. For moderate symptoms, your doctor may prescribe anti-inflammatory medications. This can include injections of cortisone. You may also be asked to wear a splint. For severe basal joint arthritis, surgery is used to repair or remove the joint. If the joint is removed, a graft (tendon from your wrist) is placed in the joint to restore function. The thumb is then placed in a splint or cast so it can heal. Ganglion Cyst A ganglion cyst is a fluid-filled lump. It can appear on the wrist or base of a finger. Some cysts occur after injuries. For others, the cause is unknown. The cyst forms when synovium (tissue that makes fluid to lubricate tendons and joints) begins to balloon outward. As the cyst fills with fluid, it may cause pain. Repeated hand movements can also worsen symptoms. Cyst Your doctor may aspirate (drain) the fluid from the cyst with a needle. You may also be given anti-inflammatory medications to relieve pain. If the cyst returns, surgery can be used to remove it. Arthritis 11

Repetitive Motion Injuries Repeating the same tasks day after day can result in repetitive motion injuries. Often, repeated use inflames a tendon and its sheath (tenosynovitis).

Trigger Finger Trigger finger (stenosing flexor tenosynovitis) affects the tendon that bends the finger. When healthy, the tendon slides easily through fibrous bands in the finger called pulleys.

12 Repetitive Motion Injuries Repeating the same tasks day after day can result in repetitive motion injuries. Often, repeated use inflames a tendon and its sheath (tenosynovitis). This can lead to pain and trouble moving the fingers. Inflamed tendons can also press on nerves, causing tingling or numbness. Trigger Finger Trigger finger (stenosing flexor tenosynovitis) affects the tendon that bends the finger. When healthy, the tendon slides easily through fibrous bands in the finger called pulleys. But if the tendon is swollen, it can begin to catch inside a pulley. This makes it hard to straighten the finger. It can also cause pain, swelling, and a popping sensation. Pulley For mild cases, rest and splinting may be enough. More often, the tendon sheath is injected with cortisone to reduce swelling. If these treatments don t help, surgery may be used to release (cut) the pulley. This enlarges the space for the tendon to move. De Quervain s Tenosynovitis For mild cases, rest and splinting may be enough. More often, the tendon sheath is injected with cortisone to reduce swelling. For severe cases, surgery may be used to release (cut) the extensor retinaculum. This is a band of fibrous tissue that sits over the tendon. Releasing the tissue provides more space for the tendon to move. Thickened tendon This problem occurs when the tendons that move the thumb become inflamed. Common symptoms include pain when grasping objects or making a fist. The thumb may also catch when it is bent. Inflamed tendon sheath Extensor retinaculum 12

Carpal Tunnel Syndrome The carpal tunnel is a pathway in the wrist. It allows the median nerve and a group of tendons to pass from the forearm into the hand.

It can also compress the median nerve and cause tingling, pain, or a weakened grip. Many people also awake from sleep with a numb hand.

13 Carpal Tunnel Syndrome The carpal tunnel is a pathway in the wrist. It allows the median nerve and a group of tendons to pass from the forearm into the hand. Repetitive motions may cause the synovium (lubricating tissue around the tendons) to thicken and enlarge. This reduces space inside the tunnel. It can also compress the median nerve and cause tingling, pain, or a weakened grip. Many people also awake from sleep with a numb hand. Nerve conduction studies may be done to test nerve and muscle function. Treatment can then include: Wearing a splint to keep the wrist in a neutral (straight) position. Using ice, anti-inflammatory medications, or cortisone injections to reduce swelling. Doing exercises that stretch and strengthen the wrist. If these treatments don t help, surgery may be used to release (cut) the ligament that forms the roof of the carpal tunnel. This creates space in the tunnel and helps take pressure off the median nerve. Compressed median nerve Thickened synovium Released ligament Median nerve no longer compressed Preventing Repetitive Motion Injuries Keep your wrists and hands in a straight line while working. Limit repeated forceful gripping or pinching. Vary your work. Switch hands as you do tasks. Take regular breaks. Stop and rest if you start to notice symptoms. 13

If You Need Rehabilitation For certain injuries, your doctor may prescribe rehabilitation

Part of your rehab will include working with a physical or occupational therapist.

Working with a Therapist Therapists are specially trained to help people recover from

In the early stages of rehab, you ll work on reducing pain, swelling, and stiffness.

You may also be asked to wear a splint to protect and position your hand.

Your Role in Recovery Proper rehab takes time and effort. Most of the work is up to you.

For best results: Talk with your therapist about recovery goals.

14 If You Need Rehabilitation For certain injuries, your doctor may prescribe rehabilitation (rehab). This is used to restore proper function in your hand and wrist. Part of your rehab will include working with a physical or occupational therapist. You ll also be given exercises to do on your own. Working with a Therapist Therapists are specially trained to help people recover from injuries. In the early stages of rehab, you ll work on reducing pain, swelling, and stiffness. This includes passive exercises in which the therapist moves your hand and wrist. You may also be asked to wear a splint to protect and position your hand. As you progress, you ll do exercises that restore strength and dexterity. Your Role in Recovery Proper rehab takes time and effort. Most of the work is up to you. The better you stick to your program, the faster you re likely to recover. For best results: Talk with your therapist about recovery goals. That way, he or she can design a program that best suits your needs. Do your exercises as often as directed. Make sure you know how to do them properly. Keep appointments for follow-up visits with your doctor. Part of your rehab may include squeezing a foam ball or therapy putty. This helps build hand strength. 14

Exercises for the Hand and Wrist Exercises are a key part of restoring normal function. Some exercises increase flexibility. Others build strength.

Tendon Gliding Blocking Exercises 1. Start with your fingers straight. Then 1.

Using the good hand, place a fingertip 2. Continue curling your fingers down to under the first joint of the injured finger. make a full fist.

Move down and repeat the exercise with each joint in the finger. Wrist Flexion and Extension 1.

15 Exercises for the Hand and Wrist Exercises are a key part of restoring normal function. Some exercises increase flexibility. Others build strength. Use slow, steady movements as you exercise. Follow any special instructions. Stop if any motion causes new or increasing pain. Tendon Gliding Blocking Exercises 1. Start with your fingers straight. Then 1. Hold the injured hand in your good curl your fingers down to make a (uninjured) hand. partial fist. Hold for 5 seconds. 2. Using the good hand, place a fingertip 2. Continue curling your fingers down to under the first joint of the injured finger. make a full fist. Hold each position 3. Curl the tip of the injured finger down shown below for 5 seconds. and hold for 5 seconds. 3. Repeat 10 or times. 4. Move down and repeat the exercise with each joint in the finger. Wrist Flexion and Extension 1. Hold your hand straight out with your forearm supported on a table or other firm surface. Your wrist and hand should dangle off the edge. 2. Slowly move your hand up and down. 3. Repeat 10 or times. Rotation Exercises 1. Sit with your arm against your body and elbow bent. 2. Point your hand straight ahead, palm up. Hold for 5 seconds. Then turn the palm over and hold for 5 seconds. 3. Repeat 10 or times. 15

Putting Your Hands Back to Work As you recover, take steps to keep your hands and wrists healthy. Do rehabilitation exercises as prescribed. Avoid activities that cause pain.

Preventing Future Problems Always wear gloves while working with sharp objects or machinery. Use safety guards on power tools. Keep your hands and wrists in a straight line while doing tasks.

16 Putting Your Hands Back to Work As you recover, take steps to keep your hands and wrists healthy. Do rehabilitation exercises as prescribed. Avoid activities that cause pain. And be sure to see your doctor if any symptoms return. To help avoid hand and wrist problems in the future, try the tips below. Preventing Future Problems Always wear gloves while working with sharp objects or machinery. Use safety guards on power tools. Keep your hands and wrists in a straight line while doing tasks. Limit forceful gripping, pinching, or twisting motions. Wear wrist guards during activities such as skateboarding, inline skating, and snowboarding. Vary your work. Take regular rest breaks or switch hands as you do tasks. Remember that pain is a warning sign. Stop any activity that causes sharp or increasing pain. Also available in Spanish TAKE OUR PATIENT SURVEY. Help us help other patients. Please visit to provide your feedback on this booklet. This booklet is not intended as a substitute for professional medical care. Only your doctor can diagnose and treat a medical problem The StayWell Company, LLC All rights reserved. Made in the USA

Flexor Tendon Lacerations

Flexor Tendon Lacerations When a Flexor Tendon Is Cut Tendons are cordlike fibers that connect muscle to bone. The flexor tendons attach muscles in the forearm to bones on the palm side of the fingers.