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The wrist
is a very complex joint. It is made up of the two bones
in your forearm, as well as the tiny bones at the bottom
part of your hand.
Ganglion Cysts
Ganglion cysts are the most common mass or lump in the
hand. These are most common on the back of the wrist.
These noncancerous, fluid-filled cysts arise from the
ligaments, joint linings, or tendon sheaths when they
are irritated or inflamed. They may disappear or change
size quickly.
Many ganglion cysts do not require treatment. However,
if the cyst is painful, interferes with function or the
patient does not like the appearance, your orthopaedic
surgeon can remove the fluid, inject steroids, or remove
it surgically.
Carpal Tunnel Syndrome
Common symptoms of carpal tunnel syndrome are numbness
and tingling in the hand, especially at night; pain with
prolonged gripping such as holding a steering wheel; or
clumsiness in handling objects. Sometimes the pain can
go all the way up to the shoulder.
These symptoms are caused by pressure on the median nerve
as it enters the hand through a tunnel in the wrist. The
tendons that bend your fingers and thumb also travel in
this tunnel.
Mild cases can be treated with a splint or brace to rest
the wrist. Steriod injections into the carpal canal to
decrease swelling may be used in more severe cases. Those
cases that do not respond to nonsurgical treatment and
those that are diagnosed late may require surgery. This
is generally done in an outpatient setting under local
anesthesia.
Tendonitis of the Wrist
DeQuervain's stenosing tenosynovitis is most common in
adult women the ages of 30 and 50. it is an irritation
and swelling of the sheath or tunnel which surrounds the
thumb tendons as they pass from the wrist to the thumb.
Pain when grasping or pinching and tenderness over the
tunnel are the most common symptoms. Sometimes a lump
or thickening can be felt with the thumb "tucked in" and
bent towards the little finger, and the pain gets worse.
Tendonitis may be caused by overuse and also can be seen
in association with pregnancy or inflammatory arthritis
such as rheumatoid disease.
If treated early, many cases improve with a rest in a
splint, injection with steroids and/or taking anti-inflammatory
medications. More severe cases or those that do not respond
to other treatment may require surgery. Modification of
the activities which caused the symptoms initially also
may be required.
"Wear and Tear" Arthritis of the Hand
Wear and tear arthritis is very common at the base of
the thumb. Pain localized to the base of the thumb, particularly
with use, is a very common early symptom. Early disease
can be treated with anti-inflammatory medication, steroid
injections into the joint, or splinting.
As the wear and deformity progresses, surgery is frequently
required. There are many procedures to relieve pain and
improve function.
Heberden nodes are "bumps" which occur at the last joint
of the finger or thumb due to wear and tear arthritis
(osteoarthritis). As the joints deteriorate, small bone
spurs form over the back of the joints and make them appear
"lumpy".
Since most Heberden nodes are not painful and seldom interfere
with function, no specific treatment is usually required.
Patients with pain can be treated with anti-inflammatory
medications. All patients should continue moving their
hands; disuse frequently results in stiffness.
Dupuytren's Contracture
A Dupuytren's Contracture is a hereditary thickening of
the tough tissue called fascia that lies just below the
skin of your palm. This condition may vary from small
lumps or bands to very thick bands which may eventually
pull the fingers into the palm.
The only treatment is surgical and is recommended if there
is progressive contracture drawing the fingers into the
hand. Small nodules or lumps in the palm do not need treatment
until they are very large and interfere with hand function.
Even with successful surgical removal, the bands may reappear
or occur in other fingers.
Trigger Finger
Trigger finger is an irritation of the digital sheath
which surrounds the flexor tendons. When the tendon sheath
becomes thickened or swollen it pinches the tendon and
prevents it from gliding smoothly. In some cases the tendon
catches and then suddenly releases as though a "trigger"
were released.
Sometimes the swelling can be treated with rest, activity
modification, oral anti-inflammatories, or steroid injections.
The tendon sheath will then return to its normal, pain-free
condition. More severe cases may require surgery to release
the tendon. This can be done as an outpatient procedure.
Normal activity can be resumed as pain allows. |
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