Issues with the Wrist and Hand

By Johnny Barthel, OTR CHT

Pain in the Wrist and Hand

When one thinks of wrist pain or a wrist injury, a number of things may come to an individual’s mind.

• “What caused my wrist and hand to hurt?”
• “How can I stop my wrist and hand from hurting?”
• “Do I need to see a doctor?”

All of these are valid questions when it comes to wrist or hand issues.  However, the answers to these questions are contingent on what occurred.  The mechanism of injury (MOI) or the cause of the injury can provide a conclusion to all of those questions.

Should I go see a physician for wrist pain or injury?

“Should I go see a physician” is a very pertinent question when it comes to wrist or hand issues.  Some people may be very reluctant to go see a physician.  However, the severity of the pain may be the determining factor.  The MOI may also be an indicator of visiting a physician.  If an issue with the wrist and hand persists over six weeks to six months, this should be a good indicator of making an appointment with a physician.  Seeing a physician with wrist/hand pain or a wrist/hand injury lasting for an extended period of time may assist with a faster recovery of the problem.

Wrist and Hand Injuries

In regards to what causes an individual’s wrist or hand to hurt, the MOI plays an important role in assisting with diagnosing the problem.  In order to determine a diagnosis, the MOI, a clinical/physical exam, x-rays, or blood tests may be required.  For instance, consider a patient comes in and says, “I’m having numbness and tingling in my hand when I sleep.  It wakes me up at night.”  Depending on which digits are involved can possibly help determine what is going on.  With a statement such as this, two diagnoses primarily may come to mind, carpal tunnel and cubital tunnel syndromes.

There are a number of ways to help determine the diagnoses as well as treat the symptoms.  The physician can perform provocative tests in the office to assist in determining his or her conclusion.  Simple tests such as tapping or compression of specific areas of the upper extremity can help the physician diagnose the issue.

The physician may elect to further explore the patient’s symptoms if he or she cannot make that determination.  Further specialized tests may be indicated as well.   As far as treating those symptoms, a physician may decide on providing the patient with a cortisone injection and something as simple as wearing a splint at night while sleeping.

Other Wrist and Hand Injuries

Another example of wrist and hand pain could be seen is if a patient comes in stating, “I do not know what is causing my wrist and hand to hurt.  I’m having a problem pinching and gripping.”  In this case the physician may decide to do a clinical/physical exam and gather x-rays.  An x-ray shows bones.  This may assist in determining if there is arthritis in a patient’s wrist or hand.  There are two types of arthritis: osteoarthritis and rheumatoid.

Osteoarthritis occurs when the cartilage that cushions the ends of the bones deteriorates over time.  The most common osteoarthritis in the wrist and hand is located in the thumb carpometacarpal joint (CMCJ).  This can be very painful when it comes to pinching and grasping.  Again, a physician may select to provide a cortisone injection or splint to calm down the symptoms.  The other type of arthritis is rheumatoid.  This type of arthritis can be diagnosed by a battery of blood test or x-rays.  This type of arthritis is an autoimmune disease in which the body’s immune system attacks its own tissue.  This is commonly treated by medications.

Wrist and Hand Fractures

Wrist and hand pain may be caused from sudden impact such as a fall.  Some may refer to this as a FOOSH (a fall on an outstretched hand).  There are three types of fractures that can commonly occur after a FOOSH: a distal radius fracture (bone at the end of the wrist), a scaphoid fracture (one of eight bones in the wrist joint), or a radial head fracture (which occurs at the elbow).  All fracture can be seen on x-ray.  Fractures may be classified as displaced or non-displaced.

A displaced fracture is when a bone breaks into two or more parts.  Therefore, the bones are not in position to heal properly.  A non-displaced fracture means the opposite.  This fracture means the bone cracks, but maintains its proper position and alignment.  Hence, the bone is in proper position to heal.

The most well known fracture that happens with a FOOSH is a distal radius fracture (commonly referred to as a broken wrist).  If person looses his or her balance, it is a natural instinct or reflex to reach out to protect him or herself.  If the distal radius fracture occurs and is non-displaced, it can be treated conservatively by using a cast.  However, if the fracture is displaced, surgical intervention maybe required.  A scaphoid fracture with a FOOSH is less common.  However, if a patient suffers a scaphoid fracture, initially, it may not be seen on x-ray.

Wrist Pain

If the pain is persistent in the wrist, it maybe advantageous for the physician to have a repeat x-ray performed at a later time.  With the follow up x-ray, the physician may be looking for evidence of healing of a fracture.  This x-ray can assist in determining if a fracture of the scaphoid actually occurred or if there is another concern.  A scaphoid fracture sometimes can have an issue with healing. Due to the scaphoid having a very poor blood supply, it may take a longer time than usual for the bone to heal.  If there are difficulties with the healing of the scaphoid through conservative treatment such as casting, the physician may take further action to assist in expediting healing.  This may require surgical intervention as well.

Finally, a radial head fracture (in the region of the elbow) is another type of fracture which can happen with a FOOSH.  The elbow is notorious for getting stiff.  Therefore, a cast or immobilization may not indicated because a radial head fracture is usually very stable.  For this particular fracture, the physician may start active range of motion early to prevent stiffness of the elbow.  This means the individual is allowed to move the elbow under their own power.

Related Articles: Fractures of the Wrist, Bones in the Wrist and Painful Wrist. 

BY: JOHNNY BARTHEL, OTR CHT

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