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Treating Hands and Wrists

Posted by on July 22, 2019

Our hands are constantly in use from the time we wake up until we go to bed. Pouring coffee, holding a steering wheel, typing, folding clothes, picking up children, and opening doors are just a very small array of tasks hands must accomplish each day. They’re called upon to complete unwieldy chores like picking up loads of firewood and also being asked to nimbly thread a needle. All is going well until you feel a pop in your wrist, or you jam your finger, or possibly suffer an unfortunate traumatic injury. When everyday function is limited, it’s hard to complete even the most basic of tasks.

Dr. Lee Hunter is the hand and wrist surgeon at Mid-Tennessee Bone and Joint. He has practiced for 22 years and joined MTBJ in 2002. According to Dr. Hunter, there are many conditions that can lead to pain in the hand and wrist. Some can be acute, like a fracture. Some conditions are the result of overuse or incorrect ergonomics, like carpal tunnel, De Quervain’s tendinosis, or trigger finger. And still others are simply due to age or genetics, like osteoarthritis. No matter the source of the pain, you want it gone.

In diagnosing hand and wrist pain, Dr. Hunter says obtaining a history from the patient and performing a physical exam, along with x-rays, are almost always necessary in order to determine the root causes of the pain. “Lots of patients come in thinking all hand pain is either carpal tunnel syndrome or arthritis,” he says. “Sometimes that’s the case, but a lot of time it isn’t.” Asking questions about the patient’s work environment, determining exactly how the pain manifests itself such as tingling or shooting, and inspecting the mechanics of the hand are all ways to help identify the patient’s condition.

One topic that usually gets a lot of attention when discussing hand or wrist pain is cracking knuckles. Everyone has heard someone say that it will cause arthritis, but what is the truth? According to Dr. Hunter, there is absolutely no evidence that habitually cracking knuckles causes any cartilage damage or arthritis. The sound may be irritating, but that is the only harm it will cause.

Dr. Hunter often sees injuries related to sports, specifically related to wrist and thumb ligaments. One such injury is called gamekeeper’s thumb and involves the ulnar collateral ligament. This is an injury of the soft tissue that connects the bones of the thumb together and happens when the thumb is pulled backward away from the hand, also described as the thumb being hyperextended. Sports injuries can likewise result in a fracture, for example, if you fall onto an outstretched hand. Jammed or dislocated fingers are also common sports injuries, indicated when the finger has a somewhat crooked appearance along with swelling and pain. Apply ice until you can see a doctor, who may recommend a splint or to “buddy tape” the injured finger to an uninjured one next to it.

Hand and wrist arthritis can be somewhat difficult to treat simply because the condition is often determined to be chronic, and if left untreated, can cause permanent injuries. But catching it early can mean more options when it comes to pain management and restoration of function. Arthritis pain typically presents with aching joints, morning pain and stiffness, fingers feeling tight, and bony lumps about the finger joints and wrists. Numbness is not generally a symptom of arthritis. Patients report feeling pain when performing everyday tasks such as opening bottle tops or jars, writing, or computer work.

The most common treatments for arthritis are nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections, and analgesics like Aspercreme and Icy Hot. These treatments vary in what they do to minimize the effects of arthritis. NSAIDs ease both pain and inflammation, corticosteroids are just used for inflammation relief, and analgesics are just for pain relief and are a good option for patients who are unable to take NSAIDs.

Partial wrist fusions are a common surgical treatment for wrist arthritis when the wrist has been damaged to the point that it no longer functions normally. The surgery allows the patient to preserve half or more of their wrist motion while providing predictable pain relief and restoring function. Total wrist fusions are much less common, but are an option for pain relief when necessary. Dr. Hunter also performs many thumb arthritis surgeries. They are very common and are performed for loss of function and pain at the base of the thumb where it joins onto the wrist. This particular surgery has very high patient satisfaction rates. Finger joint replacements, and in some cases fusions, also generally work very well.

Treatments also vary depending on the diagnosis. Dr. Hunter will often recommend cortisone injections as a first option for arthritis, but the injections have limited benefits in the thumb joint. In milder cases, a splint can provide temporary relief. Cartilage tears and ligament injuries within the wrist can often be addressed with arthroscopy. Carpal tunnel syndrome, trigger fingers, de Quervain’s disease, tendon and nerve lacerations, and Dupuytren’s disease are all common hand and wrist problems that can require surgical treatment.

One topic that usually gets a lot of attention when discussing hand or wrist pain is cracking knuckles. Everyone has heard someone say that it will cause arthritis, but what is the truth? According to Dr. Hunter, there is absolutely no evidence that habitually cracking knuckles causes any cartilage damage or arthritis. The sound may be irritating, but that is the only harm it will cause.

Dr. Hunter is here to answer any questions you may have regarding hand or wrist pain. To schedule an appointment, call our office at 931-381-2663.

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