Arthritis

In its most literal sense, arthritis means “inflamed joint.” Arthritis describes any condition where cartilage in the joint breaks down. Normal joints consist of two smooth, cartilage-covered bone surfaces that fit together as a matched set and glide against one other. Arthritis can result when these smooth surfaces become irregular as the cartilage breaks down and don’t fit well together anymore, essentially “wearing out.” . The most common forms of arthritis in the hand are osteoarthritis, post-traumatic arthritis (after an injury), and rheumatoid arthritis. Osteoarthritis is a degenerative joint disease in which the smooth cartilage that covers the bone surfaces at the joints either is injured or wears over time. Rheumatoid arthritis affects the cells that line and normally lubricate the joints (synovial tissue).

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Fractures

The bones of the hand serve as a framework. This framework supports the muscles that make the wrist and fingers move.  When one of these hand bones is broken (fractured), it can prevent you from using the hand, wrist and fingers. 

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Carpal Tunnel Syndrome

Carpal tunnel syndrome is essentially a pinched nerve in the wrist.  There is a space in the wrist called the carpal tunnel where the median nerve and nine tendons pass from the forearm into the hand.  Carpal tunnel syndrome happens when swelling in this tunnel puts pressure on the nerve.

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Complex Regional Pain Syndrome

Formerly Known as Reflex Sympathetic Dystrophy (RSD), Complex Regional Pain Syndrome (CRPS) is a pain condition that is constant over a long period of time. It is believed to be the result of dysfunction in the central or peripheral nervous systems. It causes the nervous system to send frequent or constant pain signals to the brain. The nervous system becomes overactive, causing intense burning or aching pain, swelling, changes in skin color and moisture.

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de Quervain's Syndrome

Patients with de Quervain’s Syndrome have painful tendons on the thumb side of the wrist.  Tendons are the rope-like structures that the muscle uses to pull the bone.  You can see them on the back of your hand when you straighten your fingers.

Also called de Quervain’s Tenosynovitis, the tunnel where the tendons run, can narrow, or the tendons can take up extra space in the tunnel. This can be due to a thickening of the soft tissues that make up the tunnel.  An increase in the amount of soft tissue within the tunnel can also cause this condition.  Hand and thumb motion can cause pain, especially with forceful grasping or twisting.  

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Nerve Injuries

Nerves are the body’s “telephone wiring” system that carries messages between the brain and the rest of the body. Some nerves carry messages from the brain to muscles to make the body move. Other nerves carry messages about pain, pressure, or temperature from the body to the brain. Many small fibers are bundled inside each nerve to carry the messages. There is an outer layer that insulates and protects the nerves.  Sometimes, nerves can be damaged.

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Ligament Injuries

A sprain is a partial injury to a ligament. Ligaments form the connections between the different bones in the wrist. Ligament sprains range from mild stretches to partial tears.

There are many ligaments in the wrist that can be sprained. Two of the common ones are the scapholunate ligament, in the middle of the wrist between the scaphoid and lunate bones, and the TFCC (triangular fibrocartilage complex) on the outside of the wrist. Sometimes, wrist sprains can pull off a tiny piece of bone. This is called an avulsion fracture.

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Tendon Injuries

The tendon is the strong cord at either end of a muscle that is attached to bone.  Tendons, combined with their muscles, allow you to move your joints.

Extensor tendons are just under the skin. They lie next to the bone on the back of the hands and fingers and straighten the wrist, fingers and thumb. They can be injured by a minor cut or jamming a finger, which may cause the thin tendons to rip from their attachment to bone. If not treated, it may be hard to straighten one or more joints. 

The muscles that bend (flex) the fingers are called flexor muscles. These flexor muscles move the fingers through cord-like extensions called tendons, which connect the muscles to bone. The flexor muscles start at the elbow and forearm regions, turn into tendons just past the middle of the forearm, and attach to the bones of the fingers. In the finger, the tendons pass through tunnels that keep them close to the bones, which helps them work better.

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Ganglion Cysts and Tumors

Ganglion cysts are very common lumps within the hand and wrist that occur adjacent to joints or tendons.  The most common locations are the top of the wrist, the palm side of the wrist, the base of the finger on the palm side, and the top of the end joint of the finger. A ganglion cyst often resembles a water balloon on a stalk, and is filled with clear fluid or gel.

Any abnormal lump or bump in the hand or wrist is considered a tumor. The term “tumor” does not necessarily mean it is malignant or that it is a cancer. In fact, most hand and wrist tumors are benign (not cancer).

Tumors can occur on the skin, such as a mole or a wart, or underneath the skin in the soft tissue or even the bone. Because there are so many types of tissue in the hand (e.g. skin, fat, ligaments, tendons, nerves, blood vessels, bone, etc.), there are many types of tumors that can occur. Only a few of them are seen commonly.

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Systemic Diseases

The hands, being composed of many types of tissue including blood vessels, nerves, skin (and skin-related tissues), bones, muscles, tendons, and ligaments; may show changes that reflect a disease that affects other parts of, or even the whole body (systemic diseases). The hands may show changes noticed by the patient or his/her hand surgeon even before the systemic disease is detected.

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Trigger Finger

Stenosing tenosynovitis is a condition commonly referred to as “trigger finger.” It can also be called “trigger thumb.” The tendons that bend the fingers glide easily with the help of pulleys. These pulleys hold the tendons close to the bone. This is similar to how a line is held on a fishing rod. Trigger finger occurs when the pulley becomes too thick, so the tendon cannot glide easily through it

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