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Best Orthopedic Doctor for Fractures of Hand & Wrist

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fractures

Are you experiencing sudden pain in your hand with no explanation? If you have pain around your wrist and even the slightest pressure hurts you tremendously? Then it could be because of a fracture. Fractures of the hand and wrist are very common and are very painful. The most common injuries occur in the wrist when you try to protect yourself from a fall and land hard on an outstretched hand.

People who participate in sports are at higher risk of a broken bone in the hand and wrist or if the person has a condition like osteoporosis (bones become thinner and more fragile). Treating broken bones at the earliest is very crucial or else bones may not heal in proper alignment and may cause trouble doing your daily activities.

The symptoms of a broken bone in the hand and wrist are:

  • Severe pain that aggravates even for the slightest movement in the hand
  • Swelling, pain, and tenderness around the knuckle of the little finger or above the wrist
  • Tenderness
  • Bruising in the hand
  • Obvious deformity, such as the bent wrist

There are different types of the wrist, elbow, and hand fractures:

  • Scaphoid fracture
  • Pediatric extremity fracture
  • Finger fracture
  • Elbow fracture
  • Distal radial fracture
  • Colles fracture
  • Boxer fracture

The doctor will do a physical examination and obtain X-rays to check if there is a broken bone.

Tests such as CT scans or MRI scans may be required to get a better picture of the fracture fragments and other injuries. When the wrist is broken the associated soft tissues like ligaments, tendons, muscles, and nerves may also be injured. These injuries may also need treatment.

Treatment will depend on many factors. Including, type of fracture, whether it is displaced, unstable or open.

There are two basic treatments to heal fractures:

  • Splinting: if the fracture is not severe or if it’s located in an area of the hand where surgery cannot help, then the doctor will use a cast or a splint to keep the bones in place. After some time, the bone will regenerate and join together. This treatment is done for intra-articular and extra–articular fractures.
  • Surgery: in severe fractures, like open and comminuted fractures, surgery is performed. In this, the doctor will surgically fix the bones in place by using plates and screws. The doctor may also perform muscle, tendon, ligament, or nerve repair if it is required for the patient.


Medications:

To reduce pain, the doctor will recommend medicines; if you have an open fracture, then the doctor may recommend antibiotics to prevent infection that may reach the bone.

Therapy for the hand:

Once the splint is removed, you may need hand therapy to reduce stiffness and restore normal movement of the wrist.
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Osteoarthritis

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Arthritis means inflamed joint or degenerative joint, it can affect any joint of the body that includes joints between the 29 bones of the wrist, hand, and fingers. Hand arthritis is common in the wrist, basilar joint that connects the thumb and wrist, fingertips, middle knuckle of the finger.

If you are suffering from osteoarthritis, the cartilage that covers the bone surface between the joints is injured or wears down over time and the bones will rub together without a cushion. The rubbing of bones causes mild inflammation, stiffness, and pain.

Arthritis that occur in hand is

  • At the base of the thumb (basilar joint)
  • At the joint that is closer to the fingertip (distal interphalangeal or DIP joint)
  • At the middle joint of the finger (the proximal interphalangeal or PIP joint)


All three hand arthritis causes stiffness, swelling, pain, weak grip, and deformity. Osteoarthritis also causes bony nodules at the DIP and PIP joints of the finger. Osteoarthritis at the basilar joint can cause swelling, a bump, pain at the base of the thumb.

Osteoarthritis may be caused due to any other disorder such as an infection, fracture, or any previous trauma. Sometimes the cause is not known. When the cause is unknown, it is considered primary osteoarthritis, which occurs as a gradual process resulting in damage to the joint cartilage.

The cartilage is a smooth, white, translucent substance with the almost same length as bone. If you have osteoarthritis the texture and strength of the cartilage tissue change to rough, yellow, opaque, soft, and thin substance. Cartilage serves as the cushion between the bones, when it turns thin the bones rub against each other. Some of the cartilage may tear away from the bone and fluid accumulates, it causes swelling and further impairment of joint mobility.

The doctor will do a physical examination of the hand. X-rays are taken. It will show the loss of normal joint space, bone spurs, or other changes.

The main goal in treating osteoarthritis is to get relief from pain and restore function.
Surgery is considered when non-surgical options are not helpful. The goal of the surgery is to restore the mobility of the hand or wrist and minimize pain. There are two types of surgical treatment:

  1. Joint fusion: In this, the worn cartilage is removed and the bones on each side of the joint are fused.
  2. Joint reconstruction: in this surgery, the rough joint surface is removed and it is replaced with your own soft tissue from other places in your body or with an implant.

Rheumatoid Arthritis

Rheumatoid arthritis is a condition that causes pain, swelling, and stiffness in the joints. It is known as an auto-immune condition, which means that your body’s self-defense system gets confused and starts to attack your own body’s healthy tissues.

Rheumatoid arthritis can affect anyone at any age, and it worsens quickly. Therefore early diagnosis and intensive treatment are important.

The early symptoms of RA begin when you cross 30 years. During the early stages, you may have a variety of symptoms, including:

  • Weakness
  • Dryness in mouth
  • You may feel dry, itchy, or inflamed eyes
  • Difficulty sleeping
  • Discomfort in the chest when you breathe
  • Loss of appetite
  • Weight loss

  • Joint pain
  • Swelling, warmth, and redness in the joints
  • You may have stiffness, especially early in the morning or after sitting in one place for a long time
  • Some people may develop fleshy lumps called rheumatoid nodules, which form under the skin of the affected joints

The actual cause of RA is not known, researchers are working on this to solve this complicated puzzle. The below reasons can play a part in causing RA.

  • Age: RA affects any age group, especially diagnosed between ages40 and above.
  • Gender: RA is two to three times more common in women than men.
  • Genetics: RA develops because of a combination of genetic and environmental factors such as diet and smoking. The link with genetic is not very clear but if anyone of your family member has then your chances may increase.
  • Obesity
  • Smoking
  • Diet: if you eat more meat and less vitamin C, you may have more chances of developing RA.

The joint inflammation caused by RA can occur in several parts of the body. The nature of RA leads to inflammation in multiple joints gradually wearing the bone and cartilage away.

The main areas affected by joint inflammation are:

  • Hands (fingers and knuckles)
  • Wrists
  • Elbows
  • Shoulders
  • Hips
  • Knees
  • Ankles
  • Toes


When RA symptoms occur in multiple locations, i.e., more than four different joints in the body, the condition is referred to as polyarthritis.

RA has been diagnosed bases on your symptoms; your doctor will perform a physical examination. The doctor will look for swollen joints and check your joint movements.

There is no specific test to prove that you have RA. There are other conditions that have similar symptoms.

Imaging tests such as X-rays, ultrasound scans, and MRI scans are done to check joint inflammation and damage.

Blood tests- there is no single test that can confirm RA, a few tests that can show some possible signs of the condition are ESR, CRP, full blood count, rheumatoid factor, and anti-CCP antibodies.

Treatments are given to reduce the pain and prevent permanent damage to the body. The goal of the treatment is to keep RA in “tight control”, meaning the spread of the disease is kept steadily at a low level. The goals to control RA are:

  • Reducing inflammation
  • Preventing further or permanent damage
  • Improving the quality of life
  • Reducing daily and long-term side effects


Medications for RA:

There are 4 groups of medications that are used to treat RA:

  • Pain killers
  • Non-steroid anti-inflammatory drugs (NSAIDs)
  • Disease-modifying anti-rheumatic drugs (DMARDs)
  • Corticosteroids


Physical therapy:

Keeping an active and healthy lifestyle is very imp0rtant in treating RA. Low-risk exercises like walking, yoga can reduce inflammation. A physiotherapist may help you to design a safe and effective workout that helps you keep the joints flexible.

Surgery:

Surgery is done for those who have severe joint damage. It is done to reduce pain, correct joint shape, or restore your ability to use the joint. The types of RA surgery are

  • Foot surgery: removal of inflamed tissues around the joints of the forefoot, removal of the small joints in the ball of the foot, straightening of toes, fixation of joints.
  • Hand, finger, and wrist surgery: carpal tunnel release, removal of inflamed tissue in the finger joints, the release of tendons in the finger.
  • Arthroscopy: is done to remove inflamed joint tissue.
  • Joint replacement: some cases need to replace part or all of a joint, this is known as arthroplasty. Common joint replacements are hip, knee, and shoulder.
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Carpal Tunnel Syndrome

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Carpal tunnel syndrome is a condition that occurs when the median nerve in the wrist is compressed. It causes numbness, tingling, or weakness in the hand and especially the thumb and index finger.

This condition happens because of the pressure on the median nerve, which runs the length of the arm and goes through the carpal tunnel, and ends in the hand. The movements and sensations of the fingers except the pinky are controlled by the median.

The initial signs and symptoms of carpal tunnel syndrome are:

  • You may feel like shaking or stretch your hands when you wake up in the morning.
  • Numbness or tingling in the palm, thumb, index, middle, and ring fingers.
  • Weakness in the hand and may lose grip strength to hold or grasp small objects.


As the conditions progress, these symptoms may increase during the day and you may no longer feel the sensation to tell hot or cold with the fingers.

The actual reason for the cause of carpal tunnel syndrome is not known. Studies show that women and elderly people are more likely to develop this condition. It can be due to:

  • Repetitive motions like typing, hand and wrist motions that are done for a prolonged period of time may increase the tendons in the wrist that may cause swelling and pressure on the nerve. This is very true when your hands are lower than your wrists.
  • Health conditions like diabetes, hypothyroidism, obesity, and rheumatoid arthritis.
  • Trauma, such as fracture of the wrist.

The factors that may increase this condition are:

  • If you are a woman, women are 3 times more likely to get than men. This could be because women have smaller carpal tunnels.
  • Heredity
  • Works that make you do the same motions repeatedly such as typing, sewer, or musician.

The doctor will examine the hand and wrist and perform various physical tests.

  • The doctor will tap or press down the median nerve inside of the wrist to check if it causes any numbness or tingling in your fingers. This test is called the Tinel sign.
  • The doctor will Bend and hold the wrist to check the numbness or tingling
  • Test sensitivity in your fingertips and hands by gently touching them with a special instrument.
  • The doctor will check the weakness in the muscles around the thumb.


Tests:

  • Imaging tests - ultrasound, X-rays, or MRI
  • Electromyogram
  • Nerve conduction studies

The treatment will depend on the symptoms and the severity of the condition. If it is diagnosed at an early stage, it condition can be slowed down or stop the progression of the disease.

Non-surgical treatment:

  • Lifestyle changes: if repetitive motion is causing the condition then take more breaks or reduce the activity that causes the pain.
  • Bracing or splinting: wearing a brace or splint at night will help you from bending while you sleep. It reduces pressure on the median nerve by keeping the wrist straight.
  • Nerve gliding exercises
  • Steroid injections


Surgical treatment:

The surgical treatment for carpal tunnel syndrome is called “Carpal tunnel release”. There are two different surgical methods; both methods will help to relieve pressure on your median nerve by cutting the ligament that forms the roof of the tunnel. These surgical methods increase the size of the tunnel and decrease the pressure on the median nerve.

  • Open carpal tunnel release
  • Endoscopic carpal tunnel release

Tendon Rupture

A tendon rupture is a part or full tear of your tendon. Tendons are tough bands of tissue that attach muscles to the bones. A tear could have been caused by an injury or heavy pressure on the tendon that occurs during sports or a fall. Weak tendons may be caused by tendonitis, use of steroids, old age, and chronic conditions like arthritis.

A tendon rupture is a serious problem resulting in excruciating pain and permanent disability if left untreated.

The symptoms that arise from tendon injury are mostly mechanical. When a tendon is no longer intact, the ability to move is weak or absent. In partial tears, movement there will be there but will have a weakness. Some of the common symptoms are:

  • Tearing or popping sound at the time of the injury
  • Pain, clicking, catching, or tenderness in the area of the ruptured tendon while moving the finger, hand or wrist.
  • Weakness or stiffness in the joints of fingers, hand, or wrist
  • Sweeling
  • Bruising
  • Discomfort bearing a weight
  • Deformity of the area

Tendons are of two types- flexor tendons and extensor tendons.

  • Flexor tendons: these tendons are present in the palm side of the hand, wrist, and forearm
  • Extensor tendons: these are present in the backside of the hand, wrist, and forearm.


The main aim of treatment for tendon injury is to repair the tendon and re-establish its function.

The doctor will diagnose the tendon rupture by physical examination and your symptoms.

Advanced imaging tests such as Ultrasound and MRI are done if the tendon rupture occurred without any trauma, to evaluate any internal causes.

The treatment for tendon rupture and tendon injury is very important to restore the functioning of the hand and wrist. Treatment may vary depending upon the type of tendon injury or rupture and whether it is a full rupture or partial rupture.

Full tendon ruptures are treated by surgery using sutures to bring the tendon ends together

Partial tendon ruptures are also treated surgically to prevent the weakened tendon from becoming a full rupture.

If the tears are very small then they are not treated.

The tendon repair is very straightforward, but the rehabilitation needed to regain normal tendon movement is very difficult and challenging in the entire treatment process.

The main problem that arises after tendon repair is scarring around the tendon. Scarring limits the movement. Rehabilitation focuses on moving the tendon and prevents it from scarring down. This is a very difficult process to achieve in flexor tendons because they travel through a very tight tunnel.

You need to wear a splint after the surgery for around one to two weeks. Later, sutures are removed and a removable splint is then worn for around eight weeks. Therapy sessions will start after the splint is removed and will continue for 3 months.

You may re-join work after 1-2 weeks. It depends on the kind of work you do and if you can manage with a splint. One should be very careful and avoid any activity that may cause further injury to the tendon until it is fully recovered. It may take around 6-8 weeks for the tendon to heal completely and resume normal activity.
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Sports Injuries

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Common injuries fall into one of the two different categories: Traumatic or Overuse.

Traumatic Injuries are caused for those athletes who play sports such as hockey, football, or wrestling. These sports result in traumatic injuries including:

  • Muscle Strains
  • Joint Dislocations
  • Tendon Inflammation
  • Ligament Tears
  • Fracture Injuries in the Fingers


Overuse injuries or chronic injuries are stress-induced injuries, caused by overuse. These are the injuries that are caused due to repetitive actions. Sports such as baseball, tennis, and golf may cause the risk of overuse injuries.

  • Tendonitis (Tendon Inflammation, Irritation, or Tear)
  • Tendon Dislocation
  • Nerve Injuries
  • Stress Fractures


A chronic injury does not result in long-term disability when compared with traumatic injuries. Any injury when left untreated will impact on athlete’s performance.

Any sport may cause an injury. Many sports involve close contact with other players; also sports equipment may cause or increase the chances of injury. The risk of chronic injury may increase due to repetitive motions during practice or play.

  • Scaphoid fractures
  • Jammed finger
  • Skier's thumb
  • Wrist ligament tear
  • De Quervain's Tenosynovitis

The treatment for every injury may vary. It depends upon the severity and the location of the injury. Treatment options for some of the injuries are: Muscle strains and sprains- if the muscle strains and sprains are not severe, then they can be treated with rest and compression. Ligament tears- ligament tears are very uncomfortable and painful. The doctor will take X-rays and casting will be done. In certain severe cases, surgery may be required based on the location. Joint dislocation- dislocation of the fingers is very common. If there is a dislocation of a joint, the doctor will take an X-ray to evaluate and reset the joint. In some cases, surgery may be required.

Tendonitis: this is treated with rest, ice, and by reducing repetitive movement of the hand. The doctor may recommend pain relief medicines that can help to relax the muscles and for healing. Stress fractures- these fractures are caused due to repetitive motion are they are treated by giving rest. The doctor may take an X-ray or bone scan to ensure that there is no broken bone. The person needs to stop participating in sports until he/she recovers.

Injuries are not predicted, but taking few preventative measures can help reduce the chance of injury. A few techniques that can help are:

  • Stretching
  • Maintaining good posture
  • Wearing proper gear and equipment
  • By taking frequent breaks, and giving the body a chance to rest
  • Practicing proper techniques
  • Working with an athletic trainer

Tendon Inflammation

Tendonitis is the swelling and irritation of a tendon (rope –or cord-like bands of tissues that connect muscles to bones) caused by an injury or overuse. Two problems are associated with hand and wrist tendons include tendonitis, inflammation of a tendon, and lining of the tendon sheath around a tendon.

Tendonitis occurs when the tendon becomes irritated or inflamed and causes the synovium around the tendon to swell, changing the shape of the tendon sheath compartment which makes it difficult for the tendons to move. It causes pain and tenderness in the hand or wrist that is very much noticeable when you try to grab any object, forming a fist or moving the wrist. The primary symptom of De Quervain’s tendinitis is a pain in the thumb-side of the wrist. Other types of tendinitis of the hand and wrist are wrist flexor and extensor tendons, intersection syndrome, and trigger finger.

Bursitis refers to the inflammation of the bursa (tiny sacs of fluid). This causes pain and swelling in the joints in the hand and wrist. The pain could be temporary but may happen repeatedly. If the condition is left untreated it may cause deterioration of your muscles and affect the movement of the joint.

The actual cause of tendonitis and tenosynovitis is not clear, but it is mostly caused by strain, overuse, injury, or repetitive movements. Tendonitis might be caused due to conditions such as diabetes, rheumatoid arthritis, thyroid issues, or any infection.

The doctor will perform various tests to know if you have tendinitis, and from what tendon.

  • Bursa aspiration: a small amount of fluid is collected from the affected joint with the help of a small needle. This fluid is then tested for infection and gout.
  • X-rays: hand and wrist tendons are not visible on X-ray but any bone damage that is caused by arthritis can be seen.

The treatments are involved in reducing inflammation and pain.

  • Anti-inflammatory and pain relief medicines are given.
  • Antibiotics are given to reduce pain and infection.
  • Cold therapy is given to reduce the blood flow to the painful area to minimize inflammation and swelling.
  • Cortisone injections
  • Physical therapy
  • Resting hand and wrist or avoiding an activity that causes tendonitis or bursitis to flare up.
  • Splint or cast to immobilize the affected area
  • For severe cases, surgery may be needed to open the tendon sheath compartment and make room for the inflamed tendons.


Recovery after the surgery:

After the surgery, the movement of the hand can be resumed once it gains comfort and strength.

Complications after the surgery are typically minor, and treatable.
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