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Understanding the Hand

  • Common Conditions affecting the Hand

    hand-bones-joints-muscles

    Hands are vital for daily activities, providing the capability to perform both broad and fine motor movements – be it picking up large items, performing delicate tasks, having the dexterity to use tools, or even to control a forceful grip. Each hand consists of 19 bones in total, and is made up of 4 segments, which are the fingers, back of the hand, palm and wrist. The main nerves of the hand include the median, ulnar and radial nerves, which function to relay messages from and towards the brain, thereby creating sensation and controlling movement. In this page, we explore the common hand injuries, key medical conditions affecting the hand and the treatment options available.

    Common Hand Injuries

    hand-injury

    Hands are susceptible to a number of common injuries caused by sports or recreational activities, accidental falls and even everyday wear and tear. Most minor injuries like cuts and bruises heal on their own, but certain injuries may lead to serious conditions that can affect hand function in the long run. Common hand injuries include:

    Fracture

    Trauma may fracture the bones that make up the hand, be it the small (phalanges) or long bones (metacarpals) of the fingers. The injury may require surgical attention should the force of impact cause the bone to break and displace from its original position. Fractures can result from a fall, a twisting injury or from direct contact in sports.

    Symptoms of bone fracture in the hand include pain, tenderness, swelling, deformity at the area of the fracture and limitation in movement. For minor cases, treatment usually requires immobilisation with cast support until the bone fragments heal, which can take about 6 – 8 weeks. Surgery may be required to align and stabilise badly deformed fractures. You may also choose to fix less severe fractures with strong metal screws and plates instead of having a cast. This allows you to use the hand immediately without the inconvenience of a cast and may hasten your return to sports. Consult with your doctor to understand the treatment options available.

    Arthritis

    Arthritis is a condition where inflammation occurs in the joint area. In the hands, osteoarthritis is common, where the protective cushion between the joints (cartilage) wears out due to ageing or wear and tear. Genetic factors, joint instability and injury may also contribute to osteoarthritis.

    Symptoms of osteoarthritis include pain, stiffness, limited motion, swelling at the joint area and at times a grinding sensation when moving the joint.

    Supplements such as glucosamine, fish oil, ginger and turmeric can help with symptoms of arthritis. If they become more severe, non-steroidal anti-inflammatory medication (NSAIDs) or steroid injections into the joint can alleviate pain and swelling swiftly. In very severe cases that are not responding to these, surgery may be needed to fuse the joint or replace it with an artificial one. Consult with your doctor to understand the treatment options available.

  • Carpal Tunnel Syndrome

    carpal-tunnel-syndrome

    Carpal tunnel syndrome is a condition that causes numbness, a tingling sensation, weakness and occasional pain in the hand and wrist area. It is usually caused by the compression of the median nerve in the wrist that controls sensation and movement in the hands. Repetitive hand movements, pregnancy or arthritis may cause swelling inside the wrist leading to carpal tunnel syndrome.

    Signs & Symptoms

    Gradual numbness, an occasional tingling sensation in the fingers (thumb, index and middle fingers) with some feeling of pain, are usually felt at the beginning stages of carpal tunnel syndrome. Other symptoms include:

    - Burning, prickling sensations in the hand similar to pins and needles
    - Less sensitivity to touch
    - Discomfort in the hand 
    - Weakness of the muscles at the base of the thumb
    - Reduced dexterity and being prone to dropping objects

    If left untreated, carpal tunnel syndrome may lead to permanent nerve and muscle damage.

    Diagnosis

    Your doctor may check your medical history and perform a physical examination. The following diagnostic tests may be used to further assess the condition.

    - X-ray
    - Nerve conduction study to observe the electrical activity in affected nerves

    Treatment

    Carpal tunnel syndrome should be treated early when symptoms emerge. Upon early diagnosis, non-surgical methods such as wrist splinting may help improve the condition. Your doctor may also prescribe non-steroidal anti-inflammatory medication (NSAIDS) or corticosteroids to help alleviate the swelling that may be causing nerve compression and numbness. You may be recommended to undergo carpal tunnel surgery if the symptoms persist. The goal of surgery is to relieve pressure on the impinged median nerve. This can be done with an endoscope as a form of minimally invasive surgery. Studies have shown that minimally invasive surgery may result in less scarring and a quicker return to function compared to conventional surgery. Consult with your doctor to understand the treatment options available.

  • Trigger Finger

    trigger-finger

    Trigger finger is a condition where a finger becomes locked in a bent position. This occurs when one of the tendons flexing the finger becomes swollen and inflamed, resulting in a noticeable nodule in the palm. A popping sensation can also be felt if you try to straighten the finger. Repetitive use of the hands, and certain medical conditions such as diabetes or rheumatoid arthritis may lead to the development of trigger finger.

    Signs & Symptoms

    Common signs of trigger finger include:

    - Finger stiffness or becoming locked at a bent position
    - A painful snapping or popping sensation upon bending and straightening the finger
    - A tender bump on the palm of the hand, near the base of the affected finger

    If not treated, the affected finger may become permanently stuck in a certain position, leading to difficulty performing everyday tasks.

    Diagnosis

    Your doctor may check your medical history and perform a physical examination of the hand.

    Treatment

    Treatment for trigger finger depends on the severity and duration of the symptoms. Upon early diagnosis, non-surgical methods such as splinting may help improve the condition. Your doctor may also prescribe non-steroidal anti-inflammatory medication (NSAIDS) or corticosteroids to help alleviate the pain. You may be recommended to undergo surgery if the symptoms persist. The goal of surgery is to release the affected sheath in order for the tendon to move freely again. Consult with your doctor to understand the treatment options available.

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