The non-surgical management of hand injuries and disorders utilizing physical methods such as splinting, exercise and wound care is hand therapy. Hand therapists also treat additional upper limb disorders that affect the function of the hand.
Common Hand Disorders
Trigger Finger/Trigger Thumb – A painful condition in which a thumb or finger locks or clicks as it is bent towards the palm is known as trigger finger or trigger thumb.
De Quervain's Syndrome - De Quervain's Syndrome refers to a painful and uncomfortable condition that affects the tendons where they run through a tunnel located on the thumb portion of the wrist.
Ganglion Cyst – The most common kind of hand swelling is caused by ganglion cysts. These cysts are made up of a clear, thick liquid called synovial fluid. This fluid is the body’s lubricant and is found in the tunnels though which certain tendons run as well as lubricating the joints. Even though ganglion cysts can occur from any tendon tunnel or joint, there are 4 common locations in the wrist and the hand. These are located at the base of the thumb on the front of the wrist, in the middle of the back of the wrist, on the back of an end joint of a finger and on the palmar side at the base of a finger.
Terminal Finger Joint Arthritis – The DIPJ or distal interphalangeal joint is the terminal joint of the finger. Often, Osteoarthritis affects these joints and can also affect the joint at the base of the thumb as in the condition known as Basal Thumb Arthritis.
Arthritis at the Base of the Thumb – The universal joint located at the base of the thumb, between the trapezium and metacarpal bones may become arthritic as people age. It is Osteoarthritis. This is due to the loss of the smooth cartilage surface covering the ends of the bones in the joints. The cartilage eventually becomes rough and thin and the bone ends can rub together, thus the friction leads to pain.
Dupuytren's Disease – Dupuytren’s Contracture or Dupuytren’s Disease is a common condition that generally arises in middle age or later in life. It is statistically more commonly occurring in men than in women. In this condition, firm nodules appear in the ligaments located just beneath the skin of the palm of the hand. In certain cases, these nodules extend from the cords and can prevent the finger from completely straightening.
Carpal Tunnel Syndrome – CTS or Carpal Tunnel Syndrome is a condition where the median nerve becomes compressed where it passes through a short tunnel in the wrist. This tunnel houses the tendons that bend the thumb and the fingers, along with the median nerve.
Cubital Tunnel Syndrome – Cubital Tunnel Syndrome refers to the irritation or compression of the ulnar nerve in a tunnel along the inside of your elbow, right where your funny bone is located. The ulnar nerve provides sensation to part of the ring finger and the little finger and also powers the small muscles that are situated in the hand.
Common Hand Injuries
Flexor Tendon Injury – The flexor tendons are smooth, strong cords that connect the forearm muscles to the bones in the thumb and fingers. There is one for the thumb and two for each finger. These tendons run inside tunnels located in the fingers and in the wrists. They are capable of bending your fingers similar to a bicycle brake cable. The tendons lie just beneath the skin, especially in the creases of the fingers and therefore, the tendons can be damaged by any cut across the palmar surface on the hand or the wrist.
Extensor Tendon Injury – The extensor tendons are smooth, strong cords that connect the forearm muscles and the hand to the bones in the thumb and fingers and straighten the fingers by this connection.
Mallet Finger Injury – A mallet finger injury occurs when there is a tear of tendon that straightens the end joint of the finger. Often, it is caused by catching the finger “end-on” during a sport, although, it can sometimes happen from a minor injury such as catching the finger the wrong way while tucking in the sheets on a bed.
Boutonniere Deformity – A Boutonniere Deformity is when the posture of the finger in which the middle happens to be bent down and the end joint is bent backwards. The main cause of this injury occurs from stubbing the finger on something, although, the deformity can be the result of arthritis as well.
Thumb Extensor Tendon or EPL Rupture – This situation occurs when the long extensor tendon to the thumb, known as the EPL or the Extensor Pollicis Longus ruptures. This tendon is responsible for helping to pull the thumb in towards the index finger. As well, this tendon travels around a bony prominence on the back of the wrist known as Lister’s tubercle.
Skier's Thumb – Skier’s Thumb refers to an injury to the ulnar collateral ligament located in the metacarpo-phalangeal joint. This is a very strong ligament that supports the thumb when gripping or pinching. If it becomes damaged, this may potentially lead to a chronic instability of the thumb which in turn, causes great problems with function.
Finger Sprains – A sprain is the result of an injury to the tissues supporting and surrounding a joint. This includes the joint capsule and the ligaments. The ligaments are extremely strong structures that have the responsibility of preventing a joint from moving into an abnormal position. The capsule is not as strong but acts to seal the joint from the other tissues. A sprain is determined by varying degrees, for example a first degree sprain is less severe than a third degree sprain.
Finger Joint Dislocations – Dislocating a joint means that the 2 surfaces are no longer in contact with one another. This may happen at any joint in the thumb or in a finger. The most common joint to have this affliction is the PIPJ or proximal interphalangeal joint or the middle joint in the finger. The dislocation direction will depend on the forces applied during the time of the injury.
Nerve Injury – There are 3 basic kinds of injury where a nerve is concerned: Where the inner cables or nerve fibers of the nerve are damaged but the outer layer remains intact; Where the nerve is bruised and does not work correctly for a short period of time, yet all the nerve fibers or inner cables remain intact. In this particular kind of injury, the nerve typically recovers fully and leaves no deficit. Lastly, there is the nerve injury where the nerve is totally divided. In this scenario, both the inner cables or nerve fibers and the outer layer are divided. This kind of nerve injury is severed and requires the nerve to be repaired by surgery if it is to recover.
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