The hand is a very complex structure. It is made up of 27 bones, multiple muscles and tendons, arteries and veins and the various nerves that provide sensation and motor function.
The hand allows us to manipulate our environment, for better or for worse. Since we use our hands every day, the hand is subjected to constant wear and tear and hence over a lifetime might develop aches and pain.
This article will delve into five common hand aliments:
Carpal tunnel syndrome
A major nerve that supplies sensation and motor function to the hand is the median nerve. This nerve runs down the center of the wrist through a tunnel formed by bones and ligaments.
After it enters the hand the median nerve branches into many small branches to supply sensation and motor function to various muscles of the hand, especially those of the thumb. As we age, or due to trauma or repetitive activities, the tunnel becomes smaller, compressing the median nerve and leading to pain in the hand.
This pain is often common at night and is severe enough to awaken the patient from sleep. Treatment for this is usually rest, splinting, medications, injections and, at times, surgery to relieve the pressure on the nerve.
The fingers of the hand move due to tendons pulling on the fingers. Over time these tendons can develop swelling, therefore limiting the movement of the fingers. This is called triggering, where the finger gets stuck as the hand opens and closes, and therefore can only move through a certain range of motion.
This can be a very painful condition and limit the ability to use the hand in normal daily activities. Treatment is therapy, steroid injections and, at times, a surgical release of the constriction on the tendon.
One of the most commonly affected joints in the hand, in terms of arthritis, is the joint at the base of the thumb called the first carpo-metacarpal joint (1st CMC joint). This joint is subject to a significant amount of pressure during daily activities, such as writing with a pen or turning a knob to open a door.
A patient will often complain of pain at the base of the thumb while grasping. This condition is treated with medications, a thumb splint to decrease movement in the joint and sometimes an injection. If all else fails and the joint continues to be painful, a procedure is done to remove a part of the joint and replace it with an implant to relieve the pain.
A very important bone in the wrist is called the scaphoid. This bone serves as a connection between the other carpal bones and the bones in the hand. Oftentimes, due to trauma such as a fall, this bone is broken or fractured.
When this happens, there is pain at the base of the thumb with movement. If this fracture is not properly treated and the scaphoid does not heal, there is disruption in how the wrist bone function leading to arthritis and severe pain in the wrist. Treatment at this point is often surgery to remove the damaged bones in order to relieve the pain in the wrist.
Ulnar nerve entrapment
Another important nerve that supplies sensation and motor power to the hand is the ulnar nerve. This nerve runs along the pinky finger side of the hand and can become entrapped as it crosses the wrist to enter the hand.
The ulnar nerve supplies sensation to the ring and pinky finger side of the hand and some of the small muscles of the hand. Patients with this condition will complain of numbness and at time weakness in using the hand.
This condition is treated with rest, splinting and sometimes an injection into the area where the nerve is entrapped. Surgery is used when these treatment fail is resolve the symptoms.
Dr. Dwight S. Tyndall, FAAOS, is a minimally invasive spine surgeon practicing in the Region at DrSpine.com. His column, which appears every other week, covers a wide range of health and medical issues.