Wrist Diseases

Ganglion cysts are swellings that most commonly develop along the tendons or joints of wrists or hands. They can be found either at the top of the wrist, palm side of the wrist, end joint of a finger, or at the base of a finger. Ganglion cyst is not cancerous and will not spread to the other parts of the body. It looks like a water balloon on a stalk and contains a clear fluid or jelly material. Ganglion cysts can be found in people of all ages.

Although the exact cause of a ganglion cyst remains unknown some theories suggest that small cysts are formed when trauma damages the tissue of a joint. The most likely reason might be that these cysts occur because of a defect in the joint capsule or tendon sheath that permits the joint tissue to bulge outwards.

Ganglion cysts generally appear as a mass measuring from 1 to 3 centimeters in diameter. The swelling is usually soft and immobile. It may develop suddenly or gradually over time, vary in size or even disappear or reappear. Ganglion cyst may or may not be painful. If painful, the pain may be continuous and may worsen with the movement of the joint. If the cyst is attached to a tendon, one might feel weak in the affected area. 

Your doctor will diagnose a ganglion cyst by performing various examinations starting with physical examination. The diagnosis is confirmed by needle aspiration or ultrasound. Needle aspiration is a process where some amount of the fluid in the cyst is withdrawn using a sterile needle. An ultrasound imaging can reveal whether the lump is solid or fluid filled (cystic). It can also determine if an artery or any blood vessel is causing the lump.

Magnetic resonance imaging (MRI) of the wrist may also be employed to diagnose ganglion cysts.

In many cases, these cysts may disappear without any treatment. Aspiration is performed to drain the fluid from the cyst using a needle. After aspiration, an anti-inflammatory steroid is injected into the empty cyst and a splint is placed to immobilize the area. If the cyst becomes painful or limits your activity, causes numbness or tingling of the hand or fingers, your doctor may recommend surgery to remove the ganglion cyst.

Carpal Tunnel Syndrome is a common, painful, progressive condition that is caused by compression of the median nerve at the wrist area.

Symptoms

Common symptoms of carpal tunnel syndrome include numbness and tingling sensation in all the fingers except little finger; pain and burning sensation in hand and wrist that may radiate up the arm and elbow; and weakness in hand with diminished grip strength.

Causes

Exact causes of the condition are not known. However certain factors increase the risk of developing carpal tunnel syndrome and they include congenital abnormalities, repetitive motion of hand and wrists, fractures and sprains, hormonal imbalance, and other medical conditions such as hypothyroidism, rheumatoid arthritis, diabetes, obesity, gout, overactive pituitary gland, or the presence of a cyst or tumor in the canal.

Conservative Treatment Options

Carpal tunnel syndrome may be treated using conservative approaches or surgery. The conservative treatments include:

• Treating underlying medical conditions
• Immobilization of the hand and wrist with a splint or wrist brace for 4-6 weeks
• Rest the hand for 2 weeks or more
• Ice packs to avoid swelling
• Avoid activities that tend to worsen the symptoms
• Medications such as non-steroidal anti-inflammatory drugs and steroid injections
• Strengthening and stretching exercises once symptoms diminish

Surgery

If conservative treatment options fail to resolve the condition your surgeon may recommend surgical procedure.

Carpal Tunnel Release Surgery

Carpal tunnel syndrome can be treated with carpal tunnel release Surgery Traditional surgery involves up to a 2- inch incision in the palm and wrist area, whereas endoscopic surgery involves one or two half-an-inch incisions and the use of an endoscope. During the surgery, the transverse carpal ligament will be dissected to release the pressure on the median nerve and enlarge the carpal tunnel. Your surgeon will decide which options are best for you based on your general and medical conditions.

Post-Operative Care

Your surgeon may suggest you practice certain post-operative procedures for better recovery and to avoid further complications.

• Elevate the hand above heart level to reduce swelling.
• A splint may be worn
• Ice packs to the surgical area to reduce swelling.
• Keep the surgical incision clean and dry. Cover the area with plastic wrap when bathing or showering.
• Physical therapy may be ordered to restore wrist strength.
• Eating a healthy diet and not smoking will promote healing

Risks and Complications

Most patients suffer no complications following carpal tunnel release surgery. However, some patients may suffer from pain, infections, scarring, and nerve damage causing weakness, paralysis, or loss of sensation and stiffness in the hand and wrist area.

The muscles and bones of the hand are connected by thick flexible tissue called tendons. Tendons are covered by a thin soft sheath of tissue known as synovium. Extensor pollicis brevis and abductor pollicis longus are two tendons located on the thumb side of the wrist. Inflammation and swelling of the tendon sheaths puts pressure on the adjacent nerves and leads to pain and numbness in the thumb side of the wrist.

Strain on these tendons can cause swelling and irritation and lead to a condition called De Quervain's tenosynovitis, which is characterized by inflammation. The condition is also referred to as De Quervain's tendinitis, De Quervain's tendinosis, De Quervain syndrome, or De Quervain's disease.

Causes

The exact cause of De Quervain's tenosynovitis is unknown, but is usually seen in individuals with repetitive hand or wrist movements, injury to the wrist or tendon, and inflammatory conditions such as rheumatoid arthritis and inflammatory arthritis. De Quervain's tenosynovitis is most common in pregnant and middle age women.

Signs and Symptoms

The symptoms of De Quervain's tenosynovitis include pain and tenderness on the side of the wrist at the base of the thumb. You may also have a little swelling and redness in the area. Your symptoms may get worse while making a fist, grasping or gripping things, or turning the wrist. You may experience a "catching" or "snapping" sensation while moving your thumb.

Diagnosis

Your physician diagnoses De Quervain's tenosynovitis by observing your symptoms, medical history, and performing a physical examination of the wrist. De Quervain's tenosynovitis can be confirmed through the Finkelstein test. For this test, your doctor will ask you to make a fist with your fingers covering the thumb and bend the wrist towards the little finger. Pain during this movement will confirm the condition.

Treatment

Treatment of De Quervain's syndrome consists of both non-surgical and surgical therapy.

Non-surgical therapy includes avoiding activities that increase pain and swelling, applying ice, using a splint to support and immobilize the hand, and physical therapy. Anti-inflammatory drugs are helpful in relieving pain and swelling. Your physician may also recommend a corticosteroid injection to reduce the swelling of the tendon sheath.

Surgical therapy: Your physician will recommend surgery based on the severity of your pain symptoms and response to non-surgical treatment methods. The outpatient surgical procedure involves opening or cutting the inflamed part of the tendon sheath to relieve the pressure on the tendon and allow free movement of the wrist. After the surgical procedure, a wrist splint with your thumb and fingers free and mobile is applied for a month. Your surgeon will also instruct you on exercises to strengthen your wrist.

The hand and wrist are formed during the 8^th week of gestation. This process consists of various steps and failure in any one or more of these steps may cause congenital or birth defects. The deformities may be major (absence of a bone) or minor (disproportion of a finger). The various types of hand and wrist defects include:

• Missing parts of the hand
• Webbed or fused fingers (syndactyl)
• Presence of extra fingers (polydactyl)
• Congenital constriction band syndrome (band of tissue forms around a finger, restricting normal growth and blood flow)
• Undergrowth or overgrowth of the different parts of the hand

Congenital conditions of the hand and wrist are treated based on various factors such as your child's age, severity of the condition and cause of the condition. The different treatments include:

• Surgical separation of the webbed fingers
• Removal of the extra finger
• Use of splints to realign the fingers
• Tendon transfers
• Physical therapy to increase the strength in your hand
• Skin grafts to fill in the missing parts of the hand
• Correction of contractures

The wrist is a commonly seen injured joint in the body. Problems include sprains and strains as well as fractures which can occur with lifting and carrying heavy objects, while operating machinery, bracing against a fall, or from sports-related injuries.

Some of the common wrist injuries include:

Sprains and Strains: Sprains and strains are the two most common types of injuries affecting the wrist. A sprain refers to an injury to a ligament and a strain refers to a muscle injury. Sprains and strains occur due to excessive force applied during a stretching, twisting, or thrusting action. Most sprains and strains will repair themselves with adequate rest, ice application, compression, and elevation. Surgery is occasionally required to repair the damage.

Ligamentous Injuries: Ligaments are tissues that connect bones to other bones. They are made up of several fibers and one or all the fibers may be involved. Complete ligament injury occurs when all the fibers are torn.A ligament injury may cause pain and swelling and limit the movement of wrist joints. Ligament injuries are effectively treated with splinting and taping with restriction of movement of the injured structures.

Fractures: A fracture is a break in the bone which occurs when more force than the bearable limit is applied against a bone. Crushing injuries to the wrist occur due to high degrees of force or pressure and may also cause fractures.A fracture may cause severe pain, swelling, bruising or bleeding, discoloration of the skin and limit the mobility of the limb. Fractures of the wrist bones can be treated by using a cast or splint while the bone heals. Sometimes surgery may be needed where plates, pins or screws may be placed to keep the joint stable while healing.

Repetitive Trauma Syndrome: Repetitive stress injury occurs because of repeated similar movements for long periods of time. This often causes pressure on the joints resulting in inflammation, pain, and decreased function in the extremity. The condition is more likely to develop with repetitive, rapid, forceful and prolonged movements of the wrist, or from vibration or frequent pushing, pulling or carrying heavy objects. Carpal tunnel syndrome is the most common of these syndromes.

Carpal Tunnel Syndrome: Carpal tunnel syndrome is a condition characterized by numbness or pain in the thumb and first two fingers and occurs when the median nerve is compressed at the wrist. Carpal tunnel syndrome is often a common complaint in individuals who use their hands for prolonged periods of time in an occupation such as computer work. Immobilization of the affected part for a certain period may help heal the condition. Medications, physical therapy, and surgery may also be recommended. Often, splinting for a short period of time can treat the condition.

Any problem causing pain, swelling, discoloration, numbness or a tingling sensation, or abnormal position of the wrist that persists for more than two or three days should be evaluated by your doctor to establish the cause and obtain the best treatment as early as possible.

A tumor is a lump or abnormal growth formed due to unregulated cell division. Wrist tumors can occur on or underneath the skin. They are most often benign (non-cancerous). Common tumors include:

• Ganglion cysts: Fluid-filled growths generally found at the wrist joint. It is characterized by the swelling of a joint or tendon sheath (supportive lining of tendons) and leakage of the fluid that lubricates the joint forms the cyst.
• Giant cell tumors: These are solid tumors formed because of trauma caused to a tendon sheath, which stimulates the abnormal growth of cells.
• Epidermal inclusion cyst: Keratin-filled sac formed beneath the skin. Skin cells produce keratin, a waxy substance to protect its surface. Epidermal inclusion cysts develop when skin cells are trapped under the surface of a cut or puncture of the skin and continue to produce keratin, which forms the cyst.

Other wrist tumors include fat cell tumors (lipomas), nerve cell (neuromas) and nerve sheath tumors, and connective tissue tumors (fibromas).

Wrist tumors may be associated with pain, swelling, loss of flexibility and weakness or numbness. They can be diagnosed with physical examination and imaging tests such as X-rays, MRI and CT scan. Your doctor may also order a biopsy to confirm the diagnosis of the tumor and ascertain if they are benign or malignant.

Treatments mainly involve anti-inflammatory medications, use of splints and draining of the fluid from the cyst. Surgical treatment includes excision of the tumor. Excision is usually performed under local anesthesia and is an outpatient procedure.