AUGUST 25, 2017
What’s Your Grade? Even Milder Wrist Pain May Need a Doctor’s Care
Wrist sprains rank from mild to severe in a grading system:
Grade 1: Overstretched ligaments
Grade 2: Partially torn ligaments
Grade 3: Fully torn ligaments and sometimes a fracture
Wrist sprains occur after a fall on an outstretched hand and bent wrist. They're most common during sports or falling accidents. Symptoms such as swelling, pain at impact, pain that doesn’t go away, bruising, tenderness, a popping or tearing feeling, and feverish skin feelings are all important to note, but they don’t tell the whole story.
The tricky part about diagnosing a wrist sprain is that pain and appearance don't always correspond to the severity. A grade 3 sprain may have very little swelling but still require surgery to a torn ligament to avoid problems later. Grade 3 sprains can also have fractures that aren’t felt by the patient or even easily diagnosed by a general doctor looking at an x-ray. If left untreated, the wrist heals incorrectly and often requires corrective surgery by an orthopedic hand specialist.
Surgery requires a long period of immobilization followed by a hand therapy regimen with a specialist. Full recovery after surgery may take several months. Nonsurgical treatments include a shorter immobilization time followed by stretching exercises. Recovery varies from a few weeks to a few months.
Avoid potential lifelong pain and stiffness by having your wrist pain evaluated and treated as soon as possible by a board certified orthopedic doctor specializing in hand problems. This type of doctor is highly experienced and trained to properly diagnose and treat all levels of wrist sprains. He or she can also evaluate your overall arm and body mechanics (it’s all connected!) and prescribe the right treatment and recovery program to restore you to your best possible health.
Prevent wrist injuries by wearing protective gear during high-speed, high-risk sports, such as skating and skateboarding. Ski poles can also contribute to wrist sprains if not dropped when you fall. Take extra care not to fall or trip on wet surfaces, loose dirt or gravel, and uneven footing conditions.
JANUARY 15, 2017
“My finger got bent backwards and it still hurts A LOT!”
Ball players—volleyball, basketball, football, etc.—see injury from a finger bent backwards more often than others. When the ball forces the fingers to bend the wrong way (toward the wrist), it can cause a volar plate injury. The volar plate is a ligament that attaches the PIP joint (where the finger meets the hand) to the flexor tendons, which are attached to the bones. Acute pain right after the incident, swelling, and bruising at that particular joint are the most common symptoms.
Don't try to diagnose this injury on your own. Finger and hand pain that doesn't get better quickly on its own and/or with ice and rest usually requires medical attention. Treatments are different depending on whether there was just tissue damage (ligaments and tendons) versus a fracture (broken bone). An x-ray will aid your orthopedic doctor in properly diagnosing your injury.
Ligament or tendon damage only is considered a sprain or just soft tissue damage. Treatment often includes splinting or buddy taping to the finger next to it, special finger exercises (hand therapy may be prescribed), ice, and some time avoiding the activity that caused the injury.
Sometimes a small piece of bone will break off the main bone when the injury occurs. This is called an avulsion fracture, and it needs a specialized orthopedic hand surgeon to reattach it with wires or pins. Ignoring a broken finger or splinting it before it's correctly positioned can lead to lifelong pain and mobility problems.
JUNE 23, 2016
Type with Straight Wrists. Jackhammer Less.
(And Cyclists, Change Hand Position Frequently.)
The ulnar nerve is a common culprit for numbness and tingling in the hand. If it's constricted in the wrist area, the pinky side of the hand can become numb and tingly. The thumb and forefinger can lose pinching strength when the muscle between them becomes atrophied as well. These symptoms develop gradually and can be a result of repetitive tasks irritating the nerve (such as typing with bent wrists, jackhammering, and similar actitivites), putting too much prolonged pressure on a bent wrist (such as long bicycle rides), or most often, a small ganglion cyst that develops in the wrist area and puts pressure on the nerve.
This condition is called Ulnar Tunnel Syndrome of the Wrist. It should be properly diagnosed and treated by an orthopedic doctor specializing in hand, wrist, and arm problems. Because the ulnar nerve runs from the neck to the fingers, the doctor will likely examine the elbow as well. Other symptoms he or she may look for during the examination include dry skin between the fingers and tingling in the hand when certain spots are tapped. MRI imaging can show a cyst. X-ray imaging can reveal a bone fragment. Either of these can be blamed for the symptoms. And even if you don't know exactly what's wrong, symptoms that are getting worse are usually worth a trip to the doctor.
Treatment for Ulnar Tunnel Syndrome depends on the cause. Since most cases are caused by a cyst, which must be removed surgically, seeing an experienced, well-trained hand surgeon is recommended. If the condition is brought on by activities, the doctor will likely advise changing them to reduce or eliminate pressure on the nerve. Anti-inflammatory medications, ice, and a period of rest are also common treatments.