Anatomy, Pathology and Treatment of the Wrist & Hand

James Walker
on
February 28, 2022

Hand and Wrist anatomy

The hand and wrist are made up of many bones, joints ligaments and muscles.  

The wrist is where the radius and ulna bones in the forearm meet the carpal bones in the hand.  

There are 27 bones in the hand comprising of the carpal bones, metacarpals and phalanges.  

Most of the muscles that control the hand are located in the forearm however there are some small muscles in the hand itself.

There are over 100 ligaments in the hand that help provide stability.  

The combination of all these structures allows our hands to have a high level of dexterity and function and is one of the main evolutionary features that sets us apart from other animals.

Bones of the hand

Common pathology  

Trigger finger  

This is a condition characterised by pain and stiffness in a finger with an associated locking or catching when you try to bend or straighten the finger.  

The issue occurs when the A1 pulley at the base of the finger becomes inflamed and thickened, making it harder for the tendons to glide under the pulley.

Eventually a small nodule can develop on the flexor tendon which gets caught under the pulley and will cause a triggering when it eventually passes through. Sometimes the other hand is needed to help straighten the finger.  

In a lot of cases physiotherapy can help solve the issue. A corticosteroid injection is particularly effective in resolving this condition if physiotherapy alone fails.

Colles Fracture  

A Colles fracture is described as a fracture located anywhere within the distal 1/3 of the radius bone. Put simply, it is a fracture of the forearm that is close to the wrist joint.  

It usually occurs when someone has fallen over and landed onto an outstretched arm.  

It is most common in the 60+ age group but can also occur in young adults.  

Management is either conservative; where the wrist and hand is placed in a cast, or surgical where an operation will be performed to fix the bone using a plate and screws.

After either method of management physiotherapy is required to regain the normal movement, function and strength of the wrist and hand.  

De quervain's tenosynovitis

This is a condition that effects the tendons at the base of the thumb.  

The sheath in which the tendons are encased becomes inflamed and pain is felt on activities when the thumb is stressed, such as picking up a pile of papers or turning a key.  

The cause of this issue is thought to be overuse and is usually related to either the persons work or a hobby/activity that repetitively stresses the thumb.  

Treatment often involves physiotherapy, anti-inflammatory medication and temporarily splinting of the thumb.  

Carpal tunnel syndrome

The carpal tunnel is a narrow passageway located on the palm side of your hand. Many structures pass through this tunnel as they travel into the hand. Carpal tunnel syndrome describes a condition where the median nerve gets compressed as it passes through the tunnel.  

When the nerve is compressed symptoms can include tingling, numbness, weakness and pain in the hand.  

This condition can be related to certain repetitive activities, but it can also just come on in certain people for no obvious reason.  

Treatment initially involves physiotherapy and splinting – especially at night and often this is enough to resolve the issue.  

In more stubborn cased a steroid injection and even surgery may be required.  

Carpal tunnel

Treatment

The Whitehouse Clinic is much more than just a regular physiotherapy clinic. We have the ability to facilitate any intervention that is needed to help manage and rehabilitate any type of hand and wrist issue. The information below outlines all the services available at the clinic.

Physiotherapy assessment and treatment

We have a group of highly experienced physiotherapists who will be able to provide a thorough assessment and diagnosis of your issue. Following this they will be able to provide you with the most evidence-based treatment to ensure improvement and hopefully resolution of your symptoms.

In the case where further investigations or treatment is required, they have the knowledge base and contacts to make sure the appropriate onward referrals are made with minimal waiting times.

State-of-the-art gym and rehabilitation facilities

Our clinic is equipped with both a gym and a studio both filled with modern equipment enabling our physiotherapists to provide the best rehabilitation available.

Rapid access to investigative and scanning facilities

If you require further investigation such as an x-ray or MRI scan, we have the clinical pathways to refer you quickly. Ultrasound scans, which are particularly useful for assessing the hand and wrist, can be performed at the clinic, with no waiting list.

Corticosteroid injections

In certain situations, an anti-inflammatory, pain relieving injection known as a corticosteroid injection is used in the management of hand and wrist conditions. We are able to provide these injections on site.

Direct referral links to the top orthopaedic specialists in the area

We have long standing professional relationships with the top orthopaedic specialists in the area so in the scenario where an orthopaedic referral, possibly leading to surgery, is required we are able to refer swiftly and directly.

Post-operative rehabilitation

We have a vast amount of experience in dealing with patients after surgery with many of the local hospitals referring a large variety of surgical cases to us.

After surgery there is a surgical protocol that is followed. Our physiotherapists will be able to guide you through this protocol to ensure optimal recovery is achieved.

Summary

At the White House Clinic we are able to help you with any form of hand and wrist issue at any stage of the process to recovery.

Not being able to use your hands normally can be very debilitating so we are here to help get you back in track as swiftly as possible.

If you have any questions about any of the services that we provide then get in contact with us today and we will be happy to help.

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