Understanding Hand Injuries and Conditions
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on August 20, 2024
Hand injuries and conditions encompass a variety of issues that can impact the bones, joints, tendons, and nerves in the hand, affecting its functionality and causing discomfort. Maintaining hand health is crucial for performing daily tasks efficiently, from basic activities like eating and dressing to more complex tasks such as typing and driving. The prevalence of hand injuries and conditions is significant, with many individuals experiencing problems due to repetitive motions, trauma, age, genetics, and occupational hazards.
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What are hand injuries and conditions?
Hand injuries and conditions can be broadly categorized into acute injuries and chronic conditions. Acute injuries, such as fractures or sprains, typically result from sudden trauma, whereas chronic conditions like osteoarthritis or carpal tunnel syndrome develop gradually over time due to repetitive stress or degenerative changes.
The hand comprises 27 bones, including the phalanges (finger bones), metacarpals (middle hand bones), and carpal bones (wrist bones). These bones form various joints that facilitate movement, supported by tendons and muscles. The nerves in the hand, primarily the median, ulnar, and radial nerves, are crucial for sensation and motor function. Injuries or conditions affecting these structures can significantly impair hand function and interfere with daily activities, from gripping objects to typing on a keyboard.
Common hand injuries and conditions
Carpal tunnel syndrome (CTS) Carpal Tunnel Syndrome is a condition where the median nerve is compressed as it passes through the carpal tunnel in the wrist. It typically progresses from occasional numbness and tingling in the fingers to constant pain and weakness in hand grip. Distinguishing features include symptoms that worsen at night and improve with shaking the hand.
Dupuytren's disease Dupuytren's Disease affects the fascia, a layer of tissue under the skin of the palm and fingers, leading to the thickening and tightening of this tissue. It starts as nodules or lumps in the palm and progresses to contractures that bend the fingers into the palm, making it difficult to straighten them. This condition is distinguished by its slow progression and familial tendency.
Metacarpal fracture A metacarpal fracture involves a break in one of the five metacarpal bones in the hand. These fractures often result from direct trauma, such as a punch or a fall onto the hand. They typically cause immediate pain, swelling, and difficulty in moving the affected finger or fingers.
Osteoarthritis Osteoarthritis in the hand commonly affects the joints at the base of the thumb, the ends of the fingers, and the middle joints of the fingers. It progresses slowly, starting with joint pain and stiffness, and may eventually lead to bony enlargements and reduced motion. It is characterized by a gradual onset and is often linked to aging.
Skier's thumb Skier's Thumb is an injury to the ulnar collateral ligament of the thumb, often resulting from a fall on an outstretched hand while holding a ski pole. It causes pain, swelling, and instability at the base of the thumb, making it difficult to grasp objects. This condition is acute and requires prompt treatment to restore thumb stability.
Causes of hand injuries and conditions
Repetitive motions Repetitive tasks, such as typing or assembly line work, can lead to overuse injuries like tendonitis or carpal tunnel syndrome due to prolonged strain on hand structures.
Trauma Accidents like falls, sports injuries, or direct blows can cause fractures, dislocations, or ligament tears, leading to immediate and sometimes severe hand injuries.
Age-related factors Aging can lead to degenerative changes in the hand, such as reduced joint cartilage, making individuals more susceptible to conditions like osteoarthritis.
Genetic predisposition Certain hand conditions, like Dupuytren's Disease, have a genetic component, meaning they can run in families and may be inherited.
Occupational hazards Professions involving heavy manual labor, repetitive tasks, or use of vibrating tools have a higher risk of hand injuries and conditions.
Signs and symptoms of hand injuries and conditions
Pain Pain in the hand can be sharp, dull, constant, or intermittent, depending on the specific injury or condition.
Swelling Swelling occurs due to inflammation and can limit hand movement and function.
Limited range of motion This can significantly impair daily activities, making it difficult to perform tasks that require flexibility and dexterity.
Numbness or tingling Neurological symptoms like numbness or tingling often indicate nerve compression or damage, such as in carpal tunnel syndrome.
Deformity Visible changes in the hand’s appearance, such as bent fingers in Dupuytren's Disease, can indicate underlying structural issues.
Prevention strategies for hand injuries and conditions
Ergonomic adjustments Improving workplace ergonomics can reduce the risk of repetitive strain injuries. Tips include adjusting chair height, using ergonomic keyboards, and taking regular breaks.
Proper hand care Maintaining hand hygiene and using moisturizers can prevent skin problems and maintain overall hand health.
Exercise and stretching Hand exercises and stretching can enhance flexibility and strength, reducing the risk of injuries.
Protective gear Using protective gloves and other gear can prevent injuries during activities like sports or manual labor.
Lifestyle modifications Reducing activities that put excessive strain on the hands and maintaining a healthy lifestyle can lower the risk of hand injuries and conditions.
Diagnostic methods for hand injuries and conditions
Physical examination Doctors assess symptoms and hand function during a physical exam to identify the specific issue.
Imaging tests X-rays, MRI, and ultrasound help visualize bone and soft tissue injuries.
Nerve conduction studies These tests measure the electrical activity of nerves to diagnose conditions like carpal tunnel syndrome.
Other specialized tests Additional tests may include blood tests for inflammatory markers or specialized scans for detailed views of the hand structures.
Treatment options for hand injuries and conditions
Conservative treatments The RICE method (Rest, Ice, Compression, Elevation) is commonly used for initial treatment of hand injuries.
Medications Pain relievers and anti-inflammatory drugs help manage pain and reduce inflammation.
Splinting or bracing Splints and braces support healing by immobilizing the injured area.
Surgical interventions Surgery may be necessary for severe cases, such as fractures that do not heal with conservative treatment or advanced carpal tunnel syndrome.
Alternative therapies Acupuncture, massage, and other alternative treatments can provide symptom relief for some hand conditions.
Physiotherapy for hand injuries and conditions
Benefits of physiotherapy
Physiotherapy plays a crucial role in the recovery and rehabilitation of hand injuries and conditions by:
Reducing pain and inflammation.
Restoring range of motion and flexibility.
Strengthening hand muscles and improving grip strength.
Enhancing overall hand function and dexterity.
Preventing recurrence of injuries.
Common techniques
Physiotherapists use a variety of techniques to treat hand injuries, including:
Manual therapy: Hands-on techniques such as joint mobilization and soft tissue massage to improve mobility and reduce pain.
Exercise therapy: Customized exercises to strengthen muscles, improve flexibility, and restore function.
Modalities: Use of therapeutic ultrasound, electrical stimulation, heat, and cold therapy to reduce pain and promote healing.
Splinting and taping: Creating custom splints and applying therapeutic tape to support healing and reduce strain on injured structures.
Exercise program
A typical hand therapy exercise program may include:
Finger stretches: Stretching each finger individually and collectively to improve flexibility.
Grip strengthening: Using stress balls, putty, or hand exercisers to enhance grip strength.
Pinch exercises: Pinching putty or small objects to strengthen the thumb and fingers.
Range of motion exercises: Bending and straightening the fingers and wrist to maintain mobility.
Dexterity drills: Tasks like picking up small objects or threading beads to improve fine motor skills.
Expected outcomes
The goals and timelines for recovery vary based on the specific injury or condition, but generally include:
Pain reduction: Initial phase focuses on reducing pain and inflammation.
Mobility restoration: Gradual improvement in range of motion and flexibility.
Strength building: Progressive strengthening of hand muscles to restore function.
Functional improvement: Return to daily activities and tasks with improved hand function.
Prevention of recurrence: Educating patients on preventive measures and exercises to avoid future injuries.
The role of the physiotherapist
Physiotherapists are essential in customizing treatment plans based on individual needs and progress:
Assessment: Conducting thorough evaluations to identify specific issues and limitations.
Treatment planning: Developing personalized plans that address pain, mobility, strength, and function.
Progress monitoring: Regularly assessing progress and adjusting treatment as needed.
Patient Education: Teaching patients exercises, techniques, and preventive strategies to enhance recovery and prevent future injuries.
Support and motivation: Providing ongoing support and encouragement to help patients achieve their recovery goals.
When to seek professional help
Red Flags: Symptoms That Require Immediate Medical Attention
Certain symptoms indicate the need for immediate medical evaluation and intervention. These red flags include:
Severe pain: Intense, unrelenting pain that doesn't improve with rest or over-the-counter pain relief.
Sudden swelling: Rapid onset of significant swelling, which may indicate a fracture, severe sprain, or infection.
Visible deformity: Any noticeable deformity, such as misalignment of fingers or a visibly broken bone.
Loss of function: Inability to move the fingers, hand, or wrist, which can indicate severe injury or nerve damage.
Numbness or tingling: Persistent numbness or a tingling sensation, especially if it affects the entire hand or specific fingers, which can signify nerve compression or injury.
Open wounds: Any lacerations, punctures, or wounds that expose deeper tissues, requiring immediate cleaning and possibly stitches.
Infection signs: Symptoms like redness, warmth, fever, or pus discharge around an injury site, indicating an infection that needs prompt treatment.
Circulation problems: Symptoms like bluish discoloration, coldness, or lack of pulse in the hand, which can indicate vascular issues.
Importance of hand injuries and conditions early intervention
Seeking professional help early in the course of a hand injury or condition can significantly affect long-term outcomes:
Preventing complications: Early treatment can prevent the development of complications such as chronic pain, stiffness, or permanent disability.
Faster recovery: Prompt medical attention and appropriate interventions can accelerate the healing process, reducing downtime and allowing for a quicker return to normal activities.
Reducing pain and inflammation: Immediate treatment helps manage acute pain and inflammation effectively, improving comfort and function.
Avoiding chronic issues: Addressing injuries and conditions early can prevent them from becoming chronic problems that are harder to treat and manage.
Improving function: Early intervention helps restore hand function more effectively, ensuring better long-term outcomes in terms of strength, flexibility, and dexterity.
Tailored rehabilitation: Early consultation with a healthcare provider can result in a customized rehabilitation program that addresses specific needs and promotes optimal recovery.
Better prognosis: Conditions like fractures, ligament injuries, and nerve compression respond better to treatment when addressed early, leading to a more favorable prognosis.
Choosing a specialist for hand injuries and conditions
Selecting the right healthcare provider is crucial for effective treatment and recovery from hand injuries and conditions. Here are some tips for finding the appropriate specialist:
Primary care physician: Start with a visit to your primary care physician, who can assess your condition and refer you to a specialist if necessary.
Orthopedic surgeon: Specializes in musculoskeletal injuries and conditions, including fractures, ligament tears, and severe hand conditions that may require surgical intervention.
Hand surgeon: An orthopedic or plastic surgeon with specialized training in hand surgery, experienced in treating complex hand injuries and conditions.
Rheumatologist: Specializes in inflammatory conditions like arthritis that affect the joints and soft tissues in the hand.
Physiotherapist: Provides non-surgical treatment options, including rehabilitation exercises, manual therapy, and pain management techniques.
Occupational therapist: Focuses on restoring hand function and improving the ability to perform daily activities through specialized therapeutic techniques and adaptive strategies.
Neurologist: Consulted for nerve-related issues affecting hand function, such as carpal tunnel syndrome or peripheral neuropathy.
Certified hand therapist (CHT): A physiotherapist or occupational therapist with advanced training and certification in hand therapy, skilled in managing complex hand injuries and post-surgical rehabilitation.
Conclusion
Hand injuries and conditions can significantly impact daily life, but with proper care and early treatment, most issues can be managed effectively. Maintaining hand health through preventive measures and seeking timely medical intervention is essential for optimal function and quality of life.
References:
Gyer, G., Michael, J., & Inklebarger, J. (2018). Occupational hand injuries: a current review of the prevalence and proposed prevention strategies for physical therapists and similar healthcare professionals. Journal of Integrative Medicine, 16(2), 84–89. https://doi.org/10.1016/j.joim.2018.02.003
Lehman, J. D., Krishnan, K. R., Stepan, J. G., & Nwachukwu, B. U. (2020). Prevalence and Treatment Outcomes of Hand and Wrist Injuries in Professional Athletes: A Systematic Review. HSS Journal ®, 16(3), 280–287. https://doi.org/10.1007/s11420-020-09760-w
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Article by
John Keller
Clinical Director | Sports & Musculoskeletal Physiotherapist
John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.
Reviewed by
Dr. Jenny Hynes FACP
Clinical Director | Specialist Musculoskeletal Physiotherapist
Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.