Hands & wrists

Each hand consists of 27 bones and together the hands account for around one quarter of all the bones in the human body. The wrist forms the transition from the hand to the lower arm.  It is incredibly flexible and exposed, so it’s no wonder that countless ligaments and tendons are required to keep all the bones in place and limit the joint’s freedom of movement. The carpal ligament stretches across the individual carpal bones (wrist bones) and is located inside a passageway made from connective tissue called the carpal tunnel. The flexor tendons and a major nerve cord also run through this tunnel. The nerve cord is responsible for the sense of feeling in the thumb, forefinger, middle finger and half of the ring finger, as well as for the strength of the muscle in the ball of the thumb.

Here are some of the common problems and diseases that can affect the hands and wrists.

It is not a comprehensive list.

• Osteoarthritis of the thumb saddle joint (carpometacarpal osteoarthritis)
• Broken wrist
• Carpal tunnel syndrome
• Tendon sheath inflammation (tenosynovitis)

Osteoarthritis of the thumb saddle joint (carpometacarpal osteoarthritis)

Nearly everything we do with our hands involves the thumb working opposite the rest of the fingers. Such movements primarily take place in what is known as the saddle joint. If the cartilage in this joint becomes damaged or worn out, it can lead to painful localised inflammation. This condition is called osteoarthritis of the saddle joint. Depending on the severity of the pain, treatment may include everything from resting the joint through to cortisone injections and surgery.

Broken wrist

Broken wrists are usually the result of a fall. People with reduced bone density (osteoporosis) face an increased risk. Depending on the break, the wrist can be treated conservatively (without surgery, for example using a plaster cast), or the bone fragments might have to be surgically fixed into position (using wires or screws, for instance).

For more information about different fractures of the wrist, forearm and elbow, see the clinical picture wrist fracture, forearm fracture, radius fracture and ulna fracture.

Carpal tunnel syndrome

Carpal tunnel syndrome refers to the compression of the nerve in the wrist, which leads to loss of feeling, pain and signs of paralysis. A common symptom of carpal tunnel syndrome is numbness and pain in the hand at night. A number of things can exert pressure on the nerve: long activities that involve repeatedly bending the wrist and fingers, long working hours with vibrating instruments, broken bones that have not yet healed, a build-up of lymphatic fluid (e.g. during pregnancy) and so on.

Carpal tunnel syndrome usually does not require surgery – even just wearing a splint day and night can provide relief. In cases with severe swelling, a cortisone injection can help to minimise the inflammation. If conservative treatment does not prove effective, or if the symptoms are particularly severe, then surgery is unavoidable. The operation involves severing the ligament that forms the top of the carpal tunnel in order to reduce the pressure on the nerve.

For more information, see the clinical picture of carpal tunnel syndrome.

Tendon sheath inflammation (tenosynovitis)

The tendon sheaths in the wrist are particularly prone to inflammation (tenosynovitis). Tendon sheaths surround tendons and are made of connective tissue filled with a lubricating fluid. The sheaths make it easier for the tendons to slide back and forth, and protect them against excessive friction. These tunnel-like structures are designed to protect very frequently used tendons. However, sometimes the tendons can wear away at the inside walls of the tunnel. This is primarily caused by overuse. The resulting area of inflammation should first be cooled and rested.

Aching pain when using the wrist joint is a typical warning sign of tendon sheath inflammation. If the inflammation is not treated promptly and the joint continues to be used, the disorder can become chronic.

For more information, see the clinical picture of tenosynovitis.

Click on the links below for more information.

Our medical specialists regularly answer readers’ questions in newspapers, magazines and online. We have put together a few of these questions and answers for you here. Please note that the Q&A is purely informative. The advice provided is not comprehensive and does not substitute a consultation with a medical professional. 

• Broken wrist
• Numb hand while cycling

Broken wrist

«I (65) have broken my wrist and because of my age/bone density, I should ideally have my bone set. How much time do I have to get this done? I already have a plaster cast to reduce the swelling.»

A broken wrist should be operated on within 6–8 days, because after that time the break begins to heal. After 2–3 weeks the bone is so soft that surgery should no longer be carried out. Only after 8–10 weeks is it then possible to perform a (much more difficult) corrective operation (but this should be avoided if possible!)
Prof. Dr. med. Reinhold Stober, Hand Surgery Center, Hirslanden Klinik Aarau

Numb hand while cycling

«I’m (25) an avid cyclist. Last summer I often had problems with my right hand falling asleep while I was riding. For about the last two months my right hand has also frequently gone numb while I’m working at the computer, sometimes also in the morning when I wake up. What might be causing this problem? What should I do to try and solve it?»

A feeling of numbness in the hand can be caused by an irritated nerve. Carefully paying attention to when and where your hand falls asleep will provide specialists with valuable information about which nerves could be causing the problem. The source of the problem can usually be identified by means of additional clinical examinations carried out by a neurologist (nerve specialist). The numbness can be treated conservatively, depending on the diagnosis and severity. If the examinations reveal major nerve constriction, the nerves will need to be surgically decompressed.
Dr. med. Stefan Wohlgemuth, Hirslanden Klinik St. Anna, Lucerne