Arthritis of the hand and wrist can be a major source of pain that occurs when cartilage in the joints deteriorates. A healthy joint consists of cartilage, synovial joint fluid, and a joint lining called synovium. Once joint cartilage deteriorates, it can cause pain, swelling, or stiffness in the affected joints.

Osteoarthritis (OA) often happens with aging or can be post-traumatic following an injury and results in progressive degeneration of the cartilage. An example of osteoarthritis in the hand is thumb carpometacarpal osteoarthritis (CMC OA), which is very common and can lead to pain at the thumb basal CMC joint.

Illustrations credit: ASSH.

Rheumatoid arthritis (RA) and other autoimmune inflammatory arthropathies affect multiple joints throughout the body because it is a systemic (affects your whole body) condition where your body attacks the joint linings. An example of rheumatoid arthritis is one that affects the knuckles – also called the metacarpophalangeal joint or MP joint – where the finger bones meet the bones of the hand. This type of RA is called MP joint arthritis.

Depending how severe and disabling your pain is, Dr. Yoon may recommend anti-inflammatory medications, splints, heat, physical/occupational therapy, injections including cortisone, PRP, stem cells, or surgery, depending on the severity and nature of the problem.

CTS occurs when the median nerve, which provides sensation and motor function to the palmar thumb/radial (or thumb side) fingers, is compressed at the level of the wrist at the carpal canal. The median nerve and nine flexor tendons travel through the carpal tunnel, which is made up of bones and connective tissues at the level of the carpal bones of the wrist. As a result of the compressed median nerve, you can feel symptoms of burning, pain, tingling, and numbness on the palmar thumb and radial fingers of your hand. Sometimes the compressed nerve can cause burning pain and/or discomfort that radiates along the palmar aspect of the wrist and forearm. Severe compression can lead to weakness of some thenar (thumb) muscles, which makes it difficult to grip objects. To treat CTS, Dr. Yoon may recommend resting the hand and wrist, taking oral anti-inflammatory medications, wearing a wrist splint, physical/occupational therapy, or receiving steroid injections. She may also suggest obtaining further studies including EMG/NCV and even surgery, depending on the severity of the symptoms.

Dupuytren’s disease (or contracture) is a hand deformity in which a layer of tissue under the skin in your hand gradually thickens and tightens. This can lead to nodules and more severe cases can cause one or more of your fingers to stay bent toward the palm. Dr. Yoon provides both nonoperative and operative treatment options for Dupuytren’s contracture. Nonoperative treatment options can include in-office Xiaflex® injections, a prescription medication that can soften the tissue to allow for manual manipulation of the cord to straighten the affected finger. Surgical options often involve a fasciectomy, a procedure to surgically remove some of the layer of tissue causing the contracture.

Extensor tendons are on the back of the wrist, hand, and fingers and are often very close to the skin surface. They help you to straighten (or extend) the wrist, hand and finger joints. Due to the close position of the tendons to the skin surface, even minor cuts can cause damage to the extensor tendons. Additionally, extensor tendons can also be torn off or ruptured from blunt trauma. Treatments can range from splinting to surgical repair, depending on the nature of the problem. Examples of extensor tendon injuries include lacerations and mallet fingers.

Illustrations credit: ASSH.

Muscles attach to bone through tendons. Muscle and tendon units move joints. Flexor muscles and tendons in the hand and wrist bend (flex) the wrist, hand, thumb, and finger joints. Lacerations can cause flexor muscle and tendon injuries in the upper extremity. Cuts on the hand can cause damage to flexor tendons and other nearby structures including nerves and blood vessels. Fully cut flexor tendons in the hand cannot heal without surgery. Additionally, nearby injured structures will often need to be surgically repaired as well. A simple-looking cut could be a more complex injury than what it appears to be on the outside.

Illustrations credit: ASSH.

Flexor muscles and tendons can also rupture from trauma without an open laceration. Signs and symptoms of a ruptured flexor tendon/muscle include the inability to actively bend the joint that is affected. Examples of these types of flexor tendon injuries include jersey finger or flexor digitorum profundus (FDP) tendon rupture.

Ganglion cysts are fluid-filled sacs that are commonly found at the wrist and hand. They are often found on the back and palm side of the wrist.

Illustration credit: ASSH.

Ganglion cysts can also be found on the hand, thumb, and fingers. There is no definitive known cause for ganglion cysts. Ganglion cysts are not cancerous. Treatment can often be nonsurgical. If ganglion cysts are not painful, treatment can often include observation. If ganglion cysts are symptomatic or cause discomfort, treatment options can include rest, activity modification, oral anti-inflammatory medications, intermittent splint use, aspiration/cortisone injections, and even surgical intervention. Dr. Yoon will discuss treatment options and provide a treatment plan best suited for you.

One of the most common injuries in the hand is a fracture (also called a broken bone). The hand is made up of metacarpals and phalanges. Fractures can be nondisplaced or displaced (shifted). Depending on the severity of the injury, hand fractures can be treated either nonoperatively or operatively. Nonoperative treatment can include immobilization with splints and casts. Operative treatment can include the need for hardware such as surgical pins, rods, plates, or screws.

Illustrations credit: ASSH.

Tendinitis / tenosynovitis occurs when tendons and tendon sheaths become inflamed.

Common examples of tendinitis and tenosynovitis include:

DeQuervain’s Tendinitis and Tenosynovitis

DeQuervain's is a condition that causes radial (or thumb-sided) wrist pain. Muscles attach to bone through tendons. At the level of the wrist, there are six different compartments on the back side where extensor tendons travel. The first dorsal (or back side) compartment and its tendons can get inflamed and cause pain and swelling at the radial wrist. Although there is no known specific cause for this to happen, this condition often occurs with repetitive movements and changes in hormonal levels. This condition occurs commonly in new mothers. Dr. Yoon may recommend treatment modalities including intermittent splint use, cortisone injections, and even surgical intervention for symptoms that persist despite nonoperative treatments.

Trigger Finger

Trigger finger, also known as stenosing tenosynovitis, is a condition in which your fingers or thumb can click and become locked in a bent position. The flexor tendons help bend the fingers and thumb. In order for the flexor tendons to work efficiently to bend our fingers, our hands have a pulley system to couple the tendons close to the surface of the bone. Sometimes people are born with a size mismatch between the flexor tendons and pulley system, which can cause locking of the digit/thumb from birth (congenital trigger thumb or trigger finger). Surgical intervention is usually recommended for these cases of congenital trigger thumb or trigger finger. In other cases, and more commonly among adults, the first pulley (A1 pulley) becomes inflamed. When this happens, the flexor tendons can also become inflamed and cause pain, clicking, locking when trying to bend the thumb or finger. If conservative measures including rest, over-the-counter anti-inflammatory medications, or corticosteroid injections fail to treat your trigger finger, Dr. Yoon may recommend surgery.

Ligaments attach bone to bone to stabilize a joint. The thumb metacarpophalangeal (MP) joint's ulnar and radial collateral ligaments are commonly injured during sporting activities. An example of these types of injuries includes skier's thumb.  Treatment of partial injuries can often be treated with splint or cast immobilization. Full tears often require surgical repair or reconstruction to heal.

Illustration credit: ASSH.

Also known as stenosing tenosynovitis, trigger finger is a condition in which your fingers or thumb can click and become locked in a bent position. The flexor tendons help bend the fingers and thumb. In order for the flexor tendons to work efficiently to bend our fingers, our hands have a pulley system to couple the tendons close to the surface of the bone. Sometimes people are born with a size mismatch between the flexor tendons and pulley system which can cause locking of the digit/thumb from birth (congenital trigger thumb/finger). Surgical intervention is usually recommended for these cases of congenital trigger thumb/finger. In other cases, (more commonly in adults) the first pulley (A1 pulley) becomes inflamed. When this happens, the flexor tendons can also become inflamed and cause pain, clicking, locking when trying to bend the thumb/finger. If conservative measures including rest, over-the-counter anti-inflammatory medications, or corticosteroid injections fail to treat your trigger finger, Dr. Yoon may recommend surgery.

The ulnar side (pinkie-side) of the wrist can be painful from various structures. The triangular fibrocartilage complex (TFCC) is a common cause of ulnar-sided wrist pain. Depending on the nature of your symptoms at onset, clinical examination, and severity of symptoms, Dr. Yoon will thoroughly evaluate you to determine the best treatment plan for you to regain your function and use of your wrist. Treatment options can include observation, rest, a period of immobilization, oral anti-inflammatory medications, cortisone injections, and even surgical intervention. Dr. Yoon performs both arthroscopic and open wrist procedures to treat TFCC problems. Other causes of ulnar-sided wrist pain can include tendinitis, arthritis, and even nerve compression. Dr. Yoon will thoroughly evaluate you to provide you with a comprehensive plan of care.

Fractures (also called broken bones) are among the most common injuries of the wrist. The wrist is made up of two forearm bones called the radius and ulna, and smaller wrist bones called carpal bones. Distal radius and ulna fractures often occur from falling on an outstretched hand.

Illustration credit: ASSH.

The carpal bones are the smaller wrist bones in the wrist. There are two rows of carpal bones. The scaphoid is an important carpal bone in the wrist because it links the two carpal rows together. Injuries to the scaphoid also often occur from a fall on an outstretched hand. Scaphoid fractures and ligament injuries including the scaphoid can be present even if initial X-rays of the wrist are “normal.”

Illustration credit: ASSH.

Depending on the severity of the fracture, treatment recommendations can include both nonoperative modalities including immobilization or surgery. If surgery is recommended, operative treatment often includes use of pins, metal plates, rods, and screws.

If you continue to have pain at the radial (or thumb-side) of the wrist after an injury, delaying treatment of these injuries can cause additional problems. We recommend that you seek further evaluation and treatment by a hand surgeon if you have any concerns about your injury.

Dr. Yoon has the expertise to effectively address all types of hand and wrist fractures.