Hand Injuries, Elbow Injuries, & Fracture Treatment

Hand Injuries :: Elbow Injuries :: Fracture Treatment

Hand Injuries

The hand and wrist are more prone to injuries and the problems may include sprains and strains as well as fractures can occur with lifting and carrying heavy objects, hand injury while operating machinery, bracing against a fall, or sports-related injuries.

Some of the common hand and wrist injuries include:

Sprains and Strains: Sprains and strains are the two most common types of injuries affecting the hand and wrist. A sprain refers to an injury to a ligament and a strain refers to a muscle injury. Sprains and strains occur due to excessive force applied during a stretching, twisting, or thrusting action. Most sprains and strains will repair themselves with adequate rest, ice application, compression, and elevation. Surgery is occasionally required to repair the damage.

Ligamentous Injuries: Ligaments are tissues that connect bones to other bones. They are made up of several fibers and one or all of the fibers may be involved. Complete ligament injury occurs when all the fibers are torn. Ligament injury may cause pain and swelling and limit the movement of hands and wrist joints. Ligament injury is effectively treated with splinting and taping with restriction of movement of injured structures.

Fractures: A fracture is a break in the bone, occurs when more force than the bearable limit is applied against a bone. Crushing injuries to the hand or wrist occurring due to high degree of force or pressure may also cause fractures. A fracture may cause severe pain, swelling, bruising or bleeding, discoloration of the skin and limit the mobility of the limb. Fracture of a finger bone can only be treated by using a cast or splint while the bone heals. Sometimes surgery may be needed where the plates, pins or screws may be placed to keep the stable.

Repetitive Trauma Syndrome: Repetitive stress injury occurs as a result of repeated similar movements for longer periods of time. This often causes pressure on the joints resulting in inflammation, pain, and decreased function in the extremity. The condition is more likely to develop with repetitive, rapid, forceful and prolonged movements of the hand and wrist, or vibration or frequent pushing, pulling or carrying heavy objects. Carpal tunnel syndrome is the most common of these syndromes.

Carpal Tunnel Syndrome: Carpal tunnel syndrome is a condition characterized by numbness or pain in the thumb and first two fingers and occurs when the median nerve is compressed at the wrist. Carpal tunnel syndrome is often a common complaint in individuals who use their hands for prolonged period of time in particular occupation. Immobilization of the affected part for certain period may help heal the condition. Medications, physical therapy, and surgery may also be recommended. Often, splinting for a shorter period of time can treat the condition.

Elbow injuries

Some of the common elbow injuries include:

Elbow Fractures: Fracture is a common injury to the elbow. Elbow fractures may result from a fall onto an outstretched wrist, a direct impact to the elbow or a twisting injury. Elbow fractures may cause severe pain, swelling, tenderness and painful movements. If a fracture is suspected, immediate intervention by your doctor is necessary. Surgery is often required if a bony displacement is observed.

Golf Injuries to the Hand, Wrist or Elbow: Golf, a famous sport involves the action of wrist. Insufficient strength in the forearms is the major cause for wrist and hand injuries in golfers. Common injuries in golfers include:

• Tennis Elbow/Golfer's Elbow: Tennis elbow is the inflammation of muscles on the outside of the elbow where as tendinitis on the inner side of the elbow is golfer's elbow. Overuse of the arms or a traumatic blow to the hand may cause tennis elbow or golfer's elbow. These injuries may cause severe pain and tenderness of the affected muscles that radiate down into the forearm, particularly with use of the hand and wrist. Adequate rest and immobility of the affected part helps the muscles to recover and modification of the activities helps in better healing. Heat therapy, followed by a stretching and strengthening exercises and then ice massage may offer be beneficial. A tennis elbow strap may relieve the pressure from the muscle attachment. Pain medications may be recommended to relieve the pain and inflammation
  
  
• Tendonitis: Tendonitis is inflammation of any of the tendons in the wrist. Tendonitis is usually treated with adequate rest, splinting, ice application, and with non-steroidal anti-inflammatory medicines to reduce the inflammation
  
  
• Hook of the hamate fracture: Fracture of the hook of the hamate bone, one of the small bones of the wrist, is another injury common in golfers. The hook of the hamet bone protrudes toward the palm, and is susceptible to injury from the club on a hard hit to the ground as the handle crosses right over the bony hook during gripping the club. A splint or cast may be used if the fracture is seen soon after the injury. If there is continued pain, surgery is usually performed to remove the broken bone fragment
  

Any problem causing pain, swelling, discoloration, numbness or a tingling sensation, or abnormal position of the hand, wrist, or elbow that persists for more than two or three days should be evaluated by your doctor to establish the cause and obtain the best treatment as early as possible.

Fracture Treatment

The word "Fracture" implies to broken bone. A bone may get fractured completely or partially and it is caused commonly from trauma due to fall, motor vehicle accident or sports. Thinning of the bone due to osteoporosis in the elderly can cause the bone to break easily. Overuse injuries are common cause of stress fractures in athletes.

Fracture Healing

Our body reacts to a fracture by protecting the injured area with a blood clot and callus or fibrous tissue. Bone cells begin forming on the either side of the fracture line. These cells grow towards each other and thus close the fracture.

Medical Therapy

The objective of early fracture management is to control bleeding, prevent ischemic injury (bone death) and to remove sources of infection such as foreign bodies and dead tissues. The next step in fracture management is the reduction of the fracture and its maintenance. It is important to ensure that the involved part of the body returns to its function after fracture heals. To achieve this, maintenance of fracture reduction with immobilization technique is done by either non-operative or surgical method.

Non-operative (closed) therapy comprises of casting and traction (skin and skeletal traction).

• Casting
  

Closed reduction is done for any fracture that is displaced, shortened, or angulated. Splints and casts made up of fiberglass or plaster of Paris material are used to immobilize the limb.

• Traction
  

Traction method is used for the management of fractures and dislocations that cannot be treated by casting. There are two methods of traction namely, skin traction and skeletal traction.

Skin traction involves attachment of traction tapes to the skin of the limb segment below the fracture. In skeletal traction, a pin is inserted through the bone distal to the fracture. Weights will be applied to this pin, and the patient is placed in an apparatus that facilitates traction. This method is most commonly used for fractures of the thighbone.

Surgical Therapy

• Open Reduction and Internal Fixation (ORIF)

This is a surgical procedure in which the fracture site is adequately exposed and reduction of fracture is done. Internal fixation is done with devices such as Kirschner wires, plates and screws, and intramedullary nails.

• External fixation

External fixation is a procedure in which the fracture stabilization is done at a distance from the site of fracture. It helps to maintain bone length and alignment without casting.

External fixation is performed in the following conditions:

• Open fractures with soft-tissue involvement
• Burns and soft tissue injuries
• Pelvic fractures
• Comminuted and unstable fractures
• Fractures having bony deficits
• Limb-lengthening procedures
• Fractures with infection or nonunion

Rehabilitation

Fractures may take several weeks to months to heal completely. You should limit your activities even after the removal of cast or brace so that the bone become solid enough to bear the stress. Rehabilitation program involves exercises and gradual increase in activity levels until the process of healing is complete.