Hand Anatomy – Motion Orthopaedics

The human hand is made up of the wrist, palm, and fingers and consists of 27 bones, 27 joints, 34 muscles, over 100 ligaments and tendons, and many blood vessels and nerves.

The hands enable us to perform many of our daily activities such as driving, writing and cooking. It is important to understand the normal anatomy of the hand to learn more about diseases and conditions that can affect our hands.

Bones

The wrist is comprised of 8 carpal bones. These wrist bones are attached to the radius and ulna of the forearm to form the wrist joint. They connect to 5 metacarpal bones that form the palm of the hand. Each metacarpal bone connects to one finger at a joint called the metacarpophalangeal joint or MCP joint. This joint is also commonly referred to as the knuckle joint.

The bones in our fingers and thumb are called phalanges. Each finger has 3 phalanges separated by two interphalangeal joints, except for the thumb, which only has 2 phalanges and one interphalangeal joint.

The first joint close to the knuckle joint is called the proximal interphalangeal joint or PIP joint. The joint closest to the end of the finger is called the distal interphalangeal joint or DIP joint.

The MCP joint and the PIP joint act like hinges when the fingers bend and straighten.

Soft tissues

Our hand bones are held in place and supported by various soft tissues. These include: articular cartilage, ligaments, muscles and tendons.

Articular cartilage is a smooth material that acts as a shock absorber and cushions the ends of bones at each of the 27 joints, allowing smooth movement of the hand.

Muscles and ligaments function to control the movement of the hand.

Ligaments are tough rope-like tissue that connect bones to other bones, holding them in place and providing stability to the joints. Each finger joint has two collateral ligaments on either side, which prevents the abnormal sideways bending of the joints. The volar plate is the strongest ligament in the hand. It joins the proximal and middle phalanx on the palm side of the joint and prevents backwards bending of the PIP joint (hyperextension).

Muscles

Muscles are fibrous tissues that help produce movement. Muscles work by contracting.

There are two types of muscles in the hand, intrinsic and extrinsic muscles.

Intrinsic muscles are small muscles that originate in the wrist and hand. They are responsible for fine motor movement of the fingers during activities such as writing or playing the piano.

Extrinsic muscles originate in the forearm or elbow and control the movement of the wrist and hand. These muscles are responsible for gross hand movements. They position the wrist and hand while the fingers perform fine motor movements.

Each finger has six muscles controlling its movement: three extrinsic and three intrinsic muscles. The index and little finger each have an extra extrinsic extensor.

Tendons

Tendons are soft tissues that connect muscles to bones. When muscles contract, tendons pull the bones causing the finger to move. The extrinsic muscles attach to finger bones through long tendons that extend from the forearm through the wrist. Tendons located on the palm side help in bending the fingers and are called flexor tendons, while tendons on top of the hand help in straightening the fingers, and are called extensor tendons.

Nerves

Nerves of the hand carry electrical signals from the brain to the muscles in the forearm and hand, enabling movement. They also carry the senses of touch, pain and temperature back from the hands to the brain.

The three main nerves of the hand and wrist are the ulnar nerve, radial nerve and median nerve. All three nerves originate at the shoulder and travel down the arm to the hand. Each of these nerves has sensory and motor components.

Ulnar Nerve: The ulnar nerve crosses the wrist through an area called Guyon’s canal and branches to provide sensation to the little finger and half of the ring finger.

Median Nerve: The median nerve crosses the wrist through a tunnel called the carpal tunnel. The median nerve provides sensation to the palm, thumb, index finger, middle finger, and part of the ring finger.

Radial Nerve: The radial nerve runs down the thumb side of the forearm and provides sensation to the back of the hand from the thumb to the middle finger.

Blood Vessels

Blood vessels travel beside the nerves to supply blood to the hand. The main arteries are the ulnar and radial arteries, which supply blood to the front of the hand, fingers, and thumb.

The ulnar artery travels next to the ulnar nerve through the Guyon’s canal in the wrist.

The radial artery is the largest artery of the hand, traveling across the front of the wrist, near the thumb. Pulse is measured at the radial artery.

Other blood vessels travel across the back of the wrist to supply blood to the back of the hand, fingers, and thumb.

Bursae

Bursae are small fluid filled sacs that decrease friction between tendons and bone or skin. Bursae contain special cells called synovial cells that secrete a lubricating fluid.

The Anatomy Of The Hand

Our hands are complex and essential tools. This overview explains the anatomy of the hand, and the structures that make our hands such dependable helpers.

Whether we are extending a hand in friendship or lending a hand at work, we depend on our hands as we move through our day. We need flexibility and coordination to position our fingers and thumbs as we use a keyboard, play an instrument, or perform other fine motor skills. Muscle strength enables us to bend or straighten our wrist, and to grip objects.

The structures of the hand include bones, joints, ligaments, tendons, muscles, nerves, and blood vessels.

Bones of the hand

The 27 bones in the hand can be categorized by position:

• Carpal bones: These eight bones are found in the wrist. They are connected to the two forearm bones to form the wrist joint.
• Metacarpal bones: The five metacarpals are found in the palm. They connect to the carpals at the base of the palm. Along the top of the palm, one metacarpal bone is connected to the small shafts of bone that form each of the fingers and thumb, forming our knuckle joints.
• Phalanges: These 14 bones make up our fingers and thumb. Each finger has three phalanges that connect to each other, forming two finger joints in each finger. The thumb has only two phalanges and one joint.

Connective tissues

These bones are held together by a system of ligaments, tendons, muscles, nerves, and blood vessels.

• Ligaments are tough bands of tissue that connect bones and stabilize joints. Ligaments tighten as a finger is straightened, and keep the finger bones from bending back too far, or hyperextending the joint.

• The tendons attach to muscle in the forearm. They travel from the forearm through the wrist and into the fingers. The tendons attached to the underside of the forearm bones bend the thumb and fingers; they are called flexors. The tendons that straighten our thumb and fingers connect to the top of the forearm bones, and are called extensors.

• Most of the muscles that operate the hand are anchored in the elbow or forearm. Some muscles are responsible to bend or straighten the wrist; others move the fingers or thumb. Some of the small muscles that work our fingers and thumb are anchored on our carpal bones.

• The three nerves in the hand and fingers begin together at the shoulder. These nerves travel down into the hand side by side with the blood vessels that supply the hand with blood. Nerves carry signals from the brain to move the muscles in the arm, hand, fingers, and thumb. These nerves also carry signals from the hand back to the brain to communicate sensations like touch, pain, and temperature.

Our ability to use our hands depends on how well our bones, ligaments, tendons, muscles, nerves, and blood vessels work together. Because the function of our hands is integrated through our wrists and arms to our shoulders, a problem anywhere along our arm may have a significant impact on hand function and quality of life.

Summit Orthopedics provides personalized hand and wrist expertise

The function of our hands is integrated through our wrists and arms to our shoulders; a problem anywhere along our arm may have a significant impact on hand function and quality of life. If you experience an injury or uncomfortable symptoms, our fellowship-trained hand and wrist surgeons are here to help. Summit physicians receive the highest levels of training and exclusively provide individualized care for conditions of the hand, wrist, and elbow.

Start your journey to better function and less pain. Find your hand expert, request an appointment online, or call us at (651) 968–5201 to schedule a consultation.

Summit has convenient locations across the Minneapolis-St. Paul metro area, serving Minnesota and western Wisconsin. We have state-of-the-art centers for comprehensive orthopedic care in Eagan, MN, Plymouth, MN, Vadnais Heights, MN, and Woodbury, MN, as well as additional community clinics throughout the metro and southern Minnesota.

Related resources for you

Anatomy: Hand and Wrist – BID Needham

Wrist

The wrist joint is the complex joint formed between the distal ends (furthest from the body) of the Radius and Ulna (two forearm bones) and the carpal bones. It connects the forearm to the hand and allows a good range of motion. Repetitive use does however frequently lead to injuries.

Bones and Articulation

The Ulna is the larger of the two forearm bones, although it tapers at the wrist end, to become narrower than the Radius at this point. The Radius is positioned on the thumb side of the wrist, and the ulna on the little finger side. They form the wrist joint with the carpal bones. Altogether there are 8 carpal bone which are arranged in two rows, proximal and distal

• Lunate
• Triquetrum
• Pisiform
• Capitate
• Trapezium
• Trapezoid
• Hamate
• Scaphoid

The scaphoid bone crosses both rows as it is the largest carpal bone. The scaphoid and the lunate are the two bones which actually articulate with the radius and ulna to form the wrist joint.

Hand

The human hand consists of a broad palm (metacarpus) with 5 digits, attached to the forearm by a joint called the wrist (carpus).

Digits 



The four fingers on the hand are used for the outermost performance; these four digits can be folded over the palm which allows the grasping of objects. Each finger, starting with the one closest to the thumb, has a colloquial name to distinguish it from the others

• Index finger, pointer finger, or forefinger
• Middle finger
• Ring finger
• Little finger or ‘pinky’
• Thumb

Bones

The human hand has 27 bones: the carpals or wrist accounts for 8; the metacarpals or palm contains five; the remaining fourteen are digital bones; fingers and thumb.

The palm has five bones known as metacarpal bones, one to each of the 5 digits. These metacarpals have a head, a shaft, and a base.

Human hands contain fourteen digital bones, also called phalanges, or phalanx bones: two in the thumb (the thumb has no middle phalanx) and three in each of the four fingers. These are the distal phalanx, carrying the nail, the middle phalanx, and the proximal phalanx.

Sesamoid bones are small ossified nodes embedded in the tendons to provide extra leverage and reduce pressure on the underlying tissue. Many exist around the palm at the bases of the digits; the exact number varies between different people.

Articulation

The articulation of the human hand is more complex and delicate than that of comparable organs in any other animal. Without this extra articulation, we would not be able to operate a wide variety of tools and devices, nor achieve the wide variety of possible hand gestures.

The articulations are

• Interphalangeal articulations of hand (the hinge joints between the finger bones)
• Metacarpophalangeal joints (where the fingers meet the palm)
• Intercarpal articulations (where the palm meets the wrist)
• Wrist (may also be viewed as belonging to the forearm)

Most Common Hand/Wrist Injuries

While hand and wrist injuries are very common, some athletes never seek treatment. Unfortunately, delaying the diagnosis and treatment may result in long-term problems or even a permanent disability. Here is a list of some of the most common injuries athletes experience.

Normal Hand Anatomy Pleasanton | Hand Patient Education San Francisco

Introduction

The hand in the human body is made up of the wrist, palm, and fingers. The most flexible part of the human skeleton, the hand enables us to perform many of our daily activities. When our hand and wrist are not functioning properly, daily activities such as driving a car, bathing, and cooking can become impossible.

The hand’s complex anatomy consists of

• 27 bones
• 27 joints
• 34 Muscles
• Over 100 ligaments and tendons
• Numerous Blood vessels, nerves, and soft tissue

It is important to understand the normal anatomy of the hand in order to learn about diseases and conditions that can affect our hands.

Skeletal Anatomy

The wrist is comprised of 8 bones called carpal bones. These wrist bones connect to 5 metacarpal bones that form the palm of the hand. Each metacarpal bone connects to one finger or a thumb at a joint called the metacarpophalangeal joint, or MCP joint. This joint is commonly referred to as the knuckle joint.

The bones in our fingers and thumb are called phalanges. Each finger has 3 phalanges separated by two joints.

The first joint, closest to the knuckle joint, is the proximal interphalangeal joint or PIP joint. The second joint nearer the end of the finger is called the distal interphalangeal joint, or DIP joint. The thumb in the human body only has 2 phalanges and one interphalangeal joint.

Soft Tissue Anatomy

Our hand and wrist bones are held in place and supported by various soft tissues. These include:
Cartilage: Shiny and smooth, cartilage allows smooth movement where two bones come in contact with each other.

Tendons

Tendons are soft tissue that connects muscles to bones to provide support. Extensor tendons enable each finger to straighten.

Ligaments

Ligaments are strong rope like tissue that connects bones to other bones and help hold tendons in place providing stability to the joints. The volar plate is the strongest ligament in the hand and prevents hyperextension of the PIP joint.

Muscles

Muscles are fibrous tissue capable of contracting to cause body movement. Interestingly, the fingers contain no muscles. Small muscles originating from the carpal bones of the wrist are connected to the finger bones with tendons. These muscles are responsible for movement of the thumb and little finger enabling the hand to hold and grip items by allowing the thumb to move across the palm, a movement referred to as Thumb Opposition. The smallest muscles of the wrist and hand are responsible for fine motor movement of the fingers.

Nerves

Nerves are responsible for carrying signals back and forth from the brain to muscles in our body, enabling movement and sensation such as touch, pain, and hot or cold. The three main nerves responsible for hand and wrist movement all originate at the shoulder area and include the following:

• Radial: The radial nerve runs down the thumb side of the forearm and provides sensation to the back of the hand from the thumb to the third finger.
• Median: The median nerve travels through the wrist tunnel, also called carpal tunnel, providing sensation to the thumb, index finger, long finger, and part of the ring finger.
• Ulnar: The ulnar nerve travels through a tunnel in the wrist called Guyon’s tunnel formed by two carpal bones and the ligament that connects them together. The ulnar nerve supplies feeling to the little finger and half of the ring finger.

Blood Vessels

The two main vessels of the hand and wrist are

• Radial Artery: The radial artery is the largest artery supplying the hand and wrist area. Traveling across the front of the wrist, nearest the thumb, it is this artery that is palpated when a pulse is counted at the wrist.
• Ulnar Artery: The ulnar artery travels next to the ulnar nerve through Guyon’s canal in the wrist. It supplies blood flow to the front of the hand, fingers and thumb.

Bursae

Bursae are small fluid filled sacs that decrease friction between tendons and bone or skin. Bursae contain special cells called synovial cells that secrete a lubricating fluid. When this fluid becomes infected, a common painful condition known as Bursitis can develop. 

Normal Movement

Biomechanics is a term to describe movement of the body. The fingers of the hand permit the following movements at the metacarpophalangeal joint (MCP) or knuckle joint.

• Flexion: Moving the base of the finger towards the palm.
• Extension: Moving the base of the fingers away from the palm.
• Adduction: Moving the fingers toward the middle finger.
• Abduction: Moving the fingers away from the middle finger.
• Flexion: Moving the last two segments of the finger towards the base of the fingers.
• Extension: Moving the last two segments of the finger away from the base of the fingers.

Biomechanics of the wrist include the following

• Flexion: Moving the palm of the hand towards the front of the forearm.
• Extension: Moving the back of the hand towards the back of the forearm.
• Adduction: Moving the pinky side of the hand toward the outer aspect of the forearm.
• Abduction: Moving the thumb side of the hand toward the inner aspect of the forearm.

The thumb performs different movements at three separate joints. The carpometacarpal joint is where the wrist bones, carpals, meet the metacarpals, the bones in the palm of the hand. At this articulation, the following movements can be performed

• Abduction: Moving the bone below the thumb towards the palm of the hand.
• Extension: Moving the bone below the thumb away from the hand.
• Adduction: Moving the bone below the thumb towards the back of the wrist.
• Abduction: Moving the bone below the thumb towards the front of the wrist.
• Opposition: Moving the thumb across the palm of the hand touching the other fingers.

The following movements occur at the metacarpophalangeal joint or MCP joint at the base of the thumb

• Flexion: Moving the joint at the base of the thumb towards the heel of the hand.
• Extension: Moving the joint at the base of the thumb away from the heel of the hand.
• Adduction: Movement of the thumb base towards the back of the hand.
• Abduction: Movement of the thumb base away from the back of the hand.

At the interphalangeal joint of the thumb or IP joint, the following movements can be performed:

• Flexion: Bending the top of the thumb towards the base of the thumb.
• Extension hyperextension: Moving the top of the thumb away from the base of the thumb.

Hands Up! To Do & Notice

Symptoms, diagnosis, and when to see a doctor

A broken knuckle occurs when there is a break in the long bones of the palm, which doctors call the metacarpals. Five metacarpals are present in the palm, and a break in the “neck,” or the topmost part of the bone, is common.

That being said, a broken knuckle can also affect the metacarpal head and the base of the proximal phalanx.

Some common causes of a broken knuckle include punching, sustaining a blow to the hand, and falling directly onto the hand.

This article aims to help a person determine whether or not their knuckle is broken. It also covers some signs that it is time for the person to see a doctor.

Share on PinterestA person with a broken knuckle may experience difficulty moving the fingers.

A very common type of knuckle break, or fracture, is called the “boxer’s fracture.” This type of fracture occurs when a person punches something and breaks the top of the fifth metacarpal bone. This is the bone right below the pinkie finger.

When a person has this type of fracture, their knuckle will appear sunken compared with the other knuckle bones.

However, although the boxer’s fracture is one of the most common knuckle fractures, a person can break any knuckle.

According to one article, the fifth metacarpal is the knuckle that people most commonly break. Fractures in the second metacarpal, below the index finger, are less common.

In people aged 18–34 years, metacarpal and finger fractures are the most common type of fracture in the upper extremities of the body.

Some symptoms of a broken knuckle include:

• bruising
• difficulty moving the finger on the injured knuckle
• hand and finger swelling
• numbness in the fingers and hand
• pain
• a visibly misshapen hand

The most common cause of a broken knuckle is punching or striking an object with the hand balled in a fist.

A doctor will begin diagnosing a broken knuckle by carrying out a physical examination and taking a medical history.

Sometimes, the hand’s deformity or swelling is so significant that a doctor will easily be able to diagnose a broken knuckle.

A doctor will likely take an X-ray, which can help them identify areas where the bones may have broken. Sometimes, X-rays can help a doctor tell the difference between a sprained and a broken knuckle.

They can usually use a physical examination combined with imaging to diagnose a broken knuckle.

The more severe the symptoms, the more likely it is that the knuckle is broken. If the injury does not dramatically affect the knuckle’s movement or cause much pain, it may just be a bruised knuckle.

The treatment options for a broken knuckle depend on several factors:

• whether it is an open fracture (when there is a break in the skin) or a closed fracture
• the number of affected knuckles and whether or not there are other nearby broken bones in the fingers
• the severity of the break and how much it affects the knuckle and fingers

Sometimes, a doctor will “reduce” the fracture, or put the knuckle back into place. When this is the case, they may place a special cast around the thumb or hand to stabilize the fracture and allow it to heal without surgery. If this is not possible, they may use a splint or a brace.

A doctor may recommend that the person comes back to their office 1–2 weeks later to X-ray the hand again to ensure that it is healing properly.

However, if the break is very severe, the doctor may recommend surgery to allow the metacarpal to heal and reduce the likelihood that the person will have a permanent hand deformity.

There are several different approaches a doctor can take, including inserting wires or plates to stabilize the joint.

A doctor should discuss the extent of the injury and the person’s treatment options. They should also discuss any potential side effects of treatment and what might happen if a person does not receive treatment for their injury.

When a person first breaks their knuckle, they can use the RICE method to treat any pain and swelling:

• R is for rest. Resting the affected area can help it heal.
• I is for ice. Applying cloth-covered ice packs for 10–15 minutes at a time can reduce swelling and help minimize pain.
• C is for compression. Wrapping the affected hand in a soft cloth bandage can help reduce swelling and stabilize the injury.
• E is for elevation. Elevating the extremity can reduce swelling and discomfort.

Once a doctor has cleared a person to start moving the affected knuckle, they may recommend physical therapy or some exercises to do at home. Examples might include squeezing a rubber ball and placing a rubber band around the fingers and stretching out the hand.

A doctor should discuss any potential complications from a broken knuckle if the person has had surgery to repair it. These complications include:

• poor wound healing
• stiffness
• surgical site infection

In most cases, if a person has a splint, a doctor will instruct them to stop wearing it after 4–6 weeks. However, a person may receive individual instructions based on the nature of their injury.

A person should seek immediate medical attention if they have the following symptoms:

• numbness in the fingers and hand, which could indicate nerve damage
• severe pain
• a visibly misshapen hand
• swelling that seems to worsen and makes the fingers hard to move

These are all symptoms of a broken knuckle that may require surgical repair.

If a person thinks they have a bruised or sprained knuckle and their symptoms worsen over time, they should seek medical attention

Broken knuckles are a common yet painful occurrence. Treatments will depend on how severe the break is and the number of knuckles it affects.

If a person experiences a loss of sensation in their hand or has problems moving their fingers and thinks they may have broken their knuckle, they should seek immediate medical attention.

Hand Pain and Rheumatoid Arthritis (RA)

Painful inflammation, swelling, and stiffness in the knuckles and wrists can be signs of rheumatoid arthritis. Simple tasks such as opening a jar or turning a key can become difficult.

Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease. RA symptoms appear in the hand when the immune system mistakenly attacks joint tissues in the fingers, thumb, and/or wrist.

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Inflammation, swelling, and stiffness in the knuckles and wrists can be the first signs of RA.

How Rheumatoid Arthritis Affects Hand Function

Experts estimate 90% of people who have RA have symptoms in at least one hand joint.^1,2 Hand dexterity, grip strength, and the ability to pinch objects between the thumb and fingers are likely to be affected.^3,4 People may notice their grip strength is even weaker when RA inflammation levels are high.^3,4

Problems with hand function tend to be the result of RA joint damage.⁵ This damage can weaken tendons and cause joints to be malaligned or deformed. A significant amount of joint damage happens early on in the disease process, which is why early diagnosis and treatment is important.

See Blood Tests to Help Diagnose Rheumatoid Arthritis (RA)

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Hand Joints Most Affected By Rheumatoid Arthritis

Of the 27 joints⁶ in a hand, the joints most likely to show signs of RA include:

• The metacarpophalangeal (MCP) joints, or large knuckles, where the fingers and thumb meet the hand
• The proximal interphalangeal (PIP) joints, or middle knuckles
• The joints of the wrist that connect the wrist’s eight carpal bones with each other and the bones of the forearm (the radius and ulna), including the carpometacarpal joint, midcarpal joint, radiocarpal joint, and intercarpal joints

The distal interphalangeal (DIP) joints, the joints closest to the tips of the fingers and thumb, are less likely to be affected by rheumatoid arthritis. It is more common for DIP joints to be affected by osteoarthritis than by RA. When DIP joints are affected by RA, it is typically only after symptoms appear in the MCP or PIP joints.

See Recognizing Osteoarthritis in the Hand

Hand joints are synovial joints
The small joints in the fingers, thumbs, and wrists are synovial joints. (Most flexible joints in the body, including the knees, hips, and shoulders, are also synovial joints.) Rheumatoid arthritis attacks synovial joints.

• Each synovial joint is encapsulated in a flexible membrane, called the synovium or synovial membrane. When the joint is healthy, the synovium is very thin—just one or two cells thick.
• The synovium produces a clear, viscous fluid, called synovial fluid. This fluid normally nourishes and lubricates the joint, facilitating movement.

Synovial joints in the hand are quite small and normally contain just a tiny amount of synovial fluid.

See How Do Synovial Joints Work?

In This Article:

How Rheumatoid Arthritis Develops

When rheumatoid arthritis occurs, the immune system attacks a joint’s delicate synovium. The affected finger, thumb, and/or wrist joints can become inflamed, swollen, and painful.

The disease process involves these 5 steps:

1. White blood cells invade. The immune system sends white blood cells, called leukocytes, to invade one or more hand joints.
2. Inflammation is triggered. The white blood cells trigger inflammation in the hand joints’ synovium. When synovium is inflamed it is called synovitis.
3. Pannus forms. The inflamed synovial tissue may continue to react to the white blood cell invasion by adding layers of new synovial cells at a very rapid pace. This new, abnormal tissue is called pannus.
4. Cartilage and bone are damaged. The rheumatoid pannus tissue squeezes into the joint space between bones and releases proteins that degrade the hand joints’ articular cartilage, ligaments, and bone.
5. Excess fluid is produced. In addition to releasing damaging proteins, the pannus may create excess fluid that contributes to wrist and knuckle swelling.

Changes can also occur in the hand’s tendons.

Tenosynovitis in the Hands

In addition to encapsulating joints, synovial tissue also surrounds most tendons. Tendons connect muscles to bones. Rheumatoid arthritis can cause a tendon’s synovial sheath to become inflamed, a condition called tenosynovitis. The inflammation is not always painful but can lead to tendon damage.

In the hand, flexor tendons allow a person to bend their fingers. When a flexor tendon is inflamed it can cause the PIP joint to get stuck in a bent position, a condition called trigger finger.

At least one study suggests that tenosynovitis of flexor tendons is a strong predictor of rheumatoid arthritis.⁷

Trigger Finger (Stenosing Tenosynovitis)
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Hand tenosynovitis from rhuematoid arthritis. Read Trigger Finger (Stenosing Tenosynovitis)

How RA Causes Hand Pain

Changes to the hand joint can be seen and felt. Inflammation can cause significant pain, swelling, and stiffness. In addition, joint degeneration and abnormalities can put excess strain on already damaged tendons and other tissues, leading to pain.

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When Rheumatoid Arthritis in the Hand Is Serious

Over time, damage to joint tissues can cause bones to become malaligned. This malalignment can result in hand deformities and prevent the hand from functioning normally.

RA in the hand can be a serious cause for concern if it prevents a person from being able to care for themselves, particularly if they live alone. It can also be serious if it leads to severe carpal tunnel syndrome. Advanced carpal tunnel causes numbness and/or tingling and weakness in the thumb and associated fingers, and can result in permanent nerve damage if left untreated. In either of these cases, consultation with a medical professional is advised.

References

• 1.Flemming A, Benn RT, Corbett M, Wood PH. Early rheumatoid disease. II. Patterns of joint involvement. Ann Rheum Dis. 1976;35:361–364. doi: 10.1136/ard.35.4.361
• 2.Wæhrens EE, Bliddal H, Danneskiold-Samsoe B, Lund H, Fisher AG. Differences between questionnaire- and interview-based measures of ADL ability and the association to observed ADL ability in women with rheumatoid arthritis, knee osteoarthritis and fibromyalgia. Scand J Rheumatol. 2012;41:95–102. As cited in Ellegaard K, von Bülow C, Røpke A, et al. Hand exercise for women with rheumatoid arthritis and decreased hand function: an exploratory randomized controlled trial. Arthritis Res Ther. 2019;21(1):158. Published 2019 Jun 26. doi:10.1186/s13075-019-1924-9
• 3.Palamar D, Er G, Terlemez R, Ustun I, Can G, Saridogan M. Disease activity, handgrip strengths, and hand dexterity in patients with rheumatoid arthritis. Clin Rheumatol. 2017;36(10):2201‐2208. doi:10.1007/s10067-017-3756-9
• 4.Higgins SC, Adams J, Hughes R. Measuring hand grip strength in rheumatoid arthritis. Rheumatol Int. 2018;38(5):707‐714. doi:10.1007/s00296-018-4024-2
• 5.Vliet Vlieland TP, van der Wijk TP, Jolie IM, Zwinderman AH, Hazes JM. Determinants of hand function in patients with rheumatoid arthritis. J Rheumatol. 1996;23(5):835‐840.
• 6.Sharp JT, Young DY, Bluhm GB, et al. How many joints in the hands and wrists should be included in a score of radiologic abnormalities used to assess rheumatoid arthritis?. Arthritis Rheum. 1985;28(12):1326‐1335. doi:10.1002/art.1780281203
• 7.Eshed I, Feist E, Althoff CE, et al. Tenosynovitis of the flexor tendons of the hand detected by MRI: an early indicator of rheumatoid arthritis Rheumatology (2009) 48 (8): 887-891 first published online May 27, 2009 doi:10.1093/rheumatology/kep136

Endoprosthetics of joints of hands (hand and wrist)

With the destruction of the joint – full or partial – a person is tormented by unbearable pain. The organ loses its functional features, which can lead to disability. For some time, the patient can use pain relievers, physiotherapy procedures, but only prosthetics can radically change the situation.

Medicine is trying to restore the function of the joint by conservative methods, but serious changes are not amenable to such treatment.If there is damage to the bone tissue or completely worn out cartilage, no medication will correct the situation.

Endoprosthetics of hand joints is most often in demand among older people. It makes it possible to actively move and feel good. Thanks to such operations, the patient returns to his usual life without pain.

Prosthetics, like any operation, has risks. They are defined:

• health status;
• by the severity of the problem encountered;
• type of prosthetics.

Before the operation, a thorough examination is carried out to identify the indications and contraindications for this action.

Indications for prosthetics

• joint deformity after injury;

90,017 long-standing dislocation;

• joint inflammation of a chronic nature;
• pain that cannot be stopped.

When is hand joint replacement surgery prescribed?

The doctor decides on the need for an operation on the basis of diagnostic data.This can be arthroscopy, x-rays and laboratory tests. Depending on the results obtained, the doctor prescribes:

• physiotherapy exercises;
• medicines to reduce inflammation;
• vitamin supplements.

If medications do not help, the patient may be offered an osteotomy where the surgeon corrects the deformity of the joint. This technique is simpler than replacement surgery, but the recovery period is much longer, therefore, it is performed infrequently.

Endoprosthetics are prescribed when:

• joint movement is limited;
• patient experiences persistent pain;
• problems arise with vital body functions.

Wrist arthroplasty is prescribed when other methods of restoring its function have been unsuccessful. The operation is performed if the joint has suffered irreparable damage as a result of injury, infection, or disease.The reason for this appointment may be arthritis or arthrosis.

In this case, the worn out joint is removed and replaced with an artificial one. The application of the technique restores the mobility of the wrist and restores the normal working capacity to the hand.

Stages of prosthetics:

• the back of the hand is cut;

90,017 tendons spread apart;

• damaged parts of the bone are removed;
• holes are made in the bones to hold the prosthesis;
• the implant is inserted and fixed with bone glue;
• fabrics are sutured gradually – one layer after another.

Rehabilitation usually takes about six months. The stitches are removed after two weeks, and the plaster cast after a few weeks. Classes with a physiotherapist are prescribed. Joint mobility is gradually resumed with exercise.

How is hand arthroplasty performed?

1 stage. The dislocation is corrected and the length of the finger is restored.

2 Step is determined by which joint is affected.It is replaced through a wavy incision in the dorsal side surface.

After prosthetics, a plaster cast is applied, then the doctor prescribes a recovery scheme.

Contraindications

• muscle atrophy;
• violation of blood supply;
• destruction, impossibility of holding the endoprosthesis;
• concomitant diseases in the acute stage;
• high physical activity with the impossibility of limiting the high load on the joint, which requires replacement;
• If the patient refuses to follow instructions.

Endoprosthetics of the joints of the fingers to restore their mobility is used in rheumatoid arthritis. As for recovery from injuries, the use of the technique is limited, and even vice versa – damage to tendons and ligaments due to injuries is considered a contraindication and prosthetics.

The problem is solved in stages:

• restore the correct anatomical structure;
• prepare the soft joint;
• put the prosthesis.

The risk of developing side effects increases if:

90,016 90,017 people are actively involved in sports;

After surgery, doctors monitor the recovery process to ensure a favorable outcome.

Where to do it?

In the clinic of the Central Clinical Hospital of the Russian Academy of Sciences, wrist joint replacement operations are performed every day: we restore the regular work of fingers and wrists to patients from Moscow and the regions.You can find out more about the cost of the procedure and the reviews of patients who entrusted us with the operation in the corresponding section of the clinic’s website.

Hand deformations

Congenital and acquired deformities of the hand

DEFORMATION OF THE HAND

The following pathological conditions leading to dysfunction of the hand and severe disability can be the causes of deformity of the hand:

1. Congenital

• Finger missing
• Syndactyly (fusion of fingers)
• Primary muscle contracture, eg multiple arthrogryposis, congenital (rare)

2.Acquired

• Trauma (missing fingers, tendon injuries, fractures of the bones of the hand, etc.)
• Burns (cicatricial contractures).
• Dupuytren’s contracture
• Rheumatoid arthritis
• Volkmann’s ischemic contracture
• Spinal cord injury (poliomyelitis, syringomyelia)
• Brachial plexus injuries
• Peripheral nerve injuries
• Multiple enchondroma diseases – rare diagnosed at the birth of a baby.Multiple congenital arthrogryposis is often associated with other neurological disorders; a combination accompanied by severe deformities of the limb.

  Dupuytren’s contracture

  Dupuytren’s contracture is a fairly common disease of the hand. Most often, the process involves the ring finger and / or the little finger. Dupuytren’s contracture is formed by “wrinkling”, contraction of the palmar fascia as a result of excessive development of connective tissue.Such a pathological process leads to the impossibility of extending one or two fingers. In this case, thickenings (nodules) or thick short cords are often formed in the thickness of the palmar fascia, going towards the ring finger. In advanced cases, fibrotic changes form in the joints of the involved fingers, which leads to stiffness of the fingers. Often, Dupuytren’s contracture develops simultaneously on both hands.

  The frequency of occurrence of Dupuytren’s contracture in men is several times higher than in women.The most common Dupuytren’s contracture occurs in middle-aged men.

  At a young age, this disease is quite rare, but over the years the frequency of development of Dupuytren’s contracture increases. If the disease occurs at a young age, then, as a rule, there is a rapid progression of symptoms and a more severe course of the disease.

  Causes

  The exact cause of the disease is unknown. There is a clear hereditary predisposition to this disease.Smoking is an independent risk factor for the development of Dupuytren’s contracture. Alcohol abuse also increases the likelihood of developing this condition. Recent clinical studies have shown a relationship between an increased incidence of Dupuytren’s contracture and the presence of diabetes mellitus in a patient.

  Symptoms

  The disease may have an acute onset, but in most cases, severe symptoms do not appear until several years after the onset of the disease.

  Normally, we can freely flex and extend our fingers. With the development of Dupuytren’s contracture, as a result of wrinkling of the palmar fascia, the ability to freely extend the fingers is impaired. As the disease progresses, stiffness appears in the joints of the involved fingers. With a severe course of Dupuytren’s contracture, the development of complete immobility of one or two fingers may be noted, that is, the development of ankylosis. In some patients, connective tissue nodes in the thickness of the palmar fascia are characterized by significant pain.In the initial stages of the disease, thickenings in the palm area are found in the form of dense strands or nodules. In the later stages of the disease, connective tissue nodules can be located in the area of ​​the fingers

  Treatment

  Treatment of Dupuytren’s contracture can be carried out both conservatively and surgically. The main point for choosing a treatment method is the severity of pathological changes in the palmar fascia.

  TRAUMATIC DEFECTS OF BRUSH SEGMENTS

  Traumatic defects of various segments of the hand occur as a result of severe mechanical injuries with primary tissue destruction, as well as after deep burns, frostbite, ischemia.

  Classification.

  I. Reason:
  mechanical injury;
  thermal injuries;
  others.

  II. Number of beams: isolated; plural; total.

  III. Level: compensated; subcompensated; decompensated I, II, III degree.

  IV. Side: left; right; both brushes.

  The number of defects in brush segments is determined by the number of rays. There may be an isolated defect of one ray, which is more often observed on the 1st ray in the form of a defect in the phalanges and metacarpal bones at various levels.Multiple ray defect means complete or partial loss of two to three or four rays. A total defect is an amputation of the hand at the level of the carpal bones, when the hand as an organ loses its shape and function.

  Depending on the level of the defect in the segments of the hand, three degrees of severity are distinguished, which make it possible to roughly establish the indications and choose the method of reconstruction of the stump.

  Defects of the distal phalanges of the fingers refer to compensated ones that do not require restoration.

  Subcompensated are defects at the level of the main phalanges of the fingers, while the indications for reconstruction are determined individually, in order to improve the function of gripping objects.

  Decompensated finger defects are subdivided into three severity levels. At the first level, the defect runs along the metacarpophalangeal line. Such a stump has a significant limitation of function and is indicated for reconstruction. The second level of decompensation runs along the middle of the metacarpus.Such a brush lacks gripping functions and needs to be reconstructed. The third level of decompensation runs along the line of the wrist – this is the loss of the hand. Currently, there are no ways to reconstruct such a stump. She is subject to prosthetics.

  The side of the traumatic defect of the segments of the hand is of great importance in determining the degree of compensation for the patient’s general working capacity. The adaptability to work processes and self-service in everyday life in persons with hand segment defects is very high. However, surgical reconstruction according to the indications, and in some cases on the order of the patient, increases the chances of a more complete compensation for the lost hand function.

  POSTTRAUMATIC CONTRACTURES

  Contracture – limitation of the range of motion in the joint due to pathological changes in the surrounding tissues functionally associated with the joint.

  Classification:

  I. Due to:
  1. Traumatic.
  2. Fixation resulting from prolonged immobilization with plaster casts.
  3. Ischemic, associated with circulatory disorders against the background of any trauma or tissue compression.
  4. Others.

  By localization, hand contractures are distributed according to the anatomical structure of the joints: contractures of the wrist joint, metacarpophalangeal, metacarpophalangeal, interphalangeal joints and are characterized by their clinical features.

  In terms of prevalence, the following are noted: isolated contracture of any one joint; multiple – several joints of the hand.

  By dysfunction, there are: flexion contractures with various deficits in the extension of the hand and fingers.Extension, accompanied by a large deficit in flexion of the hand and fingers; flexor-extensor, the most severe contractures with cicatricial damage to the tissues of the palmar and rear surfaces of the hand and concomitant fibrosis of the joints, tendons and muscles. As a rule, they are multiple with impaired grasping function of the hand! Abduction contractions in the position of spreading fingers and adduction – with adduction and deficiency of abduction of the fingers, limitation of interdigital and planar grips.Cicatricial degeneration of the tissues of the wrist joint is the cause of dysfunction of the hand.

  Causes

  Various types of damage to the hand and fingers: closed intra-articular bone fractures, joint dislocations, accompanied by hemarthrosis followed by plastic arthrosis; open, including gunshot, wounds of the hand, from scalped wounds to injuries of the osteoarticular apparatus, muscles, nerve tendons. Post-traumatic contractures include the most common consequences of deep, thermal and chemical burns, electrical injuries, frostbites, accompanied by an extensive scar defect of the skin and underlying tissues at various depths.

  Fixation contractures are associated with prolonged immobilization of the injured hand with various, especially plaster, bandages in an antiphysiological position. In this case, contracture develops not only in the damaged joint, but also in healthy adjacent joints as a result of adhesive fibroplastic arthritis and tendinitis. The most susceptible to fixation contractures are the metacarpophalangeal and interphalangeal joints, in which quickly, after 3-4 weeks of immobilization, stiffness develops with a transition to a persistent contracture.

  Ischemic contractures result from impaired peripheral blood flow in the damaged tissues of the forearm, hand and fingers. Prolonged ischemia causes dystrophy, primarily of muscles and nerves, and subsequent myogenic and neurogenic contracture. Ischemia can develop as a result of thrombosis of large arteries in the syndrome of positional compression or syndrome of prolonged crushing of the tissues of the hand. The cause of ischemia may be compression of muscles and nerves by deep subgaleal, subfascial hematoma of the middle muscle space of the forearm and palm.Compression with a circular plaster cast in fractures of the forearm, wrist and hand can also cause impaired blood flow and tissue ischemia with the formation of desmogenic contractures.

  Dermatogenous contractures develop with cicatricial changes in the skin and subcutaneous tissue. In this case, the scar is not welded to the deep-lying tissues – tendons, bones. Scar tissue is mobile, tightening the skin, restricts flexion or extension of the joints.

  Desmogenic contracture occurs when tendons, synovial aponeurotic canals, muscles of the forearm and hand are involved in the scarring process.In this case, there may be a combination with dermatogenic contracture. In this case, the skin scars are fused to the tendons. As a result of muscle traction, flexion contractures of the fingers are more common. Joint mobility within the limits of the scar is preserved. A special place is occupied by neurogenic contractures of the fingers. In connection with persistent damage to the ulnar and median nerves, a “claw-like hand” develops with a deficit in extension, flexion and opposition of the fingers.

  Arthrogenic contractures develop due to primary damage to the articular-ligamentous apparatus.The secondary cause of such contractures is deep dermatodesmogenic tissue lesions that keep the joint in a vicious position for a long time. In this case, wrinkling of the joint capsule, ligaments, dystrophy of the articular cartilage and, as a result, stiffness, which in the literature is called “fibrous” ankylosis, occurs. Arthrogenic contractures of the interphalangeal joints are often accompanied by phalangeal subluxation.

  Dermato-desmo-arthrogenic contractures develop after severe open fractures, gunshot injuries, deep burns as a result of cicatricial degeneration of all tissues anatomically associated with the joints of the hand and fingers.

  Treatment

  1. Prevention of contractures of the hand joints during the treatment of fresh injuries. Prevention of peripheral blood flow disorders, tissue edema, infectious complications as the main causes of degeneration of all structures of the hand and the occurrence of cicatricial rigidity, stiffness and joint contractures.

  2. Earlier complex conservative treatment of contractures after various hand injuries, including general and local use of medications and physiotherapeutic agents, aimed at restoring blood circulation, eliminating edema, resolving scar tissue, normalizing muscle tone and range of motion of joints.

  3. Timely, rational surgical treatment for persistent contractures with limited hand function in case of ineffectiveness of conservative rehabilitation methods.

  The choice of the method of operation depends on the nature of the contracture. The leading place in the treatment of contractures is occupied by various methods of skin grafting to replace scar tissue in the hand.

  Reconstructive operations on the hand using microsurgical techniques

  Reconstructive operations on the hand are performed with the aim of restoring it in case of congenital deformities or after burns, mechanical trauma, and other injuries.The treatment affects bones and joints, soft tissues, nerves, blood vessels. Treatment is usually long-term, often multi-stage.

  Modern methods of treatment allow restoring the function and structure of the hand, even with serious injuries.

  Possibilities of surgery:

  • Correction of the consequences of injuries, burns.
  • Surgical treatment of hand diseases.
  • Elimination of congenital and acquired deformities of the hand, including lost fingers.
  • Restoration of the hand-grip function in case of loss of all fingers.
  • Restoration of mobility of the joints of the fingers and the hand itself.
  • Endoprosthetics of small hand joints.

  Basic methods of restoring the damaged part of the hand:

  • free skin grafting from other parts of the body;
  • Free transplantation of complex tissue complexes from other parts of the body using microsurgical techniques;
  • Moving a complex of tissues from healthy areas of the hand
  • Moving a complex of tissues from distant parts of the body

  Possible complications
  infection,
  poor healing,
  loss of sensitivity or movement,
  hematomas
  allergic reaction to anesthesia.

  These complications are not common, but they can be.

  Dupuytren’s contracture

  Surgery is the only treatment for Dupuytren’s contracture. The thickened tissue is excised and the tendons are released, allowing free movement of the finger. The procedure is performed very delicately, as nerves can be woven into the altered tissues. The results of the surgery depend on the severity of the condition. Usually, the functions of the hand are significantly improved, and a thin and rather inconspicuous scar remains at the site of intervention.

  Congenital and acquired deformities

  One of the most common birth defects is syndactyly. With this pathology, two or more fingers are spliced ​​together. The tissues connecting the fingers are dissected, and the formed wound defects are closed by redistributing the existing tissues or, if there is a lack of them, skin transplantation is performed from other parts of the body. The operation usually provides a full range of motion and a fairly normal appearance, although the color of the transplanted skin may differ slightly from the rest of the hand.

  Deformation of the hand after burns or injuries

  The range of operations for correcting this kind of deformity is very large. However, the essence of all operations is reduced to excision of the scar-altered skin and deeper soft tissues and restoration of the resulting defect with other tissues. This can be free skin grafting, the transfer of intact skin in case of damage to a part of the hand, plastic with complex complexes of soft tissues from other parts of the body with temporary suturing of the hand to the body, or in the form of free plastic using microsurgical techniques.

  Endoprosthetics of small joints of the hand

  Endoprosthetics of small joints of the hand is performed in case of violation of the integrity of the joints due to trauma or rheumatoid arthritis.

  RETURN TO NORMAL LIFE

  The operation is just the beginning of the restoration of the hand. Further, physical exercises, massage, possible wearing of a splint, immobilization, compression garments and other treatment are required, depending on the type of hand deformity.For maximum restoration of hand function, a full course of therapy is required.

  Arthritis of the joints of the hands, feet and fingers: types, symptoms, causes, treatment and prevention

  Number of views: 105 066

  Date of last update: 03/22/2021

  Average reading time: 4 minutes

  Contents:

  Causes of arthritis
  Treatment of arthritis pain
  Prevention of arthritis
  Educational video “Pain in arthritis and arthrosis”

  Diseases are widespread in society they are most often acute or constant aching pain, which can be extremely difficult to relieve.Arthritis is an inflammatory disease of the joints. Today, there are 150 known types of arthritis. According to the World Health Organization (WHO), every tenth person suffers from one or another arthritic disease. Diseases can progress over the years, leading to thinning and deformation of the articular tissues, a significant decrease in the patient’s quality of life. Joint pain with arthritis is the main symptom that is characteristic of all forms of the disease. It is complemented by puffiness, hyperemia, limited mobility and morning stiffness.

  Up to contents

  Causes of arthritis (knee, shoulder joints and fingers)

  There are three main groups of arthritis: independent forms of arthritis, traumatic arthritis and arthritis associated with other diseases. Arthritis can develop slowly and gradually (chronic forms) or suddenly and abruptly (acute forms). The exact causes of the emergence of an independent disease arthritis can be difficult to establish.

  The cause of the development of an inflammatory process in the joint can be a local or general infection, trauma, allergy, autoimmune disorders, metabolic disorders, hormonal disorders, etc.However, the cause of some severe inflammatory joint diseases is still not clear enough. The factors contributing to the development of arthritis are hypothermia, physical overload of the joint, hereditary predisposition:

  Each type of arthritis has its own reason, the elimination of which should be directed to the main treatment. Symptoms of arthritis can also differ depending on the form of the disease and its type, but joint pain is an inevitable companion of any arthritis.Often, arthritis is accompanied by a febrile condition, swelling and redness in the joint area, impaired motor function of the joint, weakness and weight loss, morning stiffness. As the disease progresses, the pains become more intense and severely exhaust the patient. At the same time, pain in arthritis is spontaneous, most intense in the second half of the night and in the morning, and decreases after movement.

  Up to the table of contents

  Treatment of pain in arthritis

  Treatment of arthritis is long-term, takes more than one month and requires compliance with all medical prescriptions.The sooner you see a competent specialist, the higher the likelihood of recovery or a significant reduction in relapses. In the acute period, when the pain is severe, it is necessary to exclude direct loads on the joints of the arms and legs. But you can, with the permission of the doctor, go in for swimming, light warm-ups so as not to lose shape and skills.

  To get rid of joint pain, the doctor may recommend taking non-steroidal anti-inflammatory drugs as part of the complex therapy for the treatment of arthritis.After an acute period of the disease and a decrease in signs of inflammation, physiotherapy is used: ultraviolet irradiation, electrophoresis, massage, exercise therapy.

  If conservative therapy is ineffective, minimally invasive arthroscopic surgeries or endoprosthetics are recommended.

  Up to content

  Prevention of arthritis

  Prevention of arthritis is reduced to avoiding and eliminating all possible provoking factors. A healthy lifestyle, weight control, a balanced diet, avoiding excessive alcohol consumption and regular preventive examinations with a doctor will significantly reduce the likelihood of developing arthritis, and compliance with all doctor’s recommendations in the early stages of the development of diseases will significantly increase the likelihood of recovery or significantly reduce the likelihood of relapse.

  Up to Table of Contents

  The information in this article is for reference only and does not replace professional medical advice. Consult a qualified professional for diagnosis and treatment.

  Educational video “Pain in arthritis and arthrosis”

  The myth of people whose joints bend in both directions

  • Jason G. Goldman
  • BBC Future

  June 25, 2015

  Photo author, Thinkstock

  In nature, there are no people whose joints really bend in both directions, although some of us have joints that are really very elastic.And this property can lead to very unexpected effects, says the correspondent

  BBC Future .

  Surely you know someone (or, more likely, you knew as a child) who bragged about their joints flexing in both directions. As proof, these boasters flexed their thumb back so that it could touch their wrists. However, for all their bragging rights, these schoolyard performance masters are not really medical phenomena.At the very least, humans cannot have joints that bend in both directions. But what about these boasters, whose bodies and limbs are capable of wobbling in the most incredible way, like on hinges? They are simply incredibly flexible.

  Doctors and scientists call this hypermobility or joint elasticity. It just means that some people can flex their joints more than others. Most of us can bend our thumb a few degrees, but some can bend it at a large angle.We can all bend at the waist, but for some individuals, their lumbosacral joints allow us to lean back and place both hands on the floor. Each of us can spread our legs wide, but only some have the hip joint so mobile that it allows them to sit on a split.

  And in order to be able to talk about hypermobility of the joints, such flexibility must be innate, and not acquired as a result of training or stretching. Some athletes and dancers, for example, may eventually get their bodies more and more flexible through training, but the hypermobility of the joints that is occupying us right now is an innate property.

  In order to understand how a joint can be more or less flexible, a short lesson in human anatomy is required. There are two factors that limit joint mobility: the shape of the bones and cartilage, or ligaments. Michael Habib, an anatomist and specialized vertebrate paleontologist at the University of Southern California, states: “You may have a hard time exercising – it may be because something is bumping into something – or you may have a ligament. which will keep everything in its place. “

  Hooks and grooves

  If a person can bend their thumb up to the wrist, it is usually because their ligaments allow them to do so. “If you have weakened ligaments from birth, then they will be more mobile,” says Khabib.

  On the other hand, some of those individuals whose joints seem to bend in both directions, owe their flexibility to the structure of their own bones. A typical case of hypermobility relates to the joints of the elbows. Some people are able to bend their elbow joint in the “wrong” direction so that an angle in excess of 180 degrees is obtained.

  Photo author, Getty

  There is a process of bone that forms the sharp part of the shoulder, it is called the olecranon or olecranon. “It has a small hook, but the hook is actually quite large,” explains Khabib. This hook is in a small groove located on the back of the humerus; this is the upper arm bone – the humerus or humerus. And when you extend your arm, the hook slides into that little groove. When the hook rests against the end of the groove, you cannot bend your arm any further.

  “If your olecranon is small or if the groove is deep, then you can extend your arm more than 180 degrees,” says Khabib. bones have a slightly different structure. ”

  In 2004, a UK study was conducted on adult female twins. It should have confirmed the earlier assumptions that joint hypermobility is caused by genetics.It turned out that in pairs of identical twins, both sisters more often had joint hypermobility than in pairs of fraternal twins. Back in the 1930s and 1940s, researchers found that joint hypermobility is usually inherited in families.

  Researchers have also found that joint hypermobility decreases over the years. Children tend to be more flexible than their parents and grandparents. Women tend to have more flexible joints than men, although this may be due to the fact that men tend to be larger.There is also evidence that people of African, Asian and Middle Eastern descent are generally more hypermobile than the descendants of Europeans.

  Most super-flexible people are not harmed by these qualities. However, some may be diagnosed with one of the symptoms of the so-called Ehlers-Danlos syndrome, which can be quite painful. Dr. Michael Simpson wrote in an article in the Journal of the American Association for Osteopathy that 4 to 13% of people have symptoms of Ehlers-Danlos Syndrome, usually in the thumbs, little fingers, elbows, knees, and spine.

  The Dancer’s Dilemma

  There is a group of people with hypermobility of joints that is more often than others the object of scientific research – these are dancers. Joint hypermobility, even in its mildest form, is often associated with a lack of stability. “If the joint is really flexible, it will not be stable enough, and you will end up using the strength of your muscles more in order to fix it,” says Khabib.

  Photo author, Getty

  Caption,

  Women are said to have more flexible joints than men

  Because of this, people with increased joint mobility ultimately have to use their energy to maintain balance. instead of doing whatever they want to do – like lifting weights (in the case of elbows) or even just standing up straight (in the case of knees and back).

  In a 2012 report, physiotherapist Mark Scheper of the University of Applied Sciences Amsterdam questioned whether hyper-movement is “a sign of talent or vulnerability” for professional dancers. “From an aesthetic point of view, joint hypermobility is often touted – and looks like – part of professional dance education,” he writes, but this can lead to such dancers being more prone to pain and fatigue than their counterparts with less flexible joints.As a result, the dancer may develop psychological symptoms of depression and anxiety.

  For their research, Scheper and his colleagues recruited dancers from the Amsterdam School of the Academy of Arts and compared them to girls from the nearby Amsterdam Medical School. He found that overall joint hypermobility is usually accompanied by “less muscle strength, reduced maximum exercise ability, and less walking ability.”This pattern was observed in patients from both schools. However, joint hypermobility was much more common in dancers than in medical practitioners.

  Strength Test

  Dancers with joint hypermobility were more likely to complain of severe fatigue than medical students with the same symptoms. Researchers suspect this may reflect the fact that dance education in principle requires more activity, but it also suggests that even with all their training, dancers are less physically prepared than girls in medical school.In addition, dancing at a professional level requires not only flexibility, but also more control and high precision of movement. Thus, those with more flexible joints can become more tired with precision movements.

  Photo author, Getty

  Photo caption,

  Those with more flexible joints can get more tired, achieving accuracy of movements

  All dancers were more tired than doctors, but dancers with joint hypermobility were the most tired. “It is possible,” Sheper writes, “that such dancers have to put in more effort to meet the requirements of a professional dance education, but they also have to put in more effort to maintain their skills.”

  In light of their research, Scheeper and colleagues have suggested that hypermobility of the joints may be a disadvantage rather than an advantage for professional dancers.

  However, we should avoid generalizations, say British rheumatologists Howard Byrd and Elaine Foley. With advanced knowledge and understanding of anatomy, Bird and Foley point out that the art of dance is not monolithic.

  “The requirements for ballet dancers are different from those for contemporary dancers,” they write.After all, even if we talk only about modern dance, the styles and techniques of outstanding choreographers, such as the late Martha Graham and Merce Cunningham, are strikingly different from each other.

  Indeed, evaluating the effect of superflexibility on dance requires more research than a modest study of joints.

  Hand injury – treatment in Moscow on Aviamotornaya (Lefortovo)

  Hand contusion and treatment

  Injuries such as bruises are the most common.In this case, the soft tissues of the hand swell, there is an extensive hemorrhage of the soft tissues, and sometimes the temperature may rise locally.

  For treatment, drugs are used to relieve inflammation, pain and swelling. It is necessary to immobilize the limb. If at the same time the skin was damaged, antiseptics or antibacterial agents should be used. In the recovery period, it is advisable to apply the methods of physiotherapeutic treatment and a complex of exercise therapy.

  In 70% of cases, bruises do not require hospitalization and serious therapy, but sometimes injuries can be very severe, followed by impaired mobility and innervation.

  Injuries of ligaments, tendons and their treatment

  The tendons of the hand are very easy to injure, as they are superficial and more accessible for injury. Such injuries can be of a traumatic nature (due to injury with a sharp object, heavy load, etc.) or pathological (due to a number of diseases, for example, rheumatoid arthritis).

  Ligament rupture can be partial or complete.

  As a result of a tendon injury, the shape of the hand changes, and mobility is lost in the area of ​​damage.

  The peculiarity of tendon damage is that they do not recover on their own, they must be sutured surgically. If the extensor tendons are damaged, the procedure can be performed under local anesthetic and does not require hospitalization. Flexor tendon injuries require hospital treatment.

  After a tendon injury, it is important to undergo a full-fledged rehabilitation, which includes physiotherapy exercises. If you do not develop the finger from the first days, the tendon can be fixed to the surrounding tissues with impaired functional ability.It takes 3-5 weeks for the tendon to heal, after which the bandage is removed. The rehabilitation period takes 1.5-2.5 months.

  Dislocations of fingers and treatment

  Sprained fingers are one of the most common injuries and most often occur after direct exposure.

  The following symptoms indicate the presence of dislocation:

  • Severe pain that increases on palpation;
  • Deformation of the finger;
  • Complete lack of movement in the damaged finger joint.

  It is not always possible to professionally establish the presence of a dislocation on your own. The doctor diagnoses the dislocation after examination, as well as based on the results of x-rays.

  When confirming the diagnosis, the traumatologist sets and fixes the finger in the correct position. If necessary, the procedure can be performed under anesthesia. Subsequently, it is necessary to properly undergo rehabilitation treatment in order to fully restore the functionality of the hand.The duration of treatment and rehabilitation is 3-5 weeks.

  Finger fractures and treatment

  Fractures of the bones of the fingers are:

  • open or closed;
  • intra-articular or extra-articular;
  • without displacement and with displacement of fragments;
  • traumatic and pathological.

  As a result of the fracture, the mobility of the finger of the hand is significantly limited, the ability to take or hold the object is lost, any load causes sharp pain.

  The following signs indicate the presence of a fracture:

  • edema and hemorrhage;
  • deformation of the damaged segment;
  • pain on palpation and any movements;
  • limitation of mobility.

  To clarify the diagnosis, an examination by a traumatologist and radiography is carried out. In case of fractures of the wrist bones, a computer study is necessary for diagnosis.

  The fracture zone is fixed conservatively or surgically.If the fracture is displaced, surgery is performed. Plates, pins or screws can be used as bone anchors.

  Types of surgical treatment for hand injuries

  Sometimes surgery is the only possible treatment.

  Surgical interventions for severe injuries include:

  • Primary or secondary surgical debridement of wounds;
  • Osteosynthesis for fractures and unstable dislocations;
  • Primary suture of damaged tendons;
  • Staged tendon plasty;
  • Surgical treatment of false joints;
  • Treatment of post-traumatic contractures.

  Our Center uses both conservative and surgical methods of treatment for injuries and diseases of the hand. Professional traumatologists of the Scandinavian Health Center will provide qualified medical care for any type of injury. In the Center for Rehabilitation Medicine, you can undergo the entire course of rehabilitation treatment using modern techniques (shock wave therapy using a Duolit device (Switzerland), cryotherapy, laser therapy, hydraulic massage of the damaged area).

  Tunnel syndrome in IT people: when “hands fall off”

  Tunnel syndrome is pain in the wrist and numbness in the fingers that can be caused by prolonged use of the computer. Andrey Beloveshkin, candidate of medical sciences, told dev.by what the danger is and why it is easier to prevent this ailment than to cure it.

  – As the popular wisdom says, “where it is thin, there it breaks,” and where it is narrow, it is infringed. Our hands can withstand heavy loads, but they also have their weak point, the “Achilles heel”.This is the carpal tunnel (Fig. 1) , where 9 muscle tendons and one median nerve pass through one narrow opening (Fig. 2). With prolonged monotonous movements of the hand, the pressure in this channel increases. And since the nerve is softer than the tendons, it is he who is damaged. This condition is called carpal tunnel syndrome, or carpal tunnel syndrome.

  This disease is considered occupational in many workers, assemblers, draftsmen, musicians, butchers, needlewomen.Tunnel syndrome was detected in every sixth surveyed working on a computer. Because of the computer mouse, the leading hand is more often affected, but with prolonged work at the keyboard, the other hand also suffers. Preventing this condition is much easier than treating it: in advanced cases, the nerve is damaged, which takes a very long time to recover. Therefore, even surgery often does not bring relief.

  At first, there is a slight aching pain, discomfort in the wrist after prolonged work.Sometimes – in the form of itching, trembling. The pain quickly disappears after a break, a warm-up helps well. The median nerve innervates the greater half of the hand (from the side of the thumb), therefore, a characteristic sign of tunnel syndrome is the absence of pain in the little finger at the initial stage.

  Over the course of several years, the breaks “between pain” are shortened, and a slight unpleasant sensation in the wrist during work becomes the norm. After some time, this sensation will stop disappearing altogether.

  With an expanded picture of the syndrome, stiffness and a burning sensation in the wrist area are added.Often in the morning. Sometimes there is a feeling of passing an electric current, attacks of burning pain. In some people, pain can radiate up the arm, reaching the head: pain in the chest, headache on the right in right-handers, pain in the neck and shoulder. Because of this, people often confuse tunnel syndrome with osteochondrosis.

  In addition – movement disorders. The muscles of the fingers also suffer. Feelings of awkwardness or weakness can limit the execution of delicate finger movements – it is difficult to button up buttons, tie shoelaces, or tie a tie.That infrequent case when alcohol has nothing to do with hand tremors.

  If the pains suddenly receded, this is no reason to rejoice: the decrease in sensitivity occurred due to nerve damage, and it is then difficult to recover.

  There are some very simple tests to tell if you are dealing with tunnel syndrome.

  Prayer test. Fold your palms at chest level, as if praying. Smoothly lower the joined palms as low as possible to the maximum position, hold them in a bent position for at least one minute.Normally, pain and sensory disturbances (chills, burning) appear no earlier than one minute.

  Hand Hoh test. Raise your outstretched arms above your head and hold them in this position for at least one minute. The same thing: normally, pain and sensory disturbances (goose bumps, burning) appear not earlier than one minute.

  Bottle test. Raise the full bottle by the neck with your thumb and forefinger. If it slips out, then you have severe tunnel syndrome.This test manifests itself already in the later stages.

  The best way to avoid the development of the syndrome is the correct posture, hand position, individually selected mouse and keyboard.

  Correct posture: 30, 90, 180 degrees

  It is very easy to feel the correct position of the hand: stand up, put your feet at shoulder level and sit down a hundred times, lower your arms freely. Now look at how the brush is positioned: about 45 degrees to the body. That is, not parallel or perpendicular to the hips.This is its neutral position, at which muscle tension is least.

  Hence – the four main rules for creating the minimum pressure in the carpal tunnel:

  1. Brush-to-table angle = 30-40 degrees. The brush should ideally lie on the mouse at exactly this angle. The correct mouse of your size helps to achieve this (we will talk about this below).
  2. Shoulder-forearm angle = 90 degrees (Fig.5) . When working, the elbows should be bent and close to the body. Straight outstretched arms create a strong tension in the muscles.
  3. Hand-forearm angle = 180 degrees. That is, the hand and forearm should form one line both horizontally (Fig. 3) and vertically (Fig. 4) . There are tons of devices with a special bump for the wrist — a mouse pad (Figure 12), gel pads, or a computer desk with similar bumps.Alternatively, you can put something soft under your forearm, raising your hand, or use the “computer bracelet” (Fig. 13) .
  4. Elbow support, “computer arm support” (Fig. 11) . The fact is that the average weight of a human hand is 5-7 kg. If the elbow hangs without support, the weight of the arm is distributed to the deep muscles of the neck. Hence – excessive tension and pain in the neck, head, upper back (trapezius muscles are overloaded). You don’t have to buy a new chair or special table to fix your elbow.Google “computer arm support” – there are many cheaper solutions that can be bolted to a chair or table.

  Plus it is very useful to learn how to work with the left hand. The development of the skill takes about a month, gives +50 to creativity and allows less fatigue. Do not forget to change the position of your hand if you are not using either the keyboard or the mouse, do not let your hand lie idle all the time if you are not using it. Lift it up, hold it up, twirl the ball.

  The Right Gadgets

  Choosing the right gadgets can greatly relieve pain and stop the development of tunnel syndrome.

  Mouse, or shoe rule

  You don’t buy boots that are big or tight, do you? The exact same rule is true for the hand. A large computer mouse is suitable for people whose palm is larger than average. The main thing in choosing a mouse is your own feelings. And to order mice online, you can use a simple rule.If you take a ruler and measure the distance from the tip of the ring finger to the base of the palm, you will get the sizes small (up to 17 cm), medium (17-19 cm), large (19-21 cm) + photo. Alternatively, there are mice with adjustable size.

  The height of the mouse is important: it must support the palm so that it does not dangle. If the mouse is small for you, then the brush will sag over it, and if it is large, then you will have to squeeze it harder. Ideally, your brush should literally merge with the mouse.Yes, don’t forget to programmatically configure your mouse correctly.

  When moving the mouse, try to move the forearm more, use the movement with the hand only for small operations.

  Try ergonomic computer mice. The disadvantage of such mice is that it takes time to get used to them.

  1. Vertical mice (Fig. 7, see above) . In their device everything is well conceived, but the angle “brush-table surface” is too high, when working, you need to squeeze your hand, it strives to slip.
  2. “Orthopedic” mice (Fig. 6) . They are less common and more expensive. Supports the entire arm, reducing stress and tension on the interosseous membrane. Handshoe Mouse, Contour Mouse, etc.
  3. Alternative devices (graphic tablets, virtual pencils, touch screens). When working with such a device (Fig. 10), the hand is located in a neutral position (45 degrees to the table surface), the fingers of the hand receive less stress.Very effective relief for the brush.

  Keyboard, or protect your thumb

  The same rules and angles apply to keyboards. The ergonomic keyboards (Fig. 14) are especially good – they allow you to maintain the angle “hand-table” and angle “hand-forearm” (keys expanded for the right and left hands).

  Keys should be pressed softly and lightly so that there is no unnecessary strain on the fingers. Type correctly: the pain of tunnel syndrome is aggravated by the overload of the thumb, which occurs if you often press the spacebar with the thumb of only one hand.

  Exercise: Wrist Exercise

  In the early stages of carpal tunnel syndrome, exercise is helpful.

  – forcefully squeeze your fingers into a fist and unclench;

  – shake with relaxed hands, gradually lifting them to the sides and up;

  – interlace your fingers and make squeezing movements;

  – press your elbows to your sides, squeeze your fingers into a fist and rotate your brushes in different directions;

  – press your elbows to your sides, palms forward, squeeze and unclench your fingers in the phalanges;

  – put your palms together in front of your chest, pressing the fingertips with tension, tilt your hands to the right and then to the left;

  – make rotational movements with the brushes to the sides and inward;

  – take turns pulling one finger forward and twisting your finger clockwise or counterclockwise;

  – Take turns making a ring, pressing each finger with effort to the thumb.

  For exercises, you can use simple rubber soft balls, with and without spikes: twist them, squeeze strongly with the whole brush, squeeze in turn with one finger, throw and catch. If you keep such a ball on the table, it will be easier to remember the warm-up.

  Make a simple self-massage of the brushes. To do this, gradually knead your fingers in turn, first with your right hand – on your left, then vice versa. From your fingertips to your base. Self-massage and baths are effective at the onset of the disease, and in the later stages, the effectiveness decreases.

  What to do if it hurts, but you need to work

  There are times when wrist pain and uncompleted work plague you at the same time.

  The first step in such a situation is to relieve the pressure on the nerve! To do this, use special locks that hold the hand in the correct position. In pharmacies and medical equipment stores, you can buy special devices – orthoses, bandages, hand braces. They are very comfortable, easy to put on and take off, work in them, they do not restrict their owner.Such dressings are no less effective than medical and surgical treatments. If you don’t want to wear a bandage during the day, wear it at least at night. Please note that the bandage must contain a rigid or springy element. Alternative graphics tablets and styluses, touch screens can be added to the headband.

  Try placing your sore hand on your elbow more often with your fist up. And don’t overuse pain relievers. Follow the general rules and working hours, take mini-breaks. Sports activities – pull-ups, push-ups on the uneven bars, push-ups on the palms, exercises with weights – also strengthen the hands and prevent narrowing of the canal.

  The main thing is, do not give up!

  Andrey Beloveshkin – Doctor, Candidate of Medical Sciences, former lecturer at Belarusian State Medical University, TEDx speaker. Currently he consults, conducts trainings on strengthening health resources. Research area – scientific measurement of health resources, individual prognosis and assessment of disease risk, their proactive correction. The author of the blog about health resources beloveshkin.com.

  “District doctor” dev.by Andrey Beloveshkin answered questions about the daily routine and healthy sleep in the comments to the previous article. Ask more!

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