Hand & Wrist Injury Prevention and Treatment

by Wayne Chen, MD

Hand & Wrist Injury Prevention and Treatment

Think about your daily life for a moment and ask yourself how many tasks each day you perform with your hands. Almost all of them, right? Using our hands in our day-to-day activities is second nature, prompting us to undervalue them and take their importance for granted. Hand injuries can cause dramatic disruptions in our ability to function and perform even the simplest activities, and they are one of the most common injuries. According the U.S. Department of Labor, about 1 million workers go to the emergency department every year due to hand injuries.

What are the most common hand injuries and conditions?

Common hand injuries and conditions usually are one of four types.

1. Numbness and tingling

  • Carpal tunnel syndrome, caused by compression or pinching of the nerves, is the most common cause of these symptoms. Up to 6% of the adult population will develop this condition.
  • Carpal tunnel syndrome is often brought on by overuse and is associated with activities such as prolonged periods of keyboard typing, extended hours performing desk work, and constant usage of cellphones.
  • Prevention is accomplished by modifying your day to day activities to avoid things that bring on the symptoms, but unfortunately that’s not always possible due to jobs or daily living in general.
  • Treatment involves using anti-inflammatories or wearing a wrist brace at night.

2. Tendon problems and tendinitis

The two most common issues in this genre of hand injury and conditions are trigger finger and de Quervain’s tendinitis.

Trigger finger

  • Up to 10% of the population will develop symptoms.
  • Most of the time there is no particular reason why trigger finger occurs, but it can be brought on by overuse or an injury that aggravates or flares things up.
  • Since there is no clear reason for trigger finger development, prevention is not really possible.
  • When symptoms worsen, triggering becomes significant or catching/locking of the finger occurs; that is when you should go see your doctor. 
  • Treatment often involves using steroid injections or potentially surgery depending on how bad your individual case is.

de Quervain’s tendinitis

  • This particular tendinitis is defined by inflammation and pain over the outside of the wrist.
  • Again, this issue is very common. Parents with newborns for instance can develop it due to over-usage of their wrist, caused by the sudden change of constantly carrying a newborn.
  • Prevention is difficult due to the constant need of the wrist, but it can be treated using anti-inflammatories, wrist braces, and over-the-counter topical creams.

3. Arthritis

  • Basilar thumb arthritis is the second most common arthritis in the hand.
  • In fact, a lot of people actually have this arthritis unknowingly, and then something triggers it causing it to become symptomatic.
  • The main goal in treatment is to get things manageable by first trying oral and topical medication, therapy, bracing, and steroid injections.
  • When symptoms worsen and are no longer manageable with conservative measures, then the patient and physician may consider surgery.

4. Fractures

  • As our activity during the summer months rises, so will injuries and fractures.
  • The most common question asked is “when should I see a doctor?”  If you heard a pop, or there is significant swelling, or it just doesn’t feel right, then you should come in and have it checked out.
  • Ortho On Call, our same day walk in clinic, is great for fractures needing urgent care. You can bypass the emergency department and be seen the same day as the injury to your hand, wrist, or any other extremity.

Frequently asked questions about hand injuries

Is working from my laptop or working from my keyboard better for my hands and wrists?

This heavily depends upon how your workstation is set up, and the employment of ergonomic workspace management is critical for the hand and wrist. You want to ensure that you are maintaining good posture, whether you are working on your laptop or desktop keyboard. If you have a rest pad that lays in front of your keyboard, those help as well.

What is the normal time frame I should expect a trigger finger to heal with splinting and finger rest? What would be the next course of action after this time has passed and symptoms still persist?

Unfortunately, there is no rhyme or reason to why trigger finger happens. It’s what we call idiopathic. Conservative measures in treatment can include trigger finger splints, which literature shows is about 50% effective in resolving symptoms. After using trigger finger splints, anti-inflammatories, rest, and time, if symptoms aren’t improving, we can then move on to steroid injections. For me, my treatment course, conservatively, includes two steroid injections six weeks apart. The literature in this course of treatment shows a 70% effectiveness rate or about two out of three patients. While that is great, I realize that one of three patients will not have success with steroid injections, and those are the patients I talk to about surgery.

Is it possible to injure my hand from being on my phone too much?

Potentially. The most common complaint I hear is that patients will have the sensation of numbness and tingling while holding their phone. This most likely has to do more with the position of the wrists being in a flexed or bent position rather than holding of the phone itself. But yes, as with anything, you can potentially have injuries from overuse of your phone.

What are some basic wrist/finger exercises for flexibility and strengthening?

The six-pack hand exercises are available online and are good to start with. They include bending all of your joints from the top down, making a fist, and stretching your fingers out and in. Instructions online can show you in more detail. Make sure that you search for “six pack hand exercise” so you get the right kind of exercises. As far as strengthening, the TheraPutty works very well. There are also finger-strengtheners that resemble little accordions that allow you to work individually on finger strength. These are suggestions that you can certainly start on your own. If you want or need something slightly more formal, then hand therapy is a viable option. Here in our Virginia Beach office we have an excellent hand therapist, Elizabeth Medway. We have hand therapy available across the state.

What are the best anti-inflammatory and topical cream medications?

Any over-the-counter anti-inflammatory is adequate as long as you take it in the appropriate dosage. Personally, I recommend Aleve because it takes fewer tablets to achieve the prescription-strength dosage. For Aleve, you can take up to two 220 mg tablets twice a day. compared to ibuprofen or Motrin which would require twelve tablets instead of four. If you would prefer to have a prescription written there are prescription anti-inflammatories as well, such as meloxicam or diclofenac. 

For topical gels or patches, there are many different types on the market, but I often recommend Voltaren gel, an over-the-counter anti-inflammatory topical medication. Other topical creams that I would suggest using are any formulations that contain lidcoaine, a numbing anesthetic. These include Icy Hot with lidocaine, Aspercreme with lidocaine, and Salonpas with lidocaine.

 

As always, it is important to talk with your doctor about your hand, wrist, and joint pain. If you’re an OrthoVirginia patient, a great way to do this is through MyChart, where you can directly email or message one of our team members, and we will get back to you that day.