The wrist (carpus) is an assembly of eight lima bean sized bones arranged in two rows of four attached to the end of the forearm bones. Ligaments connect bones to bones and there are numerous ligaments crisscrossing between all of these small carpal bones as well as the ligaments connecting the carpus to the forearm on one side (proximal) and the carpus to the five metacarpal bones on the other side (distal). The five metacarpal bones and the muscles between them form the bulk of the hand. On the end of the metacarpal bones (knuckles) is where the fingers attach and each finger is comprised of individual phalangeal bones. The thumb only has two phalangeal bones and the four fingers each have three phalangeal bones. The hand also has a very intricate system of tendons connecting specific phalangeal bones and carpal bones to designated muscles to allow elaborate fine motor movements as well as forceful gripping. The nerve supply to the hand for sensation and movement is also critical. Three nerves (median, ulnar and radial) contribute to the skin sensation on designated parts of the hand and two of those nerves (median and ulnar) contribute to muscle movement within the hand. The median nerve is the most important of the three relative to hand function and this nerve travels through a tunnel in the wrist on its course from the forearm to the hand. This tunnel is called the carpal tunnel.
Many wrist and hand injuries are the result of repetitive overuse. Tendinitis is common involving the numerous tendons that insert on the wrist or pass through the wrist into the hand and phalanges. Some of these conditions have exotic names such as De Quervain’s tenosynovitis, which is tendinitis on the thumb side of the wrist. Tendinitis involving the tendons of the fingers can cause a peculiar and painful clicking with finger movements called trigger finger because as tendons are chronically inflamed they can thicken. Ligament damage can occur as well from repetitive overuse, which can compromise wrist joint stability and ultimately increase inflammation in the multiple carpal joints. Wrist ligaments can be sprained (shown in video) by injury. Degenerative arthritis of the carpal joints can follow and the result can be the formation of joint synovial cysts which can bulge under the skin on either side of the wrist. The triangular fibrocartilage complex (TFCC) is located on the pinky side of the wrist. Repetitive overuse can also damage that cartilaginous structure and cause wrist pain. Carpal tunnel syndrome is a condition where any or all of the processes described above contribute to increasing the pressure within the carpal tunnel, which ultimately compromises the function of the median nerve within the carpal tunnel resulting in numbness, pain, and weakness in the hand. Traumatic injuries are also very common for all of the anatomic structures in the wrist and hand.
Commonly Treated Hand & Wrist Diagnoses: Carpal Tunnel Syndrome (CTS), De Quervain’s Tenosynovitis, Ganglion Cysts, Trigger Finger, Triangular Fibrocartilage Complex (TFCC) Tear, Wrist Ligament Sprain, Wrist Osteoarthritis
Carpal tunnel syndrome is best treated by decompressing the nerve to avoid further damage and to minimize the risk for permanent sensation or movement loss. Tendon, ligament and cartilage abnormalities in the wrist and hand typically respond very well to Regenerative Medicine treatments. Call the Regenerative Spine & Joint Center today to have your wrist and hand pain evaluated. It is helpful to discuss the evolution of your symptoms and perform a detailed physical examination to confirm the diagnosis. Dr. Terebuh will then be able to give you his specific recommendations regarding whether or not Bone Marrow Cell Therapy or Platelet Rich Plasma (PRP) Therapy will help you accomplish the goals you have for your wrist or hand.