Injuries or conditions that affect our hands and wrists can be devastating for our careers and everyday life. When it comes to caring for such complicated and important joints, you should trust only the most specialized and experienced orthopedic hand surgeons. Richard Mackessy, MD has years of experience that has made him rank as one of the top hand and wrist surgeons in New Jersey for many years over. Aside from being top rated providers, the doctors at Union County Orthopaedic Group are dedicated to guiding you through your hand and wrist injuries so you can enjoy your life to the fullest.
Hand and Wrist Conditions:
- Ulnar Nerve Entrapment
- Carpal Tunnel Syndrome
- Complex Regional Pain Syndrome
- De Quervain’s Tenosynovitus
- Ganglion Cysts
- Mallet Finger
- Numbness/Tingling/Nerve Dysfunction
- Tendon Injuries
- Trigger Finger
Hand and Wrist Treatments:
- Carpal Tunnel Release
- Dupuytren’s Contracture Fasciectomy
- Ganglion Removal
- Trigger Finger Release
- Tendon Repair
Anatomy of the Hand and Wrist:
While you might refer to your wrist as a singular joint, there are actually 15 different bones that make up multiple tiny joints in our wrists and hands. The complex structure of our wrists and hands is made up of bones, cartilage, ligaments, tendons, and muscles, as well as the blood vessels and nerves. All of these parts work together to make our hands and wrists extremely mobile while giving them the strength and stability for heavy gripping and intricate movements.
Our wrist contains two rows of eight small bones, called carpal bones, all forming joints with the bones around them. The row of bones that connects to the end of our forearm bones, the ulna and the radius, is called the proximal row. This row is located right at the crease that forms when you bend your wrist. It consists of three carpal bones called the scaphoid, lunate, and triquetrum. Above these bones is the distal row, consisting of the trapezium, trapezoid, capitate, hamate, and pisiform bones.
These two rows of small joints serve as the link between the forearm and the bones of the hand, which are called metacarpals. The five metacarpals attach to the phalanges, or thin finger bones, via the joints we know as our knuckles or metacarpophalangeal joints. Our thumb, the most mobile digit, only has two phalange bones while all the other digits have three.
There are many different tissues that protect the joints of our hands and wrists and keep them functioning at their best. All of the joints need to move smoothly so we can use our hands and wrists to do even the simplest things, such as lift a cup, turn a doorknob, write with a pen, or type on a phone. The ends of every single bone are coated with articular cartilage, a slippery, rubbery tissue that allows these bones to slide against each other easily without causing any damage.
Ligaments also play an important part in maintaining the bones of our hands and wrists. Ligaments are stretchy tissues that attach to each other and our bones to form a watertight joint capsule around the eight carpal bones of our wrists and each knuckle. The joint capsule contains synovial fluid, which lubricates the joint. Ligaments also support the structure of our hands and wrists, especially the two collateral ligaments that can be found on each side of our wrist, which prevent us from bending our wrist too far to the side. Collateral ligaments are also found on either side of our fingers, preventing them from bending sideways.
Many more ligaments form complex patterns across the wrist, connecting it to the hand and forearm. Their main purpose is to keep us from bending the wrist to the point of damage and keeping it stable as we move it. Any of these ligaments can be damaged; stretching or tearing can occur after an impact or gradually after years of using the joint. Both of these scenarios can lead to arthritis of the wrist.
Tendons and Muscles
Tendons are tough, fibrous bands of tissue that connects our bones to our muscles. Two important set of tendons, the flexor tendons and extensor tendons, travel across the palm of our hand and the back of our hand. The flexor tendons attach the muscles of our forearm to the palm of our hand so we can bend our wrist and curl our fingers. The extensor tendons allow us to straighten our fingers. They run through compartments down our wrists lined with slippery tenosynovium. The fluid prevents friction in these tight compartments, but often times over use can cause the tendons to swell and rub against the walls of the tunnels, leading to conditions like carpal tunnel syndrome. While muscles that help us move our wrist start in our forearm, our hands have their own small muscles. Some of these help us move our thumb or point our fingers. Others, called intrinsic muscles, are what helps us perform very precise movements with our fingers.
Of course, there are a plethora of nerves and nerve groups that give our hands their keen sense of touch. These nerves are often affected by musculoskeletal injuries and conditions. All of these nerves originate at the shoulder from the radial, median, and ulnar nerves. The radial nerve provides sensation to the back of the hand, thumb, and ring finger. The radial nerve travels through the carpal tunnel with our extensor tendons and is irritated in cases of carpal tunnel syndrome. The ulnar nerve also passes through a tunnel called Guyon’s canal, formed by two carpal bones. They connect to muscle in the palm, wrist, and thumb, and can also become irritated during inflammatory conditions.