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We don’t often think about it, but almost every task we perform on a day-to-day basis requires the use of the hands. From drying the clothes, driving a car or typing on a keyboard – our hands and wrist are crucial to our quality of life. It also means there’s also a fairly high degree of risk involved with common physical activities. Hand and wrist injuries are actually quite common among people, both young and old.
But what are some of these common injuries, and how can specialist hand and wrist surgeons get you back to your normal activities as quickly and comfortably as possible? Mr Tim Halsey, Consultant Hand and Wrist Surgeon, takes a closer look…
A simple slip and fall onto an outstretched hand can have significant consequences. The wrist is a complex joint between the forearm bones (radius and ulna) and the 8 small carpal bones. Any of these bones or the ligaments connecting them all can be injured with the end of the radius being the most common. This is then often treated in a plaster cast or splint, but will sometimes need an operation and fixation with plates and screws.
The scaphoid is a small bone within the wrist, beneath the thumb. It gets a bad reputation as it’s notoriously difficult to diagnose and treat. This is partly because fractures are not always immediately seen on an X-ray, and sometimes further imaging (a CT or MRI scan) may be needed to make the diagnosis. The scaphoid has a slightly complicated blood supply which means that fractures can be slow to heal and other factors like whether a patient smokes can also slow down healing.
There are several small but strong ligaments in the wrist joining all the small bones together. The most important of these is the scapho-lunate ligament which connects the scaphoid to the lunate (“scaphoid” means “boat shaped” in Greek, while “lunate” comes from Latin, meaning “moon”). A heavy fall can tear this ligament which may feel as painful as breaking a bone. If ignored, this can cause serious problems with the wrist over time because the bones no longer line up the way they are supposed to.
Interestingly, one of the X-ray signs associated with this is named after Terry Thomas, a comedian famous for the gap between his teeth!
The fact that we can place our thumb to the tip of each finger “opposable thumbs” is a design feature which separates us from other animals. It does mean however that our thumbs are at risk if we fall down holding something. A common injury at this time of year is the skier’s thumb. The joint at the thumb knuckle is forced to one side tearing the ulnar collateral ligament which supports it.
This is both painful and very limiting because your thumb is responsible for almost half of your hand function.
There are different ways of trying to prevent this injury while skiing related to how you hold onto your poles.
Fingers can be injured at any time of the year. Many conversations with patients start off with “I know I shouldn’t have, but…” and then go on to describe a wide variety of ways of injuring bones, tendons, ligaments, nerves and blood vessels. A common injury comes from holding a sharp implement in one hand and cutting into some food held in the other hand. The knife slips and cuts something other than the frozen burger, oyster or avocado. The easiest way to avoid this is simply to put the item onto a flat surface and cut away from yourself down onto the chopping board and avoid holding items in your hand that you are cutting. If you are taking the pit out of an avocado please use a spoon and not a knife!