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Parts of the body

WRIST

The wrist is part of the upper limb between the hand and the forearm, which allows the spatial movement of the hand. It consists of:

  • distal part of forearm bones (radius and ulna)
  • eight wrist (carpal) bones, arranged in two rows.

The wrist consists of more than 20 joints, 26 ligaments, 24 tendons, plethora of blood vessels and nerves. The wrist functional unit consists of the radial, radiocarpal and mediocarpal joint. The Articular capsules are relatively weak and strengthening ligaments are important for their stability. Wrist movement is a summary of the movements of each of the wrist bones between one another and the joint surface of the distal radius.

Possible causes of wrist pain

  • Accident causalities – the most common cause of wrist pain is an injury. The patient is often not aware of an injury and comes in a state of severe hand disability; especially the cases of wrist injuries causing joint instability are often overlooked and inadequately treated. Consequences can often manifest prominently only after a longer period of time, when wrist arthritis can develop, resulting in irreversible changes.
  • Non-traumatic causes – they are of gradually developing nature, the cause often cannot be precisely determined.
    • nerve compression syndromes (e.g., carpal tunnel syndrome) is the most common non-traumatic cause of pain in the wrist region;
    • inflammation of tendons (e.g., Morbus de Quervain);
    • other possible causes – rheumatoid disorders, necrosis of some wrist bones.

Carpal Tunnel Syndrome

What is it?

The carpal tunnel is the area of the wrist where the tendons of the finger flexors extend along with the robust median nerve (n. medianus), which innerves the region from the thumb to the middle finger including a part of the ring finger. It provides not only for sensitivity but also for fine motor activity of fingers. This channel is bridged by a stiff strip. If there is little room in the channel, the nervus medianus is compressed by this strip, which can result in severe nerve damage up to the point of total loss of sensitivity and fine motor activity of the region from the thumb up to the middle finger.

Symptoms

Gradually developing, especially night, pain and tingling discomfort that keeps waking the patient up – typically in the region extending from the thumb to the middle finger of the affected hand. It can aggravate up to loss of sensitivity and fine finger motor capacity. The patient feels tingling in his index finger and middle finger forcing him to shaking them to achieve a relief. He has trouble holding a pot, being unable to turn on a knob; he suffers from tingling when riding a bike or opening a door.

Causes

  • unilateral labour-intensive work
  • hormonal instability during the menopause – often resulting in fluid retention
  • congenital disposition – the carpal tunnel is naturally narrow

Treatment options

Conservative solution

reduced physical stress and overloading the tendons and finger flexors

medicamentous supportive treatment (Secatoxin, Wobenzym)

channel corticoid puncture (anti-inflammatory, anti-hematopoietic effect).

Surgical solution – the procedure is performed in local anaesthesia from approximately 2.5 cm incision by intersection of the transverse ligament strip and nerve release.

The surgical solution is preceded by a neurological examination based on EMG.

Morbus de Quervain

What is it?

This is the inflammation of the tendons of the thumb and its tendon sheaths, which leads to their elimination and thus prevents the smooth and painless movement of the tendons in the area defined by the ligamental tie and the radius. It is manifested by pain and swelling of the wrist on the thumb side, especially when the wrist is moved to the sides.

Treatment options

  • Conservative solution – resting, orthosis or bandage, rehabilitation is also suitable. It is also possible to administer corticosteroids using punctures. If the conservative treatment fails, surgical treatment is opted for.
  • Surgical solution – under local anaesthesia, the tendons are released and the tendon sheaths struck by inflammation are removed, orthosis or elastic bandage are employed after surgery. It is a simple procedure and the patient goes home immediately after surgery.

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Wrist arthrosis

What is it?

  • Primary wrist arthrosis – this type of arthrosis often occurs in rheumatic patients with systemic disease. The disorder occurs without any obvious trauma.
  • Secondary wrist arthrosis – most patients suffer from wrist arthrosis based on a clear cause that was not clarified or treated in the past.

In most cases, these are post-traumatic conditions after fractures of radius, navicular bone, or conditions after damage to wrist ligaments.

Treatment options

  • Conservative solution – is limited to bandages, orthoses, punctures, and medication to reduce pain, but not to eliminate the cause alone.
  • Surgical solution – the cause of arthrosis can only be resolved surgically in early stages. In the case of advanced joint arthrosis, only those surgical procedures limiting the wrist movement partially or completely to reduce pain are considered.