CNY Orthopedic Sports Medicine, PC: Bodyzone: Hand

Body Zone: Hand

Overview
If you've ever watched a pitcher throw a curve ball, a magician make a coin disappear or a pianist play a concerto, you've witnessed the remarkable potential of the hand. Most of us use our hands in countless mundane activities every day, but rarely give much thought to their versatility and importance.

That's not to say that we always use our hands sensibly. Take the feat of Johann Hurlinger, for example. In 1900, Hurlinger walked the 870 miles between Vienna and Paris on his hands, earning a world record and, no doubt, collecting at least some calluses along the way. In fact, hands are central to most occupations and recreational activities, but it's precisely these types of activities that get the hands into trouble. In today's workplace, hands and wrists are the second most commonly injured body parts; these injuries may result from repetitive manual tasks. And technological advances haven't necessarily lightened the demands on the hands: yesterday's writer's cramp (an admittedly rare condition), for example, may be replaced by conditions associated with typing.

In the sports arena, hand and wrist injuries comprise up to 9 percent of all injuries; some of these injuries are so sport specific that they carry common names such as baseball finger, boxer's knuckle, jersey finger and skier's thumb. Musicians can be stopped midtune by a host of wrist and hand conditions, including musician's cramp.

Home mishaps account for yet another group of hand and wrist injuries; children, in particular, explore with their hands, leading to injuries ranging from animal bites to burns. Fortunately, most injuries of the wrist and hand can be treated with a variety of measures, restoring the hand's remarkable and essential functions.


Injuries
The hand is susceptible to a host of injuries and conditions, but some are certainly more common than others. Tendons and ligaments can be strained or sprained. In the workplace setting, occupations that require repetitive movements of the wrist and hand are suspected to lead to this type of injury. Strains, sprains and deep bruises are probably the most common sport-related injuries of the hand and wrist, although fractures and dislocations are the injuries that typically send athletes to the emergency room. In addition, genetics may make some individuals more susceptible to conditions such as arthritis, tumors or nerve injuries.

Carpal Tunnel Syndrome
Skier's Thumb


Harmful Behaviors
  • Repetitive motion. Performing uninterrupted, repetitive activities with the hand and wrist can result in injury.
  • Being careless. Disregarding occupational safety guidelines on the job can lead to accidents and injuries.
  • Taking risks. Participating in sports without using recommended hand and wrist protective equipment exposes the fragile bones of the hand to trauma and injury.
  • Prolonged abuse. Using the hands as tools when mechanical devices are available to perform the same task adds unnecessary wear and tear on the joints of the hand and wrist.


  • Good Practices
  • Change your routine. Modify repetitive activities before or as soon as they begin to cause hand or wrist symptoms.
  • Find a tool. Using ergonomic devices alleviates stress on the hands and wrists.
  • Take a break. Periodic breaks from repetitive tasks that involve the hands and wrists will pay dividends.
  • Be careful. Use safety devices, such as machine guards, and personal protective equipment, such as gloves, on the job to protect your hands.
  • Be prepared. Use wrist and hand protective equipment specifically designed for a given sport.


  • General Conditioning
    Because our wrists and hands are in almost constant motion, resting and stretching them periodically may be two of the most beneficial steps when it comes to keeping them healthy. Many of the sport-related injuries of the wrist and hand are unavoidable, even with ideal overall conditioning.



    Anatomy
    For their small sizes, the hand and wrist are incredibly intricate body parts. The wrist alone contains eight small bones arranged in two rows, much like the pieces of puzzle. Ligaments stabilize this delicate arrangement.

    The majority of the muscles that move the hand actually originate in the forearm; these are called extrinsic muscles, and their tendons must funnel through the wrist on their way to bones of the hand. Nine tendons and a very important nerve - the median nerve - have to squeeze through an opening in the wrist called the carpal tunnel. This narrow conduit is composed of bones and muscles on three sides and a tough fibrous band, called the flexor retinaculum, on the fourth side.

    A second group of muscles, the small intrinsic muscles, both begin and end within the hand. They permit the fine dexterity associated with finger movements.

    The hand itself contains an astonishing 19 bones. Five bones lie in the fleshy palm region of the hand. Each of the long fingers contains three small bones, while the thumb only contains two. These bones meet at joints that act like well-oiled hinges when healthy.

    Many of the tendons of the hand have a long journey. Along part of their course, several of them run inside sheaths that contain synovial fluid. This fluid nourishes the tendons and decreases the friction associated with movement. Tiny fibrous bands also tether the tendons along the length of the fingers; these bands act like pulleys and keep the tendons centered on the fingers.

    Two medium-sized arteries - the radial and ulnar arteries - carry blood to the hands. These arteries form arches in the palm and send off delicate branches to the fingers.

    Three nerves are involved in hand movement and sensation. The median, ulnar and radial nerves provide motor function to the hand and retrieve sensory messages from the exquisitely sensitive skin covering the hand.


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    Product Considerations
    Hand/Wrist Splints
    Splints are frequently used in the treatment and rehabilitation of wrist and hand injuries. Today's splints are lightweight and typically molded from aluminum or thermoplastic. They often have internal padding at sites of potential friction or pressure, and adjustable Velcro fasteners. These splints immobilize and support the wrist or hand, protect it from further injury and prevent distortions that can occur during healing. Splints are often tailored to the size and shape of a person's hand and to the underlying type of injury, so it's unwise to use a generic splint or another person's splint without first checking with your doctor.

    Grip Strengthening
    Grip-strengthening devices help work the muscles that flex the fingers. Some injuries require prolonged immobilization for healing. Once the hand is sufficiently healed and is ready to be moved, the muscles may have weakened and the hand may feel stiff. Grip-strengthening devices can gradually restore the hand's grasping and pinching strength. These devices require a squeezing motion against some form of resistance, typically an elastic band or spring. The resistance can often be adjusted as the hand gains strength. Some models also allow strengthening of individual fingers.

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