Have you ever experienced wrist pain? Is your first thought carpal tunnel syndrome? We have patients every day say they think they have carpal tunnel syndrome, but statistically, studies show that most wrist pain originates from the cervical spine. In this week’s blog, we are going to discuss the anatomy of the hand, different conditions that affect the hand, and what we can do to help.
Anatomy of the Hand
One human hand consists of eight carpal (wrist) bones, five metacarpal (hand) bones and fourteen small phalange (finger) bones. The hand has several different articulations and joint types that allow range of motion in all planes.
Radiocarpal and Ulnocarpal Joint
The proximal end of the wrist articulates with both the radius and ulna and is considered a condyloid synovial joint. A condyloid joint is a modified ball and socket joint that allows for flexion, extension, abduction, and adduction movements.
The eight wrist bones make up the intercarpal joints and are considered plane joints. These joints have limited motion and only allow gliding motions.
The distal end of the wrist articulates with the carpal bones and metacarpals and are considered plane joints except for the thumb. The carpometacarpal joint of the thumb is considered a condyloid synovial saddle joint that allows all ranges of motion.
The distal end of the metacarpals articulates with the proximal end of the fingers and are considered condyloid synovial joints that allow all ranges of motion.
The fourteen small finger bones make up the interphalangeal joints and are considered hinge joints. Hinge joints allow motion only in one axis. In this case, they allow finger flexion and extension.
Just like any joint, ligaments, muscles, blood vessels and nerves surround the wrist, hand, and fingers to work together and provide optimal function and movement. The abundance of ligaments provide stability and limit excessive range of motion at all articulation surfaces of the hand.
The muscles of the wrist are located on both side of the forearm to allow flexion, extension, abduction, and adduction. Finger flexor and extensor muscles are also located in the forearm. The interossei muscles are located on top of the metacarpals and allow fingers to spread apart and come together.
What Are Some Common Conditions Affecting the Hand?
Many conditions affecting the hand can be managed with chiropractic care; however, there are some conditions such as fractures, dislocations, and sprains that are beyond a chiropractor’s scope of practice and require deeper interventions such as surgery or casting. Most hand cases encountered in a chiropractic office typically are caused by degenerative joint disease, osteoarthritis, rheumatoid arthritis, trigger finger, carpal tunnel syndrome and nerve interference. We have talked about degenerative joint disease, osteoarthritis, and rheumatoid arthritis in several previous blogs. If you would like to brush up on those topics, we save all blogs on our website, Facebook pages, and email. One thing we will note is that arthritis is typically most common in the hands because we use these joints more than any joint in the human body.
Trigger finger is a condition affecting tendons that flex the fingers and thumb, typically resulting in a sensation of locking or catching when bending and straightening the fingers. Other symptoms may include pain and stiffness in the fingers and thumb. There’s not much research as to what causes trigger finger, but theories suggest repetitious finger flexion and extension cause the tendons to swell, therefore, restricting motions. Individuals with diabetes and rheumatoid arthritis are at higher risk of developing trigger finger.
Many patients suffer from trigger finger for years. In early stages, rest, splinting, and stretching exercises are recommended. Sometimes, that that is all that is needed, but chronic cases may involve doctors prescribing medications, injections, and even surgery to treat the condition; however, these options don’t always work.
Trigger finger isn’t frequently seen in a chiropractic facility, but we have successfully treated it several times using our Hakomed therapy machine. The Hakomed device can be used for hundreds of different conditions using different programs.
Carpal Tunnel Syndrome
Carpal Tunnel Syndrome (CTS) is a very common condition that causes pain, numbness, and tingling in the wrist and fingers. CTS happens when the carpal tunnel swells up and creates narrowing inside the tunnel. The carpal tunnel is located on the palm side of the wrist on top of the wrist bones underneath a sheath called the flexor retinaculum. The flexor retinaculum is a fibrous sheath of tissue that holds muscle and ligament structures in place. It also creates the carpal tunnel so that nerves and blood vessels can pass through. When narrowing occurs, the median nerve being compressed is what causes CTS symptoms to appear.
CTS is caused by many several factors including:
- Wrist fractures or dislocations
- Being female
- Rheumatoid Arthritis
- Thyroid disorders
- Repetitive actions such as typing on a computer all day, or texting constantly
- Vibratory forces such as using a jackhammer
When someone first develops CTS, most doctors will prescribe steroid injections into the wrist. If that doesn’t work, the next step is carpal tunnel surgery. This involves cutting the flexor retinaculum so that the carpal tunnel is open, and pressure is removed from the median nerve.
What Can We Do to Help?
Is carpal tunnel surgery the best choice? Is there an easier solution? Carpal tunnel surgery studies show different results. Some studies show that surgery is highly effective and some studies show negative results as compared to chiropractic management. Most people believe that pain originates from exactly where the pain occurs. CTS may be showing symptoms in the wrist, but the median nerve originates from the cervical spine. Most CTS cases that we encounter have been treated and managed by providing a series spinal manipulation therapy to the cervical spine. If it’s deemed necessary, we may provide manipulation therapy to the wrist and upper extremity, but 90% of cases we see are successfully treated with cervical spine manipulation alone. Along with manipulation treatment, we provide education on lifestyle changes to reduce pressure on disc and nerve roots such as correct posture. Additionally, we recommend taking frequent breaks when working on the computer, and avoiding looking down when texting.
In some cases, patients may need more than just spinal manipulation and may require non-surgical spinal decompression. We have a cervical unit to help patients with diagnosed disc bulges/herniations, shooting pains down the arm, muscle weakness, and numbness/tingling sensations.
As previously discussed, a chiropractor’s main focus is to remove any nerve interference so that the body can function at optimal levels. Nerve interference happens when a nerve is impinged between one or more vertebra causing nervous system disruption. Nerve interference symptoms include pain, weakness, numbness/tingling, and organ malfunction.
Performing a neurological exam and conducting a set of x-rays in the region of complaint is necessary to know exactly what is creating the nerve interference and the course of action required.
Whether that course of action includes spinal manipulation, non-surgical spinal decompression, and/or neuropathy management, we provide high-quality care and spend a significant amount of time with each patient so that we can achieve positive results.
For more information or questions about the anatomy of the hand and pain management, please call us at (724) 547-3377 and checkout our website at www.drlarrywilkinsspinalcare.com for more content.
Yours In Health,
Larry E. Wilkins, DC
Brian M. Steinert, DC