Hand, Wrist and Forearm

The elbow, hand, wrist, and forearm represent intricate components of the human musculoskeletal system, enabling a diverse range of motion and functionality. These structures are not only vital for daily tasks but are also prone to a variety of injuries and diseases that can significantly affect quality of life.

Anatomy

Elbow

The elbow is a hinge joint comprising three articulations within a shared capsule:

  1. Humeroulnar Joint: Between the humerus and ulna, allowing flexion and extension.
  2. Humeroradial Joint: Between the humerus and radius, permitting both hinge and rotational movements.
  3. Proximal Radioulnar Joint: Facilitates pronation and supination of the forearm.

The elbow is stabilized by:

  • Medial Collateral Ligament (MCL): Resists valgus stress.
  • Lateral Collateral Ligament (LCL): Prevents varus stress.
  • Annular Ligament: Encircles the radial head, maintaining its position during rotation.

Hand and Wrist

The wrist consists of eight carpal bones arranged in proximal and distal rows, articulating with the radius, ulna, and metacarpal bones:

  • Proximal Row: Scaphoid, lunate, triquetrum, pisiform.
  • Distal Row: Trapezium, trapezoid, capitate, hamate.

These bones form the radiocarpal and midcarpal joints. Stability is provided by a complex network of ligaments, including the triangular fibrocartilage complex (TFCC) on the ulnar side.

Forearm

The forearm comprises the radius and ulna. The interosseous membrane links the two bones, facilitating load distribution and muscle attachment. Muscles in the forearm control wrist and hand movements, with extensors located dorsally and flexors on the palmar side.

Common Diseases and Conditions

Elbow

  1. Tennis Elbow (Lateral Epicondylitis):
    • Overuse injury causing pain at the lateral epicondyle due to extensor tendon strain.
    • Management: Rest, physical therapy, corticosteroid injections.
  2. Golfer’s Elbow (Medial Epicondylitis):
    • Affects the medial epicondyle due to repetitive flexor tendon strain.
    • Similar management to tennis elbow.
  3. Elbow Fractures:
    • Commonly involve the radial head, olecranon, or distal humerus.
    • Treatment may range from immobilization to surgical fixation.
  4. Ulnar Collateral Ligament (UCL) Injury:
    • Frequently seen in throwing athletes.
    • Requires ligament reconstruction (Tommy John surgery) in severe cases.

Wrist and Hand

  1. Carpal Tunnel Syndrome:
    • Compression of the median nerve at the wrist, leading to pain, numbness, and weakness in the hand.
    • Management: Splinting, corticosteroid injections, or surgical release.
  2. De Quervain’s Tenosynovitis:
    • Inflammation of the tendons in the first dorsal compartment.
    • Symptoms include radial-sided wrist pain during thumb motion.
  3. Scaphoid Fractures:
    • Commonly caused by falls onto an outstretched hand.
    • May require casting or surgical fixation due to poor vascular supply.
  4. TFCC Injuries:
    • Result in ulnar-sided wrist pain and instability.
    • May be managed conservatively or surgically repaired.
  5. Trigger Finger:
    • A condition where a finger gets stuck in a bent position due to tendon sheath inflammation.
    • Treated with splints, steroid injections, or minor surgery.

Forearm

  1. Forearm Fractures:
    • Includes fractures of the radius, ulna, or both (e.g., Monteggia and Galeazzi fractures).
    • Typically require surgical fixation to restore alignment and function.
  2. Compartment Syndrome:
    • A surgical emergency caused by increased pressure in the forearm compartments, leading to compromised blood flow and nerve function.
    • Requires fasciotomy for decompression.
  3. Pronator Syndrome:
    • Compression of the median nerve in the forearm causing pain and weakness.
    • Managed with physical therapy or surgical decompression.

Orthopedic Surgeries

Elbow Surgeries

  1. Elbow Arthroscopy:
    • Minimally invasive technique for treating loose bodies, synovitis, and impingement.
  2. Total Elbow Arthroplasty:
    • Indicated for severe arthritis or complex fractures.
  3. Ligament Reconstruction:
    • UCL repair for throwing athletes.
  4. Radial Head Replacement:
    • Used in cases of irreparable radial head fractures.

Wrist Surgeries

  1. Carpal Tunnel Release:
    • Relieves median nerve compression by cutting the transverse carpal ligament.
  2. Wrist Arthroscopy:
    • Used for diagnosing and treating TFCC tears, ganglion cysts, and arthritis.
  3. Scaphoid Fixation:
    • Utilizes screws or bone grafts to promote healing in nonunion fractures.
  4. Ganglion Cyst Removal:
    • Surgical excision of symptomatic cysts.

Hand Surgeries

  1. Tendon Repairs:
    • For lacerated or ruptured tendons.
    • Requires precise surgical technique to restore hand function.
  2. Dupuytren’s Contracture Release:
    • Corrects abnormal palmar fascia thickening causing finger flexion deformity.
  3. Finger Joint Replacement:
    • Used for severe arthritis affecting the hand joints.

Forearm Surgeries

  1. Open Reduction and Internal Fixation (ORIF):
    • Stabilizes forearm fractures using plates and screws.
  2. Radius and Ulna Osteotomy:
    • Corrects malalignment or nonunion.
  3. Fasciotomy:
    • Emergency surgery for compartment syndrome.

Rehabilitation and Recovery

Postoperative recovery is critical for achieving optimal outcomes. Physical therapy plays a vital role in restoring strength, range of motion, and functionality. Patients are advised to follow their surgeon’s rehabilitation protocol to minimize complications and maximize recovery. Regular follow-up visits are crucial to monitor healing progress, detect potential complications, and adjust treatment plans if necessary. Assistive devices, such as splints or braces, may also aid recovery.