Carpal Tunnel Syndrome Overview

Displaced Bennett's Fracture

Often the result of a force such as that sustained in a contact sport such as football, a Bennetts's fracture is an intra-articular fracture at the base of the thumb, with a subsequent dislocation or subluxation of the carpometacarpal (CMC) joint. This type of fracture is often significantly displaced and unstable, because it involves the joint surface. If a Bennett's fracture is not properly diagnosed, it may result in an uneven joint surface at the base of the thumb - creating an unstable environment that is favorable for the late onset of arthritis in the joint.

Patients may suffer from swelling and stiffness, particularly in the fingers and thumbs, as a result of bleeding from the ends of the broken bone.

Treatment
Reduction is the primary treatment option for this type of fracture and entails pulling the bones back into place. A reduction may be either open or closed. A closed reduction utilizes a splint to reposition the bones from the outside. And an open reduction requires an incision, in order to reposition the bones from the inside. They are then held in place with internal fixation, screws and/or wires.

Triquetral Fractures

One of the eight wrist bones, the triquetrum is one of the more commonly fractured bones - generally resulting from a fall on an outstretched hand.

While there is generally only minor swelling, the site may be very tender. The fracture is confirmed and other tissue damage is ruled out following careful radiographic imaging in various wrist positions.

Treatment
Triquetral fractures tend to heal very well because of the rich blood supply to the area. Little more is needed than short-arm casting until union is achieved, which usually takes about three to six weeks.

Metacarpal Fractures

Accounting for almost 40 percent of all hand fractures, metacarpal fractures are common hand injuries. The fracture may occur at the base, shaft, head or neck of the metacarpal as a result of a fall onto the hand, a direct blow, or from the force of punching with a closed fist.

While the outer fingers and thumb are the most commonly affected, fractures at the neck of the little finger metacarpal - also known as boxer's fracture - are among the most common types of injuries to the hand.

Generally associated with a trauma, metacarpal fractures are most often seen in young boys and men.

Classified according to the location of the break, metacarpal fractures located at the neck and shaft are the most common fracture sites for the second through fifth metacarpals. Most thumb metacarpal fractures occur at the base - though are treated differently, because of the biomechanics of the thumb.

Treatment
Most metacarpal fractures are only slightly displaced, or out of alignment, and are void of rotational deformity, therefore they can be treated using closed reduction. Closed reduction entails realigning the bones from the outside and securing them in place with a short period of casting or splinting.

Unstable or inadequately reduced fractures may require surgery and internal fixation, in order to ensure rigid immobilization while allowing for early motion.

Thumb Dislocation and Fracture

Dislocation
With only two phalanges, there are only two joints in the thumb that are vulnerable to a dislocation - the interphalangeal (IP) joint and the metacarpophalangeal (MCP) joint. Dislocations of the MCP joint of the thumb are fairly common hand injuries, generally occurring when a force to the thumb causes extreme hyperextension.

When a dislocation of a thumb joint occurs, pain can be mild to moderate. There may also be evidence of swelling.

These types of dislocations are best corrected with open reduction, in order to directly reposition the tissue and bone. Failure to sufficiently correct the dislocation of a thumb joint could result in joint instability, chronic joint stiffness, an inability to flex and extend the thumb in a normal way - and eventually the early onset of arthritis.

Fracture
A fracture involving the thumb greatly limits a patient's ability to grasp items securely in the hand. Such trauma to a joint, particularly that of the thumb, also increases the risk of arthritis later in life.

Thumb fractures often occur when the bone is placed under direct stress such as in a fall or that which is experienced in some ball sports. Though, some fractures are the result of awkward twisting and muscle contraction.

Individuals most at risk for such fractures are those involved in contact sports, as well as those with a history of bone disease or calcium deficiency.

When such a fracture occurs, symptoms may include severe pain, swelling, reduced thumb movement, and sensitivity.

Treatment
While the class of fracture is identified based on the type and location of the break, those involving a joint require special attention and are at greater risk for complications.

Prompt and proper treatment of joint injuries to the hands reduces the risk of developing other conditions. Initially, rest, cold compression, and elevation are advised. A splint may also be used to help maintain the thumb in position until appropriate treatment is determined.

When treating a nondisplaced fracture, a thumb spica cast is indicated in order to realign the bones. More severe fractures of the thumb require surgical repair and possibly internal fixation.