Hand joints and intercarpal ligaments

Wrist joint

is a bony joint formed by the radius and three carpal bones: the lunate, scaphoid and triquetrum. This joint connects the hand and forearm. On the outside, the joint is covered with a durable membrane (articular capsule). The articular capsule with the help of ligaments is attached on one side to the bones of the hand, and on the other to the radius and articular disc. The wrist joint is a particularly mobile connection of the bones of the upper limb: the forearm and hand of a person. This joint is complex in the composition of the bones included in it, is responsible for a variety of actions in the hand (rotational function of the hand, flexion, extension, abduction and adduction of the hand) and takes on various force loads, so this area is very vulnerable.

Types of damage

Common types of injuries to the wrist joint include:

• Fractures. The radius bone is especially often injured. There are two types of fracture of the radius at the wrist joint: Smith's fracture (flexion fracture). The cause of injury is a fall on an outstretched arm, on its back side. The bone breaks and at the same time there is a displacement of bone fragments towards the palm.
• Colles' fracture (extension fracture). Damage occurs when a person falls on the palm, and there is a displacement of bone fragments towards the thumb and the back of the hand.

• Sprain. When sprained, damage to the fibers of the ligaments occurs as a result of their excessive tension; the tissue remains intact, but the functionality of the joint is lost for a certain time.
• Dislocations. With dislocations in the area of ​​the wrist joint, the articular ends are displaced, as a result of which they completely lose contact with each other. Dislocations can be pathological (due to diseases of the bones and joints) and traumatic (due to injury).
• Inflammatory diseases
  . They can occur against the background of previous injuries, hormonal disorders, excessive joint tension, infections, etc. Tenosynovitis is an inflammatory lesion of the tendons and surrounding membranes in the wrist area.
• Styloiditis is an inflammation of the ligaments attached to the styloid processes of the radius or ulna.
• Synovitis is an inflammatory lesion of the synovial membrane of a joint.
• Bursitis is an inflammatory disease of the synovial bursae with the formation and accumulation of fluid in its cavity.

Symptoms and diagnosis of osteoarthritis of the hands

Osteoarthritis of the hands progresses slowly. At the initial stages of the development of the disease, patients may feel discomfort in the hands and fingers at the end of the working day. Over time, nodular thickenings of bone tissue appear in the area of ​​the joints of the hand. They come in two types.

Bouchard's nodes affect the proximal joints located between the phalanges of the fingers. Seals are found on the back of the hand. When palpating the nodules, there is usually no discomfort. Sometimes the patient may experience mild pain. Bouchard's nodes, if left untreated, lead to limited movement of the joints of the hands.

Heberden's nodes are more common. They usually form at the distal interphalangeal joint. Most often, the seals are concentrated on the middle and index fingers. Less commonly, they can be found on the little finger and ring finger. With osteoarthritis of the hands, Heberden's nodes form on both hands. In most patients they are not a source of pain. Patients sometimes feel discomfort. Unpleasant sensations often bother women going through menopause.

A few years after the nodules appear, patients begin to experience pain. Symmetrical damage to the fingers is noted. Osteoarthritis affects the interphalangeal joints and the joints of the “base” of the thumb. Osteoarthritis of the metatarsophalangeal joint may develop. Externally, deformation of the joints becomes noticeable, they deviate from the axis, and subluxations form. From time to time, patients note swelling and swelling on the fingers and redness of the skin. The pain is accompanied by stiffness in the joints, discomfort occurs when performing flexion and extension movements.

To establish an accurate diagnosis, rheumatologists at the Yusupov Hospital prescribe an x-ray examination of the hand. X-rays reveal the following signs of osteoarthritis;

• Narrowing of the joint space with smooth, clear contours of the articulating bones;
• Marginal bone growths;
• Subchondral osteosclerosis.

In all stages of the disease, smooth, clear contours of the articulating bones are preserved, narrowing of the joint space and marginal bone growths are formed over a fairly long time. If indicated, a computed tomography scan is performed. Radiologists distinguish 4 stages of severity of the degenerative-deforming process in the joint:

1. The first stage is characterized by a slight narrowing of the joint space without obvious signs of bone growths and cysts; moderate subchondral sclerosis may occur;
2. In the second stage, a more pronounced narrowing of the joint space is determined, which may be uneven. There is pronounced subchondral sclerosis, and minimal marginal osteophytes can be detected;
3. The third stage is characterized by a clear uneven narrowing of the joint space. Multiple osteophytes of significant size are visualized, subchondral sclerosis is pronounced;
4. In patients with the fourth degree of osteoarthritis, the joint space is not visible at all; there may be signs of aseptic necrosis of the bones of the hand or phalanges of the fingers. Sclerotic changes are strongly expressed.

In clinical and biochemical tests, deviations from the norm are not detected. The pathological process is not accompanied by an increase in erythrocyte sedimentation rate, as is the case with arthritis.

Symptoms and location of pain

For each type of injury listed above, there are characteristic symptoms, based on which a qualified specialist will establish an accurate diagnosis and prescribe the necessary treatment. The main signs of damage to the wrist joint include:

• Joint pain of varying intensity and location
• Edema and swelling of the injured area
• Changes in the appearance of the hand and wrist
• Redness of the skin in the damaged area
• Hemorrhage at the site of injury
• Joint contracture (severe limitation of joint mobility)
• Increase in overall temperature
• Weakness, malaise, chills
• The appearance of cones (with hygromas)

Hand Surgery Clinic

Rhizarthrosis (arthrosis of the first carpometacarpal joint)

- arthrosis of the thumb. This is the destruction of cartilage tissue in the joint between the first metacarpal bone and the trapezium bone.

Rhizarthrosis is a common problem that usually occurs with age or due to injury.

Typical signs of rhizarthrosis:

• Pain at the base of the first finger, which increases with weight bearing and movement of the first finger
• Inflammation and stiffness at the base of the big toe
• Decreased hand strength
• Limitation of range of motion of the thumb
• Deformation at the base of the thumb

Diagnostics

The disease is usually diagnosed based on x-rays. In some cases, a computed tomography (CT) scan may also be required, as well as a consultation with a rheumatologist.

Treatment

In the early stages of rhizarthrosis, conservative therapy is usually sufficient: making a custom thermoplastic orthosis, taking non-steroidal anti-inflammatory drugs, as well as physiotherapeutic treatment.

If these methods are ineffective, symptomatic therapy is used, which allows delaying surgery: injections with glucocorticoids or hyaluronic acid preparations.

Surgical treatment is indicated when other methods are unsuccessful. The most common surgical procedure used to treat deforming arthrosis of the thumb is arthrodesis. This operation removes mobility in the affected joint, as a result of which pain disappears.

Also, with arthrosis of the first metacarpal joint, patients often undergo trapezectomy. The essence of this operation, which is performed under local anesthesia, without hospitalization, is to remove the trapezium bone, on which the first metacarpal bone presses.

What is needed for treatment?

In our center it is possible to treat rhizarthrosis in one day. To do this, you just need to send photographs of your hands and x-rays by email or whatsapp (+7-996-766-76-08), describe your complaints and answer our questions. Our specialists will study the information received and draw up an individual treatment plan.

To clarify the diagnosis, it may be necessary to undergo additional examination - CT scan and consultation with a rheumatologist. Also, for surgical treatment, it is necessary to pass a set of tests: a general blood and urine test (valid for 10 days), a biochemical blood test - glucose, uric acid, CRP, rheumatoid factor (valid for 10 days). Risk factors - analysis for hepatitis B, C; RW; HIV (valid for 3 months).

It is advisable to indicate in the letter:

• Full name and year of birth
• Contact phone number and city of residence
• Do you experience pain in your hand or fingers?
• Was the tumor discovered accidentally or after a hand injury?
• Have you been operated on before? If so, where and when (it is advisable to send a copy of the discharge summary after the operation, and mark the postoperative scar on the photo of the hand with a marker)?
• Indicate the desired dates for the operation (consultation)
• Do you have chronic diseases (rheumatoid polyarthritis, gout, diabetes mellitus, etc.)?

Attach photographs of the hand and x-rays.
In any form, describe the problem, what is bothering you and for how long. Who did you turn to for help, what treatment did you receive and was there any effect, what studies were carried out (if any, you need to attach copies of medical documents)?

You can also simply schedule a consultation by phone, where we will make an accurate diagnosis and decide on a further treatment plan.

Which doctor should I contact?

Depending on the signs of the disease, you should seek help and advice from the following specialists:

• Traumatologist, surgeon (for fractures, bruises, dislocations, sprains, hygromas, synovitis)
• Rheumatologist, therapist, dermatologist, urologist (for various types of arthritis, arthrosis, bursitis).

Function [edit]

The following movements occur in these joints: flexion, extension, adduction, abduction and circumduction; abduction and adduction movements are very limited and cannot be performed while the fingers are clenched. [2]

The flexion and extension muscles are as follows:

Diagnostics

Diagnosis of various types of diseases of the wrist joint mainly includes:

• Initial examination by a specialist
• Urine and blood tests
• Ultrasound
• or MRI
• X-ray brush
• Referral for consultation to specialized specialists (with the appointment of the necessary additional examination)

Structure [edit]

Links [edit]

Metacarpophalangeal joints and finger joints. Ulnar aspect.

See also: Palm plate

Each junction has:

• palmar ligaments of the metacarpophalangeal joints
• collateral ligaments of the metacarpophalangeal joints

Dorsal surfaces[edit]

The dorsal surfaces of these joints are covered by extensions of the extensor tendons along with some loose areolar tissue that connects the deep surfaces of the tendons to the bones.

Clinical significance[edit]

MCP arthritis is a hallmark feature of rheumatoid arthritis, in contrast to the distal interphalangeal joint of osteoarthritis.

Other animals[edit]

In many quadrupeds, especially horses and other larger animals, the metacarpophalangeal joint is called a "button joint". This term is literally translated as “foot stopper.” In fact, although the term "button" is not applied specifically to the metacarpophalangeal joints of other species (e.g., humans), the "second" or "middle finger" joints of the human hand anatomically correspond to the buttons of larger tetrapods. For lack of a better term, the abbreviated name may seem more practical.