Wrists, Hands & Fingers

Hand and Wrist Anatomy

An inside look at the structure of the hand and wrist.

The hand and wrist are made up of many different bones, muscles and ligaments that enable a wide range of movements.

The following are the main structures of the hands:

Bones

The wrist is formed where the two bones of the forearm – the radius (the larger bone on the thumb side of the arm) and the ulna (the smaller bone on the pinky side) – meet the carpus. Rather than a single joint, the wrist is actually made up of multiple joints where the bones of the arm and hand meet to allow movement

The carpus is formed from eight small bones collectively referred to as the carpal bones. The carpal bones are bound in two groups of four bones:

• the pisiform, triquetrum, lunate and scaphoid on the upper end of the wrist
• the hamate, capitate, trapezoid and trapezium on the lower side of the hand.

Other bones of the hand are:

• the metacarpals – the five bones that comprise the middle part of the hand
• the phalanges (singular phalanx) – the 14 narrow bones that make up the fingers of each hand. Each finger has three phalanges (the distal, middle, and proximal); the thumb has two.

Joints are formed wherever two or more of these bones meet. Each of the fingers has three joints:

• metacarpophalangeal joint (MCP) – the joint at the base of the finger
• proximal interphalangeal joint (PIP) –  the joint in the middle of the finger
• distal interphalangeal joint (DIP)  – the joint closest to the fingertip.

Each thumb has two joints.

The surfaces of the bones where they meet to form joints are covered with a layer of cartilage, which allows them to glide smoothly against one another as they move. The joints are enclosed by a fibrous capsule that is lined with a thin membrane called the synovium, which secretes a fluid to lubricate the joints.

Ligaments and Tendons

The ligaments are tough bands of connective tissue that connect the bones to support them and keep them in place. Important ligaments of the hand are:

• collateral ligaments – strong ligaments on either side of the finger and thumb joints, which prevent sideways movement of the joint
• volar plate – a ligament that connects the proximal phalanx to the middle phalanx on the palm side of the joint. As the joint in the finger is straightened, this ligament tightens to keep the PIP joint from bending backward.
• radial and ulnar collateral ligaments – a pair of ligaments which bind the bones of the wrist and provide stability
• volar radiocarpal ligaments – a complex web of ligaments that support the palm side of the wrist
• dorsal radiocarpal ligaments – ligaments that support the back of the wrist
• ulnocarpal and radioulnar ligaments – two sets of ligaments that provide the main support for the wrist.

Tendons are bands of connective tissue that attach the muscles to the bone enabling the muscles to move the bones.

The main tendons of the hand are:

• superficialis tendons, which pass through the palm side of the wrist and hand, and attach at the bases of the middle phalanges. They act with the profundus tendons to flex the wrist and MCP and PIP joints.
• profundus tendons, which pass through the palm side of the wrist and hand, and attach at the bases of the distal phalanges. They act with the superficialis tendons to flex the wrist and MCP and PIP joints. They also flex the DP joints.
• extensor tendons of the fingers, which attach to the middle and distal phalanges and extend the wrist, MCP, PIP and DP joints.
• flexor tendons, nine long tendons which pass from the forearm through the carpal tunnel of the wrist. They diverge in the palm, where two go to each finger (one attaches at the DP and one at the MCP) and one goes to the thumb.
• extensor pollicis brevis and abductor pollicis longus, which run from the muscles in the top of the forearm and enable movement of the thumb

Rings of connective tissue, called pulleys hold tendons of the fingers close to the bone.

Wrist, Hand & Finger Pain Causes

Arthritis and Diseases That Affect the Hand and Wrist

From joint inflammation to compressed nerves, problems that may be to blame for painful hands and wrists.

Many forms of arthritis and related conditions that affect the joints, muscles and/or bones can cause problems like pain, stiffness and swelling in the wrist and fingers. Other conditions can cause additional problems, such as numbness and tingling, pitted nails, painful ulcers or thickened skin that makes bending the fingers difficult. Here are some possible disease-related problems that affect the hands and wrists.

• Osteoarthritis (OA). The most common form of arthritis, osteoarthritis is a chronic condition characterized by the breakdown of the cartilage that cushions the ends of the bones where they meet to form joints. This breakdown causes the bones to rub against each other, causing stiffness, pain and loss of movement in the joint. In the hand, the joints most commonly affected by osteoarthritis are the wrist, the joint at the base of the thumb (the basal joint), the joint in the middle of the finger (proximal interphalangeal joint or PIP) and the joint closest to the nail (distal interphalangeal joint or DIP). In the finger joints, OA can lead to the formation of bony knots. In the PIP joint these are call Bouchard's nodes. In the DIP joint they are called Heberden's nodes.

• Rheumatoid arthritis (RA)   Rheumatoid arthritis is a chronic inflammatory disease of the joints that occurs when the body’s immune system – which normally protects us from infection – mistakenly attacks the synovium, the thin membrane that lines the joints. The result can be joint damage, pain, swelling, inflammation, loss of function and disability. Rheumatoid arthritis commonly affects the wrist and finger joints and can cause deformities that make it difficult to use the hands.

• Juvenile arthritis (JA). Juvenile arthritis is the term used to describe arthritis when it begins before age 16. There are several different types of juvenile arthritis that can cause pain and swelling in the wrist and joints of the hands.

• Gout. Gout is a form of  arthritis that occurs when excess uric acid, a bodily waste product circulating in the bloodstream, is deposited as needle-shaped monosodium urate crystals in tissues of the body, including the joints. For many people, the first symptom of gout is excruciating pain and swelling in the big toe – often following a trauma, such as an illness or injury. Subsequent attacks may occur off and on in other joints, including the wrist and joints of the fingers. After years with the disease, lumps of uric acid, called tophi, may form beneath the skin of the hands.

• Reactive arthritis. Reactive arthritis is a chronic form of arthritis that often occurs following an infection of the genital, urinary or gastrointestinal system. Features of reactive arthritis include inflammation and swelling of the joints, eyes and structures within the gastrointestinal or genitourinary tracts, such as intestines, kidneys or bladder. A small percentage of people with the disease develop a rash or hard nodules on the soles of their feet or palms of their hands.

• Lupus. Lupus is a chronic autoimmune disease, meaning the body's immune system creates antibodies that attack healthy tissues, including the joints. The wrist and small joints of the hands are among those most commonly affected by lupus. Lupus can also cause inflammation in many organs, including the skin, heart, lungs and kidneys.

• Psoriatic arthritis. Psoriatic arthritis is a form of arthritis accompanied by the skin disease psoriasis. The skin disease often precedes the arthritis; in a small percentage the joint disease develops before the skin disease. The joint involvement of psoriatic arthritis often causes inflammation of the entire finger, giving it a sausage-like appearance. Approximately 80 percent of people with psoriatic arthritis experience changes to the nails including pitting, thickening and/or separation from the nail bed. The skin rash of psoriatic arthritis can also affect the hands.

• Infectious arthritis. Also called septic arthritis, infectious arthritis refers to arthritis that is caused by an infection within the joint. Infectious arthritis is often caused by bacteria that spread through the bloodstream to the joint. Sometimes it is caused by viruses or fungi and can affect the joints of the hands.

• Raynaud's phenomenon. Raynaud’s phenomenon is a condition characterized by a narrowing of the blood vessels to the extremities, usually the hands, in response to cold temperatures or stress. When blood vessels close down, fingers become cold and white, then blue, and numb or painful. When the vessels open up again, the hands become red or purple. Raynaud’s is often associated with connective tissue diseases, notably scleroderma.

• Osteoporosis.   Osteoporosis is a condition in which the bones lose enough mass that they become brittle and prone to breaking with slight trauma.   The bones of the wrist are among those most commonly fractured in people with osteoporosis.   The condition can occur with aging,   inflammatory disease (such as rheumatoid arthritis)   inactivity, a low-calcium diet or use of corticosteroid medications.

• Carpal tunnel syndrome.   This condition occurs when the median nerve, a nerve that runs from the forearm into the hand and supplies sensation to the palm and thumb side of the hand, becomes compressed within the carpal tunnel in the wrist. The carpal tunnel is a narrow passageway formed by bones and a ligament, through which the median nerve and several tendons run. If there is swelling within the tunnel, the nerve can become compressed, resulting in pain, weakness, and/or numbness in the hand and wrist, radiating up the arm.

• Scleroderma. Literally translated "hard skin," scleroderma is an umbrella term for disorders that involve the abnormal growth of the connective tissue supporting the skin and internal organs. Although there are several different forms of scleroderma, all can cause thickening and tightening of the skin on the fingers called sclerodactyly. This can make it harder to bend or straighten the fingers.

• Dermatomyositis. Dermatomyositis is an inflammatory muscle disease that often has a severe onset. Symptoms can include muscle pain and weakness, joint pain, skin rash, changes around the beds of the fingernails and roughening and cracking of the skin on the palms and fingertips, often referred to as Mechanic's hands.

• Dupuytren’s contracture.   Dupuytren's contracture, sometimes called Dupuytren's disease, is an abnormal thickening of the fascia, a flat band of tissue beneath the skin, in the palm of the hand. This can lead to the development of firm cords and lumps that cause the fingers to bend toward the palm. The ring and little finger are most commonly affected.   The disease, which occurs primarily in men older than age 40 of European descent, less commonly affects the fascia on the soles of the feet.

• Ganglion cysts. Ganglion cysts are lumps that form next to the joints or tendons in the hand and wrist. The most common locations are the joints at the base of the fingers (metacarpophalangeal joint or MCP), joints closest to the nail (distal phalangeal joint or DP), the top of the wrist and the palm side of the wrist. These cysts can occur in people of any age, they may come and go for no apparent reason, and they may or may not be painful.

• Stenosing tenosynovitis (trigger finger). This condition, also known as trigger finger, occurs when the pulley (one of the rings connective tissue that hold tendons of the fingers close to the bone) at the base of a finger or thumb thickens, constricting the tendon that enables the finger to move. This can cause popping, pain or a catching feeling in the finger or thumb. In some cases, repeated use can worsen inflammation and make it difficult to straighten or bend the finger.

Hand and Wrist Injury

Common and some not-so-common injuries of the small joints of the hands and wrists.

The bones, connective tissue and small joints of the hands and wrists are prone to several types of injuries. These injuries can happen in otherwise healthy joints – for example, a blow to the finger causes it to bend backward or jamming a finger causes the tendons to pull away from the bone. In other cases, a disease process may make an injury more likely. For example, wrist bones weakened by osteoporosis are prone to fracture. The following are some of the more common hand and wrist injuries.

Flexor Tendon Injuries

The flexor tendons are long strands of connective tissue that connect muscles in the forearm to the small bones of the finger and thumb, enabling them to move. If one of these tendons is severely injured the finger it connects to cannot move.

The most common causes of flexor tendon injuries are cuts and sports injuries. Flexor tendons may also rupture spontaneously in people with rheumatoid arthritis.

Extensor Tendon Injuries 

Injuries to the extensor tendons (tendons on the backs of the hands and fingers that enable fingers and thumbs to straighten) can result in a number of different problems. The most common are:

• Mallet finger – a drooping of the end of the finger that occurs when an extensor tendon becomes separated from the bone. This can happen if the finger is cut or jammed. It is also called baseball finger.

• Boutonniere deformity – a deformity in which the joint in the middle of the finger (proximal interphalangeal joint or PIP) bends toward the palm and the joint closest to the nail (distal phalangeal joint or DP) bends upward. It can result from a cut or tear of the extensor tendon at the middle joint, a blow to the bent finger or damage from rheumatoid arthritis.

Other hand and finger injuries:

• Finger dislocations. If a finger is hit or bent back beyond its normal range of motion, it can become dislocated, meaning the ends of the bones move so that they are no longer properly aligned. Any of the finger joints can be dislocated.

• Finger fractures. Finger fractures can result from a number of causes, including jamming a finger, falling on it or closing it in a car door. Regardless of how it happens, the result can be the same: pain, swelling, inability to move the finger, and in some cases, deformity.

• Wrist fractures. A common cause of wrist fracture is stopping a fall with outstretched arms. Although anyone of any age can fracture a wrist this way, the risk is greater in people whose bones are weakened due to osteoporosis.

Wrist fractures may be classified as either Colles' fractures or Smith's fractures. Both are breaks of the radius (the bone of the forearm) near the wrist. The difference is in the way the bone is broken. A Colles' fracture occurs when the bone is broken with the hand outstretched. A Smith's fracture (sometimes called a reverse Colles' fracture) occurs when the hand is flexed and the back of the hand is hit.

Wrist & Hand Pain Diagnosis

Diagnosing Hand and Wrist Problems

How your doctor can start to identify the cause of your hand and wrist pain.

Diagnosing a hand or wrist problem will begin with a physical exam and assessment of your medical history. During the medical history your doctor will ask you questions such as:

• What symptoms are you experiencing?
• When did you first start noticing them? Were they the result of an injury?
• Are your symptoms worse after activity or rest? Are there certain activities that make them worse – or better?
• Do you recall having an illness or accident around the time your symptoms began?
• Are you experiencing symptoms in any joints besides the fingers and/or wrists?
• Do any of your family members have arthritis or other hand and/or wrist problems?
• Do you have other medical problems that could be causing your symptoms?

During the physical exam your doctor will look at and touch your hands and any other joints you may be experiencing problems with. Your doctor will be looking for areas that have tenderness, pain or swelling, as well as indications the joint may be damaged. Depending on the findings of the history and exam, your doctor may order lab tests and imaging tests to help make or confirm a diagnosis.

Imaging and Electrodiagnostic Tests

Imaging tests can allow your doctor to see the structures inside your hand noninvasively. The most common imaging tests to diagnose hand and wrist problems are:

X-ray (radiography). A standard X-ray is a simple test in which an X-ray beam (a form of electromagnetic radiation) is passed through the hand to create a two-dimensional picture of the bones that form the joint. A doctor can use X-rays to view:

• joint space. Narrowing of the space between the bones, which are normally covered by cartilage, can be a sign of arthritis and its severity.
• bone spurs. Bony overgrowths at the joint are a sign of osteoarthritis.
• fractures. Broken wrists and fingers will show up on X-rays, however, small cracks in the bone may not. 

In some cases, a contrast dye is injected into the hand to enable the doctor to better see the joint on X-ray. This is called arthrography.

Computerized axial tomography (CAT) scan. Also called a computed tomography (or CT) scan, this noninvasive test combines X-ray equipment with sophisticated computers to produce multiple images, which are combined to depict cross-sectional slices of internal structures. CT scans may be used to diagnose hand and wrist fractures that don't show up on X-ray. They also show soft tissues, such as ligaments and muscles more clearly than traditional X-rays, so they are more useful for diagnosing certain hand and wrist problems.

Magnetic resonance imaging (MRI). This procedure uses a strong magnet linked to a computer to create a picture of the internal structures in black and white and shades of gray. Because an MRI shows the soft tissues as well as the bones, it is particularly useful for diagnosing injuries to the cartilage, tendons and ligaments, as well as areas of swelling. The test is accurate in determining the severity of carpal tunnel syndrome.

Video fluoroscopy. This test, using an X-ray and a fluorescent screen, allows a doctor to view the internal structures and movements of the hand instantly, and to create an "X-ray movie" that can be viewed repeatedly.

Bone scan. This technique can be used to view stress fractures caused by repetitive trauma. It involves injecting a small amount of radioactive material into the bloodstream. The material collects in the bones, particularly in areas of new bone growth where fractures are healing, enabling doctors to see those areas with a scanner.

Electrodiagnostic Tests. For diagnosing problems, such as carpal tunnel syndrome, where there is compression of the nerve, a doctor may use electrodiagnostic tests such as nerve conduction studies and electromyography. For nerve conduction studies, the doctor fastens electrodes to the wrist and hands, then sends small electric shocks to the nerves in the forearm, wrist and fingers, and measures the speed of conduction of nerve fibers. In the electromyography, the doctor inserts thin needles into the muscle to record electrical activity. The electrical signals are viewed on a screen.

What Your Hands Say About Your Health

Your hands can’t talk, but they can tell you a lot about your health. Find out how.

Our hands are one of our greatest tools. Their multiple small joints work together with muscles to produce precise motions and strength. They allow us to button a shirt, open a jar, wave to a neighbor, stroke a pet’s fur or provide a comforting touch. But hands also can be prone to arthritis and related problems and, in some cases, provide clues to what’s happening elsewhere in our body. 

Use your hands – and this story – to learn what your hands may be telling you about your health. And be sure to discuss any concerns you have with your doctor or health professional.

Symptoms: Bony outgrowths on the finger joints, which can interfere with hand function and cause fingers to look deformed.

What it may mean: Nodules on the joint closest to the fingertip, known as Heberden’s nodes, or the middle joint, known as Bouchard’s nodes, are characteristic of osteoarthritis, or OA. As the cartilage in the finger joints wears away, the ends of the bones rub together, stimulating the growth of these bony spurs.

Treatments: Rest, pain relievers, splints, heat or ice, physical therapy, and in severe cases, surgery.

Symptoms: Bumps of rubbery tissue on thumbs, knuckles or other pressure points that get a lot of use

What it may mean: Poorly controlled rheumatoid arthritis, or RA. About 25 percent of people with RA have these nodules, which are associated with more aggressive disease.

Treatments: In some cases, corticosteroid injection directly into the nodules. Nodules often disappear with treatment for underlying disease.

Symptoms: Fingers that change colors – first pale, then bluish, then red – in response to cold temperatures or emotional stress. The color changes may be accompanied by numbness, tingling and pain.

What it may mean: Raynaud’s (ray-nohz) phenomenon, a condition in which the small blood vessels in extremeties – fingers, toes, even the tip of your nose – narrow in response to cold or stress, reducing blood supply. As the blood supply is slowed, skin can turn pale and then blue. As it returns, the skin turns red. Raynaud’s often occurs in conjunction with autoimmune diseases such as rheumatoid arthritis, lupus and scleroderma, but it also can occur on its own.

Treatments: Simple measures such as keeping the extremities warm and avoiding tight fitting jewelry, and in more severe cases, oral medications used to treat high blood pressure.

Symptoms: Pitting or crumbling of the nails; separation of the nails from the bed.

What it may mean: Fungal infection, psoriasis or psoriatic arthritis (especially if accompanied by joint pain).

Treatments: If it’s a fungal infection, an antifungal. Topical steroids or vitamin A or D derivatives are applied directly to the nail, ultraviolet light therapy combined with the prescription drug psoralen, and sometimes surgical removal of the affected nails. Systemic treatment for psoriatic arthritis may also improve the nails.

Symptoms: Tight, thickened skin on the fingers that often appears shiny and can make bending your fingers difficult.

What it may mean: Scleroderma, a condition characterized by a buildup of collagen in the skin, causing skin tightening and thickening.

Treatments: Physical or occupational therapy, if skin thickening makes movement difficult; ointments and lotions to help soften skin. Other problems, including Raynaud’s phenomenon, calcium deposits under the skin and difficulty swallowing, often go along with skin thickening and will require their own treatment.

Symptoms: A finger that gets stuck – especially when your first wake up in the morning – and is painful when you try to extend it; painful clicking or snapping when you try to flex the affected finger.

What it may mean: Trigger finger, a condition that happens when the tendons that move the fingers thicken or become inflamed. Tendons in the hand are like ropes that move the fingers; these ropes run through tunnels, or sheaths, that hold them in place. If the tendon – or the sheath through which it moves – becomes thickened, movement can be difficult. Bending the finger may pull the swollen portion through the narrowed sheath, making a popping or snapping noise and causing pain.

Treatments: Use of a splint to keep the finger straight, or in more severe cases, nonsteroidal anti-inflammatory drugs, or NSAIDs, steroid injections and/or surgery to loosen the tendon sheath.

Symptoms: Painless bending/curling of the fingers toward the palm of the hand.

What it may mean: Dupuytren’s disease, a condition in which the connective tissue under the skin of the palm of the hand becomes thickened, eventually forming tough bands, or cords, of tissue, which can cause the fingers to bend toward the palm. This is called Dupuytren's contracture.

Treatments: Splints, an injection of an enzyme called collagenase to break up the cord, or surgery to cut the cord.

Symptoms: Tingling, numbness, weakness, or pain felt in the thumb, index finger, middle finger, thumb side of the ring finger and/or palm. You may have symptoms in one hand, or if both hands are affected, they may be worse in one hand.

What it may mean: Carpal tunnel syndrome, a condition in which swelling of tissues in the wrist puts pressure on the median nerve, which supplies movement and feeling to the thumb side of the hand. In severe cases the nerve can become irreversibly damaged, permanently affecting hand function.

Treatments: A splint to support the wrist, hot and cold compresses, oral NSAIDs, corticosteroid injections directly in to the wrist and, in some cases, surgery to release the compressed nerve.

Lab Tests for Diagnosing Hand and Wrist Problems

Tests that tell what's going on inside your body.

Often a sample of blood or joint fluid can help you doctor confirm a diagnosis. For example, a blood test showing high blood levels of rheumatoid factor – an antibody that acts against the blood component gamma globulin – or an antibody called anti-cyclic citrullinated peptide antibody (anti-CCP) may suggest rheumatoid arthritis. High levels of antinuclear antibodies (ANAs), abnormal antibodies directed against the cells' nuclei, could suggest lupus or another inflammatory disease.

Tests of fluid drawn with a needle from the joint may reveal crystals of uric acid, confirming a diagnosis of gout, or a bacterium, suggesting that joint inflammation is caused by an infection.

Wrist, Hand & Finger Care

Ways to Prevent Hand & Wrist Pain and Get Around

Braces, assistive devices and other ways to manage hand pain.

In addition to medication and surgery there are many things you can do on your own or with your doctor or hand therapist to relieve hand pain and perform daily activities. Here are some techniques and devices worth trying.

Hot and cold. When hands are swollen and painful from arthritis, cold packs can numb the painful joints and reduce swelling. Cold is also helpful for reducing swelling and inflammation from a new joint injury. For aching hands without acute inflammation, heat may provide relief. For Raynaud's phenomenon, keeping the hands warm is helpful.

Splints and braces. Splints and braces made of neoprene, metal and other materials are used in the treatment of arthritis, injuries or other conditions of the wrist and fingers. For example, a splint that immobilizes the wrist may be prescribed for nighttime use to relieve the tingling and numbness of carpal tunnel syndrome or to provide rest and support for arthritis in the wrist. Finger splints may be used to help fractured or dislocated fingers heal or to prevent deformities in fingers affected by rheumatoid arthritis. Splints and braces may be prefabricated or custom made by a hand therapist.

Assistive devices. If your hands are stiff or painful, or if you have trouble holding, gripping and turning, assistive devices can make tasks easier on joints and more efficient for you. These products, which range from simple to elaborate, help keep joints in the best position for functioning, provide leverage when needed and extend your range of motion. Simple arthritis self-help devices, such as jar openers, reachers and easy-grip utensils, can be purchased at many hardware or medical supply stores.

Wrist, Hand & Finger Pain Treatment

Medications to Treat Hands and Wrists

What you need to know about the many medications used for hand and wrist problems.

Medications to ease pain, relieve inflammation, slow bone loss, modify the course of an inflammatory disease or prevent joint damage are an important part of treatment for many hand and wrist problems. The medications used to treat arthritis and other problems that affect the hands and wrists will depend largely on the form of arthritis or related condition that is diagnosed. The types of medications commonly used in arthritis treatment are:

Nonsteroidal anti-inflammatory drugs. Including more than a dozen different drugs, some of which are available without a prescription, nonsteroidal anti-inflammatory drugs (NSAIDs) are used to help ease arthritis pain and inflammation. They are used for all forms of arthritis.

Corticosteroids. These quick-acting drugs, similar to the cortisone made by your own body, are used to control inflammation. If inflammation is due to a systemic inflammatory disease, your doctor may prescribe oral corticosteroids. If inflammation is limited to one or a few joints, your doctor may inject a corticosteroid preparation directly into the joint.

Analgesics. Analgesics are among the most common drugs for many forms of arthritis. They also may be used to relieve pain from hand and wrist injuries and surgery. Unlike NSAIDs, which target both  pain and inflammation, analgesics are designed purely for pain relief. For that reason, they may be safe for people who are unable to take NSAIDs due to allergies or stomach problems, for example. When used as prescribed, they’re also an appropriate, and possibly safer, choice for people whose arthritis causes pain but not inflammation.

If hand pain is in the soft tissues, you may find relief from an analgesic salve, rub or balm available over the counter under trade names such as Aspercreme, Ben-Gay, Capzasin-P, Eucalyptamint, Icy Hot, Voltaren Gel and Zostrix. These topical preparations work through a variety of active ingredients and may be helpful if you are unable to take oral medications, or if medications fail to relieve pain or reduce it to a manageable level.

Disease modifying anti-rheumatic drugs. Disease-modifying anti-rheumatic drugs (DMARDs) are drugs that work slowly to modify the course of inflammatory disease. Different DMARDs may be useful for a number of different forms of arthritis including rheumatoid arthritis, lupus and psoriatic arthritis, all of which can affect the fingers and/or wrists. 

Gout medications. Some medications for gout are designed to reduce levels of uric acid in the blood to prevent future attacks of joint pain and inflammation. Others are designed to relieve the pain and inflammation of an acute attack. Many people with gout take both types of medication.

Biologic response modifiers. The newest category of medications used for rheumatoid arthritis and a few other inflammatory forms of arthritis are the biologic agents. There are currently eight such agents approved by the FDA. Each blocks a step in the inflammation process without suppressing the entire immune system. In addition to rheumatoid arthritis, certain biologic agents may be used in juvenile arthritis, ankylosing spondylitis and psoriatic arthritis.

Biologic response modifiers. The newest category of medications used for rheumatoid arthritis and a few other inflammatory forms of arthritis are the biologic agents. There are currently eight such agents approved by the FDA. Each blocks a step in the inflammation process without suppressing the entire immune system. In addition to rheumatoid arthritis, certain biologic agents may be used in juvenile arthritis, ankylosing spondylitis and psoriatic arthritis.

Osteoporosis medications. Osteoporosis medications are those used to slow the loss of bone or help the body build new bone. Although they are not used specifically to treat hand or wrist problems, strong bones are less prone to fracture. Wrist fractures are among the most common osteoporotic fractures.

Hand and Wrist Surgery

Wrist and finger replacements, fusions, carpal tunnel release and other surgeries for hands and wrists.

If the hands are injured or arthritis in the fingers or wrists leads to deformity and/ or interferes with function, surgery may be an option – or a necessity. Here are some of the most commonly performed arthritis-related hand and wrist surgeries.

Wrist fusion. This procedure involves surgically removing the surfaces of the joints affected by arthritis and joining the bones with plates and screws until they grow together, or fuse. If the entire wrist is not involved, the surgeon may perform a partial fusion, in which the joints that are not damaged are preserved, allowing some movement of the joint. For more extensive arthritis, the surgeon may fuse the entire wrist, which leaves the wrist rigid and immobile, but usually free of pain.

Wrist replacement. Unlike hip or knee replacement, wrist replacement can be performed on an outpatient basis. To replace a wrist, the surgeon makes an incision on the back of the wrist and cuts away the damaged joint surfaces of the ulna, the radius and in some cases the first row of carpal bones.  The surgeon then inserts a metal prosthesis into the center of the radius, which is held in place with cement. Depending on the prosthesis design, the carpal component of the artificial joint may be inserted in the center bone of the hand (the third metacarpal) or screwed into the remaining row of carpal bones. This part of the prosthesis is also cemented in place. A polyethylene spacer is inserted between the two metal components, and the carpal bones may be fused together to hold the prosthesis. Unlike wrist fusion, wrist replacement can allow movement of the wrist; however, it is not appropriate for people who put heavy demands on their wrists.

Learn more about wrist replacement surgery from the American Academy of Orthopaedic Surgeons.

Finger joint fusion. Similarly to wrist, certain joints of the fingers can be fused to ease pain and correct deformity. The most commonly fused finger joint is the distal phalangeal joint (DP), the joint closest to the nail.

Finger and thumb joint replacement. For the proximal and metacarpophalangeal joints (MCPs) where mobility is more important, joint replacement is possible. For pain and deformity in the MCP joints a doctor often uses flexible silicone implants. A doctor may also replace the basal joint, the joint at the base of the thumb.

Carpal tunnel release. In this procedure, the surgeon releases, or cuts free, the carpal ligament from the median nerve to relieve the symptoms of carpal tunnel syndrome. Traditionally this has been done through an open surgical procedure, meaning the wrist was opened. In recent years, surgeons have used two less invasive approaches to carpal tunnel surgery:

• The mini open approach, which involves a smaller incision, a shorter recovery time and possibly a lower risk of complications than the traditional procedure.
• The endoscopic approach, which involves making small incisions in the palm and wrist and inserting one or two camera-equipped tubes called endoscopes to view the inside of the wrist on a monitor. Guided by the image on the monitor, the doctor inserts small tools into the tubes and through the incisions to perform the procedure. For some people this approach involves less pain and a shorter recovery time than traditional carpal tunnel release.