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Forearm, Wrist and Hand (Repetitive Strain Injury)

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In the treatment of hand disorders resulting from RSI the primary emphasis should always be on restoration of function.  Symptoms in the hand are often caused by disorders of the neck (with the involvement of the brachial plexus) and sometimes by disorders at the elbow.

Movement of the Hand
Movement of the hand occur mainly at the three groups of joints:

  • The carpo-metacarpal joint of the thumb
  • The metacarpo-phalangeal joints
  • The interphalangeal joints

Classification of Disorders of the Forearm, Wrist and Hand

Infections of bone:       Acute Osteomyelitis and Chronic Osteomyelitis.

Miscellaneous:             Volkmann’s ischaemic contracture and Acute frictional tenosynovitis.

Deformities:                Madelung’s deformity

Arthritis:                      Pyogenic arthritis, Rheumatoid arthritis and Osteoarthrits

Miscellaneous:            Keinbock’s disease

Extra-Articular Disorders about the Wrist and Hand:
Acute infections of the fascial spaces

Chronic infective tenosynovitis

Neurological disorders: compression of the median nerve in the carpal tunnel.

Miscellaneous: Ganglion; Dupuytren’s contracture; rupture or severance of tendons; De Quervain’s tenovaginitis; Digital stenosing tenovaginitis.

Acute Frictional Tenosynovitis (peritendinitis; paratendinitis)
This is an easily recognised clinical condition common in young adults whose occupations demand repetitive movements of the wrist and hand.  It is attributed to friction between the tendons and the surrounding paratendon, from over use of the hand.

Articular Disorders of the Wrist and Hand – Madelung’s Deformity
(Radio-ulnar dyschondrosteosis)  This is congenital subluxation or dislocation of the lower end of the ulna, from malformation of the bones.

Pyogenic arthritis of the wrist is uncommon.  Infection may be haematogenous, or it may be introduced through a penetrating wound.  The distal interphalangeal joints of the digitis are prone to infection spreading from a suppurative lesion in the adjacent pulp space or from a penetrating wound.