When Reasons for Hand and Wrist Pain Seem Out of Our Grasp

A fall on an outstretched hand. A laceration. A crushing injury. The hand and wrist, with 27 bones, numerous ligaments and tendons, and a delicate web of nerves and blood vessels, is a complex limb. Even what seems like a simple problem has the potential to end a career or bring a lifetime of disability if not treated correctly.

But if Elizabeth Ann Ouellette, M.D., MBA, has anything to say about it, your pain will be relieved and your function restored. A renowned orthopedic surgeon, Dr. Ouellette is chief of hand surgery at Baptist Health Orthopedic Care.

Elizabeth Ann Ouellette, M.D., MBA, chief of hand surgery at Baptist Health Orthopedic Care

With decades of experience and years of research in studying and developing the most innovative hand surgery techniques, Dr. Ouellette shared her expertise at the recent Baptist Health International World-Class Medical Care International Symposium. The meeting was attended by 115 physicians from 17 countries and was broadcast live to several medical schools in Latin America and the Caribbean.

Among the common hand injuries she discussed were triangular fibrocartilage complex (TFCC) tears and distal radius fractures. The TFCC consists of ligaments and cartilage in the wrist that contribute to hand function, wrist motion and stabilization. A distal radius fracture is a break in the radius, the bone located on the inner portion of the arm, close to the wrist. The injuries can result in pain, loss of grip strength and a reduction in pronation and supination.

While the problems can appear obvious at times, they can also be difficult to detect without an experienced surgeon and imaging specialist, Dr. Ouellette said.

“I treated a professional male tennis player later in his career who had fallen on an outstretched wrist. Nobody could find a fracture. Everybody told him there’s nothing wrong and to go back out and play. But he couldn’t,” Dr. Ouellette said. “When he finally came to see me, I told him it wasn’t his fault his career ended. He had a ring injury, or a tear in the peripheral part of the cartilage of the TFCC. These can be very subtle on imaging. You typically don’t see them on X-ray.”

When it comes to the hands and wrists, her message to patients — and to physicians — is clear. “Have a broader mind about falling on an outstretched wrist. Take a look. And then take a closer look,” she said.

Another injury that should be considered after a fall upon the hand is a fracture of the scaphoid, a small bone located between the base of the thumb and the end of the radius. “We went into the biomechanical lab and recreated falls,” Dr. Ouellette said. “The most common break was the scaphoid.”

Many hand injuries, from trauma and gunshot wounds to lacerations and falls, involve damage to the nerve, which can lead to sensory and motor loss, pain, numbness and weakness. Dr. Ouellette and other physicians at Baptist Health Orthopedic Care are involved in several hand research studies to repair nerve damage, including:

• Using a connective tissue membrane to provide protection and a framework for nerve regeneration.

• Using an ultrasound-guided pulse generator to place an electrode near a damaged nerve and send small electrical pulses to the nerve to promote healing.

• Exploring structured water, or hydrogels, as a supportive environment for nerve cells to grow.

In addition to fractures, ligament, tendon and cartilage problems and nerve conditions, the hand and wrist team at Baptist Health Orthopedic Care cares for patients with arthritis, dislocations, sprains, tendonitis, Dupuytren’s contracture, ganglion cysts, trigger finger and other complex conditions.

“Our work is really about learning how to help people. That includes offering psychological support, listening to our patients, teaching coping strategies and reducing stress,” Dr. Ouellette said.

Dr. Ouellette and the hand team also train orthopedic surgeons in advanced surgical techniques. The Florida International University/Baptist Health Orthopedic Hand Surgery Fellowship begins this July. For more information on the program, click here.