Carpal Tunnel Treatment
Pressure on the median nerve on the palm side of the wrist causes numbness in the fingers of the hand, loss of strength, and frequently pain in the hand and forearm (particularly at night). These symptoms are commonly referred to as “carpal tunnel syndrome”. There are many causes for this problem including some medical conditions such as hypothyroidism, arthritis, and even pregnancy. Most people with carpal tunnel syndrome have acquired the problem from every day use of their hands. Initial treatment for mild symptoms includes splinting of the affected wrist, use of non-steroidal anti-inflammatory medications, and avoidance of any activities that aggravate the symptoms. For persistent symptoms, we generally recommend that you have a nerve study to determine the extent of the injury to the nerve. Sometimes a steroid injection into the carpal canal can provide temporary relief from the pain and numbness. Definitive treatment involves surgery to divide the ligament that is compressing the nerve. This operation is done under local anesthesia with or without some sedation. Recovery time to most activities takes 2 to 6 weeks. It is common for patients to have symptoms in both hands. We recommend surgical treatment for one hand at time.
“Trigger finger” is the common term for a condition known as stenosing tendovaginitis. This is an inflammation of the tendons that bend fingers down into the palm resulting in a swelling of the tendon itself. It may occur in a single finger or multiple fingers at the same time. This swollen area then begins to be trapped on one side or the other of a pulley near the big knuckle of the hand. A person with a trigger finger will experience pain in the affected finger, snapping or locking of the finger, and in advanced cases the inability to either bend or straighten the finger. Trigger fingers are common in diabetic individuals. Initial treatment is injection of the affected finger with a steroid preparation. This is highly effective at resolving the symptoms but may need to be repeated. For trigger fingers that do not resolve with injections, a small surgical procedure can be done under local anesthesia to treat the problem. Recurrence after surgical release is uncommon.
This condition is also known as “radial styloiditis” referring to the prominence on the forearm bone at the wrist that is the site of inflammation of the tendon that pulls the thumb into the “hitch hiker’s position”. The condition is common in women. It is characterized by severe pain with wrist movements such as wringing out a wash cloth. It can occur after a period of increase activity with the affected hand. The pain is usually unrelenting and significantly limits use of the hand. Initial treatment can include, splinting, non-steroidal anti-inflammatory drugs, and /or steroid injection into the tendon sheath. Surgical decompression of the affected tendon sheath is reserved for those individuals in whom more conservative management has not been successful. The procedure is done as an out-patient under a twilight anesthesia. Recovery to full use of the hand is two to four weeks.
Joint pain in the fingers and hand results from aging, wear and tear, and traumatic injuries. For the majority of people with hand arthritis, non-surgical management that includes modification of activity, therapy, splints and anti-inflammatory medicine can provide satisfactory relief. For persons that fail medical management, surgical treatment may be effective at alleviating joint pain. If you would like an evaluation contact our office.
Our surgeons have extensive experience in treating both simple and complicated fractures of the bones in the hand and wrist. Most procedures are done on an out-patient basis. We work closely with the MetroHealth Hand Occupational Therapists who provide post-operative support and instruction aimed at restoring the best function possible.
The tendons that bend and straighten our fingers are frequently injured from cuts or other traumatic injuries. Occasionally a tendon may “pop” from a violent motion alone. Tendon injuries require an evaluation in a timely fashion as early repair results in better function. Although the quality of the surgical repair is critical, equally important is the hand therapy provided after the repair. We work as a team with our hand therapists to guide you to the best recovery possible. To learn more about specific injuries open the links listed below.