Carpal tunnel syndrome
What is carpal tunnel syndrome?
Carpal tunnel syndrome, the most common compression neuropathy, is caused by compression of the median nerve at the wrist level. In carpal tunnel syndrome, the transverse carpal ligament is too thick and compresses the nerve. The nerve compression leads to symptoms of numbness and tingling, pain, weakness and clumsiness as you progress into advanced stages. The symptoms are primarily in the thumb, index finger, middle finger and half of the ring finger.
Why does carpal tunnel syndrome occur?
Why carpal tunnel syndrome occurs is not entirely understood. There are several predisposing factors including diabetes, hypothyroidism, alcohol use, obesity, and tobacco use. Women get it more commonly than men. It is also associated with pregnancy, rheumatoid arthritis and repetitive motion activities.
Symptoms of carpal tunnel syndrome
The symptoms can be reproduced by performing certain maneuvers when examining a patient, such as tapping on the wrist in a specific place or turning the wrist a certain way that increases the pressure on the nerve. Once you think that there is carpal tunnel syndrome, the next step is typically to order a nerve test to find the degree of damage to the nerve.
Treatments for carpal tunnel syndrome
Conservative carpal tunnel treatments relieve pain but do not cure the condition. These treatments include cortisone injections and bracing; I don’t typically inject with cortisone unless there’s a reason that the patient can’t undergo a surgery.
The curative procedure is a carpal tunnel release, which may be done as an open release or as an endoscopic release. The open release is performed through an incision in the palm and is the more traditional surgery. The newer endoscopic release is done through an incision in the wrist through which an endoscope with a blade is placed into the carpal tunnel, you visualize the transverse carpal ligament through the camera and then deploy the blade thereby releasing the nerve from the inside. I favor this technique because it tends to be a little bit less traumatic to the tissues.
Trigger finger
What is trigger finger?
Trigger finger, or stenosing tenosynovitis, is very, very common. It is an entrapment of the tendon, where there is a spot of swelling and the flexor tendons can’t move smoothly through a tunnel. The symptoms include catching and popping, which can be painful. In severe cases, the finger can lock down and get stuck in flexion (bent), requiring manual manipulation to extend the finger.
Who gets trigger finger?
The cause of trigger finger is not entirely understood, although inflammation is most commonly cited. Predisposing factors include being a woman, age 55 to 60 years, diabetes, gout, kidney disease and rheumatoid arthritis.
How is trigger finger diagnosed?
Typically, you’ll have pain in the palm in an area called the A1 pulley region. That’s where the tunnel is where the tendon gets stuck.
Treatment for trigger finger
Cortisone injection is the first line of treatment for a trigger finger and leads to a roughly 70% success rate. Splinting is not commonly used.
If you fail conservative treatment with the injection, a trigger finger release surgery can be performed. A small incision is made in the skin and in the tunnel to open up the tunnel so the tendon can glide freely.
De Quervain’s Disease (Tendonitis of the Wrist)
Like trigger finger, tendonitis is also a stenotic condition in which tendons become inflamed and entrapped.
What is De Quervain’s disease?
De Quervain’s disease is one of the most common forms of tendonitis. There are two tendons in the wrist that go out to the thumb and become trapped and inflamed, leading to pain on the thumb side of the wrist.
Who gets De Quervain’s disease?
De Quervain’s disease is more common in women and tends to peak during childbearing and perimenopausal years. Like carpal tunnel, it can be associated with pregnancy. It’s also associated with diabetes.
How is De Quervain’s disease diagnosed?
Typically, diagnosis is made by holding the hand so the fingers are parallel to the floor, holding the thumb with the rest of the fingers, and then flexing the wrist down. If someone has De Quervain’s disease, they will have significant pain when moving their wrist in this maneuver.
How is De Quervain’s disease treated?
Conservative treatments include anti-inflammatory medications, activity modifications, thumb bracing, and cortisone injections. One to two cortisone injections are typically about 80% effective at curing symptoms.
If symptoms are not alleviated by conservative means we perform surgery, which is an incision made over the thumb side of the wrist to release those tendons from their sheath, allowing them to stop rubbing and stop the inflammation.
Fractures
What is a distal radius fracture?
A distal radius fracture is a wrist fracture. It’s one of the most common fractures of the musculoskeletal system and is typically caused by a fall on an outstretched hand or wrist.
Distal refers to the location of the fracture and means that it is far down the bone. The bone that is fractured is the radius bone.
Treatment for a distal radius fracture
In children or in fractures without too much displacement or angulation, you can manipulate the bone back into position. Once it is in position you place a cast on it to hold it there while it heals.
In fractures in which the manipulation has failed or in fractures in which there’s too much angulation, you would perform surgery. Plates and screws would hold the bone in the appropriate anatomic position so it can heal.
Frequently asked questions
Is it better to treat hand issues with heat or with ice?
I typically recommend ice for things that involve inflammation, such as De Quervain’s disease in which the tendons are inflamed. In addition to the things that I mentioned like cortisone injections, anti-inflammatory medications, and bracing, ice is more helpful for inflammatory disorders because the ice acts to decrease the inflammation. If you’re suffering from an issue that causes stiffness in the fingers or wrist, I recommend heat because the heat will warm up the tissue such that you can move better.
For conditions like trigger finger or carpal tunnel, are there any exercises that can be done at home?
For carpal tunnel syndrome, nerve glide exercises, or certain types of stretches, can help the nerve to glide better and decrease compression. However, nerve glides only work in early-stage disease. As carpal tunnel syndrome progresses, the nerve glides don’t work well. You can see a hand therapist for the exercises.
Unfortunately, there are not any exercises to help with trigger finger.
Once an incision is made for a carpal tunnel release, will the tunnel ever heal or will it always be open?
The tunnel remains more open after the surgery and scar tissue forms over top. Since the tunnel heals over while it is wider, there’s more space for the nerve.
What causes someone’s fingertip to feel tingly and how can it be treated? Does the cause vary by finger?
The cause could vary, but typically it will be something nerve-related. If it is the thumb, index finger, middle finger and half of the ring finger, it could be carpal tunnel syndrome. If it is the other half of the ring finger or the small finger, it could be cubital tunnel syndrome, or nerve compression at the elbow. There may be a digital nerve issue in one of the nerves specific to that finger.
It may also be a circulation issue.