Carpal Tunnel Syndrome
Description
Carpal tunnel syndrome is a common source of hand numbness and pain. It is more common in women than men and affects up to 10 percent of the population. It is caused by increased pressure on a nerve entering the hand through the confined space of the carpal tunnel.
The median nerve travels from the forearm into your hand through a tunnel in your wrist. The bottom and sides of this tunnel are formed by wrist bones and the top of the tunnel is covered by a strong band of connective tissue called a ligament. Your doctor may make the diagnosis by discussing your symptoms and examining you. If symptoms continue to bother you, electrical testing of the nerve function is often performed to help confirm the diagnosis and clarify the best treatment option in your case.
Symptoms
Symptoms usually begin gradually without a specific injury. Numbness, tingling and pain in the hand are common. You may experience an electric-like shocking feeling. The thumb side of the hand is usually most involved. Symptoms at night are common and may awaken you from sleep. During the day symptoms frequently occur with holding a phone, reading or driving. Symptoms may occur at any time. Moving or shaking the hands often helps decrease symptoms. Sometimes strange feelings and pain will travel up the arm. Initially symptoms come and go, but over time they may become constant. A feeling of clumsiness or weakness can make delicate motions like buttoning buttons difficult and may cause you to drop things. If the condition is very severe, muscles in the palm may become visibly wasted.
Risk Factors
The actual cause is unknown in most people. Carpal tunnel syndrome is more common in women. In women, the swelling that occurs during pregnancy may cause symptoms, but those will frequently go away after delivery. Carpal tunnel syndrome becomes more common as we grow older and seems to affect people with certain medical conditions such as diabetes, thyroid conditions and rheumatoid arthritis more frequently.
Treatment Options
Symptoms can often be relieved without surgery. Treatment often begins with a brace or splint worn at night to keep the wrist in a natural position. Splints can also be worn during activities that aggravate symptoms. Simple medications such as Tylenol® or Advil® can help decrease pain. Changing patterns of hand use to avoid aggravating positions and activities may be helpful. A corticosteroid injection will often provide temporary relief, but symptoms may come back.
If your carpal tunnel syndrome continues to bother you and you do not gain relief from non-surgical treatments, surgery can be effective in diminishing symptoms. Because carpal tunnel syndrome is not a dangerous problem, the decision whether to have surgery is based mostly on the severity of your symptoms.
► If your symptoms are severe and won't go away you may want to consider surgery.
► In more severe cases, surgery is considered sooner because other treatment options are less helpful.
► In very severe cases, surgery may be recommended to prevent irreversible damage.
Treatment Options: Surgical
The strong roof of the carpal tunnel is cut during carpal tunnel surgery to increase the size of the tunnel and decrease pressure on the nerve. This is done through an incision in the palm or wrist. A small camera may be used to allow the surgery to be performed through a smaller incision. Risks of the surgery include bleeding, infection and nerve injury. Some pain, swelling and stiffness are expected, but severe problems are rare.
After surgery, elevating the hand and moving the fingers helps minimize swelling and stiffness. Minor soreness in the palm is common for several months after surgery. Most patients have improvement following surgery, but recovery may be gradual. When carpal tunnel syndrome has been present longer and the nerve is more severely affected, recovery is slower and less complete.
deQuervain's Tendinitis
deQuervain's Techniques
What is it? deQuervain's tendinitis is a condition brought on by irritation or swelling of the tendons found along the thumb side of the wrist. The irritation causes the compartment (lining) around the tendon to swell, changing the shape of the compartment; this makes it difficult for the tendons to move as they should. The swelling can cause pain and tenderness along the thumb side of the wrist, usually noticed when forming a fist, grasping or gripping things, or turning the wrist.
Signs and Symptoms
Pain over the thumb side of the wrist is the main symptom. The pain may appear either gradually or suddenly. It is felt in the wrist and can travel up the forearm. The pain is usually worse with use of the hand and thumb, especially when forcefully grasping things or twisting the wrist. Swelling over the thumb side of the wrist is noticed and may be accompanied by a fluid-filled cyst in this region. There may be an occasional "catching" or "snapping" when moving the thumb. Because of the pain and swelling, it may be difficult to move the thumb and wrist, such as in pinching. Irritation of the nerve lying on top of the tendon sheath may cause numbness on the back of the thumb and index finger.
Diagnosis
A Finkelstein test is generally performed. In this test, the patient makes a fist with the fingers over the thumb. The wrist is then bent in the direction of the little finger. This test can be quite painful for the person with deQuervain's tendinitis. Tenderness directly over the tendons on the thumb side of the wrist is the most common finding, however.
Treatment
The goal is to relieve the pain caused by the irritation and swelling. In some cases, your doctor may recommend resting the thumb and wrist by wearing a splint. Anti-inflammatory medication taken by mouth or injected into that tendon compartment may help reduce the swelling and relieve the pain. In some cases, simply not doing the activities that cause pain and swelling may allow the symptoms to go away on their own. When symptoms are severe or do not improve, surgery may be recommended. The surgery opens the compartment (covering) to make more room for the irritated tendons. Normal use of the hand can usually be resumed once comfort and strength have returned. Your hand surgeon can advise you on the best treatment for your situation.
Hand Fractures
Fractures of the hand can occur in either the small bones of the fingers (phalanges) or the long bones (metacarpals). They can result from a twisting injury, a fall, a crush injury, or direct contact in sports.Symptoms
Signs and symptoms of a broken bone in the hand include:
► Swelling
Tenderness
► Deformity
► Inability to move the finger
► Shortened finger
► Finger crosses over its neighbor when making a partial fist
► Depressed Knuckle
A depressed knuckle is often seen in a "boxer's fracture." This is a fracture of the fifth metacarpal, the long bone below the little finger.
Diagnosis
A physical examination is done to check the position of the fingers and the condition of the skin. The examination may include some range of motion tests and an assessment of feeling in the fingers. This will ensure that there is no damage to the nerves. X-rays identify the location and extent of the fracture.
Non-Surgical Treatment
Most of the time, the bones can be realigned by manipulating them without surgery. A cast, splint or fracture-brace is applied to immobilize the bones and hold them in place. The cast will probably extend from the fingertips down past the wrist almost to the elbow. This ensures that the bones remain fixed in place.
A second set of X-rays will probably be needed about a week later. These X-rays are used to ensure that the bones have remained in the proper position.
The cast will be worn for three to six weeks. Gentle hand exercises can probably be started after three weeks. Afterward, the finger may be slightly shorter, but this should not affect the ability to use the hand and fingers.
Surgical Treatment
Some hand fractures require surgery to stabilize and align the bones. These fractures usually break through the skin or result from a crushing accident. . An orthopaedic surgeon can implant wires, screws, or plates in the broken bone to hold the pieces of the fractured bone in place.
If the bone changes position while healing, the finger may lose some function.
After the bone has healed, the surgeon may remove the implants or may leave them in place.
The physician may want to examine the hand periodically to ensure that the joint doesn't tighten (contract) during healing. Joint stiffness may be experienced because of the long immobilization period. Exercises can help restore strength and range of motion. A physical therapist may be able to help with this.
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