CARPAL TUNNEL SYNDROME
Carpal Tunnel Syndrome is caused by compression of the median nerve as it travels from the forearm into the wrist through an anatomic passageway called the carpal tunnel. There are a number of causes of the compression, but the result is a sense of numbness, tingling, and pain in the hand, mostly in the thumb, index, long, and radial (thumb) side of the ring finger. The symptoms often occur at night and after prolonged use of the hand. In severe cases, muscles supplied by the median nerve may atrophy. Diagnosis may be based on history and exam and may be supplemented by tests that measure how well the nerve is conducting impulses. Treatment can include splinting, avoidance of exacerbating activity, cortisone, and frequently surgery to relieve the symptoms. Click here to learn more about carpal tunnel syndrome.
Dupuytren’s contracture is thickening of the fibrous tissue of the palm just below the skin, which happens for unknown reasons. Early on, there are painless nodules which may progress to form tough bands of tissue, which lead to an inability to fully straighten the fingers, most often the ring finger. Treatment is conservative unless the contractures inhibit functional use of the hand, when enzyme injection (Xiaflex) or surgical excision of the band may be necessary. For more information please click here.
Trigger finger is painful locking of a digit caused by swelling or thickening of the tendon to that digit. As the tendon tries to slide through one of the pulleys in the palm that helps control the motion, the swollen tendon becomes stuck, ‘locking’ the finger in flexion. If the symptoms are bad enough, a cortisone injection is often helpful, and, if that is not successful, surgery may be indicated. For more information please click here.
Ganglion cysts are common causes of bumps in the hand and wrist. The cyst is essentially a pocket full of joint or tendon fluid which collects outside the joint or tendon, causing a usually painless, benign bump, which may wax and wane in size. Treatment is entirely elective and may be observation, traumatic ruptire (of historic interest only!), aspiration, or surgical excision. For more information please click here.
DeQuervain’s tenosynovitis is a painful inflammation of the tendons which extend the thumb as they pass through an anatomic tunnel near the wrist. Pain and sometimes numbness on the thumb side of the hand are the main symptoms. Ice, anti-inflammatory medications (NSAIDs), and splinting may be helpful, and sometimes a cortisone shot is necessary. If these measures fail to alleviate the symptoms, an operation can be curative. For more information please click here.
Arthritis can affect virtually any joint in the body, including the many joints of the hand and wrist. There are a number of varieties of arthritis, the most common being degenerative and rheumatoid arthritis, which cause pain, stiffness, weakness, and progressive deformity of the hand and wrist. Diagnosis is usually made through history, physical exam, and plain x-rays. There are many treatment alternatives which may be recommended based on the symptoms, including medications, splinting, exercises, and surgery. For more information please click here.