Hand Disorders

Hand Problems

We are dedicated to providing comprehensive care for a variety of hand problems. Beginning with your initial consultation, and concluding with your last visit, our team strives to make your experience a positive one. Our specialists can treat a variety of hand conditions, including:

What is carpal tunnel syndrome?

Carpal tunnel syndrome is when the median nerve is compressed as it passes through the carpal tunnel. The carpal tunnel is an opening in your wrist that is formed by the carpal bones on the bottom of the wrist and the transverse carpal ligament across the top of the wrist. The median nerve provides sensory and motor functions to the thumb and 3 middle fingers. If it gets compressed or irritated, you may have symptoms.

Some Facts-

• Carpal tunnel release is one of the most common hand conditions requiring surgery.
• Women get carpal tunnel syndrome three times more often than men.
• Carpal tunnel syndrome is a progressive condition that can worsen without proper care.
• Symptoms of carpal tunnel syndrome often occur during pregnancy and can be alleviated with nonsurgical treatments. Symptoms often improve after delivery, but such patients are at higher risk of developing carpal tunnel syndrome later in life.

Carpal Tunnel Syndrome Causes and Risk Factors

Carpal tunnel syndrome is caused by an increase in pressure within the carpal tunnel, which leads to compression of the median nerve as it travels across the wrist into the palm through the carpal tunnel.

In most cases, this increase in pressure inside the carpal tunnel is difficult to attribute to one cause.

What are the symptoms of carpal tunnel syndrome?

These are the most common symptoms:

• Pain or numbness in one or both hands
• "Pins and needles" feeling in the fingers
• Swollen feeling in the fingers
• Burning or tingling in the fingers, especially the thumb and the index and middle fingers
• Pain or numbness that is worse at night, interrupting sleep

Treatment of carpal tunnel syndrome

Treatment may include:

• Splinting your hand. This helps keep your wrist from moving. It also eases the compression of the nerves inside the tunnel.
• Anti-inflammatory medication. These may be oral or injected into the carpal tunnel space. These reduce the swelling.
• Surgery. This eases compression on the nerves in the carpal tunnel.

Surgery for carpal tunnel syndrome

Surgery for carpal tunnel syndrome is usually done as an outpatient. Two types of carpal tunnel surgery are done: open surgery and endoscopic surgery. You may have local or general anesthesia, or both, for either surgery.

During open surgery, the surgeon cuts open your wrist. The tissue that is pressing on the nerves is cut. This relieves the pressure on the nerve.

During endoscopic surgery, the surgeon puts a long, thin rod through a tiny cut on the wrist. The rod, or scope, contains a camera and a light. The scope lets the surgeon to see inside your wrist. He or she cuts the tissue using tiny surgical tools.

Recovery from carpal tunnel surgery is different for each person. If your nerve has been compressed for a long time, recovery may take longer. You will be encouraged to move your fingers and wrist a few days after surgery to help prevent stiffness.

Dupuytren's contracture

Dupuytren's contracture is an abnormal thickening of the tissue between the skin and the tendons in the palm, which may limit the use of one or more fingers or may eventually cause the fingers to be pulled in toward the palm in a bent position.

The first sign of the condition is usually a small lump or nodule in the palm, often occurring in the crease of the hand that is closest to the base of the ring and little fingers. Further indication is that at a certain point, the palm cannot be placed flush with a flat surface such as a table. As the disease progresses, the involved finger is drawn toward the palm by the band of fibrous tissue that forms there.

Dupuytren's contracture is a hereditary condition and the cause is not known. It is more common in men over the age of 50.

Treatment

Treatment is most effective when sought at the nodule (small lump) stage. Collagenase injections are available as a nonsurgical option. Surgery will only temporarily restore use to the fingers. With time, the condition will return.

De Quervain's disease

De Quervain's disease is an irritation and swelling of the sheath or tunnel that surrounds the thumb tendons as they pass from the wrist to the thumb.

The source of DeQuervain's disease is often unknown, but it may be caused by overuse and repetitive motions and has been associated with pregnancy and certain inflammatory conditions such as rheumatoid arthritis. Although anyone can get DeQuervain's, it affects women considerably more often than men.

Treatment

In almost all cases, nonsurgical treatments are explored first. Splints, oral anti-inflammatory medications or injections may help reduce the irritation and swelling. Temporary avoidance of activities that cause pain may also ward off symptoms.

For those cases that do not respond to nonsurgical treatments, surgery may be recommended. The procedure enlarges the tendon compartment to make more room for the irritated tendon. Normal use of the hand can be resumed once comfort and strength return.

Hand cysts and tumors

A tumor is any kind of unusual group of cells that grows in your body. We often associate tumors with cancer, but most hand tumors are not cancerous.

A ganglion cyst is the most common hand tumor and generally grows either on the top or inner side of your wrist. These fluid-filled pouches can put pressure on your nerves, causing pain.

A giant cell tumor of tendon sheath is another common hand tumor, but it is solid, rather than filled with fluid. It grows on the protective covering that surrounds the tendons in the fingers.

Treatment

Physicians generally seek to heal ganglion cysts without surgery. In some cases, ganglion cysts disappear on their own without any treatment. For cysts that do not resolve themselves, treatment options include:

• Brace or splint: Wearing a brace or splint keeps the affected wrist from moving. Resting the wrist keeps the cyst from growing, and helps to relieve pain
• Aspiration: Your physician may drain the fluid within the cyst, helping it to heal and disappear
• Surgery: Surgery is recommended for giant cell tumors of tendon sheath and ganglion cysts that return even after aspiration.

Minimally invasive hand surgery is employed to remove the cyst or tumor, as well as any affected surrounding joint tissue.

Fractures

Generally, fractured hands, fingers, and wrists will heal without surgery and nonsurgical treatment often includes splints or casts and physical therapy. If your injury caused your bones to shift out of place or break through the skin, you may need surgery to restore the proper alignment. During surgery, your orthopedic surgeon may use wires, screws, or plates to secure your bones back to the correct position.

Tendon problems

Two major problems associated with tendons include tendonitis and tenosynovitis. Tendonitis, inflammation of a tendon (the tough cords of tissue that connect muscles to bones) can affect any tendon, but is most commonly seen in the wrist and fingers. When the tendons become irritated, swelling, pain, and discomfort will occur.

Tenosynovitis is the inflammation of the lining of the tendon sheaths which enclose the tendons. The tendon sheath is usually the site that becomes inflamed, but both the sheath and the tendon can become inflamed simultaneously.

Common tendon disorders include the following

Treatment for most tendon problems may include:

• Activity modification
• Ice
• Splinting or immobilization
• Steroid injections
• Nonsteroidal anti-inflammatory medications
• Surgery

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