Carpal tunnel

Carpal tunnel syndrome is known as a compression neuropathy: the symptoms are caused by the compression of the median nerve. It’s the most common compression neuropathy, and one million adults in the US are diagnosed with carpal tunnel syndrome each year.

What is carpal tunnel?

Carpal tunnel syndrome is compression of the median nerve, typically by the transverse carpal ligament. The nerve compression leads to symptoms of numbness/tingling, pain, and when advanced, weakness/clumsiness.

Symptoms are primarily in the thumb, index finger, long finger, and half of the ring finger.

Why does carpal tunnel occur?

The “why” is not fully understood. Predisposing factors include:

  • Diabetes
  • Hypothyroidism
  • Excessive alcohol use
  • Obesity
  • Tobacco use
  • Female sex
  • Pregnancy
  • Rheumatoid arthritis
  • Repetitive motion activities.

How is carpal tunnel diagnosed?

Your doctor will perform a clinical examination, to see if your symptoms happen when they move your wrist and press on your wrist in certain ways.

Nerve studies can be done to quantify the extent of damage to the nerve fibers.

How is carpal tunnel treated?

Conservative measures include steroid injection and night splints, which may help but are not guaranteed to work.

You can also have a carpal tunnel release surgery, either through an incision in the palm (open) or an endoscopic technique.

Trigger finger

Trigger finger is a stenosing tenosynovitis, or tendon entrapment. It’s a mechanical impingement of the flexor tendons as they pass through a narrowed pulley (tunnel).

Entrapment leads to symptoms of painful catching or popping.

In severe cases, the finger will “lock” into place in a bent position (flexion) and require manipulation of the finger into being straight (extension).

Why does trigger finger occur?

The exact cause of trigger finger is disputed, but inflammation has been cited as a reason. Predisposing factors include:

  • Female sex
  • Age 55-60 years
  • Diabetes
  • Gout
  • Kidney disease
  • Rheumatoid arthritis.

How is trigger finger diagnosed?

Your doctor will examine your hand. If you have pain over the A1 pulley region or if your finger is catching/locking when it is bent and straightened, you may have trigger finger.

How is trigger finger treated?

You may have a steroid injection into the A1 pulley, which has about a 70% success rate. You can also have a splint on your finger with a couple of different options for where the splint is and what angle the splint is at.

A surgery to release the A1 pulley can also treat trigger finger.

Tendinitis of the wrist

A range of conditions in which tendons become inflamed and entrapped within their sheaths or by surrounding structures, causing pain.

DeQuervain’s Disease

DeQuervain’s disease is stenosing tenosynovitis of the first dorsal compartment, or a type of tendon entrapment. It’s more common in women and peaks in childbearing years and perimenopausal years. It’s associated with pregnancy and diabetes and leads to pain on the thumb side of the wrist.

How is DeQuervain’s disease diagnosed?

Your doctor will examine your hand and wrist. DeQuervain’s disease includes tenderness with touch over the thumb-side of the wrist and swelling.

How is DeQuervain’s disease treated?

Conservative measures to treat DeQuervain’s disease include:

  • Anti-inflammatory medications
  • Activity modification
  • Thumb spica splint/brace
  • Steroid injection (cortisone).

Surgical treatment is release of the inflamed tendons.

Thumb Base Arthritis

Basal joint arthritis is arthritis at the base of the thumb, where it attaches to the hand. It’s extremely common, and includes pain when you pinch your hand, turn keys, turn a door knob, or open jars. It’s more common in women.

How is thumb base arthritis treated?

Arthritis at the base of the thumb is treated conservatively with splinting, anti-inflammatory medications and cortisone injections. For surgical patients, either fusion (for younger patients) or removing the arthritic bone and filling in the space with tendon are performed.

Finger Arthritis

Finger arthritis is diffuse pain and stiffness throughout the finger joints (knuckles). It may be gradual from “wear and tear” over the years or inflammatory from conditions such as rheumatoid arthritis or psoriatic arthritis.

How is finger arthritis treated?

Conservative treatment for finger arthritis includes splinting, anti-inflammatory medications, steroid injections, and activity modification. Surgical options include joint fusion or joint replacement.

Fractures or Broken Bones

Two common fractures are of the knuckles (metacarpal) or the wrist (distal radius).

Boxer’s fracture

A boxer’s fracture is the fracture of the small finger metacarpal neck, or breaking the bone in your finger just below the knuckle. It’s typically treated with splinting or casting. If the bone has moved too much for a splint or cast to be effective, surgery is performed.

Distal Radius Fracture

Distal radius fractures are also known as wrist fractures. They are one of the most common fractures of the musculoskeletal system and are typically caused by a fall onto an outstretched hand and wrist.

How is a wrist fracture treated?

In younger patients, and in fractures without much displacement or angulation, moving the arm to put the bone in place and then using a cast to keep it there while it heals may be enough. If that doesn’t work or the bone has moved too much for it to be effective, surgery is required.