Carpal Tunnel Syndrome
- Are you experiencing numbness, tingling, burning, or pain in your thumb or fingers?
- Have you had any shock-like sensations to your thumb and index, middle, and ring fingers?
- Have you noticed pain or tingling that travels up your forearm toward your shoulder?
- Does your hand feel weak or clumsy?
- Have you been dropping things to weakness or numbness?
You may have carpal tunnel syndrome. In most cases, the symptoms of carpal tunnel syndrome begin gradually—without a specific injury. Many patients find that their symptoms come and go at first. However, as the condition worsens, symptoms may occur more frequently or may persist for longer periods of time. Night-time symptoms are very common because many people sleep with their wrists bent.
Carpal tunnel syndrome is a common condition that causes pain, numbness, and tingling in the hand and arm. The condition occurs when one of the major nerves to the hand — the median nerve — is squeezed or compressed as it travels through the wrist. Most people find that carpal tunnel syndrome gets worse over time, so early diagnosis and treatment are important. Early on, symptoms can often be relieved with simple measures like wearing a wrist splint or avoiding certain activities.
Some of the common risk factors for carpal tunnel syndrome include:
- Sex – More women experience carpal tunnel syndrome than men.
- Heredity – Passed down by family through your genes.
- Repetitive Hand Use – Repeating the same hand and wrist motions or activities over a prolonged period of time may aggravate the tendons in the wrist, causing swelling that puts pressure on the nerve.
- Hand and Wrist Position – Doing activities that involve extreme flexing or extension of the hand and wrist for a prolonged period of time can increase pressure on the nerve.
- Pregnancy – Hormonal changes during pregnancy can cause swelling.
- Health Conditions – Such as diabetes, rheumatoid arthritis, and thyroid gland imbalance are conditions that are associated with carpal tunnel syndrome.
Good news! There are multiple nonsurgical options for treating carpal tunnel syndrome including:
- Bracing or Splinting – Wearing a brace or splint at night will keep you from bending your wrist while you sleep.
- Medication – Anti-inflammatory drugs such as ibuprofen and naproxen can help relieve pain and inflammation.
- Activity Changes – Symptoms often occur when your hand and wrist are in the same position for too long—particularly when your wrist is flexed or extended.
- Exercise – Some patients may benefit from exercises that help the median nerve move more freely within the confines of the carpal tunnel.
- Steroid Injections – Corticosteroid, or cortisone, is a powerful anti-inflammatory agent that can be injected into the carpal tunnel.
If none of the nonsurgical treatments resolve your carpal tunnel syndrome you may need to consider surgery. The surgical procedure performed for carpal tunnel syndrome is called a “carpal tunnel release.” There are two different surgical techniques for doing this, but the goal of both is to relieve pressure on your median nerve by cutting the ligament that forms the roof of the tunnel. This increases the size of the tunnel and decreases pressure on the median nerve.
In most cases, carpal tunnel surgery is done on an outpatient basis. The surgery can be done under general anesthesia, which puts you to sleep, or under local anesthesia, which numbs just your hand and arm. After surgery, the ligament may gradually grow back together—but there will be more space in the carpal tunnel and pressure on the median nerve will be relieved.
Wrist Lumps and Cysts
- Are you experiencing a lump on your wrist?
- Did it appear quickly?
- Grow rapidly?
You may have a ganglion of the wrist. Most ganglions form a visible lump, however, smaller ganglions can remain hidden under the skin. Although many ganglions produce no other symptoms, if a cyst puts pressure on the nerves that pass through the joint, it can cause pain, tingling, and muscle weakness.
Ganglion cysts are the most common mass or lump in the hand. They are not cancerous and, in most cases, are harmless. They occur in various locations, but most frequently develop on the back of the wrist. These fluid-filled cysts can quickly appear, disappear, and change size. Many ganglion cysts do not require treatment. However, if the cyst is painful, interferes with function, or has an unacceptable appearance, there are several treatment options available including:
- Immobilization – Activity often causes the ganglion to increase in size and also increases pressure on nerves, causing pain. A wrist brace or splint may relieve symptoms and cause the ganglion to decrease in size.
- Exercise – As pain decreases, your doctor may prescribe exercises to strengthen the wrist and improve range of motion.
- Draining – If the ganglion causes a great deal of pain or severely limits activities, the fluid may be drained from it.
If your symptoms are not relieved by the nonsurgical treatments or of the ganglion has returned after draining, you may need to consider surgical treatment. The procedure to remove a ganglion cyst is called an excision. Surgery involves removing the cyst as well as part of the involved joint capsule or tendon sheath, which is considered the root of the ganglion. Even after excision, there is a small chance the ganglion will return.
Arthritis of the Hand
- Are you experiencing joint pain in your hand that may feel dull?
- Do you have a burning sensation in your hand?
- Does your hand seem stiff in the morning?
- Have you noticed pain or discomfort when doing things such as opening a jar or starting your car?
You may have arthritis of the hand. Simply defined, arthritis is inflammation of one or more of your joints.
There are three types of arthritis that are the most common in the hand are:
- Osteoarthritis – which is typically age-related “wear and tear” type of arthritis. It usually occurs in people 50 years of age and older.
- Rheumatoid Arthritis – which is an inflammatory arthritis. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain, and stiffness.
- Post-traumatic Arthritis – which can follow a hand injury such as a fracture.
Good news! There are multiple options for nonsurgical treatment of arthritis in the hand including:
- Medications – The most common medications for arthritis are anti-inflammatories, which stop the body from producing chemicals that cause joint swelling and pain.
- Injections – When first-line treatment with anti-inflammatory medication is not appropriate, injections may be used. These typically contain a long-lasting anesthetic and a steroid that can provide pain relief for weeks to months.
- Splints – A splint helps support the affected joint to ease the stress placed on it from frequent use and activities.
If nonsurgical treatment fails to give relief from your arthritis, you may need to consider one of several types of surgery.
Trigger Finger or Trigger Thumb
- Do you experience pain when bending or straightening your finger or thumb?
- Have you noticed a catching or popping sensation in your finger or thumb joints?
- Are your fingers or thumb stiff when you wake up in the morning?
Trigger finger limits finger movement. When you try to straighten your finger, it will lock or catch before popping out straight. Symptoms of trigger finger usually start without any injury, although they may follow a period of heavy use of your hand. Trigger finger is a condition that affects the tendons in your fingers or thumb.
The flexor tendon can become irritated as it slides through the tendon sheath tunnel. As it becomes more and more irritated, the tendon may thicken and nodules may form, making its passage through the tunnel more difficult. If you have trigger finger, the tendon becomes momentarily stuck at the mouth of the tendon sheath tunnel when you try to straighten your finger. You might feel a pop as the tendon slips through the tight area and your finger will suddenly shoot straight out.
The cause of trigger finger is usually unknown, but there are several factors that put people at greater risk for developing it including:
- Sex – Trigger fingers are more common in women than men.
- Age – Trigger fingers are more common in people between the ages of 40 and 60 years old.
- Medical History – Trigger fingers are more common in people with certain medical problems, such as diabetes and rheumatoid arthritis.
Good News! There are many nonsurgical options for treating trigger finger including:
- Rest – If your symptoms are mild, resting the finger may be enough to resolve the problem.
- Splint – Your doctor may recommend a splint to keep your finger in a neutral, resting position.
- Medications – Over-the-counter anti-inflammatory medicines such as ibuprofen and naproxen or acetaminophen can be used to relieve the pain.
- Steroid Injections – Your doctor may choose to inject a corticosteroid into the tendon sheath.
If these nonsurgical treatments do not resolve your trigger finger problem, you may need to consider surgery. Surgery for trigger fingers is performed on an outpatient basis using a local anesthetic. The surgery is performed through a small incision in the palm or sometimes with the tip of a needle. The tendon sheath tunnel is cut. When it heals back together, the sheath is looser and the tendon has more room to move through it.
- Are you experiencing pain in one of your fingers?
- Is your finger swollen or bruised?
- Does your fingertip droop?
- Are you only able to straighten your finger if you push it up with your other hand?
You may have mallet finger. Mallet finger is an injury to the thin tendon that straightens the end joint of a finger or thumb. Although it is also known as “baseball finger” because it can happen to anyone when something like a ball strikes the tip of a finger or thumb and forces it to bend further than it is intended to go.
In a mallet injury, when an object hits the tip of the finger or thumb, the force of the blow tears the extensor tendon. Occasionally, a minor force such as tucking in a bed sheet will cause a mallet finger. Mallet finger injuries that are not treated typically result in stiffness and deformity of the injured fingertip. Good news! The majority of mallet finger injuries can be treated without surgery. Most mallet finger injuries are treated with splinting. A splint holds the fingertip straight until it heals.
If a splint does not resolve your mallet finger we may recommend surgical repair if there is a large fracture fragment or the joint is out of line. In these cases, surgery is done to repair the fracture using pins to hold the pieces of bone together while the injury heals. If you are experiencing mallet finger call the Orthopaedic Center of Vero Beach at 772-778-2009 to schedule an appointment. We’ll conduct a thorough examination and discuss the best treatment options for you.