Commonly treated conditions
CARPAL TUNNEL SYNDROME
Carpal tunnel syndrome is a pinched nerve in the wrist caused by increased pressure on the nerve. Symptoms of carpal tunnel syndrome include pain, numbness, tingling, weakness, clumsiness, and a tendency to drop things. The numbness and/or tingling most often affects the thumb, index, middle, and ring fingers. Electrodiagnostic studies are often used to confirm the diagnosis and rule out other conditions. Treatment options include wrist splints, activity modification, steroid injections, and surgery.
GANGLION CYSTS
Ganglion cysts are common lumps within the hand and wrist that occur adjacent to joints or tendons and are filled with clear fluid or gel. The cause of ganglion cysts is unknown however joint strain and tendon irritation may play a role in their formation. Ganglions occur in patients of all ages. Ganglions may increase or decrease in size or even disappear altogether. They may or may not be associated with pain. The diagnosis is usually based on clinical examination. Treatment can include observation, aspiration or drainage, and surgical removal. Surgical treatment is generally successful although cysts may recur.
TRIGGER FINGER
Trigger finger occurs when normal tendon gliding is prevented by swelling and inflammation. Trigger fingers are more common with certain medical conditions such as rheumatoid arthritis, gout and diabetes. Repetitive tasks may aggravate the condition. In most cases, however, the cause of the trigger finger is unknown. Trigger finger may start with discomfort felt at the base of the finger or thumb. Other symptoms may include pain, catching or locking, and stiffness. Treatment options include anti-inflammatory medications, night splinting, steroid injections, and surgery. The goal of surgery is to open the tunnel at the base of the finger so that the tendon can glide more freely. Finger motion can return quickly, or there can be some stiffness after surgery. Occasionally, hand therapy is required after surgery to regain motion.
Cubital Tunnel Syndrome
Cubital tunnel syndrome is entrapment of the ulnar nerve as it travels across the elbow. Symptoms may include numbness and tingling in the ring and small fingers as well as the hand. Diagnosis is based on clinical examination as well as electrodiagnostic studies. When identified early, symptoms may be managed with conservative treatments such as activity modification, anti-inflammatory medication, and steroid injection. If conservative methods fail to provide relief, or if muscle weakness develops in your hand, surgery may be necessary to relieve pressure along the nerve. The results of surgery are generally good. However, if the nerve is badly compressed or if there is muscle loss, the nerve may not return to normal function and some symptoms may remain even after the surgery. Nerve recovery can take a prolonged period of time.
HAND AND WRIST FRACTURES
Fractures can affect any bone of the hand and wrist but commonly occur at the distal radius (wrist), metacarpal bones (hand), and phalanges (fingers). Some fractures are stable and may be treated in a cast or splint. Other fractures are unstable in which surgery may be necessary to restore proper alignment and aid in healing. Hand and wrist fractures are often accompanied by pain and swelling in the region of injury, limited motion, and difficulty using the extremity. X-rays are commonly used to identify fractures. Additional imaging studies, such as CT scans or MRIs may be needed to better visualize the fracture and other associated injuries. Fracture treatment ranges from splinting or casting to surgery. Surgical options include pins, screws, plates, external fixator devices, and bone grafts. Following nonoperative and operative fracture management, hand therapy is often helpful to regain motion, strength and function.
THUMB ARTHRITIS
Arthritis is thinning of the cartilage, which is the smooth surface of the joint. Thumb arthritis can result from a genetic predisposition and can also occur with age and long-term wear and tear. Patients with thumb arthritis report pain and weakness with pinching and grasping, opening jars, writing, and turning doorknobs or keys. X-rays can aid the diagnosis of arthritis, demonstrating narrowing of the joint space, bone spurs, and deformity. Initial options for treatment can include conservative methods such as ice/heat, antiinflammatory medicines, splinting, hand therapy, and injections. Surgical treatment is an option when conservative methods fail to provide adequate relief.
Dupuytren's Contracture
Dupuytren's contracture is a thickening of the fibrous tissue layer underneath the skin of the palm and fingers. Although painless, the thickening and tightening of this fibrous tissue can cause the fingers to flex into the palm. Dupuytren's disease is more common among men than women and often runs in families. Development of contractures often occurs over long periods of time. Diagnosis is based on clinical examination. When significant contractures develop, surgical treatment may be necessary to restore range of motion and function. Hand therapy is often required following surgery.
Tennis Elbow (Lateral Epicondylitis)
Tennis elbow, or lateral epicondylitis, is a painful condition of the elbow caused by overuse. The forearm muscles and tendons become damaged from overuse and repetitive motion. This leads to pain and tenderness on the outside of the elbow. Diagnosis is based on clinical examination. Imaging studies such as MRI may be useful in evaluating the extent of injury. Tennis elbow often responds to conservative treatment, however, resolution of symptoms may take a prolonged period of time. Treatment options may include, rest, heat/ice, anti-inflammatory medications, steroid injection, splinting, and physical therapy. Surgical treatment is an option should conservative therapy fail.
Platelet-rich plasma (PRP) is another injection option that may speed the healing of a variety of tendon injuries including tennis elbow. PRP is a preparation developed from the patient's own blood containing a high concentration of growth factors important in the healing of injuries.
Adapted from the American Society for Surgery of the Hand and the American Academy of Orthopaedic Surgeons.
OTHER CONDITIONS
•DeQuervain's tenosynovitis
•Tendon and ligament injuries
•Wrist and hand arthritis
•Nerve injuries
•Wrist and hand masses