Hand / Wrist Conditions & Procedures
Performed at The Hand/Wrist Center at Total Orthopedics
Carpal Tunnel Syndrome
The Carpal Tunnel is composed of a narrow passage that begins on the palm side of the wrist and extends up the arm. This tunnel serves to protect the main nerve to the hand and the nine tendons that allow for the bending of the fingers. When this nerve becomes compressed or impinged, the symptoms of Carpal Tunnel Syndrome may arise and become progressively more painful.
Several factors can contribute to Carpal Tunnel Syndrome, however one of the most noted factors is chronic use and strain of the wrist. Musicians, laborers and those whose jobs require the use of a keyboard for typing have a higher risk of developing Carpal Tunnel Syndrome.
Carpal tunnel syndrome often begins with a dull ache in the wrist that extends into the hand or forearm. As the condition progresses the symptoms become more severe.
Signs and symptoms of Carpal Tunnel Syndrome may include:
- Tingling or numbness in all fingers besides the pinky finger
- Aching of the hand and/or wrist
- Pain that radiates from the hand into the arm
- Weakness in the hands or fingers
Carpal Tunnel Release
Carpal Tunnel Release is an effective arthroscopic surgical procedure for those experiencing chronic wrist pain and weakness as a result of Carpal Tunnel Syndrome. The goal of this procedure is to release or decompress the nerve that is causing symptoms.
To begin Carpal Tunnel Release, the surgeon will make one or more small incisions on the palm where the pencil sized cameras and surgical instruments will be inserted. Next, a clear sterile fluid is injected that allows the surgeon to visualize the area in greater detail.
Once the median nerve has been identified, the transverse carpal ligament is trimmed or resected. This resection releases the pressure on the median nerve that was causing the symptoms of Carpal Tunnel Syndrome.
Trigger Finger occurs when the flexor tendon in the fingers becomes damaged as a result of trauma or repetitive stress. These injuries create small tears in the tendon that result in swelling and will accumulate scar tissue as it tries to heal. This causes the finger to remain in a curled position, as if it was surrounding a trigger. This can be severely painful.
In mild cases, the finger can be pulled back into a straight position with enough force. However, this often results in pain and the finger may snap back into the curled position when the force is released. In more severe cases, the finger will not move from the curled position even with a good amount of force.
In an effort to avoid permanent deformity of the finger, the tendon must be decompressed allowing the finger to be released into a normal position.
Signs and symptoms of Trigger Finger may include:
- Curled appearance of the finger
- A sensitive nodule or ball on the palm
- Pain when trying to straighten the finger
- A “popping” or “snapping” of the joints of the finger
The wrist joint is made up of the two main bones in the forearm. The radius is the bone on the thumb side of the forearm, and the ulna is the outer bone of the forearm located on the side of the pinky. Fractures of these bones in the forearm are the most common wrist fractures in all age groups. These fractures generally occur during a fall on an outstretched arm. Children with these fractures may have only a small amount of swelling and deformity. For adults, however, fractures near the wrist can cause a large amount of swelling and deformity.
A fracture to the scaphoid bone, which is located just below the thumb, is more uncommon. This injury would take 2-3 months to heal and would require a cast that goes above the thumb. This injury is very common to teens and young adults.
Most fractures are treated simply with a cast; sometimes the bone fragments have to be gently pushed back to a normal position before the cast is put on. Some fractures are too unstable and a cast will not be able to hold the pieces of bone in a normal position to heal, and surgery may then be necessary.
Finger dislocation is a very common injury, especially for athletes. It occurs when the bones of the finger are forced from their normal position. Finger dislocation can occur in any of the joints of any finger, but it occurs most often in the middle knuckle of the middle, index and ring fingers.
This injury can be caused by a “jamming” force applied to the end of the finger, or the finger may be forcefully overextended. It is easy to see that the finger is dislocated as it has very clear symptoms:
- The finger will have obvious deformity, usually crooked and very swollen
- There will be pain in the area of the finger
- The patient will not be able to bend or use the finger at all
Duputryen’s Disease, also known as Duputryen’s Contracture, is a process that causes the fascia in the hands and fingers to contract and form cords. This can cause firm, painful nodules in the palm, or even contract pulling on the fingers. This makes it difficult or even impossible to extend the finger completely. This causes difficulty placing the hand flat on a table, putting it in a coat pocket and can make it difficult to grasp objects.
This disease does not derive from frequent hand use in any way. It can be hereditary or come about because of another medical condition. It is more frequently seen in men rather than women.
Surgery for Duputryen’s contracture divides or removes the thickened bands to help restore finger motion. Sometimes the wound is left open and allowed to heal gradually. This would generally be an outpatient procedure.
DeQuervain’s Syndrome, or DeQuervain’s tendinosis, occurs when the tendons around the base of the thumb are irritated or constricted. The word “tendinosis” refers to a swelling of the tendons. The patient will feel pain and tenderness along the thumb side of the wrist. This is particularly noticeable when forming a fist, grasping something, or when attempting to turn the wrist. DeQuervain’s Syndrome is associated with overuse of the hand and Rheumatoid Arthritis.
Tendons are rope-like structures that attach muscle to the bone. They are covered by a slippery thin soft-tissue layer, called synovium. This layer allows the tendons to slide easily through a fibrous tunnel called a sheath. Any swelling of the tendons and/or thickening of the sheath, results in increased friction and pain with certain thumb and wrist movements.
Surgery would require opening up the tunnel to make more room for the swollen tendons. This would generally be an outpatient procedure.
Symptoms may include:
- Pain over the thumb side of the wrist
- Pain running up the forearm
- Swelling over the thumb side of the wrist
- A “catching” or “snapping” sensation may be felt when moving the thumb
- Limited movement in the thumb and wrist area
CMC Joint Osteoarthritis
Carpometacarpal (CMC) Arthritis is known as a degenerative joint disease affecting the first carpometacarpal joint. This CMC joint is formed by the trapezium bone of the wrist and the first metacarpal bone of the thumb. Because of the joint’s relative instability, this is a common place for osteoarthritis to occur. This occurs when the cushioning cartilage of the joint wears away resulting in damage to the joint.
Symptoms would include:
- Immense pain in the thumb area
- Swelling in the thumb area
- Loss of strength and/or full range of motion
- Difficulty grasping objects
There are many different opinions about the surgical treatments that exist, so there is a large variety of ways to treat this condition. However, there are four types of surgical techniques that are most commonly used:
- Joint fusion (arthrodesis) – In arthrodesis, the bones are permanently fused in the affected joint to increase stability and reduce pain. The fused joint can then bear weight without pain, but has limited flexibility.
- Joint replacement (arthroplasty) – In this procedure, part or all of the affected joint is removed and replaced with a plastic or metal prostheses.
- Osteotomy- In this procedure, the surgeon with reposition the bone in order to minimize the pain.
- Trapeziectomy. In this procedure, the surgeon removes the trapezium, one of the bones in the thumb joint.
Flexor and Extensor Tendon Tears
The flexor tendons are located on the palm-side of the fingers and attach the flexor muscles to the finger bones, allowing the finger to flex towards the palm to grasp and grip something. Extensor tendons are on the top side of fingers and help the fingers straighten, grasp and let go of objects.
Laceration to either of these tendons resulting from an injury can cause pain and potential loss of function. The injury can partially sever the tendons, in which fingers can still move, or completely cut the flexor or extensor tendons.
Symptoms of flexor or extensor tendon laceration are typically easy to identify, because it will cause sudden immobility of a given finger.
The following are common symptoms:
- Open injury on the hand, such as a cut
- Inability to independently bend or straighten a joint or finger
- Numbness of a finger (could suggest a nerve injury)
Due to the complications that can arise from this type of injury, it is important to seek medical attention immediately following the injury. This is to ensure that the patient gets the best possible care.
Tendonitis of the Wrist and Hand
Tendonitis is a relatively common overuse condition which may affect one or more tendons in the hand or wrist. This condition is characterized by inflammation and swelling of the affected tendons.
During contraction of the muscles of the wrist, tension is placed through the tendons. When this tension is excessive due to too much repetition or high force, damage to these tendons may occur. Activities that may cause tendonitis include sports, carpentry, painting, use of machinery or working at a computer. It is uncommon but it can come about due to a specific incident of trauma as well.
The symptoms associated with this condition usually develop gradually over a period of time. Initially, symptoms may present as an ache or stiffness in the wrist following an aggravating or unaccustomed activity. As it progresses, pain may be felt during everyday activities involving the wrist and fingers. A patient may feel pins and needles and/or numbness in some cases as well.
Scapholunate Ligament Tears & Instability
The scaphoid is a small bone in the wrist on the thumb side. Of the many ligaments located in the wrist, the scapholunate ligament is the most commonly injured. The scapholunate ligament connects the scaphoid to the lunate (small bone in the center of the wrist). Normally, the scaphoid and the lunate move together because the scapholunate ligament connects them very tightly. When a scapholunate ligament tear occurs, the scaphoid flexes forward and the lunate bends backwards and a gap forms between the two bones. A scapholunate ligament tear can vary from mild sprains all the way to complete tears with other torn ligaments.
This particular injury is broken down into 4 categories based on the severity:
- Pre-dynamic- the mildest form of a scapholunate ligament tear. It is at worst a partial tear of the ligament.
- Dynamic- the ligament is completely torn or stretched to the point that it cannot function. There may be injury to the surrounding ligaments.
- Static- the ligament is completely torn, and some surrounding ligaments are also injured. A gap has formed between the scaphoid and the lunate.
- SLAC injury- the ligament is completely torn, and the injury has been there for a certain amount of years. This caused arthritis, and/or evidence of cartilage damage. This is a predictable pattern of arthritis that develops with longstanding, untreated ligament injuries.
Osteoarthritis of the Wrist or Hand
Osteoarthritis is a progressive condition that destroys the smooth cartilage that covers the ends of bones. Healthy joints move easily because of this cartilage but, Osteoarthritis causes this cartilage to wear away.
Osteoarthritis can develop due to normal wear and tear in the wrist, it is commonly seen in people who have a family history of arthritis. It may also develop as a result of a traumatic injury, such as a broken wrist bone or a wrist sprain.
Osteoarthritis of the wrist can also develop from Kienböck’s disease. This occurs when the blood supply to the lunate is interrupted. If the bone does not receive blood supply over time, it can lead to osteoarthritis.
Osteoarthritis in the hand is located most frequently in the joint located at the base of the thumb. It can also be located in the joint at the end of the finger. When Osteoarthritis forms near the thumb, the patient will have difficulty gripping anything or applying any type of pressure.
Symptoms of Osteoarthritis will include:
- Loss of Full Range of Motion
- Mucus cysts forming near end of fingers (hand only)
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