Although there are many disorders of the hand and wrist, one of the most common is carpal tunnel syndrome (CTS). It often affects workers who perform repetitive hand movements, such as typing or assembly tasks, and causes numbness, tingling and burning. Although CTS can be painful and debilitating, it is also highly treatable if diagnosed early.
Eventually, as the pain increases, your grip weakens and you may begin dropping things. Getting an early and accurate diagnosis is extremely important, both to relieve the pain and to help prevent permanent nerve damage.
The carpal tunnel is a tunnel in the center of the wrist containing tendons and a major nerve. CTS is caused when too much pressure is put on the median nerve which runs through the wrist. This can be due to swelling, thickening or irritation of the membranes that surround the tendons in the carpal tunnel. Common causes include:
- repetitive grasping with the hands
- repetitive bending of the wrist
- bone dislocation and fractures
- fluid retention
This compression causes pain, numbness, tingling and burning in the fingers. Eventually, as the pain increases, grip weakens and one may begin to drop things.
Getting an early and accurate diagnosis is extremely important, both to relieve pain and to help prevent permanent nerve damage. During your evaluation, your doctor will take a medical history and will perform a physical exam. Other tests such as X-rays, a nerve conduction study or an electromyogram may be performed.
Once CTS has been diagnosed, initial treatment may begin with a wrist splint to help reduce pressure on the nerve. Both night splints and occupational splints worn while working keep the wrist in a neutral position to help reduce swelling. Medications or injections are also used to reduce swelling and inflammation.
If you have severe pain or if other symptoms persist despite non-surgical treatment, your physician may recommend carpal tunnel release surgery. As the word “release” implies, the ligament that forms the roof of the canal is cut to relieve the pressure on the median nerve. This procedure takes less than twenty minutes and can be performed on an outpatient basis, often under local anesthesia.
This procedure can be performed endoscopically using a smaller incision, or through a common “open” approach. In open carpal tunnel release, the physician makes a small incision, usually around two inches in length.
The transverse carpal ligament is cut, while the median nerve is protected. By cutting the ligament, pressure is relieved on the median nerve. This cut in the ligament will gradually fill with scar tissue. After the procedure, the skin is sutured, or sewn closed.
Before your surgery, your doctor will explain the procedure, anesthesia options, risks and possible complications. You may need pre-operative lab tests. You may be instructed not to eat or drink anything after midnight the night before surgery.
You will be monitored in the recovery room after your procedure. Your hand will be bandaged and your arm will be elevated and will be in a well-padded dressing. You will be able to begin using the hand immediately.
A follow-up visit to your physician will be arranged and you will be given instructions about your home recovery and rehabilitation. You can expect tenderness at the incision site until complete healing occurs. Patients can usually return to normal activities in a few weeks.
A contracture is a thickening of the fascia, the tissue below the skin of your palm. This thickening can result in the fingers being pulled toward the palm, unable to be straightened. The condition is not usually painful, but it impairs the function of the affected hand.
Dupuytren’s contracture is considered to be an inherited condition of unknown cause.
Advanced cases of Dupuytren’s contracture may require surgical correction to restore movement. This is done by removing the thickened bands from the fascia. Surgical repair is usually followed by rehabilitative therapy to restore the hands flexibility.
Elbow pain and stiffness may be related to a wide range of injuries or conditions. Proper treatment depends on the underlying cause of the discomfort.
Medial Epicondylitis or “Golfer’s Elbow”
This disorder occurs when the muscles that bend the wrist down are overused, as may occur when swinging a golf club. The resulting pain is experienced in the inner portion of the elbow joint.
Lateral Epicondylitis or “Tennis Elbow”
This injury occurs when the muscles that bend the wrist backward are overused, as may occur during the backhand swing of a tennis player. The resulting pain is experienced directly over the elbow joint.
The olecranon bursa is a sac at the tip of the elbow that allows the skin to move freely over the bone. It may become irritated due to repetitive movement and become swollen and painful.
The biceps are the large muscles in the front of the upper arm that help bend the elbow. Through overuse, the tendon attached to the muscles may become irritated and cause pain in the front of the elbow joint.
Serious injury may occur when the elbow joint sustains trauma and becomes dislocated, displacing the bones from their proper alignment. The resulting pain is experienced around the entire joint.
The shoulder is the most moveable and one of the most fragile joints of the body. It is actually several joints combined with tendons and muscles. Its ability to move in a wide range of motion makes it prone to injury.
Because your shoulders are in use during so many everyday activities – such as reaching, lifting, pushing and pulling – even simple movements can cause pain if you’ve suffered an injury. Most shoulder problems involve the soft tissues: the muscles, ligaments and tendons, most commonly instability, tendinitis and bursitis.
The bones of the shoulder can move out of place or can be forced out of place by an injury. This instability can result in dislocation. Unfortunately, once you’ve dislocated your shoulder, the chances of it happening again become greater.
When a dislocation occurs, the ligaments and tendons may stretch and can even tear. If repeated dislocations occur, your physician may recommend surgery to correct the problem.
Tendinitis and Bursitis
The tendons connect muscle to bone and other tissue. Excessive wear and tear on the tendons can lead to inflammation or tendinitis. Tendon damage can result from overuse in sports- or work-related activities and from the normal aging process.
Injury can also cause tendinitis. Rotator cuff injuries are the most common to this category. Severe tendinitis can cause partial or complete tearing of the rotator cuff resulting in pain, weakness, and loss of normal movement.
Excessive use of the shoulder can also lead to bursitis, the inflammation and swelling of the bursa. Bursae are the fluid-filled sacs around the joints that cushion the movement of the shoulder. Bursitis frequently occurs in association with rotator cuff tendinitis.
Medications may be prescribed or injections can be used to reduce pain and inflammation. Surgical correction is also available for cases that do not respond to treatment.
An accurate diagnosis is important, both to relieve pain and to prevent further damage. During your evaluation, your doctor will take a medical history and will perform a physical exam. Tests such as X-rays, CT scan, or magnetic resonance imaging (MRI) may be done to get a detailed picture of the shoulder’s bones and soft tissues assisting the doctor with diagnosis. Arthroscopic surgery can also be performed to look inside the joint for a diagnosis and to make repairs. For more information about this procedure, select: arthroscopy
Most shoulder problems respond to non-surgical treatment methods, including modification of activities, medications and exercise. However, if your condition requires surgery, your physician will explain the procedure, anesthesia options, risks and possible complications.
You will be monitored in the recovery room after your procedure. Your arm may be in a sling and you may have an ice pack. These, along with pain medication, may help you be more comfortable.
A follow-up visit to your physician will be arranged and you will be given instructions about your home recovery and rehabilitation. Patients can usually return to normal activities in a few weeks.
Trigger finger is a type of tendinitis, an inflammation of the tendons, which can result from overuse. It occurs when the tendon sheath becomes swollen or thickened within the flexor tendon pulley system preventing the tendon from sliding freely. In some cases, the tendon catches and then releases. This motion is similar to the action of releasing a trigger of a gun.
The swelling and irritation is usually first treated with anti-inflammatory medication or a steroid injection. If the condition does not respond to conservative treatment or if the case is severe, surgery to release the tendon may be performed.
The procedure involves making a small cut in the first pulley overlying the inflamed tendon. This procedure is done on an outpatient basis under local anesthesia with the patient free to resume normal activities in a few days.