Most Common

Hand and Wrist Complaints

Carpal Tunnel Syndrome:

Definition: Carpal Tunnel Syndrome occurs as a result of squeezing or constriction of the medial nerve as it passed through the wrist.

Symptoms: Patients will often note numbness of the hand, particularly the thumb, index, and middle fingers, weakness of the hand, and pain in the area of the wrist. Patients often will associate pain at night, noting that it will wake them up at times and when they do so they often note shaking their hands helps "bring the feeling back to them". Patients can report difficulty opening jars or cans and this condition is occupationally related. If the compression is long standing there can be irreversible muscle damage.

Tests: Tapping over the region of the wrist (Tinel's sign) can cause tingling in the area of the nerve described above. Other provocative tests can be performed (Phalen's test, reverse Phalen's test, strength testing, and sensory examination) by the physician.

Treatment: The first formal treatment for this carpal tunnel syndrome is immobilization at night in wrists splints and nonsteroidal anti-inflammatory medications. Avoidance of activity that aggravates the symptoms is also important. If the person does not respond to this conservative treatment, they may be a candidate for either an injection of the carpal canal or surgical intervention.

Persons having complaints of carpal tunnel syndrome or other wrist problems should seek medical attention by their family physician with possible referral to an orthopedic surgeon. Nonsteroidal anti-inflammatory medications (NSAIDs) can cause gastric, kidney, or liver problems. They should only be taken at the recommendation of your physician so that they can be properly monitored. Repeated cortical steroid injections also may lead to rupture of tendons or long term complications and should only be done under the supervision of your treating physician.

Trigger Finger (Thumb):

Definition: A trigger finger or (trigger thumb) occurs when the tendon that is responsible for flexing the digit develops a swelling in the palm and gets caught as it passes through a pulley. As one attempts to straighten their finger, then the pressure builds within this pulley until finally the pull is great enough that the swelling in the tendon pop through the pulley, giving a clicking sound as the finger straightens.

Symptoms: Generally, patients have a painful nodule or mass in the palm just proximal to the fingers. Swelling or stiffness at the fingers can occur, particularly in the morning and more than one finger can be involved.

Treatment: Physicians may rest the tendon by splinting, use nonsteroidal anti-inflammatory medications, or injections to reduce the swelling within the tendon sheath. The definitive form of treatment for this problem is to release the pulley surgically through a one-quarter inch incision in order to allow the tendon to move freely without constriction.

Persons having complaints of trigger finger (trigger thumb) or other hand problems should seek medical attention by their family physician with possible referral to an orthopedic surgeon. Nonsteroidal anti-inflammatory medications (NSAIDs) can cause gastric, kidney, or liver problems. They should only be taken at the recommendation of your physician so that they can be properly monitored. Repeated cortical steroid injections also may lead to rupture of tendons or long term complications and should only be done under the supervision of your treating physician.

Tendinitis (deQuervains):

Definition: Tendinitis (deQuervains) is characterized by pain noted at the base of the thumb, particularly with making a fist or flexing one's thumb. There may be a sensation of locking of the thumb associated with pain in this region. This condition occurs due to constriction or squeezing of the tendon as it passes through a compartment at the base of the thumb. There may be sensation of "creaking" or squeaking when the person attempts to make a fist.

Exam: Finkelstein's test, that is making one's fist and allowing the wrist to move at a direction opposite the thumb is largely diagnostic of this condition.

Treatment: Avoidance of aggravating activities is important in reducing the symptoms. If these activities cannot be avoided, splinting of one's thumb and the use of nonsteroidal anti-inflammatory medications is often helpful. A physician may elect to inject this area to reduce further inflammation. The definitive treatment would be a release of this compartment, such that there is no further squeezing or constriction of the tendon occurring.

Persons having complaints of tendonitis or other wrist problems should seek medical attention by their family physician with possible referral to an orthopedic surgeon. Nonsteroidal anti-inflammatory medications (NSAIDs) can cause gastric, kidney, or liver problems. They should only be taken at the recommendation of your physician so that they can be properly monitored. Repeated cortical steroid injections also may lead to rupture of tendons or long term complications and should only be done under the supervision of your treating physician.

Ulnar Collateral Ligament Tear (Gamekeeper's thumb or skier's thumb):

Definition: An ulnar collateral ligament tear refers to a rupture or tear of the ligament responsible for holding the thumb straight in relationship to the index finger. If an undo amount of stress is placed on the thumb, as a skier may experience when the pole is ripped from their hand while going downhill, this small ligament may rupture causing pain at the base of the thumb adjacent to the index finger. This will lead to difficulties with lifting objects and weakness in the grasp strength of the hand.

Exam: In the acute phase there is often redness, swelling, and heat over the base of the thumb on the side adjacent to the index finger. This is very painful to touch.

Treatment: Complete tears should almost always be treated operatively in order to oppose the tendon properly providing a good chance for it to heal. Only partial tears of this ligament can be treated with a cast or splint, in order to provide stability for healing. Non-surgical treatment of this problem may result in weakness of pinch.

Persons having complaints of ulnar nerve collateral ligament tear or other hand problems should seek medical attention by their family physician with possible referral to an orthopedic surgeon. Nonsteroidal anti-inflammatory medications (NSAIDs) can cause gastric, kidney, or liver problems. They should only be taken at the recommendation of your physician so that they can be properly monitored. Repeated cortical steroid injections also may lead to rupture of tendons or long term complications and should only be done under the supervision of your treating physician.