Hand and Wrist
Carpal Tunnel Syndrome
Carpal tunnel syndrome is a common condition involving numbness, pain, tingling and instability in the wrist, hand and fingers. It occurs when pressure is put on a nerve in the wrist called the median nerve, which controls motor function in the wrist and hand. This pressure, called impingement, is most often caused by bone spurs, rheumatoid arthritis, repetitive use or injury.
Carpal tunnel syndrome can be diagnosed with tests such as an electromyogram or a nerve conduction study. It can often be effectively treated with nonsurgical therapies such as wrist splints, anti-inflammatory drugs or corticosteroids. In cases where pain and numbness persist, surgery (usually endoscopic surgery) may be necessary to relieve pressure on the nerve.
Carpal Tunnel Release
Carpal tunnel release is an outpatient procedure performed to relieve pressure on the median nerve and reduce the symptoms of carpal tunnel syndrome. This procedure can help restore muscle strength and dexterity, and is typically performed on patients who have had persistent symptoms that do not respond to conservative treatment methods.
Carpal tunnel release can be performed endoscopically or through an open procedure. Both types offer different advantages to the doctor and patient, and should be considered after a thorough evaluation of the patient’s individual condition. Open carpal tunnel release involves a two inch incision in the middle of the palm and gives the surgeon a better view of the treated area with less risk of accidentally damaging nerve tissue. Endoscopic carpal tunnel release involves two tiny incisions and offers patients less post-operative pain and the ability to return to work more quickly.
Patients can return home the same day, but may need prescription pain medication at first to manage the pain from the procedure. The hand may be kept in a splint for the first few weeks after surgery in order to protect the wrist while it heals. Although patients may continue to experience carpal tunnel symptoms after this procedure, most report that symptoms are significantly reduced after carpal tunnel release.
Dupuytren’s contracture is a rare hand deformity in which knots of tissue form under the skin that can pull fingers into a bent position. This makes it difficult for the fingers to straighten and can interfere with normal hand function. Dupuytren’s contracture is not usually painful but can lead to other conditions such as plantar fibromatosis. Although the cause of this condition is not known, it may run in families and can be influenced by tobacco and alcohol use.
Mild cases of Dupuytren’s contracture that do not have much of an effect on hand function may not require any treatment and can simply be monitored through regular checkups. More severe cases may benefit from steroid injections, radiation therapy, needle aponeurotomy or physical therapy. Surgery is also an option for people who may become disabled from this condition and may involve removing tissue or amputating the finger.
Ganglions and Cysts
Ganglions and other types of cysts are typically benign fluid-filled masses that form in the soft tissue of the wrist or hand. They feel like a firm, rubbery lump and are not usually painful unless they grow large enough to put pressure on a nerve.
Ganglions occur most often in women aged 25-45 and are also common in people with osteoarthritis. They often form spontaneously (with no underlying cause) when the soft sheath around a tendon or joint swells and fills with mucus, and they can also grow or shrink. Ganglions only require treatment when they cause significant discomfort. Drainage of the fluid through a needle may relieve symptoms, although the ganglion frequently returns. Surgical removal may then be recommended, which involves a simple outpatient procedure with local anesthetic.