Carpal tunnel syndrome is the most common form of nerve compression that produces symptoms which include numbness and tingling in the thumb, index, and middle finger. Electrodiagnostic studies help to confirm the diagnosis of carpal tunnel. Mild cases can respond to bracing and anti inflammatory medication, but more severe cases require a surgical release. The least invasive surgical approach utilizes an endoscopic technique.
Distal radius fractures, in the forearm closer to the hand, are the most common fractures in the body. In many cases, they can be treated with a cast or brace, but the more severe ones that are displaced or that extend into the joint require internal fixation to restore function and prevent traumatic arthritis.
Trigger finger occurs when a swollen tendon gets caught and then snaps free when closing and opening a fist. In many cases, a steroid injection can cure the trigger finger. When this is not sufficient, surgery can release the tight portion of the sheath surrounding the tendon.
Injury to the medial collateral ligament (MCL) of the elbow can cause pain and weakness. This often happens in throwing athletes. Reconstruction of the ligament with a tendon graft can restore function and enable athletes to return to play.
“Tennis elbow” (lateral epicondylitis) involves pain along the lateral aspect of the elbow. It is particularly severe with gripping and lifting activities. It often occurs in individuals who do not play tennis. Treatment can involve therapy, bracing, and occasionally injections. For patients who don’t respond to these treatments, surgery to clean and lengthen the partially torn tendons can provide pain relief and enable individuals to return to sports and other activities.
Arthritis of the base of the thumb is one of the most common patterns of arthritis, particularly affecting women. Steroid injections along with bracing and therapy can provide substantial relief. In patients with pain that persists despite these treatments, joint replacement surgery can restore function and relieve pain.
Rheumatoid arthritis is a systemic arthritis that can cause not only very painful joints, but also deformity of the hands and wrists. Bracing, physical therapy, and occasionally injections can provide some initial relief. In severe cases of finger or wrist deformity, joint replacement or joint arthrodesis (fusion) can improve function and relieve pain. The joint replacement procedures preserve as much motion as possible to maximize function.
The word “ganglion” is a Latin word for a bump or a knot. These can occur from benign cysts in healthy young patients. In many cases, injection and aspiration to draw out the joint fluid can cure them. The ones that are persistent or painful can be surgically removed.
Dupuytren’s disease is a hereditary condition that causes a painless contracture of the fingers. This is most common in men with a Western European or Scandinavian background. Bracing and therapy does not help Dupuytren’s disease. Needle fasciotomy or collagenase (Xiaflex) injections can help in milder cases. In severe cases, surgical removal of the Dupuytren’s cords is necessary.
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