Hand, Wrist & Elbow
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 syndrome can usually be treated through conservative methods that include:
- Resting the hands
- Applying cold packs
- Anti-inflammatory medication
- Corticosteroid injections
- Physical therapy
These treatments work to relieve symptoms and are usually effective in doing so. CPS caused by other conditions can often be relieved by treating the underlying cause.
More severe cases of CPS, or those that persist for more than six months, may require surgery to relieve tingling and numbness. Surgery to treat carpal tunnel syndrome involves cutting the ligament that is pressing on the nerve. This may be done through endoscopy or an open procedure.
Trigger finger is a common disorder of the flexor tendon in the finger caused by a disparity between the sizes of the tendon and its supporting structures. The finger possesses no musculature, so movement of the bones is accomplished through manipulation of the connecting tissues (tendons) by much bigger muscles in the forearm. This allows for the slender fingers to have all of the power afforded by multiple large flexor digitorum muscles.
Trigger Finger Release- is a surgical procedure performed under local anesthesia to release the tightened portion of the flexor tendon sheath. The treated area is then wrapped in a bandage for a few days before function can be restored to the finger.
A wrist fracture is one of the most common types of fracture and involves a break in the distal radius bone, the longer of the two bones that make up the forearm. This injury often causes pain, swelling and physical deformity within the wrist, and can be diagnosed through a physical examination and X-ray images of the affected area.
Treatment for a broken wrist in which the bones are not significantly displaced usually involves wrapping the wrist in a plaster cast until it heals. If the bones are not aligned correctly, surgery may be needed to correct the deformity and allow the wrist to heal properly.
Surgery for a broken wrist typically involves the use of metal plates, screws or pins to hold the bone in place while it heals, ensuring that full function will be restored.
Some patients may also benefit from external fixation treatment, which involves the use of pins and a device outside the skin to align the bones back into position. This treatment avoids the need for an incision. Your doctor will decide whether or not surgery is right for you after a thorough evaluation of your condition.
Athletes are not the only ones to experience elbow problems. Many of the repetitive motions used in everyday activities can result in tennis elbow, also called lateral epicondylitis, an inflammation of the tendons that makes every move extremely painful. Hours spent typing on a computer keyboard or moving around a mouse can be as damaging as the repetitive swinging of a tennis racquet. Any profession that requires repeated hand motions, including dentistry, carpentry and house painting, can cause tennis elbow.
But injury to the elbow does not always stem from overuse and getting older. Traumatic injury that is caused by a fall, car accident, heavy lifting and the like occurs frequently, and can result in a separated or fractured elbow. Pain, swelling and bruising, and limited movement are all symptoms of traumatic injuries, which should always be evaluated by a medical professional as quickly as possible.
Types of Elbow Injuries
- Golfer's elbow (medial epicondylitis)
- Tennis elbow (lateral epicondylitis)
- Biceps tendon rupture
Cubital Tunnel Syndrome
Cubital tunnel syndrome is a condition that causes numbness or pain in the elbow, hand, wrist or fingers. Also known as ulnar nerve entrapment, cubital tunnel syndrome occurs when the ulnar nerve in the arm becomes compressed or irritated. The ulnar nerve travels from the neck down to the hand and through the cubital tunnel, which is located just inside the elbow. It is one of the three main nerves in the arm. The most common location where the ulnar nerve gets compressed is behind the elbow. When the elbow is bent, the cubital tunnel can stretch and may irritate the nerve over time.
Treatment of Cubital Tunnel Syndrome
Treatment for cubital tunnel syndrome usually begins with anti-inflammatory medication to minimize pain and other symptoms. Taking frequent breaks during physical labor can help prevent symptoms from occurring and wearing a splint or brace can control pain overnight.
Steroid injections are an effective method of treatment to reduce swelling and ease pressure on the ulnar nerve. A steroid medication such as cortisone is injected directly into the inflamed area and works by minimizing the body's reaction to inflammation. As the inflammation decreases, the pressure is relieved and as a result, patients experience a decrease in symptoms such as pain, numbness or tingling. Symptoms may subside within a few days and the results of the injection may last for a few weeks or up to a few months.
If symptoms do not improve with conservative treatments, surgery may be needed to release pressure on the ulnar nerve as it passes through the cubital tunnel. This can be done through ulnar nerve transposition or medial epicondylectomy, both of which are outpatient procedures that are performed under general or regional anesthesia.