Carpal tunnel syndrome, or compression of the median nerve at the wrist, is one of the most common hand problems seen by hand surgeons. Symptoms include numbness and tingling in the thumb, index, and middle fingers, sometimes waking patients at night. Patients also note aching wrist pain, particularly with activities that elevate their hands.
Further diagnosis of carpal tunnel syndrome is often necessary using a test called a nerve conduction test and electromyogram. This tests how the nerves conduct electrical signals across the wrist and other areas.
Non-operative treatment of carpal tunnel syndrome include wearing a splint , steroid injections, and hand therapy. Anti-inflammatory medications are also helpful. When a patient fails to improve using these measures, surgery is often needed.
When a patient notes that one of their fingers locks or catches with the finger bent, this is called a trigger finger. Often patients complain of pain at the knuckle joint, because this is the joint that they have to unlock by pulling on the finger. Trigger finger is caused by swelling in the tendon that bends the finger, called the flexor tendon. The flexor tendon is held tightly to the bone of the finger by connective tissue slings called pulleys. A trigger finger occurs when the swollen area of the tendon gets caught under one of the pulleys.
Non-operative treatment of a trigger finger include splinting and steroid injection. If the finger continues to lock and catch, often surgical release of the pulley is needed.
Hand surgeons see and treat a variety of cysts, or fluid-filled masses, on the hand and fingers. There are several types of cysts, including ganglion cysts, retinacular cysts, and mucous cysts.
Ganglion cysts are most commonly seen at the wrist and are thought to be caused by an injury or sprain of a wrist ligament, called the scapholunate ligament. The cyst grows from the ligament and is filled by joint fluid; it may increase or decrease in size over time. Taking the fluid out with a needle, or aspiration, will decrease the size of the cyst but will not take it away. A ganglion cyst can be removed only by surgery.
Retinacular cysts are cysts in the fingers, usually arising from tendons which allow the finger to bend and extend. The fluid that fills these cysts is usually from the tendon sheath, the tissue that surrounds the tendon. These can also increase or decrease in size And some resolve on their own. They can also be removed surgically.
Mucous cysts are found at the distal joint of the finger. They are usually due to arthritis of the joint, causing inflammation of the joint and causing a fluid-filled sac to form under the skin. When they are surgically removed, the joint also has to be cleaned of extra bone.
Hand surgeons treat various fractures of the upper extremity, including elbow, forearm, wrist, and hand. The following are some descriptions of the most common fractures:
Wrist Fractures: Fractures of the distal radius, the large bone of the wrist, commonly occur from a fall on the outstretched hand. Some of these fractures can be treated in a cast alone but others need to be reduced or put back into place and then held with a cast. Finally, some require surgery, which can use plates, screws, wires, or a combination of all three.
Scaphoid Fractures: There are eight small bones of the wrist, but the one that is most frequently injured is the scaphoid bone, on the thumb side of the wrist. This small bone has a poor blood supply and when fractured, is sometimes hard to heal. If a scaphoid fracture occurs and the scaphoid is not displaced (the broken pieces have not moved apart), this can be treated in a cast but often takes an average of 16 weeks in a cast to heal. When the pieces are displaced or when the patient does not want to spend an extended amount of time in a cast, hand surgeons can fix the fracture with a special type of screw. When the bone’s blood supply is too poor and the bone does not heal, other types of surgery are often needed, including bone grafts.
Metacarpal Fractures: Metacarpals are the bones that make up the palm of the hand, and the most commonly broken bone is the metacarpal of the small finger. These are usually treated by reduction and casting, but sometimes require surgery to fix the fracture.
Lateral epicondylitis, or tennis elbow, is caused by inflammation of the tendon insertion at the outside of the elbow. Patients complain of pain at the outside part of the elbow, and difficulty lifting objects. Non-operative treatment includes splints including a special elbow pad splint, steroid injections, and hand therapy for massage, ultrasound, and other treatments. When patients don’t get better with these treatments, surgery is sometimes necessary.
Arthritis of the upper extremity takes many forms, and hand surgeons treat arthritis at several joints, including the base of the thumb, the wrist, and the elbow.