TOPIC: Surgical & Non-Surgical Treatments for the Hand
Tom Dovan, MD: orthopaedic hand surgeon
news notes via www.webmd.com
FINGER, HAND & WRIST PROBLEM OVERVIEW
Everyone has had a minor problem with a finger, hand, or wrist. Most of the time our body movements do not cause problems, but it's not surprising that symptoms occur from everyday wear and tear, or overuse. Finger, hand, or wrist problems can also be caused by injuries or the natural process of aging.
Your fingers, hands, or wrists may burn, sting, or hurt, or feel tired, sore, stiff, numb, tingly , hot, or cold. Maybe you can't move them as well as usual, or they are swollen. Perhaps your hands have turned a different color, such as red, pale, or blue. A lump or bump might have appeared on your wrist, palm, or fingers. Home treatment is often all that is needed to relieve your symptoms.
Finger, hand, or wrist problems may be caused by an injury. If you think an injury caused your problem, see the topic Finger, Hand, and Wrist Injuries. But there are many other causes of finger, hand, or wrist problems.
Bone, muscle, or joint problems
Problems from medical conditions
What is carpal tunnel syndrome?
Carpal tunnel syndrome is the term used to describe a combination of tingling, numbness, weakness, or pain in the fingers, thumb, or palm, and sometimes in the forearm. These symptoms occur when there is pressure on a nerve (median nerve) at the wrist (carpal tunnel). .
Carpal tunnel syndrome can often be linked to repetitive hand and wrist motion. Swelling in the wrist area, as during pregnancy or caused by a medical condition, can also cause or contribute to carpal tunnel symptoms. Chronic and severe carpal tunnel syndrome can lead to permanent nerve damage, pain, and muscle weakness and wasting (atrophy).
What are the risks of chronic, severe carpal tunnel syndrome?
Long-standing carpal tunnel syndrome can cause:
What kind of surgery is done for carpal tunnel syndrome?
The goal of surgery is to reduce the pressure on the median nerve in the wrist. The surgery used to relieve carpal tunnel symptoms is called carpal tunnel release . This procedure involves cutting the transverse carpal ligament to relieve pressure on the median nerve in the wrist.
Two approaches for this surgery are open and endoscopic. Each has advantages and disadvantages. When done by an experienced surgeon, endoscopic carpal tunnel release heals more quickly and does not leave the larger and potentially painful scar that open surgery produces.
How does surgical treatment success compare with wrist splint therapy?
Arthritis and Trigger Finger
Trigger finger and thumb are painful conditions that cause the fingers or thumb to catch or lock in a bent position. The problems often stem from inflammation of tendons that are located within a protective covering called the tendon sheath.
The affected tendons are tough, fibrous bands of tissue that connect the muscles of the forearm to your finger and thumb bones. Together, the tendons and muscles allow you to bend and extend your fingers and thumb, for example, as in making a fist.
A tendon usually glides quite easily through the tissue that covers it (also called a sheath) because of a lubricating membrane surrounding the joint called the synovium. Occasionally a tendon may become inflamed and swollen. When this happens, bending the finger or thumb may pull the inflamed portion through a narrowed tendon sheath, making it snap or pop.
What Causes Trigger Finger?
Trigger finger may be caused by highly repetitive or forceful use of the finger and thumb. Medical conditions that cause changes in tissues -- such as rheumatoid arthritis, gout, or diabetes -- also may result in trigger finger. Prolonged, strenuous grasping, such as with power tools, also may aggravate the condition.
Who Gets Trigger Finger?
Farmers, industrial workers, and musicians are frequently affected by trigger finger since they rely on their fingers or thumbs for multiple repetitive movements. Trigger finger is more common in women than in men and tends to occur most frequently in people who are between 40 and 60 years of age.
What Are the Symptoms of Trigger Finger?
One of the first symptoms may be soreness at the base of the finger or thumb. The most common symptom is a painful clicking or snapping when attempting to flex or extend the affected finger. This catching sensation tends to worsen after periods of inactivity and loosen up with movement.
In some cases, the finger or thumb that is affected locks in a flexed position or in an extended position as the condition becomes more severe, and must be gently straightened with the other hand. Joint contraction or stiffening may eventually occur.
How Is Trigger Finger Diagnosed?
No X-rays or lab tests are used to diagnose trigger finger. It is generally diagnosed following a physical exam of the hand and fingers. In some cases, the affected finger may be swollen and there may be a nodule, or bump, over the joint in the palm of the hand. The finger also may be locked in a flexed (bent) position, or it may be stiff and painful.
How Is Trigger Finger Treated?
The first step to recovery is to limit activities that aggravate trigger finger. Occasionally, your doctor may put a splint on the affected hand to restrict the joint movement. If symptoms continue, anti-inflammatory medications, such as ibuprofen or naproxen, may be prescribed. Your doctor may also recommend an injection of a steroid medication into the tendon sheath. If the condition does not respond to conservative measures or consistently recurs, surgery may be recommended to release the tendon sheath and restore movement.
How Long Does Recovery From Trigger Finger Take?
The time it takes to recover from trigger finger depends on the severity of the condition, which varies from person to person. The choice of treatment also impacts recovery time. For example, splinting may be necessary for six weeks. However, most patients with trigger finger recover within a few weeks by resting and limiting the use of the affected finger and/or using anti-inflammatory medications.