Carpal Tunnel Syndrome is a condition cause by increased pressure on the median nerve at the wrist. The nerve runs through a tunnel in the wrist along with 9 tendons that attach muscles in the forearm to the bones in your hand. These tendons help bend your fingers. Swelling that occurs in the tunnel around the nerve can compress the nerve, causing numbness, tingling and pain in the wrist, hand and fingers (typically your thumb, index, middle and part of your ring finger), and weakness in the muscles of the thumb that help you pinch. Fractures and arthritis can also narrow the tunnel and pinch the nerve, as can fluid retention from pregnancy, diabetes and thyroid conditions.
Certain activities such as driving, reading and sleeping can bring on symptoms. Diagnosis can often be made by physical exam alone, although sometimes your physician may send you for additional testing to determine whether there are any measurable changes in the speed of nerve conduction or damage to the muscles of the thumb. Non-operative treatment options for carpal tunnel syndrome include splints/orthoses, exercise, activity modification and steroid injections. If non-operative measures fail, or symptoms are severe, surgery may be necessary. The carpal tunnel is opened by a surgical release, which can be done open or endoscopically. Each type offers different advantages, and should be considered after a thorough evaluation of the patient's individual condition.
CRPS or Reflex Sympathetic Dystrophy (RSD) occurs when there is an abnormal response to an injury, causing continued pain out of proportion to the injury, with unusual swelling, changes in blood flow and sweat patterns, and trophic changes (changes in the tissues due to lack of normal nutrition). These trophic changes include nail, skin and hair changes, loss of muscle bulk and bone loss. If not adequately treated in a timely fashion, permanent functional loss can occur. The “Stress Loading” program was developed at The Hand Center to treat this condition. The fundamental principle of this program is active exercise that requires progressive use of the affected extremity with minimal motion of painful joints. Load, not motion, is critical. Your hand therapist will measure your progress and modify the program accordingly. (See our Research page for additional information.)
Congenital differences of the hand are physical deformities present at birth that can significantly affect a child's hand function and appearance. These conditions may occur as a result of abnormal development or genetic factors, and can involve fingers that are fused together (syndactyly), an underdeveloped hand (club hand), extra fingers (polydactyly) and other abnormalities. Treatment for congenital deformities varies depending on the type and severity of the deformity, but may include tendon transfers, skin grafts, limb manipulation, external appliances or prosthetic devices to restore function and improve the appearance of the hand.
Cubital Tunnel Syndrome is caused by increased pressure on the ulnar nerve at the elbow. Significant nerve irritation and compression will cause symptoms, which may include pain at the inside of the elbow, numbness, and tingling of the small and ring fingers. Prolonged symptoms can cause hand weakness and functional loss. Treatment for cubital tunnel syndrome may include anti-inflammatory medication, splints/orthoses, activity modification and exercise to relieve symptoms or prevent them from occurring. For symptoms that do not respond to conservative methods, surgery may be needed to relieve pressure on the ulnar nerve. This can be done through ulnar nerve release or transposition (moving the nerve out of its groove into the front part of the elbow to decrease the strain on the nerve).
DeQuervain's disease is an inflammation of the tendons at the base of the thumb that help move the thumb away from the hand. The lining or sheath around the tendons can swell, causing pain with certain thumb and wrist movements. Pain is localized at the thumb side of the wrist, especially with grasping or twisting. This condition may be caused by overuse, trauma or disease, and is more common in women than in men, especially new mothers (positioning and holding infants). DeQuervain's disease can be diagnosed through physical exam. Treatment for this condition focuses on relieving pain and minimizing swelling. Treatment may include anti-inflammatory medication, corticosteroids, splints/orthoses and rest. Surgery to make more room for irritated tendons may be recommended for severe cases that fail conservative management.
Dupuytren's disease is a hereditary condition causing abnormal thickening of the tissue layer just under the skin of the palm, known as fascia. Nodules (lumps) may occur. Over a period of time, a contracture may develop, which means the fingers are pulled into a bent position and may be unable to straighten. Dupuytren's contracture is not usually painful. Although the exact cause of this condition is not known, it tends to run in families of Northern European decent and most commonly affects men older than 40.
Mild cases of Dupuytren's contracture that do not affect hand function may not require any treatment beyond simple observation. More severe cases may benefit from treatment, including surgery to remove the abnormal tissue or a newer injectable medication (Xiaflex) that can break down the abnormal tissue and allow the finger to be manipulated into a straighter position. (See Dupuytren’s Treatment.)