Hand and Wrist Surgery
Carpal Tunnel Syndrome (CTS) occurs when the Median nerve, which supplies sensation and motor function to parts of the hand, is pressed on as it passes through the carpel tunnel of the hand. Carpal Tunnel pressure at median nerve can cause numbness, weakness, and muscle weakening in the rest of the hand.
As pressure builds up, the nerve stops conducting causing numbers and weakness. This can be caused by diabetes, thyroid disease, vitamin B12 deficiency, smoking, rheumatoid arthritis, and other conditions that cause swelling in the carpal area. Trauma or repetitive aggravation are also common causes. CTS may start with mild symptoms but develop permanent damage to the nerve but most cases are mild and can be easily treated.
First the cause must be found and if possible modify or treat aggravating factors. Physical examination is usually enough to diagnose CTS but sometimes a nerve conduction study is done (this helps to decide if severe cases should proceed to surgery). Rest and treatment with the anti-inflammatory drugs may decrease the swelling. Cortisone injections are used by some experts, but are useful in reducing symptoms. Hand physiotherapy is useful in treating the swelling and strengthening weak muscles. Surgery of severe cases involves releasing the pressure around the wrist.
This is a painful tendonitis if the Extensor Pollicis Brevis and Abductor Pollicis tendons of the thumbs. Anti-inflammatories, rest, ice, and elevation, may treat this but severe cases may also need physiotherapy or a cortisone injection.
This injury occurs when a tensed finger is forcibly struck causing sudden pain and a load snap as the extensor tendon of a finger is broken. Careful of the injury will show a finger that will not straighten. Treatment involves splinting the finger for at least 6wks so that the tendon will heal. Failure to do so may result in the mallot deformity.
This injury of the finger occurs at the proximal knuckles of the fingers, as the central slip of the finger is broken. Careful splinting and very prompt hand physiotherapy is essential to prevent deformity.
This tendonitis of the wrist occurs at the point where wrist tendons cross over. An audible crepitus or crackling may be heard. Treatment includes PRICE, NSAIDs and therapy.
This occurs when the flexor sheath of the finger became nodular because of scarring or inflammation. The nodular section will catch as the finger is flexed, causing a “locked finger”, often released after a painful snap. Treatment may include a carefully administered cortisone injection into the tendon sheath or referral to a hand surgeon.
Acute Hand Injuries
New injuries should be managed with proper splinting, ice, elevation, and assessments if a serious injury is suspected (particularly if any deformity or lack of function exists) and facilitate early referral to a hand surgeon or therapist if required.