Hand & Upper Extremity

Common Hand and Wrist Disorders

Carpal Tunnel Syndrome

Increased pressure on the median nerve in the wrist.

Symptoms

  • Pain
  • Numbness/Tingling
  • Swelling
  • Itching
  • Difficulty picking up small objects
  • Weakness
  • Tendency to drop objects

Conservative Treatment to decrease swelling around the nerve

  • Wrist brace at night
  • Steroid injection


Surgical Treatment

  • Release the ligament over the nerve to decrease the pressure (increase volume of the tunnel)

Trigger Digits

Pulley (tunnel) and/or tendon become thick and do not glide smoothly. Cause typically unknown associated with rheumatoid arthritis, gout, diabetes, carpal tunnel syndrome.

Symptoms

  • Pain at the base of the finger in the palm
  • Nodule
  • Locking/clicking of the digit


Conservative Treatment

  • Nothing
  • Splint/NSAIDS
  • Steroid injection - Approximately 70% cure rate may do 2 shots

Surgical Treatment

  • Goal is to release the first tunnel (pulley) to allow smooth gliding of the tendon.

DistalRadiusDistal Radius (Wrist) Fracture


Symptoms

  • Swelling
  • Deformity
  • Bruising

Conservative Treatment

  • Cast

Surgical Treatment

  • Plate and Screws
  • External Fixation

Arthritis of the Finger

Smooth cartilage surfaces damaged (worn out)

Symptoms

  • Pain
  • Swelling
  • Stiffness

Conservative Treatment

  • NSAIDS
  • Splints
  • Cremes – Capsaicin®, Voltaren®
  • Steroid Injection

Surgical Treatment

  • Arthrodesis-fusion of joint or Arthroplasty

Arthritis of the Thumb

Loss of cartilage at the base of the thumb

Symptoms

  • Pain at the base of the thumb while opening a bottle or turning a key

Conservative Treatment

  • NSAIDS: aspirin, ibuprofen, naproxen, etc.
  • Splint/brace
  • Cremes - Voltaren gel, Capsaicin
  • Steroid injection

Surgical Treatment

  • Arthroplasty
  • Ligament reconstruction tendon interposition

DeQuervains

Irritation (inflammation) of thumb base tendons – Tendons to the thumb do not glide smoothly

Symptoms

  • Pain at thumb side of the wrist
  • Swelling, catching
  • Worse with movement of thumb and wrist

Conservative Treatment

  • Patience
  • Rest – avoid specific motions
  • Thumb/wrist brace
  • NSAIDS
  • Ice
  • Steroid injection
  • Physical therapy

Surgical

  • Release the tunnel the tendons go through to decrease the irritation/inflammation.

Tennis Elbow

Micro-tear of the wrist extensor tendon attachment to the elbow

Cause

  • Overuse
  • Trauma

Conservative Treatment

  • Activity modification
  • Medication
  • Brace/force dissipation
  • Physical therapy
  • Steroid injection

Surgical Treatment

  • Only after at least 6 months of conservative treatment (Most people get better without surgery)

Ganglion Cyst Fingers

Called a Mucous Cyst

Symptoms

  • Arthritis at the distal finger joint

Conservative Treatment

  • Observation
  • Excision

GanglionCystsWristGanglion Cysts Wrist


Symptoms

  • Fluid-filled benign mass

Conservative Treatment

  • Observation
  • Splint/Medication
  • Aspiration

Surgical Treatment

  • Excision - recurrence can occur