FAQ Category: Hand

Good question! And one that many, many experts have applied themselves to in trying to answer. Despite the fact that many people are affected by this condition, there just hasn’t been enough consistent evidence to point us in the right direction.

Clinical tests used for years to diagnose carpal tunnel syndrome have been tested and compared trying to find one test that could be used as the gold standard. If a test like that could be found, the physician could conduct the test and say with certainty, Yes you do or No you don’t have this problem.

It isn’t always clear that the symptoms are coming from compression of the median nerve in the carpal tunnel area. For example, similar symptoms can be caused by pressure on the peripheral nerves in the cervical (neck) spine. Electrodiagnostic tests like nerve conduction velocity (NCV) and electromyography (EMG) can be used to confirm the diagnosis. But even when the tests are negative (indicating no problem with conduction of signals along the nerve), there are some folks who still really have carpal tunnel syndrome.

Once a diagnosis has been made and confirmed, then as you found out, it’s not a cut and dried decision about treatment. There isn’t a magic pill that takes away this compressive neuropathy disorder. Steroids (oral or injection) might be of some help. Ultrasound (heat energy) has been used with some success by physical therapists over the patient’s wrist where the nerve passes through the carpal bones. Splinting the forearm and wrist to hold it immobile and in a position that doesn’t stretch or stress the nerve can also yield positive results with decreased pain and other symptoms.

That’s the conservative (nonoperative) approach to treating carpal tunnel syndrome. Studies show that if splinting doesn’t help after three months and oral (pill form) steroid medications haven’t improved symptoms in eight weeks, then it’s time to consider surgery.

Don’t let these various treatment choices confuse or confound you. Your surgeon will be able to help you navigate the treatment path. There are several options. If one doesn’t work, there are others available. The majority of patients do get permanent relief from the pain and numbness/tingling.

MRSA stands for methicillin-resistant staphylococcus aureus. Staphylococcus aureus is known more commonly as a staph infection.

MRSA is a potentially serious problem (it can be fatal) because the staph bacteria have mutated (changed) enough that antibiotics can no longer kill it. Staph can usually be treated with antibiotics. But over many years, some strains of staph — like MRSA — have become resistant to antibiotics that once destroyed it. Staph is now resistant not only to methicillin but also to amoxicillin, penicillin, oxacillin, and many other antibiotics.

Treatment is usually surgical drainage of the infection. And according to a recent study conducted at the University of Washington in Seattle, MRSA hand infections that are treated surgically resolve without further complications. There’s even some suggestion that further treatment with antibiotics aren’t needed but this decision is made on a case-by-case basis.

It is also true that more than one surgical drainage may be needed to clear the area completely. Second procedures are common. Occasionally, patients need three or more operations before the infection is finally cleared up. And in a few cases, patients pick up a second (separate) infection in the process of trying to get rid of the first one.

Patients often report hand stiffness and swelling after surgery but these symptoms gradually go away. The real concern is for loss of blood supply to the finger resulting in gangrene and amputation. When a joint is affected, arthritis is a distinct possibility some time later.

You can ask your surgeon what is your own personal prognosis. The outcomes are often influenced by other factors such as your general health and the presence of comorbidities. Comorbidities refers to other diseases. In the case of MRSA, having diabetes, being an injection drug user, or having a documented case of the human immunodeficiency virus (HIV) increases the risk of developing MRSA infections. Whether these risk factors also affect final outcomes has not been reported.

MRSA stands for methicillin-resistant staphylococcus aureus. Staphylococcus aureus is known more commonly as a staph infection. It can be community-acquired (CA) or hospital-acquired (HA). Community acquired means the person was exposed to the bacteria somewhere out in their work, home, or recreational environment. In other words, they didn’t pick up the bacteria while being hospitalized. Developing this type of infection while living in an assisted living facility is still considered community acquired.

MRSA doesn’t affect everyone. There are certain people who seem to be more susceptible (more likely to get MRSA). These at-risk groups include people involved in contact sports, athletes sharing equipment, and individuals who are immunosuppressed (poor immune system function). It doesn’t sound like that describes your mother.

But the very young and the very old are two age-related groups at increased risk for developing MRSA. Depending on how old your mother is age could be a risk factor. On the other hand, there’s also been a disturbing trend of MRSA infections in people who have no obvious risk factors. It is widely believed that living in close quarters (e.g., jails, dormitories, barracks) is a risk factor for CA-MRSA. An assisted living situation can be much like a dorm with meals eaten together in a common area, shared public bathrooms, and group activities.

The important thing now is to make sure your mother’s infection is treated. She will need to see a physician if she hasn’t already. Serious infections may need to be surgically drained but the physician will determine this. Occasionally, infection drainage takes more than one procedure. For the best results, follow all instructions provided by the physician while she is in your home and at her assisted living facility.

Carpal tunnel syndrome is a syndrome that causes pain and/or numbness in the hand because of pressure on the medial nerve, which runs from your arm to your hand. Seniors can and do develop carpal tunnel syndrome and, often, seniors have more intense symptoms than do younger people.

The answer to your question about if seniors have surgery to correct the problem is “it depends.” Surgery is always somewhat of a risk. Surgeons always have to take into account the health of their patients before agreeing to operate. Age shouldn’t be a deciding factor if the patient is healthy enough and doesn’t have any illnesses that could make the surgery or recovery differently. Therefore, whether your father would have surgery depends on his doctor, on the severity of the carpal tunnel syndrome, and on his health and motivation.

Carpal tunnel release, the surgery for carpal tunnel syndrome, may permanently eliminate symptoms or it may not. It isn’t possible to know ahead of time who may end up having pain again.

Is it normal that the pain return? Not necessarily and not because of age. A recently completed study found that patients who were over 65 years when they had carpal tunnel release, still had a high number of patients who were pain-free five years after their surgery. The best thing is for your mother to see her doctor to see if carpal tunnel is really the problem and if there are ways to help her relieve the symptoms.

Giving antibiotics prophylactically, preventatively, is common with certain types of surgery. For example, surgery on your colon has a high risk of infection, so usually patients are treated with antibiotics beforehand. Other surgeries are not as cut-and-dry when it comes to how many people may develop an infection, so whether they are given antibiotics beforehand depends on the surgeon, the patient’s overall condition, and hospital policy.

Recent research has found that there doesn’t seem to be a difference in infection rates after carpal tunnel syndrome surgery in patients who do or who do not receive antibiotics before the procedure. So, again, it boils down to what the surgeon feels is right for each individual.

Any type of surgery carries a risk of infection because of what happens during the procedure. Whenever there is a cut or opening in the skin, there is the potential for infection and while doctors and nurses do their best to reduce the risk of infections, sometimes they still happen.

Without knowing your mother-in-law’s history, it would be impossible to tell why she developed an infection and how it happened. The infection rate for carpal tunnel release is not high, but when the infections do occur, they are painful and cause problems for the patient.

Carpal tunnel syndrome is a condition that occurs when the medial nerve, the nerve that runs down the arm, through the wrist and into the hand, becomes inflamed or irritated, usually due to pressure or rubbing from repetitive actions. It falls under the repetitive stress injury category.

If carpal tunnel syndrome is caught early enough, it is possible to treat it without having surgery. This could be through bracing the hand and taking anti-inflammatory medications, for example. By resting the wrist and not allowing the nerve to become irritated or rubbed against, it could begin to heal. However, that being said, if it does heal and you go right back to the activity that caused the problem in the first place without making any changes, it is very possible, maybe even probable, that the carpal tunnel syndrome symptoms will return.

Carpal tunnel syndrome, irritation of the nerve that runs from the arm, through the wrist, to the hand, has been around for as long as humans have done repetitive work. Some occupations or hobbies may be obvious contributors to the problem, such as writers, but many others that don’t seem so obvious may as well, such as:

Cashiers
Assembly line workers
Seamstresses or tailors
Mechanics
Musicians
Bakers (particularly decorating cakes, for example)

Hobbies, such as knitting, cause many knitters to have to put down their craft. So, it’s not a new problem, but definitely one that has come to the forefront, with the advent of computers and all that come with them.

Bennett fractures are named for a physician who first wrote about them in the medical literature way back in 1885. The specific bone that’s affected is the thumb metacarpal. Metacarpal is another word for the bone in the thumb that is closest to the wrist. The joint that is affected is the carpometacarpal (CMC) joint. This is where the base of the thumb is connected to the wrist.

A Bennett fracture is a break along the bottom side of the thumb metacarpal closest to the wrist bone. The location at the base of the thumb metacarpal next to the wrist is why it affects the carpometacarpal joint. And because this is a pivotal joint that contributes to all the movements of the thumb, a close and careful fracture reduction is important.

Reduction refers to putting the broken pieces of bone back together so that the bone surfaces line up exactly and the carpometacarpal joint is fully restored. The surgeon uses wires, pins, or screws (called fixation) to hold the bone in place while it heals.

Usually, this type of surgery can be done arthroscopically with the aid of fluoroscopy (real-time, 3-D X-rays). The arthroscope is inserted into the joint and the broken fragment is rotated and slipped back into place carefully with a tiny probe. While holding the probe in place and keeping the bone in its perfect spot, the surgeon then fixes the bone in place using a screw, pin, or wires.

When Bennett fractures of the thumb can be surgically repaired in this fashion, patients have a much better long-term result. More complex fractures may still require an open surgery. If the shaft of the bone is broken and/or the soft tissues around the area have been torn, then a more extensive reconstructive procedure may be needed that requires a full incision.

Sometimes the surgeon doesn’t know the full extent of the damage until inside the joint looking around with the scope. At that point, it may be necessary to back out with the arthroscope and proceed with an open incision procedure. Arthroscopic or open surgery both require splinting or casting postoperatively. If the surgeon sees that complete immobilization is needed for healing and recovery, then the cast is used.

Timing of the follow-up to remove sutures and replace the cast with a half-cast or splint will be determined by the surgeon. When wires are used, these are removed four to six weeks after surgery. Athletes often wear a special protective splint that still allows them to grip the ball but full return-to-play may not occur for six weeks (when X-rays show a healed fracture).

This information is only a general idea of what you might expect. Once you see the surgeon and get the big picture of what happened and why, then the necessary recommendation will be made.

To determine if you have carpal boss, you must see a doctor who will x-ray and maybe scan the hand to see if this is, indeed, what your problem is.

Most often, treatment of the bony prominence, the carpal boss, is with surgery to remove it.

There have been reports from bartenders and others who repeatedly turn the hand palm up and palm down. This problem is not common but has been described by violin players, swimmers, military personnel, and bartenders.

The condition is thought to be a nerve palsy called posterior interosseous nerve (PIN) syndrome. A branch of the radial nerve in the forearm that supplies motor (movement) function to the extensor muscles of the thumb and fingers is affected.

The repetitive motion of the forearm causes muscle contraction of the supinator muscle. The nerve gets pinched by this muscle as it contracts and especially if it gets built up in bulk from constant use.

It would be a good idea to see an orthopedic surgeon or hand specialist for an examination and proper diagnosis. You may be able to benefit from a special splint to rest the muscle and nerve while still allowing you to do your job. Antiinflammatory medications can help reduce any swelling. Rarely, more invasive treatment such as surgery is needed when there is a tumor, cyst, or scar tissue pressing on the nerve causing the same symptoms.

Minors in possession (MIP) are often under the influence of alcohol and/or other drugs. They can sustain injuries they don’t remember even before being apprehended by the police. Handcuffs have been known to contribute to a particular nerve palsy called superficial radial nerve palsy.

The radial nerve in the forearm is fairly close to the surface of the skin as it moves from the forearm to the wrist and then down to the hand. Symptoms on one side occur with handcuffs most likely because the wrist is larger on the dominant side. Muscle bulk is greater giving less room for the opening of the cuffs.

Excess or prolonged pressure on the nerve can result in a temporary (and even permanent) loss of sensation. The same problem has been reported with a too-tight wristwatch band. The pain is present at rest, as well as when the hand and thumb are moving. This helps differentiate it from other wrist/thumb problems that are not present at rest.

It would be a good idea to have a physician get a baseline on symptoms and document the injury. Treatment may not be needed, especially if the symptoms resolve over the next few days. Conservative care may be needed such as antiinflammatory medications, rest, and/or splinting to protect the nerve. The surgeon will be able to advise you once an examination has been done and a diagnosis made.

Carpal boss is a condition that affects the wrist, just as carpal tunnel does. However, carpal boss does not involve the tunnel that protects the nerve that runs from the arm to the wrist. Instead, carpal boss is a growth that is found in the joint between the first long bone of the finger and the wrist. This can be caused by either a degeneration of the joint or trauma to the area.

Carpal boss causes pain and swelling to the wrist and if it interferes with daily activities, surgery to remove the growth is the usual treatment.

At first glance, mallet finger fractures can seem like a no big deal kind of problem. Put a splint on it and you’re better in six weeks. But as you just discovered, when you need every finger and every joint of every finger to do your job, the injury just got very complicated.

Occasionally surgeons face this same problem. Without the full use of their hands, they can’t operate. So we turned to a recently published article by a hand surgeon who also suffered a mallet finger fracture from a skiing injury. He reviewed all of the literature on these kinds of finger fractures to find out what’s the best way to treat it.

Mallet injuries can be fairly complex. The surface of the finger joint can be involved. There is avulsion (rupture) of the tendon. The joint may become subluxed (partially dislocated) or fully dislocated. Depending on the location and severity of the injuries, treatment may be accomplished either with a splint to immobilize the joint or surgery to repair the damage.

Surgery involves using a pin to hold the bone fragments together. The pin functions like an internal splint to allow the patient to keep using the hand (such as in the case of a surgeon or piano teacher).

But there can be problems associated with the pin such as infection, failure to hold the fractured bone together while it heals, and loss of skin as a result of the infection. So that’s why splinting is tried first. Surgery is usually saved for complex injuries or splinted injuries that just don’t heal. Given your situation, you may want to see an orthopedic surgeon to see if you could be a candidate for a pin that would allow you to continue moving and using your finger while tickling the ivories!

A neuroma is a growth of nerves where there shouldn’t be such a growth. When you injure nerves, they try to grow back, to regenerate. Sometimes, this works well. Other times, the nerve fibers they send out, the axons don’t go to the right place and end up bunching together. This can cause pain, numbness, and other symptoms.

Every patient is different and if surgery is an option for you is something you should discuss with your doctor. Some people live with neuromas that don’t cause too much trouble, so they leave them for a while. For others, the neuroma may be causing severe problems with pain, numbness, cold intolerance, and stiffness. In these cases, surgery may help.

Without knowing your medical history and seeing you, it is impossible to tell you what is wrong with your hand. But, in general terms, sometimes a crushing injury to a hand can cause a long-lasting problem called a neuroma, a bundle of nerves that have developed into a growth. For some people, a neuroma can cause problems such as pain and stiffness, and intolerance to the cold, as you describe.

The best thing to do would be to go to a doctor and have him or her examine your hand. Only then could a diagnosis be made.

People with rheumatoid arthritis can end up with severe deformities in their hands as their knuckles become damaged. This not only causes pain, but makes it difficult to do every day tasks. There is now hope for some people with these types of deformities.

A procedure called silicone arthroplasty has been done successfully on the lower knuckles of the hands, the metacarpophalangeal joints. Whether your mother is a candidate for this type of surgery though, is only something that she and her doctor can decide.

There is a type of surgical implant done on the lower knuckles of the hand called silicone arthroplasty. It has been fairly successful for many people, but it doesn’t seem to be consistent with all fingers. A recent study found that this type of implant had a better result in the two fingers you mention, the little finger and the ring finger, than the index (pointing) finger and middle finger.

This could have something to do with how the knuckles themselves work. Each finger moves slightly different from the others and their range differs too.

You may be experiencing a problem called trigger finger. Trigger finger (and trigger thumb) are conditions affecting the movement of the tendons as they bend the fingers or thumb toward the palm of the hand. This movement is called flexion.

This problem is common in folks who have been involved in light-to-heavy manual labor. Other problems affecting the hand such as diabetes, carpal tunnel syndrome, or Dupuytren’s disease often occur in patients with trigger finger. Your problem also sounds suspiciously like Dupuytren’s.

Dupuytren’s first shows up as a thick nodule (knob) or a short cord in the palm of the hand, just below the ring finger. More nodules form, and the tissues thicken and shorten until the finger cannot be fully straightened. Dupuytren’s contracture usually affects only the ring and little finger. The contracture spreads to the joints of the finger, which can become permanently immobilized (unable to move).

For individuals with diabetes, the abnormal metabolism of glucose can cause a variety of soft tissue problems, especially affecting the hands. See your primary care physician or an orthopedic surgeon to find out for sure what’s going on. Early diagnosis and treatment is often the best way to get results and avoid developing a chronic problem.