FAQ Category: Hand

Diagnosing nerve entrapments such as carpal tunnel syndrome can be a challenge. There’s really no single test that says, yes you have carpal tunnel syndrome or no you don’t. Most physicians, surgeons, and other specialists rely on what you tell them (the medical history) and what they see during the exam.

Sometimes when the results are inconsistent or unclear, the physician will order electrodiagnostic tests. Electrodiagnostic tests include electromyograms(EMGs) and nerve conduction velocity (NCV).

An electromyogram (EMG) measures the electrical activity of muscles at rest and during contraction. Nerve conduction studies measure how well and how fast the nerves can send electrical signals to the muscles. Carpal tunnel syndrome can reduce nerve signals to the muscles resulting in muscle atrophy (wasting) and weakness.

Electrodiagnostic tests are often done to confirm a diagnosis, especially if surgery is a treatment consideration. The physician carefully weighs the pros and cons of each test ordered. Are the results of the test going to confirm or rule out the provisional diagnosis? Will the results of the test change (in any way) the treatment decision(s)?

If the answer to these questions is no, then there may be no need to add inconvenience, delay, discomfort, and cost in making a diagnosis.

Carpal tunnel syndrome is a common problem affecting the hand and wrist. Symptoms begin when the median nerve gets squeezed inside the carpal tunnel of the wrist. Carpal tunnel syndrome is also known as nerve entrapment or compressive neuropathy. Any condition that decreases the size of the carpal tunnel or enlarges the tissues inside the tunnel can produce the symptoms of carpal tunnel syndrome.

To diagnose carpal tunnel syndrome, the physician relies on the patient’s history, results of the clinical exam, and sometimes, additional tests such as electrodiagnostic tests. Electrodiagnostic tests include electromyograms(EMGs) and nerve conduction velocity (NCV).

An electromyogram (EMG) measures the electrical activity of muscles at rest and during contraction. Nerve conduction studies measure how well and how fast the nerves can send electrical signals to the muscles. Carpal tunnel syndrome can reduce nerve signals to the muscles resulting in muscle atrophy (wasting) and weakness.

There isn’t strong agreement about the value of electrodiagnostic tests at this time. Some studies show that only those patients with positive findings on the electrodiagnostic tests should be treated surgically. Others suggest that clinical tests are enough to make the diagnosis. They suggest that adding the electrodiagnostic tests is unnecessary except in some cases.

A new test called the CTS-6 is now available to help with this decision. The CTS-6 test can be used to determine the chances a patient has carpal tunnel syndrome. This instrument has six parts. The six items include 1) numbness in the hand and fingers supplied by the median nerve, 2) muscle atrophy and/or weakness, 3) a positive Phalen test (standard clinical test used to diagnose carpal tunnel syndrome), 4) loss of two-point discrimination (feeling two separate points touched on the skin), 5) numbness at night that wakes the patient up, and 6) a positive Tinel sign (another standard clinical test used to diagnose carpal tunnel syndrome).

Each of the six items is given a point value. A total score of 12 or more suggests a strong probability (80 per cent chance) that the patient has carpal tunnel syndrome. A total score less than five indicates a very small chance (25 per cent) that the patient has carpal tunnel syndrome.

With the availability of the CTS-6, there is much less need to use electrodiagnostic studies. The goal in making any diagnosis is to do so in the least amount of time, with minimal discomfort to the patient, and at the lowest cost. The right diagnosis is important in planning treatment that will bring the most successful results. But for the most part, the value added by electrodiagnostic testing is minimal when the CTS-6 score predicts carpal tunnel syndrome.

You may need to consult with both the hand therapist and your surgeon. It’s possible the hand therapist can give you a modified program that is easy enough and simple enough to do quickly but still get the desired results. Perhaps this is something you can even do during your breaks at work.

Talking with the surgeon may help you identify the specific purpose and usefulness of the exercises. In many cases, movement is needed to keep the tendons from getting all bound down by scar tissue, adhesions, and fibrous attachments. For smooth motion and function, it really is necessary to have the tendons slide and glide smoothly through the tendon sheath that wraps around the outside of the tendon.

When a patient is able to complete an exercise program, it is referred to as patient compliance. Noncompliance can compromise your final outcome. Studies show that practice does indeed make perfect — well, at least doing the exercises regularly improves your ability to do them correctly and thereby gain the value they add to your recovery.

The best approach in rehab for surgically repaired extensor tendon injuries is still up in the air. For a long time, immobilization (no movement) was the standard treatment. Patients were splinted or casted to keep them from moving until the surgeon gave the go-ahead.

Then it became clear that no movement causes scar formation and loss of motion. The healing tendon(s) got bound down and no longer slid smoothly through the sheath covering them. Hand therapists started using movement early on after surgery.

There are two ways to approach mobilization after tendon repairs. One is early but controlled motion (some guided movement). The other is early and active (full movement). But what works best: immobilization (no movement), early but controlled mobilization (some movement), or early and active mobilization (full movement)?

There are some studies out there comparing these treatment approaches. And a group of researchers from the University of Amsterdam in the Netherlands took the time to review and summarize them. What they found was that early controlled mobilization results in better range-of-motion at the end of six weeks (compared with immobilization). At the end of 12 weeks, there was no difference in motion between the two groups.

Grip strength comes back faster and stronger with controlled mobilization compared with immobilization. Overall results are better at the end of six weeks with mobilization (compared to
immobilization). But by the end of six months, both groups had the same final results in terms of motion and strength. There is conflicting evidence about the short-term effects of early controlled mobilization versus active mobilization. But all studies agreed that the long-term results are the same.

All in all, it looks like early controlled mobilization is the superior approach for postoperative rehab following surgical repair of extensor tendon injuries. Even though there are no apparent long-term benefits of active motion, an earlier return to full function and strength may get you back to work sooner and improve your quality of life and satisfaction.

A chondroma is a benign tumor made up of cartilage cells. They are usually benign but can cause painful swelling. The most common location is in the hands and feet (fingers and toes). Usually, a chondroma is removed with clear margins to prevent local recurrence. Clear margins means when viewed under the microscope, the tumor is completely surrounded by a layer of normal cells.

Reconstruction of the finger and joint may be optional — especially if the patient is only interested in the minimal amount of surgery. Let your surgeon know what are your preferences. Find out what are all your treatment options.

Plan together (with your surgeon) the best approach for you. The surgeon may not know what you want. And there may be some specific reasons why the surgeon is recommending removal and the more extensive surgery for reconstruction.

Studies of the general population report as many as 15 per cent of adults have carpal tunnel syndrome (CTS). If you are comparing yourself to other patients in a hand surgeon’s office, then the number of people with this condition is much higher — more like 70 per cent. That makes sense since those patients have a common problem treated by a single individual (the surgeon).

These figures don’t put carpal tunnel syndrome in a category of epidemic, but they do reflect a possible increase in the number of people affected. This syndrome has received a lot of attention in recent years because of suggestions that it may be linked with occupations that require repeated use of the hands, such as typing on a computer keyboard or doing assembly work. Actually, many people develop this condition regardless of the type of work they do.

Any condition that causes abnormal pressure in the tunnel can produce symptoms of CTS. Various types of arthritis can cause swelling and pressure in the carpal tunnel. Fractured wrist bones may later cause CTS if the healed fragments result in abnormal irritation on the flexor tendons.

Other conditions in the body can produce symptoms of CTS. Pregnancy can cause fluid to be retained, leading to extra pressure in the carpal tunnel. Diabetics may report symptoms of CTS, which may be from a problem in the nerve (called neuropathy) or from actual pressure on the median nerve. People with low thyroid function (called hypothyroidism) are more prone to problems of CTS.

The way people do their tasks can put them at more risk for problems of CTS. Some of these risks include force, posture, wrist alignment, repetitive motions, temperature (usually prolonged exposure to cold), and vibration.

One of these risks alone may not cause a problem. But doing a task that involves several factors may pose a greater risk. And the longer a person is exposed to one or more risks, the greater the possibility of having a problem with CTS. However, scientists believe that other factors such as smoking, obesity, and caffeine intake may actually be more important in determining whether a person is more likely to develop CTS.

Pressure on a nerve can cause entrapment leading to symptoms such as pain, numbness, and/or weakness. Carpal tunnel syndrome is a common problem affecting the hand and wrist. Symptoms begin when the median nerve gets squeezed inside the carpal tunnel of the wrist.

The carpal tunnel is an opening through the wrist to the hand that is formed by the bones of the wrist on one side and the transverse carpal ligament on the other. Any condition that decreases the size of the carpal tunnel or enlarges the tissues inside the tunnel can produce the symptoms of carpal tunnel syndrome.

Making the diagnosis for this problem can be difficult. The physician relies on your history, clinical presentation, and results of specific tests. Most of the tests depend on your subjective response to provocative tests. The examiner taps over the nerve or places the arm, wrist, and/or hand in a position that makes the symptoms better or worse. These tests are provocative because they can irritate an already compromised nerve and confirm that there is a problem.

Electrodiagnostic tests can also help make the diagnosis. For example, nerve conduction tests are done by passing electrical energy through the nerve and measuring the time it takes to generate a response. A lag time in nerve messages sent to the skin (sensory) or to the muscles (motor) is a sign that the nerve isn’t functioning properly. But nerve conduction tests of this sort aren’t always accurate enough.

With all of these tests, patient responses can vary widely. Studies of test sensitivity and specificity have not found one test that is both sensitive and specific. Sensitivity means the test shows a true positive when there’s a problem. Specificity refers to the ability of the test to also show a true negative (the person doesn’t have the problem). If a test isn’t sensitive enough, patients who have the problem will be missed. If the test isn’t specific enough, patients who don’t have the problem won’t be eliminated.

To overcome low sensitivity and/or low specificity, the examiner must use more than one test. After all the tests are done, then the results are compared. The physician looks for a pattern to confirm or rule out nerve entrapment. What physicians really need is one test that is both specific and sensitive to replace the whole battery of other tests.

The results of a new study suggest that the scratch collapse test may be that test. The test is done by first resisting the patient’s forearms as he or she tries to move the forearms away from the body. During the test, the patient is sitting facing the examiner with the elbows at the sides and bent 90 degrees. The palms of the hands are facing each other.

After the resistance, the examiner scratches the patient’s skin over the area of the affected nerve. For carpal tunnel syndrome, the skin is scratched over the palm-side of the wrist. Then the resistance test is repeated. A positive response for nerve entrapment is a sudden (but temporary) weakness of the forearm.

This test has other advantages. It is easy to use and repeatable. In other words, the test can be done more than once without a rest. Patients don’t seem to get fatigued, so the test can be repeated to verify results. Mild to severe entrapment can be assessed by how severe the weakness is. The test can be used to sort out patients who might be seeking secondary gain (a money settlement) for their injury.

The scratch collapse test appears to be sensitive and specific enough to be reliable. The studied showed that it was also reproducible. This means the test was reliable no matter who performed it (so long as the examiner was trained to do the test). And since the results don’t depend on the patient reporting on results, it is considered a more objective clinical test. A video of this test is available at www.jhandsurg.org. Tests like this may eventually replace the more painful and expensive nerve conduction tests.

There are many potential causes of carpal tunnel syndrome (CTS). Most people are familiar with CTS from repetitive motions, especially from activity in the work place. But CTS can also occur as a result of a wrist fracture.

Symptoms of CTS begin when the median nerve gets squeezed inside the carpal tunnel of the wrist, a medical condition known as nerve entrapment. The carpal tunnel is a canal formed by the wrist bones arranged in a circle. Nerves and blood vessels pass through the tunnel going from the wrist to the hand. Anything that causes pressure inside the carpal tunnel can compress the median nerve leading to CTS.

There are two bones in the forearm: the ulna and the radius. The radial bone is the larger of the two forearm bones. It’s on the thumb side of the forearm. A recent study showed how the risk of CTS after a distal radial fracture increases if the two ends of the bone are displaced (separated). Distal refers to the end of the bones in the forearm that’s closest to the wrist.

The researchers found that increased pressures within the carpal tunnel following fracture was the main cause of the acute CTS. With a fracture, there can be contusion, deformity, or swelling from elevated pressure within the tunnel. Any of these problems can cause median nerve dysfunction and lead to permanent damage of the median nerve. Early recognition and treatment of any of these factors can prevent long-term problems.

Trigger finger is a catching or popping of the tendons as they move the fingers. Usually this problem occurs as the finger is moved toward the palm of the hand. This movement is called flexion.

The tendons that move the fingers are held in place on the bones by a series of ligaments called pulleys. These ligaments form an arch on the surface of the bone that creates a sort of tunnel for the tendon to run in along the bone.

To keep the tendons moving smoothly under the ligaments, the tendons are wrapped in a slippery coating called tenosynovium. The tenosynovium reduces the friction and allows the tendons to glide through the tunnel formed by the pulleys as the hand is closed to grasp objects. Triggering makes it difficult to fully flex the finger. And if the soft tissues get stuck, then you may not be able to relax the hand and open up the fingers.

Triggering is usually the result of a thickening in the tendon. Constant irritation from the tendon repeatedly sliding through the pulley causes the tendon to swell in this area. A nodule or knob forms. The pulley ligament may thicken as well. The nodule catches on the pulley causing a popping or catching sensation.

Sometimes, a thickening in the band of connective tissue across the back of the wrist is the cause of the problem. This area is called the extensor retinaculum. Even minor changes in the tendon can cause catching of tendon as it tries to glide under the retinaculum.

Surgery is usually done using regional anesthesia, which means only the arm is put to sleep. But the surgery can also be done under a general anesthesia in which you go to sleep. This type of surgery could be done in a field hospital such as a mobile army surgical hospital (MASH) unit. But the U.S. Army decommissioned the last MASH unit in 2006. MASH units have now been replaced by U.S. Army’s Combat Support Hospitals. It’s likely that you will be transferred to this type of facility for the procedure.

With any surgery (no matter how simple), there are some risks. There is a slight risk of infection. Decreased motion, instability, and nerve or blood vessel damage can occur. Any of these (or other) complications can delay recovery.

However, if everything goes well and there are no complications, you will be able to move your fingers and wrist soon after surgery. Stitches are removed after two weeks. A physical therapist may see you to make sure you can move your wrist normally and perform all of your required duties. This is important to the safety of all the soldiers within your unit.

A ganglion is a small, harmless cyst, or sac of fluid, that sometimes develops in the wrist. Doctors don’t know exactly what causes ganglions. Technically, a ganglion cyst causes a trigger finger. The ganglion is just one of many possible causes of trigger finger. Let’s define some of these terms to help you understand this better.

Trigger finger is a catching or popping of the tendons as they move the fingers. Usually this problem occurs as the finger is moved toward the palm of the hand. This movement is called flexion. But in rare cases, trigger finger of the extensor tendons (the ones that straighten the fingers) is the problem.

The tendons that move the fingers are held in place on the bones by a series of ligaments called pulleys. These ligaments form an arch on the surface of the bone that creates a sort of tunnel for the tendon to run in along the bone.

To keep the tendons moving smoothly under the ligaments, the tendons are wrapped in a slippery coating called tenosynovium. The tenosynovium reduces the friction and allows the tendons to glide through the tunnel formed by the pulleys as the hand is opened to release objects.

Triggering is usually the result of a thickening in the tendon. Constant irritation from the tendon repeatedly sliding through the pulley causes the tendon to swell in this area. A nodule or knob forms. The pulley ligament may thicken as well. The nodule catches on the pulley causing the popping or catching sensation.

Ganglions are generally attached by a stalk of tissue to a nearby joint capsule, tendon, or tendon sheath (tissure covering the tendon). Ganglions have been seen in almost every joint in the hand and wrist. Most of them occur along the back of the wrist/hand.

The ganglion that attaches itself to a tendon or tendon sheath can cause tendon triggering. As the finger bends, the tendon slides and glides through the tendon sheath. If there’s a ganglion attached to the tendon, the cyst can get stuck on a pulley or the edge of the retinaculum. The retinaculum is a band of fibrous tissue that goes across the wrist (front and back).

Tendon thickening on the palmar side of the hand can cause triggering when the nodule bumps up against the retinaculum. Ganglion cysts on the back of the wrist/hand cause triggering when the cyst cannot pass under the retinaculum. Regardless of the cause, the result is the same: there’s a palpable click, pop, or catching response.

Treatment for carpal tunnel syndrome (CTS) is not standardized yet. Evidence from studies done so far suggest trying conservative (nonoperative) care first. If your symptoms are not improved within the first two months, then try another approach. The most common conservative care includes nonsteroidal antiinflammatory drugs (NSAIDs), physical therapy, or steroid injections (more on injections in a minute).

The therapist will help you find ways to modify your posture and activities to give the nerve a rest from any tension or compression. If appropriate, you may be given splints to wear while sleeping at night. In some cases, the splints are advised on a full-time basis (day and night). They are only taken off briefly to bathe.

The therapist will teach you nerve and tendon gliding exercises and perform techniques to release tension on the nerve. A form of therapy called manual therapy will be used to help realign the soft tissue and bony structures. This can also help reduce compression within the carpal tunnel.

The things you will learn in therapy will help you for a lifetime. Maintaining good posture, using proper body mechanics, and modifying activities as soon as symptoms start can be very helpful in avoiding future problems.

For short-term relief, a steroid injection directly into the carpal tunnel area may be therapeutic and diagnostic. There is evidence that relief after a single injection predicts a successful result after surgery.

Surgery is considered an option when electrodiagnostic tests show that the median nerve is damaged. When surgery is done, the flexor retinaculum should be completely cut all the way through. This is recommended no matter what surgical approach (open, mini-incision, endoscopic) is taken. The flexor retinaculum (also known as the transverse carpal ligament) is a band of connective tissue across the wrist over the carpal tunnel.

Scientists are trying to get a handle on how helpful steroid injections are for symptoms of carpal tunnel syndrome. So far, there’s no evidence that the drug actually changes the nerve function. But it does give the temporary relief you have experienced.

It does not appear that more is better. In other words, increasing the dose (amount of steroid used or number of injections given) doesn’t reduce the pain, numbness, or tingling any faster or better than a single dose. Likewise, injecting a specific area (above or below the wrist crease) doesn’t provide different results.

The biggest predictor of results with steroid injection is the outcome of electrodiagnostic tests. Electrical impulses through the nerve are evaluated. Slow or absent messages from the nerve to the muscles are an indication of damage to the median nerve.

Electrodiagnostic tests showing that the median nerve is damaged are an indicator that surgery is advised. A steroid injection may provide symptom relief, but it’s only temporary. Patients with altered sensation and slow nerve impulses have the poorest response to injection. And they are more likely to have a relapse with return of symptoms.

For now, it looks like a single steroid injection is safe and offers fast relief from symptoms. Results are short-term and the symptoms may come back if there is damage to the nerve.

On the other hand, patients who have normal electrodiagnostic tests are actually more likely to benefit from a steroid injection. Steroid injection is one option for patients who want to avoid having surgery for as long as possible or for those who need immediate symptom relief.

If you have not had any nerve conduction tests done, it may be a good idea to pursue this. With the information from the tests, your surgeon will be able to advise you about further conservative (nonoperative) care versus having carpal tunnel surgery.

If the electrodiagnostic tests show nerve impairment, chances are that conservative care with steroid injection won’t help. But if the test results are normal, then a second (up to three) steroid injections can be given. And keep in mind that steroid injections are only one way to treat carpal tunnel syndrome. Other nonsurgical treatment such as nonsteroidal antiinflammatory drugs (NSAIDs) and physical therapy can also help.

Carpal tunnel syndrome occurs when the median nerve that passes through the carpal tunnel in your wrist becomes pinched or pressed. It’s usually caused by repetitive motions in the wrist, that can cause swelling or scarring, which then causes the pressure.

To be diagnosed with carpal tunnel syndrome, doctors look for you to be experiencing pain or discomfort (numbness, pins and needles) in your hand and/or wrist, pain that wakes you at night, and loss of sensation to the thumb and lower part of the hand. The doctor can also do two tests: the Phalen test, which involves pushing back your hand for 60 seconds, perhaps triggering the pain, and the Tinel sign, which involves tapping along the median nerve on the wrist to see if this worsens the tingling or pain.

If you have a positive Tinel sign (meaning it does cause pain), it is possible that you have carpal tunnel syndrome, but if you don’t have any of the other symptoms, it’s also possible that you don’t. If you are concerned, you should speak to your doctor the next time you have an appointment.

People who have carpal tunnel syndrome do often feel pain that wakes them at night. The syndrome occurs when the median nerve that passes through the carpal tunnel in your wrist becomes pinched or pressed. It’s usually caused by repetitive motions in the wrist, that can cause swelling or scarring, which then causes the pressure. But, at night, as you sleep and relax, the soft tissues in your wrist may swell up a little, but just enough to put more pressure on the nerve. This is what causes the pain.

Some doctors recommend wearing a splint at night to keep your wrist from bending and this keeps the nerve from getting pinched. It may take some getting used to, though. If your pain is causing disturbed sleep, you should speak with your doctor to see what treatment is available to you.

A healthy, normal individual should have no problem playing the guitar for long periods of time without affecting the position of the fingers. The inability to straighten the last two fingers may be a sign of something else going on.

The most common cause of this problem is called Dupuytren disease. Dupuytren’s contracture is a fairly common disorder of the fingers. The condition usually 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.

One or both hands can be affected. Although the exact cause is unknown, it occurs most often in middle-aged, white men. It is genetic in nature, meaning it runs in families. Dupuytren disease is seven times more common in men than women. It is more common in men of Scandinavian, Irish, or Eastern European ancestry. The disorder may occur suddenly. More often, it progresses slowly over a period of years. The disease usually doesn’t cause symptoms until after the age of 40.

There are some other known risk factors for this disease. These include diabetes, alcohol abuse, and tobacco use. Trauma from injury or vibration during manual labor can also increase the chances of developing Dupuytrens. The natural course of the disease is unpredictable. Some people have a mild case that doesn’t cause problems. Others progress to severe contracture preventing proper use of the hand.

The natural course of the disease is unpredictable. Some people have a mild case that doesn’t cause problems. Others progress to severe contracture preventing proper use of the hand. Although your symptoms sound like Dupuytren disease, it could be something else. It’s best to see an orthopedic surgeon and get a diagnosis first before assuming you have this particular problem.

Dupuytren’s contracture is a fairly common disorder of the fingers. Although the exact cause is unknown, it occurs most often in middle-aged, white men. It is genetic in nature, meaning it runs in families.

The condition usually 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.

Surgery to release the soft tissues (fasciectomy) and/or remove the contracted fascia (connective tissue) (fasciotomy) is the main treatment approach. The procedure is done through the skin and is called percutaneous needle fasciectomy/fasciotomy (PNF).

But because the problem is genetic, it’s likely to recur despite treatment. In fact, up to 65 per cent of the time, the fingers start to stiffen up again soon after the operation. Sometimes the trauma of the surgery makes the problem worse instead of better. The younger the patient is when the disease occurs, the more likely the problem will repeat itself over time. Results from surgery aren’t always perfect.

Carpal tunnel syndrome is a common problem affecting the hand and wrist. Symptoms begin when the median nerve gets squeezed inside the carpal tunnel of the wrist, a medical condition known as nerve entrapment. Any condition that decreases the size of the carpal tunnel or enlarges the tissues inside the tunnel can produce the symptoms of CTS.

This syndrome has received a lot of attention in recent years. Many people thought it might be linked with occupations that require repeated use of the hands. The number of patients with CTS seemed to be increasing as more people were spending time typing on a computer keyboard or doing assembly work. Actually, many people develop this condition regardless of the type of work they do.

The American Association of Orthopaedic Surgeons (AAOS) recently put together a special committee to develop a clinical practice guideline on the treatment of carpal tunnel syndrome (CTS). The Guideline Workgroup worked together reviewing the most up-to-date evidence collected from clinicians and researchers to guide them.

They reported that once the diagnosis is made, conservative (nonoperative) care is the first step.
Many types of nonoperative treatment are available. So far, there isn’t enough evidence for or against their use, so there isn’t a one-treatment-fits-all approach. Conservative care includes such things as physical therapy, acupuncture, electrical stimulation, nutritional supplements, yoga, or magnet therapy.

If conservative care does not improve your symptoms within two to seven weeks, then try a different nonoperative approach. Splinting or steroids (oral or injections) are two treatment possibilities that have shown successful results. Heat should not be used to treat this problem.

Surgery is considered an option when electrodiagnostic tests show that the median nerve is damaged. Usually, the surgeon performs a carpal release. The band of connective tissue that goes across the wrist over the carpal tunnel area is cut (released) to take pressure off the median nerve as it goes through the carpal tunnel.

Be sure and ask your physician what recommendations he or she has. Sometimes there are specific circumstances (e.g., in your health or the cause of your symptoms) that direct treatment. You may be able to save yourself some time and money by taking this approach.

Magnet therapy (also known as magnetic therapy involves the use of electromagnetic devices or permanent static magnets. The magnets or magnetic devices are placed on various parts of the body for health benefits.

Magnets are sold in many forms such as bracelets and jewelry; straps for the wrists, ankles, and back; and shoe inserts. They even come in mattresses and can be woven into blankets. In some places, magnetized water is sold for internal magnetic therapy.

The idea is that pain (and other symptoms) can be relieved by subjecting certain parts of the body to magnetic fields produced by these permanent magnets. So far, there is a lack of any real evidence that magnet therapy can improve health or speed up the body’s natural healing process. The magnets used are too weak to have any measurable effect on blood flow.

There is inconclusive evidence that using them for carpal tunnel syndrome or diabetic neuropathies is helpful. This is not to say that studies haven’t been done. There are several studies specifically related to magnets and nerve pain. But experts who have taken a closer look at the studies say that they are flawed and an unreliable source of information.

High-quality studies that have been approved as reliable by statistical experts show no benefit from magnet therapy. In fact, several companies producing and selling magnets with claims of improving circulation, reducing nerve pain, or treating effects of diabetes have been barred from making these false claims by the Federal Trade Commission.

The bottom line is that there is no scientific evidence that static magnets can relieve pain or change the course of any disease. Many of today’s magnetic devices don’t even generate enough of a magnetic field to be measurable at (or below) the skin’s surface.

There may be a placebo effect of any alternative treatment such as magnet therapy. This means the patient believes it will work, so they see improvements in their symptoms or overall health. If you are under the care of a medical doctor, make sure there isn’t a medical reason why you shouldn’t use magnet therapy before trying it.

The first ray refers to the area including and between the thumb and the first finger of your hand. This includes the bones, joints, ligaments, and muscles in the area.

Luckily for professional football players, according to the database kept by the National Football League, hand injuries don’t usually end a player’s career. Hand injuries include fractures, sprains, strains, overuse, and inflammatory injuries, most of which can heal well without too long a period of lost play.