FAQ Category: Hand

Splinting has been reported successful with mild cases of trigger finger. A custom-made splint is advised. It will hold the joint at the knuckle in a slight bent position. The rest of the finger is left free. Usually an occupational therapist can help you get the right splint.

You’ll have to wear the splint 24/7 for at least six weeks. For mild cases involving only one finger, splinting is a good way to go. If that doesn’t work you can always try a steroid injection or two. If all else fails, a simple surgery can be done to release the pulley mechanism of the tendon.

Steroids do have some dangerous side effects. Most of the time these occur when patients have to take oral steroids for a long period of time. When steroids are injected, the side effects are much less serious.

In the case of a bothersome trigger finger, corticosteroid injection is a very common treatment used. It works well and gives long-lasting relief from the triggering symptoms. Sometimes patients get good results after only one injection. In other cases it may take up to three injections.

There is one thing to think about. Studies show that patients who wait four to six months or more before getting injected have less success with injections. Sometimes it takes longer to work and requires more injections. The reason for this is the build up of scar tissue and fibrocartilage. Steroids can’t always reverse this.

The radial collateral ligament (RCL) of the thumb is injured much less often than the ulnar collateral ligament (UCL). The RCL is located just at the base of the thumb between the thumb and the forearm. It actually crosses the wrist line at that point. The UCL is on the other side of the wrist.

Studies of the RCL are limited. The tear is usually graded from one to three. One is a mild injury and three is a complete tear. Splinting or casting is used for grade 1 and 2 tears. Doctors disagree on the best way to treat grade 3 tears.

Some advise casting it for six to eight weeks. Others insist surgery is the only way to go. A recent study of 26 patients with grade 3 tears reported on the results of surgical treatment for grade 3 RCL tears.

Patients who had the surgery within the first three weeks of the injury had a repair. Patients who waited months to years to have the surgery had a full reconstruction. The results were excellent in both groups.

Based on this study, the authors recommended surgery in the acute stages of RCL ruptures. They predict it will reduce the risk of a painful, unstable joint and arthritis developing later.

Chronic pain and difficulty with these types of activities suggests a serious injury, perhaps a bone fracture or a torn ligament.

Patients with a torn radial collateral ligament (RCL) often describe exactly these symptoms. They also describe trauma or an injury caused by compression through the tip of the thumb. The weight of your body and force of the injury hyperextends the thumb joint tearing the ligament at the base of the thumb.

An orthopedic surgeon or hand specialist will need to make the diagnosis. History and examination are often all that’s needed. An X-ray may be taken to rule out a fracture.

Your son may have what’s called a “trigger finger”. Inflammation of the lining of the tendon keeps the tendon from sliding and gliding through its tunnel. It literally gets stuck.

It’s also possible he has a locked metacarpophalangeal (MP) joint, which is the large knuckle on the back of the hand. There are many possible causes for a locked MP. Since he’s so young, it’s unlikely that degenerative changes from aging are the problem. It could be the shape of the bone. A large bump on one side or the other can catch the ligament and pin it against the joint.

Sometimes a piece of bone gets bumped off and floats inside the joint causing catching or locking. A torn ligament or rough edge inside the joint can have the same effect. There’s no way to really know for sure without an X-ray and exam by an orthopedic surgeon.

Have it checked out if this is happening on a regular basis. It may be a quick fix if caught early on.

A chiropractor could put a subluxed or dislocated joint back in place with a manipulation. In this case it’s more likely an orthopedic surgeon or the team doctor injected a local anesthetic like novacaine into the joint. Gentle traction is applied by pulling the bone away from the joint. The finger is straightened and rotated or turned slightly.

The joint usually responds to this treatment and the bones go back into place normally. This is called a closed reduction or manipulation. The doctor must be careful not to use too much force in order to prevent fracture or bleeding in the joint.

If a closed reduction doesn’t work then surgery may be needed. An opening is made with an incision to see inside. The soft tissues around the joint are examined. Sometimes the problem is a ligament that has gotten caught under the bone or inside the edge of the joint. Sometimes the problem is inside the joint and the surgeon must cut the joint open. Whatever is causing the locking is removed or repaired.

Studies confirm what you’ve noticed. Patients with early signs of carpal tunnel syndrome (CTS) often report hand weakness and clumsiness. Yet when grip and pinch strength are measured, they seem normal.

The nerve to the thumb (median nerve) is affected by CTS. The effects may be different than expected. For example, according to a recent study at the Hand Research Lab in Pittsburgh, it looks like the other nerves help take over for the damaged median nerve.

Grip and pinch strength are also movements accomplished using several muscles. The other muscles may kick in giving a “normal” strength reading. But when it comes to a fine motor task such as picking something up, the impaired coordination of sensory and motor messages make the task difficult if not impossible.

Scientists don’t have the complete answer to your question. For now we can validate your experience and say more studies are underway to find an explanation.

Severity of carpal tunnel syndrome (CTS) can be difficult to assess before surgery. Sometimes patients have minor symptoms with severe nerve compression. Other times patients report severe symptoms with minor compression.

Tests used by doctors to make the diagnosis include Phalen’s test, Tinel’s sign, carpal-compression test, and several others. Only Phalen’s test (prolonged wrist flexion) can link the severity of the condition with the symptoms.

Studies show that the results of nerve conduction tests before surgery may be a good way to tell the final outcome. Evidently certain values can forecast or predict improvement in symptoms and functional use of the hand. If you haven’t had these tests done, you may want to ask the surgeon about them.

Doctors often rely on signs and symptoms along with patient history to make a diagnosis. They actually make a differential diagnosis. This means they carefully consider all the possible causes for the symptoms.

For example, pregnancy can cause carpal tunnel syndrome (CTS) but if you aren’t a woman and you aren’t pregnant, that’s not likely going to be the problem. Diabetes can cause CTS but if you don’t have diabetes then that’s not it.

Sometimes a neck problem can refer pain to the hand. But if you have normal neck motion, no history of trauma or accident, and normal X-rays then cervical spine disorder can be ruled out.

The doctor goes through each possible cause of CTS and looks to see if any of these might be a match for you. Additional tests can be done. These include sensory testing, and nerve conduction velocity (NCV) tests. The doctor can also conduct some specific tests on your wrist and hand to look for CTS.

The jury’s not all in on this one. Some studies show better results after carpal tunnel surgery for patients who don’t have diabetes. A recent report from Italy shows no difference between patients with and without diabetes after carpal tunnel release. All patients in the study had rapid relief from painful symptoms.

Talk to your doctor about this. There may be special things to think about depending on your particular situation. It can depend on the cause of the carpal tunnel syndrome. If it’s pressure on the nerve for any reason, you have a good chance for recovery. Damage to
the nerve from the diabetes may not respond as well.

Many patients get instant relief from painful symptoms after carpal tunnel release. The doctor will advise you about when to return to work and to daily activities. What you can
and can’t do often depends on how the operation is done and if there are any problems.

Many carpal tunnel releases can be done endoscopically. This means the doctor makes a small opening over the carpal tunnel area of your wrist. A special tool called an
endoscope is inserted. The scope allows the doctor to see inside the wrist area. A band of tissue across the wrist called the retinaculum is cut. This is done to take the pressure off the nerve.

If there’s no extra bleeding or swelling, you may go home with just a simple bandaid across the wrist. In some cases an ace wrap around the hand and wrist is needed to control swelling. Many doctors advise patients not to bend the wrist back or to lift, grasp, or pull with the hand for 10 days.

You should be okay to handle the cards if you hold them in your other hand during the game. Be sure and check with your doctor for any other guidelines and restrictions.

You may have a chronic tendonitis. If you haven’t tried an anti-inflammatory medicine, now might be a good time to give that a try. Physical therapy is another possible option. The therapist can use deep heat along with friction massage and/or tendon and nerve
mobilization. These techniques can help reduce inflammation and help the tendon to glide again.

If conservative care doesn’t work, then surgery is another option. The doctor can make a cut along the outside covering of the tendon (the tendon sheath). The tendons are separated from one another. This operation releases pressure on the tendon and allows it
to move freely.

Tendonitis of the thumb tendons from overuse is called Drummer’s palsy. The term was first used in 1891. This was a time when drumming was an actual occupation. It’s likely that more than just using the hand over and over in the same motion causes the
tendon to tear. The person may have a bone spur, bony bump, or spike of bone under the tendon. As the tendon moves back and forth over the bone, friction occurs. The body responds to the friction with inflammation of the tendon (called tendonitis).

The usual cause of this condition is repeated and forceful work. These factors cause local stress in the tissues. Intensive repetitive activity or forceful use done on a daily basis doesn’t allow the tissues a chance to recover.

Let’s start with snuff box. Snuff is tobacco in fine powder form. It’s inhaled through the nostril. Snuff is kept in a small snuffbox. It should hold just enough snuff for a day’s use. The user takes just a pinch or a dip each time.

In the wrist, at the base of the thumb is the anatomical snuffbox. When you pull your thumb up as if to hitch a ride, you’ll see a ridge of tendon. In fact there are two
tendons: the extensor pollicis brevis and abductor pollicis longus. When these tendons contract a small hole or indentation is formed between them. This is the anatomical snuffbox. It’s just about the right size to hold a pinch of snuff.

These two tendons share a common covering or sheath. Friction between these tendons and their common sheath from repeated forceful use of the hands can cause tendonitis.

Carpal tunnel syndrome (CTS) is a common finding in patients with certain endocrine or metabolic problems. Hypothyroidism (low thyroid) and diabetes are the two most common conditions.

Anything that puts pressure on the median nerve as it goes through the carpal tunnel in the wrist can cause CTS. In the case of low thyroid, the thyroid gland isn’t producing enough thyroid hormone. As a result, the tissues of the skin and connective fascia get separated by mucopolysaccharides (sugar) and proteins. The tendons get thick and stuck together putting pressure on the nerve.

In addition, water binds with the sugar-protein complex. Swelling occurs in places like the eyes, hands, and feet. This puts even more pressure on the nerve. Treatment of the thyroid condition usually takes care of the CTS symptoms.

There are several steps you can take. First try a short course of anti-inflammatory drugs. Your doctor can prescribe these. Then visit a physical or occupational therapist.

Therapists can help the nerves and tendons glide freely in the wrist. They can also
stretch the tight band of tissue that crosses the carpal tunnel and puts pressure on the nerve.

You can also have the nerves in your wrist and hand tested. This will show if the nerve is the source of symptoms. It there’s a loss of sensation or increased time for the nerve to send a message, surgery may help.

Early treatment is best, especially for older adults. There are some studies that show symptoms may not go away in adult over 70 years. This is because age affects the nerve’s ability to regrow or repair itself.

Doctors don’t all agree on the answer to this question. Some warn that the result is poor for severe disease. Others report good recovery even after long-standing nerve pressure.

Overall it seems that complete return to normal is more likely when carpal tunnel syndrome is treated early. Muscle weakness or muscle wasting before surgery points to a poor result. Constant pain and numbness is also a sign that recovery may be limited.

In a recent study at the University of Rochester, results of carpal tunnel release in older adults (over 70 years) are reported favorably.

Early treatment after symptoms begin is the key to success with carpal tunnel syndrome (CTS). A six to eight week trial of therapy is the first step. This may include anti-inflammatory drugs and physical or occupational therapy.

If the symptoms aren’t better, surgery may be the next step. A band of tissue across the carpal tunnel is released to take pressure off the median nerve. Even with severe CTS
and/or a delay in treatment, studies show most patients get better.

If treatment is delayed too long, full return to normal may not happen.

The main muscle that allows you to turn your palm up is called the supinator. Motor weakness of the supinator can be caused by pressure on the posterior interosseous nerve at the elbow. If this nerve is involved, you may be having some weakness lifting up (extending) the wrist and fingers.

There are many possible causes of nerve pressure. Sometimes a fibrous band of connective tissue grows over or around the nerve. A ganglion cyst or tumor may be the cause of these symptoms. Repetitive use of the arm may be a factor. It’s best to have a doctor examine your arm and find out the exact cause.

You may be describing symptoms of joint arthritis. Various studies report different amounts of osteoarthritis (OA) in the general population. Most say it’s around eight to 12 percent. A few researchers put it as high as 33 percent (one in three) among postmenopausal women.

The reason for these rates is unclear. Hormones may have a key role. Smoking and obesity have been shown as risk factors for thumb OA in women.

According to one study, work load and physical stress aren’t directly linked to finger or thumb OA. More studies are needed to find the most common risk factors for each age group. This would include premenopausal and postmenopausal women and men of all ages.