FAQ Category: Hand

“Teno” refers to tendon, and “synovitis” means swelling inside the lining around the tendon. Carpal tunnel syndrome (CTS) occurs when pressure is placed on the nerve as it passes through the wrist.

Anything that takes up space in the carpal tunnel can cause tendinitis and then tenosynovitis of the wrist tendons. Doctors used to think tendinitis/tenosynovitis caused CTS. Studies have since shown that tenosynovitis is more likely the result of CTS. In other words, the CTS develops and then causes tenosynovitis.

Repeat surgeries are most often required when there has been incomplete release of the ligament that crosses the nerve. There may also be excessive scar tissue across the site where the body tried to heal the “broken” (cut) tissue.

A physical therapist can use ultrasound and stretching treatments to help release this tissue. Exercises to improve nerve and tendon “glide” may be helpful in reducing painful symptoms.

At least three months of conservative care after the first surgery are recommended. If you have done this without improvement, a second surgery may be necessary.

Most experts agree that surgery is indicated when symptoms persist despite a three-month period of conservative care. Conservative care may include putting the wrist in a neutral or slightly extended position using a splint. Medications such as cortisone injections may also be used.

Physical therapy to stretch the broad band of ligament across the nerve can be done. This is usually followed by exercises for the nerve and tendons passing through the carpal tunnel. These exercises restore the nerve and tendon “glide” necessary for normal movement.

Surgery may be considered if these efforts do not change symptoms and improve function. Tests to measure nerve function called nerve conduction studies are often done to help make this decision. These tests show how well the nerves are working and if there is permanent damage.

Injury to the thumb ligaments is common in skiing and snowboarding. When the snowboarder lands on the hand with the thumb out wide and pulled back, the ulnar collateral ligament on the inside edge of the thumb joint can be torn.

If this is the case, surgical reattachment of the ligament is usually necessary. Immediate surgery is best, though surgery can be delayed three or four weeks after the injury. Waiting longer can result in the need for more extensive surgery. This happens when the ligament gets scarred down and loses its ability to steady the joint.

Continuing to ski or snowboard with an injury of this type is risky. Any further falls or injuries to the thumb can complicate the recovery. Follow your doctor’s advice to avoid complications.

The open method involves making an incision through the skin. The doctor can see inside and release the tendon pulley. In the percutaneos procedure, the doctor simply inserts a needle through the skin, just under the tendon pulley. By twisting the needle, the tendon pulley is cut, and the tendon is able to glide freely.

In a recent study comparing the two methods, one hundred trigger digits were surgically treated. Just under half (46) were treated with the open method; the others were treated percutaneously. Surgery time was markedly longer using the open method. By comparison, people got quicker results when treated with the percutaneous method. Their pain went away almost twice as fast, and they got back to work within four days, compared to nearly eight in the open group.

Doctors prefer to try nonsurgical treatments before going ahead with surgery. Cortisone, a strong anti-inflammatory medicine, can help reduce swelling in the nodule and stop your finger from triggering. Unfortunately, in two of every three cases, the nodule will return again within one year.

To answer this question, researchers looked at records from almost 400 emergency rooms across the US. In 1998, there were 352 hand and forearm injuries treated in these emergency rooms. Forty-four percent involved the ulna or radius, the bones on the little-finger and thumb sides of the forearm, respectively. Finger injuries came next at 23 percent. Then came injuries to the bones in the top of the hand (18 percent), and the wrist (14 percent). Multiple hand fractures were rare.

Different age groups were more prone to injure certain parts of the hand and forearm. Children ages 5 to 14 were the most likely to hurt their radius or ulna. People over 85 had the highest rate of wrist and finger fractures, possibly because of accidental falls.

Children ages 5 through 14 have more hand injuries than any other age group. According to a recent study of injuries treated in ERs across the US, this age group accounts for 26 percent of hand and forearm fractures.

Different age groups are more prone to particular kinds of hand and forearm injuries. Children ages 5 to 14 are the most likely to injure the bones in their forearms. Young adults (ages 15 to 24) have the most injuries to the bones in the top of the hand. Young children (ages 0 to 4) are the most likely to injure multiple parts of the hand at once. And patients over 85 are at the greatest risk for wrist and finger fractures, possibly because of accidental falls.

Occasionally, a nerve is unintentionally divided during the surgery. This can leave a finger permanently numb but is usually more an annoyance than a problem. You should report this to your physician. You may still experience improvement up to 18 months after the surgery.

Dupuytren’s is not necessarily an indication for surgery unless you’re having a lot of problems using the hand. In the early stages of Dupuytren’s a more conservative approach is recommended. Once a contracture has developed (tissue does not stretch at all), exercise, splinting, and medications will not improve your situation and surgery may be needed. Your doctor will be able to best make this determination.

Although Dupuytren’s is genetic, meaning it tends to run in families, the problem usually affects mostly men after age 40. This is an extremely rare condition in children with only one case under the age of 8 even reported. If you still have concerns, don’t hesitate to talk about this with your physician.

Researchers looked at records from emergency rooms across the United States to answer this question. Among 352 hand and forearm fractures, accidental falls were the most common cause of injury by far (47 percent). Fifteen percent of the injuries came from being hit by a person or object, such as in sports. Seven percent came from motor vehicle accidents. A small number of injuries came from getting a hand stuck between objects, or from tools and machinery.

Pressure on the median nerve in the wrist can cause symptoms of carpal tunnel syndrome. These include numbness, tingling, or pain in the wrist, hand, and fingers. During pregnancy, the amount of fluid in the body can increase dramatically to help support the growing child. This increase in body fluid puts pressure on the nerve as it passes through the wrist.

Usually carpal tunnel syndrome brought on by pregnancy goes away after the birth of the child. If you have kept on additional weight after each pregnancy, ask your doctor for nutritional advice to help you maintain a healthy weight gain during pregnancy and weight loss after pregnancy. If you chose to work with a nutritionist, he or she can also help you find ways to decrease water retention. Wearing a wrist splint at night can help relieve pressure around the median nerve by enlarging the area inside the carpal tunnel. A splint also keeps the wrist from curling up and putting pressure on the nerve while you sleep.

The surgery your doctor has in mind is probably arthrodesis. This procedure stabilizes the joint so the bones can grow together properly.

Research suggests that this procedure can be very effective for patients your age. A recent article reported the results of arthrodesis for 59 joints. Patients were between 41 and 73 years-old (average = 54). Like you, they had pain where two small bones meet at the base of the thumb.

About seven years later, patients were asked to rate their pain on a scale from one to 10, with one being no pain. On average, patients said their pain was next to nothing at 1.5. All but one of the patients said they would have the surgery again given the same circumstances. The researchers concluded that arthrodesis gives good, lasting pain relief to patients your age who have arthritis in the base of the thumb.

Arthrodesis is surgery to stabilize the thumb joint so bones can grow together. A recent article gave the results of this procedure for patients between the ages of 41 and 73 (average = 54). These patients had surgery where two small bones meet at the base of the thumb.

Out of 59 joints, only four did not heal together properly after surgery. Three of these were not painful. One of the joints was painful; it was fixed by an additional surgery.

There were no major complications from surgery. At follow-up about seven years later, patients had almost no pain. All but one of them said they’d choose the surgery again.

The researchers concluded that arthrodesis is safe for older patients. Though doctors have generally only recommended it for patients under 40, older patients seem to get lasting relief from this procedure.

Doctors have sometimes shied away from operating on the joints of older, arthritic hands. They’ve thought that surgery could make arthritis worse.

A recent study tested this idea on a group of patients ages 41 to 73 (average = 54). These patients had surgery to permanently join the bones at the base of the thumb. About seven years later, 27 of the patients had X-rays. Seven cases showed further signs of arthritis. However, the patients didn’t have any symptoms. On a scale of one to 10, with one being no pain at all, these patients said their pain was a 1.4. (This score was even a little lower than the norm than for those who had never had surgery.)

Researchers felt the surgery was safe for older, arthritic hands. In nearly all of the cases, the surgery seemed to provide lasting pain relief without any major complications.

The joint in the base of the thumb is called the trapeziometacarpal joint (TM). If the ligaments around this key joint are injured or stretched, the joint becomes loose and unstable. This causes the tissues in and around the joint to be strained during relatively simple activities. Talk with your doctor about treatments that can help ease pain.

A method of tightening a loose and painful thumb joint is to weave sections of nearby tendons through and around the bones of the thumb.

In a recent study of 35 patients who had this surgery, 97 percent had either an “excellent” or “good” result. Only one patient required another surgery because of ongoing pain. All patients showed stable thumb joints after surgery. And all but two resumed their jobs and sports.

A procedure to weave sections of nearby tendons through and around the bones of the thumb shows promise in delaying, and possibly preventing, thumb joint arthritis.

This form of surgery is best used when the trapeziometacarpal (TM) joint of the thumb is mildly loose–but not arthritic. When arthritis is present other surgical procedures may be recommended. When these guidelines are used, ligament reconstruction surgery appears to keep the joint from eventually becoming arthritic. In a recent study, follow up X-rays taken as many as 17 years after this type of surgery showed no signs of thumb arthritis.

The traditional surgery for trigger digits is the “open” method. This involves making an incision through the skin over the swollen nodule. By opening the skin, the doctor is able to see inside and cut the tendon pulley.

A newer way to release the tendon pulley is to use a percutaneous (across the skin) method. The doctor simply inserts a needle through the skin, just under the tendon pulley. By twisting the needle, the tendon pulley is cut, and the nodule is free to move. The challenge with this surgery is the surgeon is unable to see the tendon pulley.

Patients seem to do well with both types of surgery. However, the open method takes longer, and people have less pain and get back to activities faster after the percutaneous method. Your doctor will know which method is best for your particular condition.