FAQ Category: Hand

One of the first symptoms of carpal tunnel syndrome is gradual numbness in the areas supplied by the median nerve. This is quickly followed by pain where the nerve gives sensation in the hand. The hand may begin to feel like it’s “asleep,” especially in the early morning hours after a night’s sleep.

Pain may spread up the arm to the shoulder and even to the side of the neck. If the condition progresses, the thenar muscles of the thumb can start to weaken and atrophy, causing the hand to be clumsy when picking up a glass or cup. If the pressure keeps building in the hand, the thenar muscles may begin to shrink (atrophy).

Touching the pad of the thumb to the tips of the other fingers becomes difficult, making it hard to grasp items such as a steering wheel, newspaper, or telephone.

Heavy gripping and pinching, common with your occupation, should be avoided for up to six weeks. These actions need to be avoided to keep the tendons from pushing out against the healing transverse ligament in the wrist. After six weeks, you should be safe to resume gripping and pinching without irritating the wrist.

When pressure starts to build up on the median nerve, the blood supply to the outer covering of the nerve slows down and may even be cut off. The medical term for this is ischemia. At first, only the outside covering of the nerve is affected. But if the pressure keeps building up, the inside of the nerve will start to become thickened. New cells, called fibroblasts, form within the nerve and start forming scar tissue. This is thought to produce the feelings of pain and numbness in the hand. If pressure is taken off right away, the symptoms will go away quickly. Pressure that isn’t eased right away can slow or even stop the chances for recovery.

Injecting the wrist with a steroid (usually cortisone) can help ease symptoms of carpal tunnel syndrome. It also aids your doctor in making a diagnosis. If you don’t get even temporary relief from the injection, it could indicate that some other problem is causing your symptoms. When your symptoms do go away after the injection, it’s likely they are coming from within the carpal tunnel. Some doctors feel this is a signal that a surgical release of the transverse carpal ligament would have a positive result.

The surgery releases the carpal ligament, taking pressure off the median nerve. By using the endoscope, surgeons can accomplish this without disrupting the nearby tissues.

Proponents of the procedure feel that patients heal faster, are able to use their hand faster, and have fewer problems of tenderness in the palmar incision. Other physicians are not convinced that this procedure is better than the open incision technique.

It is called endoscopic carpal tunnel release. This newer procedure is done using an endoscope (a small, fiber-optic TV camera) to look into the carpal tunnel through a small incision just below the wrist. Using the camera allows the surgeon to release the ligament without disturbing the overlying tissues.

Pressure on the median nerve inside the carpal tunnel of the wrist can produce symptoms of carpal tunnel syndrome (CTS). In fact, 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. 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. Also, fractured wrist bones may later cause CTS if the healed fragments result in abnormal pressure and irritation on the flexor tendons.

A wrist brace will sometimes decrease the symptoms in the early stages of CTS. These braces keep the wrist in a resting position (not bent back nor bent down too far). When the wrist is in this position, the carpal tunnel is as big as it can be–so the nerve has as much room as possible inside the carpal tunnel. It can be especially helpful for easing the numbness and pain felt at night and can keep your hand from curling under as you sleep. The wrist brace can also be worn during the day to calm symptoms and rest the tissues in the carpal tunnel.

Pain is the main problem with degenerative arthritis of any joint. This pain occurs at first only related to activity. Usually, once the activity gets underway there is not much pain, but after resting for several minutes the pain and stiffness increase. Later, when the condition worsens, pain may be present even at rest. The most noticeable problem with basal joint arthritis is that it becomes difficult to grip anything. It causes a sharp pain at the base of the thumb in the thick part of the heel of the hand.

When the articular cartilage starts to wear off the joint surface, the joint may make a squeaking sound when moved. Doctors refer to this sound as crepitus.

Degenerative arthritis will eventually affect the motion of a joint. The basal joint can become stiff and lose motion. It may become difficult to move the thumb away from the palm. This is referred to as a contracture.

Injury to a joint, such as a bad sprain or fracture, can cause damage to the articular cartilage. An injury to the basal joint of the thumb–even if it does not injure the articular cartilage directly–can alter how the joint works. This is true for a fracture of the thumb metacarpal bone where the bone fragments don’t quite “line up” correctly and heal differently from the way they were before the break occurred. This is similar to any mechanical device or machinery. If the mechanism is out of balance, it tends to wear out faster. A bad thumb fracture early in life can help explain why why you now have problems with thumb arthritis.

The procedure is called excision arthroplasty. The term excision means to “take out.” In this surgery, the surgeon takes out a small bone at the base of the thumb and fills in the space with a rolled up section of tendon. The soft tissue forms a “false joint.”

The main goal of this surgery is to ease pain where the surfaces of the thumb joint are rubbing together. The doctor uses a piece of tendon to form a “spacer” that separates the surfaces of the joint. Unlike a fusion surgery that simply binds the joint together, excision arthroplasty can help take away pain while allowing the thumb joint to retain some movement.

Patients are able to return to normal activity within three to five weeks after having spherical implant surgery. Recovery is faster because the procedure doesn’t require the doctor to disturb the tendons near the joint. Range of motion exercises can start within one week after surgery using the ceramic ball.

The newer method for replacing the thumb joint is to use a spherical implant that looks much like a ceramic marble. The doctor makes a small, one-inch incision at the base of the thumb joint. The ends of the bones that form the thumb joint surfaces are taken off, forming flat surfaces. A burr (a small cutting tool) is used to make a small notch in the ends of the two bones. The surgeon shapes the notch so the ceramic ball will fit snugly in the joint. The ceramic ball is placed between the ends of the shaped bones. The soft tissues are sewn together, and the thumb is splinted and bandaged.

After surgery, you will probably wear an elbow-length cast for about six weeks. This gives the ends of the bones time to fuse together. Your surgeon will want to check your hand in five to seven days. Stitches will be removed after ten to fourteen days, though most of your stitches will be absorbed into your body. You may have some discomfort after surgery. You will be given pain medicine to control the discomfort.

You should keep your hand elevated above the level of your heart for several days to avoid swelling and throbbing. Keep it propped up on a stack of pillows when sleeping or sitting up.

Arthritic joint surfaces can be a source of stiffness, pain, and swelling. The artificial joint is used to replace the damaged joint surfaces so you can do your activities with less pain. Unlike a fusion surgery that simply binds the joint together, arthroplasty can help take away pain while allowing the thumb joint to retain movement.

After surgery, your finger will be bandaged with a well-padded dressing and a splint for support. The splint will keep the finger in a straightened position during healing. Your surgeon will want to check your hand in five to seven days. Stitches will be removed after ten to fourteen days, though most of your stitches will be absorbed into your body. You may have some discomfort after surgery. You will be given pain medicine to control the discomfort you have.

You should keep your hand elevated above the level of your heart for several days to avoid swelling and throbbing. Keep it propped up on a stack of pillows when sleeping or sitting up.

The way people do their tasks can put them at more risk for problems of CTS. Some of these risks are listed here:

• force


• posture


• wrist alignment


• repetition


• temperature


• vibration

One of these risks alone may not cause a problem. But doing a task where several factors are present 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 may actually be more important in whether a person is more likely to end up having CTS.

Not necessarily. When the middle thumb joint is fused together with arthrodesis surgery, a person’s ability to do day-to-day tasks isn’t affected that much. This is because some people have a very small range of motion in this joint anyway. Fusing the joint keeps the joint from moving, but it also protects it from eventually becoming arthritic and painful.

Mucous cysts are small, fluid-filled sacs that form on the fingers. They are associated with osteoarthritis (OA) and usually develop in patients fifty to seventy years old. These cysts appear between the last joint of the finger and the bottom of the fingernail. Unless a mucous cyst is painful or in danger or rupturing, it can be left alone without causing  harm to the patient. But even surgically removing a mucous cyst may not alleviate pain if the underlying cause of the pain is OA.

A mucous cyst is typically visible just under the skin on the finger. It may be painful. You may notice a groove in the fingernail just above the cyst. The groove is a result of pressure from the cyst on the nail bed. The skin over the cyst may have thinned.