CARPAL TUNNEL SYNDROME
CARPAL TUNNEL SYNDROME
Caused by nerve compression at the wrist (within the carpal tunnel). Most people complain of discomfort, numbness and tinging in the fingers and thumb.
If the symptoms are mainly at night a splint worn across the wrist can help while sleeping.
A steroid injection can help with the symptoms, but usually only provides temporary relief.
Surgery involves releasing the carpal tunnel and alleviating the pressure on the nerve. Results after surgery are usually very good, but are best before the numbness becomes permanent or the thumb becomes weak.
The tendons that bend the fingers run in tunnels/pulleys next to the bones in the fingers. When a trigger finger occurs the tendon is swollen or the tunnels become thickened and the tendon cannot glide smoothly. This can start with pain and progress to a trigger finger which causes the finger to stay locked in a flexed position.
Common treatments include a steroid injection or a small operation to release the entrance of the tunnel allowing more room for the tendon.
Dupuytren's disease is named after a French anatomist and military surgeon Baron Guillaume Dupuytren. It is a common condition and is linked to Viking ancestry. It is caused by the abnormal thickening of a layer of tissue (fascia) within the hand and fingers. This thickening causes lumps and cords of tissue to develop in the skin of the hand. As this tissue matures, it contracts causing the fingers to curl into the palm. These deformities make using the hand for everyday activities such as washing your hair or putting gloves on, very difficult.
Osteoarthritis from general "wear and tear" or Rheumatoid arthritis (auto-immune) where the body attacks its own joints, both result in loss of cartilage and joint destruction. Symptoms include stiffness, swelling and pain.
Management options include exercises with a hand therapist to maintain joint movement, splinting and simple pain relief like paracetamol. Surgical options are cleaning (debriding), fusing (stiffening), replacing or reconstructing the affected joint. Selecting the best treatment depends on the severity of the arthritis, age and level of function.
Nerve compression like in Carpal Tunnel Syndrome can occur in other areas. The next most common condition effects the "funny bone" nerve on the inside of the elbow. Symptoms include numbness and tingling in the little finger, this is usually worse when the elbow is flexed and while sleeping.
As the condition worsens the small muscles in the hand begin to weaken and shrink.
If the symptoms continue to worsen surgical decompression of the nerve is usually required, best results are achieved before the nerve becomes to compromised.
Tendons on the back of the wrist and hand run within individual compartments. Similar to a Trigger Finger if these tendons become swollen or inflamed, common with overuse, they can cause localised pain.
Commonly this occurs in the tendons that extend the thumb in new parents.
Treatments include exercises and splinting with a hand therapist, steroid injection or an operation to release the compartment and the compression on the tendons.
BRACHIAL PLEXUS INJURIES
BRACHIAL PLEXUS INJURIES
As the nerves to your arm and hand exit the spinal cord they form an intricate network of cables. During high energy injuries, like the ones sustained during a motorcycle accident these nerves can be stretched or permanently injured. These are devastating injuries and may need complex microsurgical procedures to graft or transfer healthy nerves to the damaged ones, or tendon transfers to regain some function in the affected limb.
Over the last 30 years a large number of orthopaedic procedures on joints have been performed using an arthroscope, where a fiber optic telescope is used to look inside the joint. Through this type of keyhole surgery, fine instruments can be introduced through small incisions (portals) to allow surgery to be performed without the need for large cuts. This allows many procedures to be performed as a day stay and allows quicker return to normal function of the joint.
Arthroscopy is used in wrist surgery to diagnose and treat specific conditions, in particular those effecting ligaments and cartilage.
The tendons, ligaments and bones in the hand and wrist are commonly injured due to their use in daily and sporting activities. Depending on the injury X-rays, a CT or MRI scan may be required for diagnosis.
Treatment depends on the severity and characteristics of the injury. Fractures that involve joint surfaces or are grossly deformed or lacerations to tendons often need surgical intervention followed by a period of casting. Other injuries can be treated with splinting and hand therapy or casting.