HAND: Injuries & Conditions

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome (CTS) is a common condition affecting the hand and wrist. It is generally the result of irritation and swelling, which causes compression within the narrow carpal tunnel located at the wrist – through which one of the major nerves in the arm, the median nerve, passes. This nerve becomes irritated in the compressed tunnel and can cause numbness, pain, tingling and weakness in the thumb, index and middle fingers. Affecting nearly five percent of the population, it is particularly common in middle-aged women. If conservative treatment fails to resolve the problem, a minimally invasive procedure known as Endoscopic Carpal Tunnel Release relieves the compression within the tunnel.

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Cubital Tunnel Syndrome

Cubital Tunnel Syndrome is a common condition affecting the hand and forearm. It is the result of compression placed on the ulnar nerve at the bony part of the elbow (medial epicondyle), often occurring when resting on the elbow for an extended period of time or placing unusual strain on the nerve by bending the elbow excessively. It can cause numbness and tingling at the ring and little fingers. While mild cases of Cubital Tunnel Syndrome are resolved non surgically and with the help of an occupational (hand) therapist, more severe cases non responsive to conservative treatment may require surgery. In this case, a minimally invasive Endoscopic Cubital Tunnel Release is preformed.

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Trigger Finger/Trigger Thumb

Trigger Finger, which is also known as Tenosynovitis, occurs when an activity places stress on the tendons that facilitate the bending of the thumb and fingers. As the tendons become irritated they no longer move smoothly through the narrow tunnel in which they slide and become briefly “stuck” upon entry before “popping” free. It is this sensation of catching and popping free for which the condition was named. Trigger Finger most often affects middle-aged women and the cause is not always known – though it is frequently seen with other conditions such as diabetes and Rheumatoid Arthritis (RA). While conservative treatment and anti inflammatory medication are sometimes effective in relieving symptoms, in most cases, a Trigger Finger Release is effective in cases resistant to conservative treatment.

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Boxer’s Fracture

Named after a sport implicated in causing its fair share of hand fractures, a boxer’s fracture involves a break in the neck of the fifth metacarpal bone. This was described originally as such, because the metacarpal bone of the little/pinky finger is the most common one to break when punching an immovable object.

The metacarpal bones connect the bones of the fingers (the phalanges) to the bones of the wrist (the carpals). The neck of the metacarpal bone is where the bone begins to widen out towards the knuckle.

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Basilar Joint (Thumb) Arthritis

Basilar Joint Arthritis, also known as Arthritis of the Thumb, is often seen in patients suffering from osteoarthritis and affects the basal joint of the thumb, or the carpometacarpal (CMC) joint. This is a common form of arthritis because of the repeated wear and tear of this joint. It is seen most frequently in women, over the age of 40. While the pain and discomfort may be relieved with conservative treatment plans, such as non steroidal anti inflammatory medication (NSAIDs), splints and occupational therapy, more severe cases may require surgical intervention.

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Finger Arthritis

Finger Arthritis is arthritis affecting the small joints of the fingers. This may be the result of osteoarthritis (wear and tear), rheumatoid arthritis (inflammatory) or post traumatic arthritis (injury related). Arthritis of the fingers can affect one of three joints – the metacarpophalangeal (MCP) joint, the proximal interphalangeal (PIP) joint and the distal interphalangeal (DIP) joint. Treatment is determined based on the type of arthritis, joint affected and severity of the damage. While a conservative treatment plan is first established, surgery may be indicated depending on the amount of bone and joint damage.

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Rheumatoid Arthritis

Rheumatoid Arthritis (RA) is an inflammatory type of arthritis, which is generally associated with a genetic predisposition rather than an injury or natural wear and tear of the joints. RA affects nearly 1.3 million Americans and is most commonly seen in women. It results in the rapid degeneration of joints and subsequent bone damage. The white blood cells of an RA patient produce certain proteins and can over time cause cells to attack healthy tissue, resulting in inflammation. If left untreated, this process can continue to cause chronic inflammation and the progressive damage of cartilage, bone and other joint tissue. Treatment plans depend on the severity of the symptoms and the health of each patient.

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Dupuytren’s Contracture

Dupuytren’s Disease is primarily a genetic condition affecting the hand and is most often seen in men. It can result in contractures known as Dupuytren’s Contracture. The condition causes excessive thickening of the “fascia” – the tough, fibrous tissue located between the tendons in the palm and the skin. Beginning with a small knot in the palm of the hand, the increasing thickness can begin to pull the fingers into the palm. This may prevent full extension of the fingers and eventually hinder movement of some fingers and function of the affected hand. A procedure known as Needle Aponeurotomy (NA) has been utilized to treat the condition and entails use of a tiny needle and small points of entry to divide the contracted fascia – releasing the fingers and restoring hand function.

Another nonsurgical treatment for Dupuytren’s Contracture, which is gaining popularity, is XIAFLEX injection therapy. This newest treatment is yielding excellent results for Dupuytren’s patients.

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Tendon Lacerations

Tendon Lacerations are often the result of trauma to the hand or fingers and may either affect the flexor tendons in the hand or the extensor tendons. While these tendon injuries frequently present in the emergency room, where initial treatment is determined, both extensor and flexor tendon injuries require careful assessment by an orthopedic hand specialist, as other soft tissue damage often exists. Flexor tendon injuries, in particular, often have “concomitant” injuries (accompanying injury) and deep structure damage.

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