Carpal Tunnel Syndrome

This very common condition is caused by a pinched nerve at the wrist (the median nerve). The carpal tunnel is a passageway through the wrist carrying tendons and one of the hand's major nerves. Pressure may build up within the tunnel because of disease (such as rheumatoid arthritis), injury, fluid retention during pregnancy, overuse, or repetitive motions. The resulting pressure on the nerve within the tunnel causes a tingling sensation in the hand, often accompanied by numbness (especially of the thumb, index and middle fingers), aching, and impaired hand function. This is known as carpal tunnel syndrome. The Phalen’s, or wrist-flexion, test involves having the patient hold his or her forearms upright by pointing the fingers down and pressing the backs of the hands together. The presence of carpal tunnel syndrome is suggested if one or more symptoms, such as tingling or increasing numbness, is felt in the fingers within 1 minute. In some cases, splinting of the hand and anti-inflammatory medications will relieve the problem. If the carpal tunnel syndrome is caused by another underlying disease (such as diabetes or thyroid disease), treatment of that disease may relieve the carpal tunnel syndrome. Treatment includes splinting and medications; however, if this treatment fails, an operation is available that releases the ligament pinching the nerve. The operation is performed on an outpatient basis under a form of local anesthesia. In the operation, Dr. Harris makes a short incision from the middle of the palm to the wrist and divides the ligament that's pressing on the nerve, in order to release the pressure: he may also remove any other tissues compressing the nerve. The skin stitches remain in for 2 weeks, during which time the patient may wear a splint. The scar usually fades and become barely visible. The results of the surgery will depend in part on how long the condition has existed and how much damage has been done to the median nerve. Long standing carpal tunnel syndrome may result in permanent numbness and weakness of the thumb.

 

These cysts are very common "lumps", usually found on the top of the wrist or fingers, but sometimes on the palm side of the wrist or fingers. Ganglia are often painless; however, they may cause pain with movement or cause mechanical problems (limiting range of movement) depending on where they are located. They have a tendency to wax and wane in size, presumably as the fluid contained within the cyst drains back into the joint or tendon sheath and again produces fluid and fills. The biggest problem with a ganglion may be the fear a patient may have that it is something more ominous. The cyst can be distinguished from a solid tumor by transillumination (light will pass through the hollow fluid filled ganglion, but not a solid tumor mass). Treatment is not required unless the cysts are painful, unsightly or limit hand function. Sometimes, wrist ganglions are treated by removing their fluid and wearing a splint; however, surgically excising the cyst offers the lowest recurrence rate. This operation is performed on an outpatient basis under a form of local anesthesia.

 

 

Dupuytren's contracture is a disorder of the skin and underlying tissue on the palm side of the hand. It is caused by progressive thickening of the fascia of the palm, resulting in "chords" that draw the fingers into the palm so they can not be fully straightened. The ring and little fingers are most commonly affected, although other parts of the body, such as the knuckles and feet can also be involved. The contracture is painless, but as it progresses, the palm can not be placed flat on a surface.  The condition usually develops in mid-life and has no known cause (though it has a tendency to run in families, particularly those with ancestors from Northern Europe). Surgery is presently the only treatment for Dupuytren's contracture, although there is currently some fascinating research that suggests in the future it may be possible to treat this disease with an injection of a medicine into the contracted chords. For the surgical treatment of this problem, the surgeon cuts and separate the bands of thickened tissue, freeing the joints and allowing better finger movement. The operation must be done very precisely, since the nerves that supply the hand and fingers are often tightly bound up in the abnormal tissue. The skin incisions are made in a zigzag fashion to help re-establish a full range of motion post-operatively. In some cases, skin grafts are also needed to replace tightened and puckered skin. This operation is performed on an outpatient basis, under a form of local anesthesia. Dr. Harris keeps his patients in a splint for several weeks after the procedure to help straighten the fingers. Post operatively, many patients will require a course of therapy. Although an operation may restore normal hand motion, the condition can return with time.

 

The damage that tennis elbow incurs consists of tiny tears in a part of the tendon and in muscle coverings. After the initial injury heals, these areas often tear again, which leads to hemorrhaging and the formation of rough, granulated tissue and calcium deposits within the surrounding tissues. Collagen, a protein, leaks out from around the injured areas, causing inflammation. The most effective conventional and alternative treatments for tennis elbow have the same basic premise: Rest the arm until the pain disappears, then massage to relieve stress and tension in the muscles, and exercise to strengthen the area and prevent re-injury. If you must go back to whatever caused the problem in the first place, be sure to warm up your arm for at least 5 to 10 minutes with gentle stretching and movement before starting any activity. Take frequent breaks. Conventional medicine offers an assortment of treatments for tennis elbow, from drug injections to surgery, but the pain will never go away completely unless you stop stressing the joint. For most mild to moderate cases of tennis elbow, ibuprofen will help address the inflammation and the pain while you are resting the injury, and then you can follow up with exercise and a "tennis-elbow" splint to speed healing. For stubborn cases of tennis elbow your doctor may advise corticosteroid injections. If rest, anti-inflammatory medications, and a stretching routine fail to cure your tennis elbow, you may have to consider surgery. One procedure is for the tendon to be cut loose from the epicondyle, the rounded bump at the end of the bone.