Hand Conditions

Carpal Tunnel Syndrome (CTS) is a repetitive strain condition - most often resulting from a constant, repetitive motion associated with a job or activity. The repetitious movement subsequently causes the median nerve, which is located in a narrow passage inside the wrist called the carpal tunnel, to become irritated and compressed with increasing pressure within the tunnel.

Within the carpal tunnel, nine tendons accompany the median nerve - and a covering consisting of a tight ligament called the transverse ligament helps protect it. In patients performing repetitive activity, the membranes that lubricate the tendons as they glide in the tunnel begin to swell. When the median nerve, which provides feeling to the thumb, index and middle fingers, as well as a portion of the ring finger and several muscles in the hand, malfunctions as a result of increasing irritation and swelling, the condition is diagnosed as CTS.

Symptoms may vary and include simply a mild numbness and tingling on the palmar surface of a finger, or a more severe pain that radiates upward towards the shoulder. If untreated, symptoms generally become worse - affecting wrist, hand, or finger movement, as well as reducing grip strength and disrupting sleep.

While most often diagnosed between the ages of 40 and 60, women are diagnosed three times more often than men - generally as a result of hormone-related conditions such as pregnancy, breastfeeding, menopause, hypothyroidism, and excessive growth hormone, all of which create an increased vulnerability and susceptibility to the condition

Others at risk for CTS include those with occupations that entail repetitive hand tasks such as keyboard operators, assembly line workers, typists, barbers, musicians, and drivers. Also at risk are workers using vibrating tools such as jackhammers, chain saws, chippers, grinders, drills and sanders.

Some medical conditions may also increase the likelihood of an individual to suffer CTS - including arthritis, diabetes, Raynaud's disease and tumors and cysts within the carpal tunnel. Genetics may also play a role, as inheriting a narrow carpal tunnel can increase a person's chance of developing the condition.

Diagnosis and Treatment
There are a series of tests that help in the diagnoses of CTS. Among the simplest is a Tinel's Sign test, which entails a few firm taps on the patient's wrist in order to assess the patient's response and level of pain. A patient suffering from CTS may feel an electric shock sensation during the taps. A compression test is another fairly simple test effective in the diagnosis of CTS. During this test, the patient's wrist is bent with the thumb positioned down, as close to the forearm as possible. This position is held for a brief moment and the amount of tingling or numbness the patient experiences in the hand is assessed.

Imaging tests are also used in the diagnosis of CTS. These tests may involve an X-ray, a computed tomography (CT) scan, or a magnetic resonance imaging (MRI) scan, in order to more precisely identify the root cause of a patients CTS - as well as any other problems that may exist as a result of the condition.

Following diagnosis, treatment options are discussed and based on the severity of the condition and the lifestyle and overall health of the patient.

CTS is most often treated with non-invasive methods if diagnosed early. These methods include a period of rest from the repetitive activity, and the use of anti-inflammatory medication to ease pain and reduce inflammation. In more severe cases, a minimally invasive surgical procedure - either an Arthroscopy or an Endoscopic Carpal Tunnel Release - is performed to both diagnose the severity of the condition and treat it.

Rehabilitation
Rehabilitation is one of the most important aspects of treatment for any injury. After a period of rest, patients are encouraged to begin a series of stretching exercises to improve range of motion and grip strength. Depending on the treatment and severity of the condition, the resumption of daily activities and work may range from several days to several weeks. Though, the chance of a recurrence is minimal and complications extremely rare. Rehabilitation Exercises for Carpal Tunnel.

Focal Dystonia is a musculotendinous overuse or repetitive use condition which is called "simple" if resultant of a single task, such as playing the piano or writing, and "dystonic" if it affects other activities requiring similar hand posture. The condition is believed to result from the improper functioning of the basal ganglia, which are deep brain structures involved in controlling movement. Sometimes the disorder progresses to include the elevation of shoulders or retraction of the arm while writing.

Also commonly referred to as "writer's cramp" or graphospasm, the exact cause of this improper functioning is unknown though thought to be the result of muscular overuse in posture-specific activities involving the hand. Symptoms include cramping or a slight aching in the fingers, wrist or forearm. Symptoms usually occur when performing the task that requires fine motor movements -initially only during specific tasks and eventually spreading to other tasks requiring similar hand positioning.

Unlike other over-use conditions prompting muscle cramps and pain, such as Carpal Tunnel Syndrome - a condition for which it is often mistaken, Focal Dystonia Syndrome is more likely to affect coordination and cause only mild discomfort.

Risk Factors
The condition affects both men and women between the ages of 30 and 50, who are involved in specific activities requiring the repetitive use of unique hand posture - such as musicians (pianists, violinists) writers, typists, and some athletes involved in such sports as golf.

Diagnosis and Treatment
A thorough physical examination, detailed patient history review and possibly a neurological examination will confirm Focal Dystonia Syndrome. An electromyogram (EMG) can also help determine which muscles are overactive and the degree of stress imposed.

Treatment options generally focus on alleviating the symptoms and consist of a period of rest and refrain from the activity that prompted the condition. In chronic cases, either oral medication, or botulinum toxin injections may be indicated. More severe cases may require surgery. Physical therapy and muscular retraining may also be beneficial, depending on the form and degree of severity of the condition.

Similar to the type of compression placed on the median nerve in Carpal Tunnel Syndrome cases, Guyon's Canal Syndrome is a less common nerve compression affecting the ulnar nerve as it passes through a tunnel in the wrist called Guyon's Canal.

Running from the neck and down the arm to the hand and fingers, the ulnar nerve crosses the wrist with the median and radial nerves. The ulnar nerve and ulnar artery run through the Guyon's canal - a tunnel formed by two bones, the pisiform and hamate and connecting ligaments. Once it passes through the canal, it branches out to supply feeling to the little finger and half of the ring finger. Other branches of this nerve supply the small muscles in the palm, as well as the muscle that pulls the thumb toward the palm. A number of activities or other conditions may cause the ulnar nerve to become compressed, resulting in this condition.

Symptoms generally include numbness in the little finger and half of the ring finger. Progression can cause the gradual weakening of the muscles controlled by the ulnar nerve, which eventually makes it difficult to spread out the fingers and pinch the thumb.

Risk Factors
Generally adult men and women involved in strenuous tasks involving the wrist, such as; heavy gripping or twisting, constant pressure placed on the palm such as in cycling and weightlifting, and uncommon or unnatural activities placing great pressure on the wrist such as using a jackhammer or crutches, or pushing a stroller, are at greatest risk for Guyon's Canal Syndrome.

A traumatic injury to the wrist may also cause swelling and place pressure on the ulnar nerve within the canal. And arthritis in the wrist bones and joint may irritate and compress the nerve as well.

Diagnosis and Treatment
Upon a thorough physical examination, patient history review and possible nerve conduction velocity (NCV) test, which measures how fast nerve impulses travel along the nerve, the type of compression and its exact location are determined.

Occasionally the NCV test is performed in conjunction with an electromyogram (EMG). The EMG can determine if the forearm muscles controlled by the ulnar nerve are functioning properly. If the symptoms were the result of a traumatic wrist injury, an X-ray may be taken to check for a fracture or dislocation.

Conservative treatment is generally all that is indicated for Guyon's Canal Syndrome - NSAIDs and reduction of the activity causing the pressure, or change of hand position. Physical therapy may help to facilitate this process. A wrist brace may also be used to alleviate the symptoms by keeping the wrist in "resting position" and decreasing the pressure placed on the nerve.

A surgical procedure to release the ligament above the canal and reduce the pressure to the ulnar nerve is performed, if conservative treatment is unsuccessful.

Hypothenar Hammer Syndrome (HHS) is a neurovascular overuse condition that generally results from a continuous, or ongoing pounding motion affecting the ulnar side of the palm, the hypothenar region. It is often prompted by a trauma to the ulnar artery distal to the Guyon's canal, leading to thrombosis of the ulnar artery.

Symptoms of HHS may include sensitivity to cold and pain in the palm, as well as ulnar digital numbness and tingling. More severe cases may result in weakening grip strength, discoloration of the finger and an ulcer at the fingertip.

Risk Factors
HHS often affects those involved in such sports-related activities as excessive biking, karate, and lacrosse. It also affects those involved in non sports-related activities such as the use of a jackhammer or repeated hammering required in roofing. In fact, those involved in manual labor that subjects hands to constant pounding and aggressive motion are most frequently diagnosed with the condition.

Diagnosis and Treatment
The patient's medical and work history, as well as the symptoms experienced and location of the pain, will often times identify this condition. Imaging scans may also be indicated in order to identify any obstruction to the blood vessel that may exist.

While surgery is required in some severe cases of HHS, conservative treatment is generally all that is indicated - refraining from the activity prompting the condition, rehabilitative exercises and possibly medication to assist in blood flow.

Also known as Tenosynovitis, Trigger Finger or thumb is named for the "trigger" or flicking motion that is caused when the affected finger is extended. This happens when a stress placed on the tendons that help bend the fingers and thumb causes irritation and corresponding restriction in the already snug tunnel through which they slide. While flexion remains relatively unaffected, extending the finger or thumb in this environment causes the tendon to become momentarily stuck at the mouth of the tunnel before popping free as it continues to slip through the constricted area. This may cause pain.

Following a period of inactivity, stiffness and "catching" may become worse. As it loosens throughout the day, it may begin to feel unstable. And in severe cases, the finger may become stuck in a bent position.

Risk Factors
While the exact cause of Trigger Finger is unclear, the condition most often affects women between the ages of 40 and 60. It is thought that this condition is often secondary to an existing medical condition, as many of the patients suffering from trigger finger also suffer from other conditions such as diabetes and rheumatoid arthritis, or have a history of repeated injury to the affected area.

Diagnosis and Treatment
Easily diagnosed, the symptoms generally point to trigger finger or thumb. And a thorough patient history review and physical examination of the affected area confirms the diagnosis without further tests.

Conservative treatment is all that is indicated in mild cases, which generally entails resting the affected hand. Anti-inflammatory medication may also be recommended in order to alleviate pain. More severe cases failing to respond to initial conservative treatment may require splinting to maintain the finger or thumb in a position of rest. Cortisone treatments may also be used. In those cases nonresponsive to the described courses of conservative treatment, Trigger Release may be indicated.

While most men and women will experience some type of arthritis over the course of their life, osteoarthritis (OA) is among the most common forms of arthritis in the United States. And the finger and thumb joints are the joints most affected among the upper body joints.

Arthritis of the hand is a degenerative joint disease that often begins with an injury or condition causing stress to the joint. Improper healing or trauma will cause degenerative conditions within the joint and an eventual breakdown of joint cartilage resulting in pain and stiffness.

Risk Factors
Osteoarthritis is often the result of a previous injury or trauma. It may also accompany other forms of arthritis. According to recent statistics, approximately 90 percent of women and 80 percent of men between the ages of 75 and 79 suffer from osteoarthritis in their hands.

Diagnosis and Treatment Options
A thorough review of patient history, listing of symptoms experienced and imaging tests will confirm the presence of arthritis and the severity of the condition.

While it is always best to identify conditions conducive to this degeneration as early as possible, there are more new techniques and treatment options available today than ever before that can slow or even reverse the progression of arthritis and arthritic conditions. And restoring joint function in severe cases can be accomplished through such procedures as joint restructuring, or arthroplasty, arthrodesis and total joint replacement using small bone and joint technology.

Read more about Arthritis.

Arthritis of the thumb, also called Basilar joint arthritis because it affects the basilar joint of the thumb, is a common form of arthritis affecting the hand. A form of osteoarthritis, arthritis of the thumb affects the first carpometacarpal joint located near the wrist at the base of the thumb and is generally secondary to a previous injury or trauma to the joint.

The unique ability of the thumb to span across the palm and touch opposing fingers is both a characteristic that distinguishes human beings in the animal kingdom and creates vulnerability. The unique shapes of the small bones of the thumb permit this range of movement, with stability of the carpometacarpal joint dependant on several small ligaments that remain close to the joint surfaces while allowing movement. Loosening of these ligaments may result in excessive sliding of the joint surfaces and increase wear on the joint cartilage. This is a degenerative environment that will eventually lead to arthritis if untreated.

If joint degeneration continues to progress, inflammation may occur - resulting in pain when pressure is applied to the joint in pinching and grasping activities. In this environment, joint surfaces are eventually destroyed and bony spurs may develop around the joint. In severe cases, there may be complete joint destruction, an inward collapse of the metacarpal, and deterioration around the trapezium. Other joints may also become affected as they react to the changes.

Basilar joint arthritis will produce pain that progresses over time, eventually discouraging use of the thumb. This correspondingly results in joint weakness and muscle loss. Upon examination, there may be swelling at the base of the thumb as a result of joint inflammation.

Risk Factors
Arthritis of the Thumb more commonly affects women than men and generally occurs after the age of 40. It is most often the result of the same joint conditions prompting osteoarthritis of other joints - joint instability, cartilage deterioration and wear and tear. Many of these conditions are affiliated with common hand injuries and conditions discussed in this section, which, if treated early, can reverse or slow the progression of an environment within the joint that will eventually lead to arthritis of the thumb. A fracture or other traumatic injury can also lead to joint dysfunction and deterioration that can lead to arthritis of the thumb as well.

Diagnosis and Treatment
Following a thorough review of a patient's medical history and physical examination of the thumb, a series of imaging scans will determine joint damage, the severity of the degeneration and the rate of progression.

The best treatment for arthritis of the thumbs varies from patient to patient and is usually determined based on the severity of the condition and the state of the joint environment. If conservative treatment is indicated, it may entail the use of NSAIDs (nonsteroidal anti-inflammatory drugs), the refrain from activity causing stress to the affected area, corticosteroid injections, rehabilitation and occupational therapy. Splinting of the thumb may also be indicated in order to help support it and keep it in a rest position, which will reduce the pain and prevent deformity.

Advanced cases and arthritis may require ligament reconstruction tendon interposition (LRTI) arthroplasty, in order to remove the damaged surfaces within the joint and create a stronger joint. This will eliminate pain, improve hand strength and range of motion necessary for day-to-day activities. Total joint replacement may also be considered.

Dupuytren's Disease is a condition that causes abnormal thickening of the tissue located between the skin and the tendons of the palm, known as the fascia. Dupuytren's Disease is a genetically inherited disease that occurs slowly - beginning with a small knot in the palm near the crease of the hand at the base of the ring and little fingers. It can also develop in the foot and around other fibrous tissue.

The thickening, which can also occur over the knuckles, may limit movement of one or more fingers. The knot may cause the fingers to bend into the palm and prevent the complete extension of the fingers. While the disease is usually painless, continued progression can result in the formation of a cord that makes placing the palm flat on an even surface difficult. And the fingers become drawn into the hand as a result of contracture of the fascia near the finger joints (known as Dupuytren's Contracture).

Those developing Dupuytren's Disease at a young age or those with a strong family history may experience more aggressive forms of the disease.

Risk Factors
Dupuytren's Disease is seen far more frequently in men than women and generally begins to appear between the ages of 40 and 60. Genetically inherited, family history plays a large role in who is affected by the disease and to what degree.

Treatment
While the severity of the condition would determine the best treatment option, generally initial treatment is nonsurgical and entails careful observation in order to determine the rate of progression. And while there is no permanent cure for Dupuytren's disease, surgical excision of the fibrous bands in the palm can temporarily alleviate the contracture causing the fingers to bend into the palm, restoring use of the fingers. A procedure known as Dupuytren's Contracture Needle Aponeurotomy Percutaneous Fasciotomy is also yielding positive results for sufferers.

Navicular Avascular Necrosis is the result of an insufficient flow of blood to the bone. This can happen to a carpal bone as a result of a trauma that disturbs the blood supply to the bone. It has also been associated with repetitive motion trauma.

Among some of the conditions associated with Navicular Avascular Necrosis include: Kienbock's disease (Lunate Avascular Necrosis), Preiser's Disease and Carpal Avascular Necrosis - each resulting from trauma to a different area of the carpal, though all accompanied by similar symptoms. Those suffering from the condition generally have a history of a single major wrist injury, or multiple minor occupational injuries. They suffer from chronic wrist pain, tenderness and swelling - and experience limited range of motion.

Kienbock's disease
When the affected carpal bone is the lunate, patients are diagnosed with Kienbock's disease or Lunate avascular necrosis - with pain and tenderness experienced in the middle finger. This is a rare condition, which is seen in patients from 20 to 40 years of age with a history of engaging in manual labor. Often there is a history of trauma.

Carpal Avascular Necrosis
Carpal Avascular Necrosis is generally associated with scaphoid fractures and can often go undetected until more serious problems occur. This happens when a patient assumes that an injury is a minor sprain that can heal on its own and fails to seek proper medical attention.

Proper care of scaphoid fractures is particularly important because it has a vulnerable blood supply. This blood supply enters from the top of the bone, though most fractures occur in the middle or lower portion of the bone - potentially cutting off the supply. When a scaphoid bone breaks and loses connection with its blood supply, avascular necrosis is the result. If left untreated, it may cause the bone to crumble and the wrist joint to be destroyed.

Diagnosis and Treatment
While X-rays can often time times identify areas of vulnerability, ongoing pain in certain fingers will further indicate possible navicular avascular necrosis. X-rays in advanced stages will show changing bone shape and possibly bone fragmentation and collapse depending on the severity and stage of the condition.

Intermittent immobilization for several months may be indicated for those patients suffering from carpal avascular necrosis in the early stages, in order to allow for reconstitution of normal bone architecture. And a series of range of motion exercises may also be established.

In more advanced cases, surgery may be indicated in order to address bone fragments and collapse.