Hand and Wrist
You need your hands! This need becomes that much more noticable when you are plagued with chronic hand and wrist pain. Dr. Davis is able to diagnose and address many sources of hand and wrist pain. Schedule an appointment to be evaluated today!
What is carpal tunnel syndrome?
Carpal tunnel syndrome is a condition that is characterized by compression of a nerve, the median nerve, at the wrist. The carpal tunnel is a canal in which the median nerve travels that also contains synovium, or connective tissue, and flexor tendons. Over time, this space may become restricted, resulting in chronic radiating pain and cramping to the hand. Several risk factors predispose patients to developing carpal tunnel syndrome. These include age, smoking, female gender, obesity and repetitive motion activities. Additionally, metabolic conditions such as diabetes, thyroid problems, and rheumatoid arthritis may increase the likelihood of developing carpal tunnel syndrome. Symptoms typically begin as cramping/tingling in the palm of the hand. This worsens with activity and can improve when that activity is stopped. As the condition progresses, irreversible changes to the nerve may occur, leading to wasting/weakening of the muscles in the palmar aspect of the hand. The goal of evaluation/management is to prevent the progression to this point. At your visit with Dr. Davis, a history and physical will occur, with focus on the sensory and motor exam to the hand. Additionally, some special tests can induce symptoms and key Dr. Davis into the presence of your condition severity. The diagnosis is made clinically, and will be discussed during your visit. However, an EMG/nerve conduction study is commonly ordered to confirm nerve compression at the wrist and eliminate potential other causes for your symptoms.
Treatment
Initially, treatment will begin by attempting to utilize nonoperative modalities. These include activity modification, anti-inflammatory medications and the use of night splints. Night splints prevent positioning of the wrist that causes further compression to the carpal tunnel. If initiated early, these modalities may prevent symptom progression and prevent the need for operative intervention. An additional non-operative option is a steroid injection. This typically provides short term relief. However, a small portion of patients may experience long term relief from injection, preventing the need for an operation. Steroid injections also provide utility in cases where the diagnosis is difficult, providing insight into whether the symptoms are, in fact, originating from the carpal tunnel. If non-operative modalities fail, discussion will be had with Dr. Davis about the surgical options available.
Surgical Intervention
Surgical intervention for carpal tunnel syndrome involves direct release of the canal in a procedure called a carpal tunnel release. This involves a small incision in the palm with dissection down to the ligament that traverses the canal, commonly causing compression. This ligament is the transverse carpal ligament. When released, the compressive source is eliminated, allowing appropriate blood flow to return to the median nerve. You will have several stitches in the palm following the procedure.
Post Op
Following surgery, use of the hand should be limited until the soft tissue incision heals. Otherwise, activity may resume as tolerated. You will be allowed to shower 3 days after surgery and stitches will be removed 1-2 weeks postoperatively. Following stitch removal, return to normal activities as tolerated may occur.
What is a cubital tunnel syndrome?
Cubital tunnel syndrome is a compressive condition of the ulnar nerve at the elbow that results in numbness, tingling and pain in the small and ring fingers. Occasionally, symptoms may arise as cramping and fatigue occurring with certain activities. Additionally, inflamed ulnar nerves may also cause radiating pain down the ulnar side of the wrist (small finger side). Additionally, certain risk factors may contribute to developing the condition. Similar to carpal tunnel syndrome, cubital tunnel may be associated with female sex, diabetes, thyroid problems and occupations/hobbies that cause chronic elbow flexion. The ulnar nerve subsequently becomes compressed in its canal on the inside of the elbow. During your visit with Dr. Davis, he will check for numbness in the correct distribution of the ulnar nerve. He will also check the status of the nerve to confirm that it is inflamed. At this point, assessment of the muscles of the hand will determine the severity of this condition. Additionally, an EMG/nerve conduction study may be ordered to aid in confirmation of the condition in cases where it may be difficult to diagnose.
Treatment
Initially, treatment will be aimed at conservative measures, attempting to avoid an operation if possible. This will include activity modification and anti-inflammatory use. Excessive elbow flexion places the nerve in the highest degree of compression and can lead to chronic symptoms. Patients who are in this position frequently (chronic phone use, sleep positions, etc) should focus on activity modification to prevent this action. Once the symptoms of ulnar nerve compression have progressed and non-operative modalities have been exhausted, operative direct ulnar nerve release is indicated.
Surgical Intervention
Ulnar nerve decompression involves an incision on the inside of the elbow, exposing the ligament and fascia, or connective tissue, that overlies the ulnar nerve. Dr. Davis will expose this tissue and carefully release it throughout the full course of the ulnar nerve at the elbow. This is a fairly common procedure, and the major risks involve damage to the nerve itself while performing the release, but significant care is taken throughout to prevent damage from occurring. Once the nerve is released, dynamic examination will allow Dr. Davis to see if the nerve is stable in its location. If not, the nerve may need to be transposed, or “moved”, to the front of the elbow to prevent continued symptoms. This will be discussed at length during your office visit.
Post Op
Following the completion of your procedure, you will remain in a sterile dressing for a period of 3 days. At this point, dressings may be removed and showering may take place. Full elbow range of motion may be initiated after 3 days postoperatively and will continue to be monitored until full range of motion is achieved. Weight Bearing and work activities will be restricted until the surgical incisions are fully healed.
What is dequervain’s tenosynovitis?
Dequervain’s tynosynovitis is a very painful condition affecting the radial, or thumb side, of the forearm. It occurs with inflammation is present in one of the compartments housing extensor tendons to the thumb. These tendons, for a multitude of reasons, may become inflamed due to overuse. Pain typically occurs while attempting to grip or hold things with the affected limb. Commonly, a Dequervain’s flair will occur for new mothers. This is due to the increased amount of lifting occurring under their baby’s, or toddler’s, arms. Lifting in this forearm position puts the first extensor compartment tendons under stress, leading to an inflammation episode that can be nearly debilitating. During your visit, Dr. Davis will inquire about any new injury that may have occurred. If the picture is unclear, plain x-rays may be needed at your initial visit to rule out bony abnormality. However, history and physical exam alone are usually all that is needed to diagnose the problem.
Treatment
Initial treatment will be focused on conservative management in an attempt to avoid surgery if possible. This includes the use of a splint, stationary or removable, along with oral anti-inflammatory medications. Activity modification can significantly aid in symptom relief. This may include modifying methods used to hold your baby/toddler. A steroid injection in the first dorsal compartment may be discussed. This focuses on decreasing the accumulation of local inflammation to the area, minimizing unpleasant symptoms and allowing you to return to function. Most patients respond well to conservative management. However, in rare cases, conservative management fails and operative intervention will need to be discussed at your visit.
Surgical Intervention
Following failure of non-operative management, it may be necessary to move forward with surgery. The procedure indicated is called a first dorsal compartment release. This involves a small incision on the dorsum (top) of the forearm, dissection down to the tendon sheath and release of the tissue housing the tendons. This allows for painless excursion, or passage, of the tendons. Risks are minimal in this procedure. However, they include infection and damage to or stretching of the superficial radial nerve branch, responsible for sensation to the top of the hand. This will be discussed at length with Dr. Davis.
Post Op
Postoperatively, you will be placed in a bulky dressing to protect the incision. This will immobilize the thumb for up to 10-14 days. Following this, range of motion of the thumb will resume, with the goal of working on pinch strength by 3 weeks. Full return to function should be expected around the 6 week mark with relatively pain free use of the extremity.
What is a Duputryen’s contracture?
Duputryen’s contracture is a condition characterized by thickened nodules in the palm of the hand. These nodules can cause a multitude of symptoms, including pain, tenderness and decreased range of motion of the hand. Occasionally, these nodules and tight “bands” may extend into the fingers, limiting their range of motion as well. The most common fingers to be involved are the small and ring fingers. This condition is more common in men, more common in caucasian individuals, and presents in the 5th-6th decade of life. Typically, patients have experienced progressive symptoms that lead to decreased quality of life, warranting evaluation by a physician. Occasionally, this condition may be associated with both hands. Additionally, other conditions such as plantar fasciitis may be associated.
Treatment
Initially, Dr. Davis will assess the severity of your contracture resulting from the fibrous bands that have formed in the palm/fingers. In the initial stages, non-operative management with therapy and range of motion exercises may be utilized. Additionally, activity modification, avoiding things that inflame the nodules, may be attempted. It should be noted, however, that the fibrous/abnormal tissue will not resolve spontaneously and the condition is likely to worsen with time.
For mild symptoms and mild deformity (<5 degrees), an injection of a medicine called Xiaflex, or a collagenase, is utilized to break down the abnormal tissue bands. This medication is injected into the palm, followed by relatively aggressive manipulation and splinting within 24-48 hours. This treatment has reasonably reported outcomes to the palm. However, finger deformity is less likely to improve significantly.
The last “non-operative” treatment option is a needle aponeurotomy, or breaking of the fibrous bands with a needle. This is reserved for mild deformity that is located at the palm versus the finger. Additionally, patients unable to undergo an operation are good candidates for this. The hand is then manipulated and splinted in a similar fashion to resist recurrence of deformity. This in office procedure provides convenience. But, it is associated with higher recurrence rates than an operation.
Surgical Intervention
Finally, when more conservative measures are contraindicated or have failed, operative intervention will be discussed. This involves a brunner’s, or “zig-zag”, incision to the palmar surface of the hand/finger. Upon exposure, the pathologic palmar tissue is resected with special attention to the arteries and nerves of the hand. This provides a satisfactory likelihood of resolution with a fairly low recurrence rate. Complications do include, however, skin and wound healing problems, damage to palmar structures in the hand, and blood flow problems with correction of chronic deformity. These issues will be discussed at length during your appointment with Dr. Davis. Please write down any questions you may have.
Post Op
Postoperatively, you will be placed in a splint to allow wound healing. This will be transitioned early (post op day 5-7) to allow for range of motion to be initiated with hand therapy. Additionally, night time extension splinting can assist in maintenance of deformity correction. You will likely be followed for 3-6 months to confirm recurrence has not occurred.
What is First CMC Arthritis?
Pain at the base of the thumb is very common. Joint pain stemming from the 1st CMC joint is one of the most common areas in the hand to develop arthritis, which is inflammation and pain resulting from cartilage loss. The 1st CMC (carpometacarpal) joint is a specialized saddle-shaped joint at the base of the thumb. The trapezium carpal bone of the wrist and the first metacarpal bone of the hand form the 1st CMC or thumb basal joint. The saddle shape of this joint, formed by the trapezium and 1st metacarpal, allows the thumb to have such a uniquely wide range of motions including up/extension, down/flexion, in/adduction, out/abduction and opposition.
Treatment
Surgical Intervention
Post Op
What is Jersey Finger?
Jersey finger is an injury to the flexor tendon that starts at the tip of the finger and runs to the base, typically the result of a tear. While jersey finger isn’t an injury exclusive to athletes, it is largely seen in sports including football, basketball, and soccer. Athletes in such sports typically suffer from jersey finger when grabbing another player’s jersey as that player is running in the opposite direction. Similarly, an athlete can sustain a jersey finger injury if they grab another player’s uniform and that player suddenly pulls away.
Treatment
Surgical Intervention
Post Op
What is Mallet Finger?
Mallet finger is an injury to the thin tendon that straightens the end joint of a finger or thumb. Although it is also known as “baseball finger,” this injury can happen to anyone when an unyielding object (like a ball) strikes the tip of a finger or thumb and forces it to bend further than it is intended to go. As a result, you are not able to straighten the tip of your finger or thumb on your own.
Treatment
Surgical Intervention
Post Op
What is Trigger Finger
Trigger finger is a condition in which one of your fingers gets stuck in a bent position. Your finger may bend or straighten with a snap — like a trigger being pulled and released.
Trigger finger is also known as stenosing tenosynovitis (stuh-NO-sing ten-o-sin-o-VIE-tis). It occurs when inflammation narrows the space within the sheath that surrounds the tendon in the affected finger. If trigger finger is severe, your finger may become locked in a bent position.
People whose work or hobbies require repetitive gripping actions are at higher risk of developing trigger finger. The condition is also more common in women and in anyone with diabetes. Treatment of trigger finger varies depending on the severity.
Treatment
Surgical Intervention
Post Op