Raleigh Hand to Shoulder Center Doctors are experts in the diagnosis and treatment of carpal tunnel syndrome. The also treat many other conditions of the hand and arm. Carpal tunnel syndrome is the most common nerve problem in the hand. It is caused from increased pressure on the median nerve at the wrist within the carpal tunnel. Symptoms such as hand numbness, tingling, weakness, and pain can result if the nerve is pinched. Patients often wake up at night with the hand numb and tingling. Carpal tunnel symptoms should be evaluated by a doctor, and not ignored.

The carpal tunnel is a passageway in the wrist through which the median nerve and tendons of the hand travel. This tunnel is a narrow and tight space. The bottom of the tunnel is made up by the carpal bones of the wrist and the roof is created by the transverse carpal ligament. The median nerve is at risk for compression within this tunnel. If there is abnormal swelling, altered wrist anatomy, or injury to this area, the function of the median nerve may be affected.

Patients with CTS commonly report “numbness” or “tingling” in the fingers. Some patients feel that the fingertips are “asleep” or report “poor circulation” in the hands. Symptoms often wake patients up at night. Some patients report increased symptoms while gripping a steering wheel. Dropping objects, clumsiness with the hands, or a weak grip are also common complaints. Some people also report pain in the forearm, wrist or fingers. In severe cases, the muscles at the base of the thumb (thenar muscles) can become weak and atrophy, sometimes permanently.

Often the diagnosis can be made on the basis of your symptoms, medical history, and physical examination. A nerve test can be ordered to confirm the diagnosis. Please call (919) 872-3171 to schedule a consultation with a hand specialist at Raleigh Hand to Shoulder Center in Raleigh, NC.

Surgical and non-surgical treatments are available.

Options include hand therapy, night splints, stretching exercises, cortisone injections, and carpal tunnel surgery.

Raleigh Hand to Shoulder Center doctors are members of the American Society for Surgery of the Hand. They treat conditions from the fingertips to the shoulder including carpal tunnel syndrome.

Dupuytren’s Contracture is a common condition affecting the hands. Patients with this condition develop nodules in the palms followed by fibrous cords extending into the fingers. In many patients, the cords gradually contract and cause the fingers to bend or flex. If left untreated, the fingers may remain permanently bent and impair hand function. Activities such as shaking hands, wearing gloves, and reaching into a pocket can be difficult. Fortunately, if treated in the early stages of contracture, the results are usually good to excellent and the results frequently last many years.

In mild forms of the disease, intervention is not always required. Once a finger contracts to the extent where the palm cannot be placed flat on a table top, it is usually time for treatment.

There is no cure for Dupuytren’s disease. The goal of treatment is to remove or break up the contracted palmar cords to allow for improved finger range of motion and better hand function. Recurrence of the contracture is possible with any of the available treatments. There are 3 main techniques used by hand doctors today:

Surgical excision (Dupuytren’s fasciectomy): this surgery is performed by the hand doctor in the operating room under the care of an anesthesiologist. During surgery the diseased, contracted Dupuytren’s tissue is removed through incisions in the palm. Patients are treated with splinting, wound care, and hand therapy for a few weeks during the recovery process. Results from surgery can last a lifetime and typically the results last many years.

Needle aponeurotomy (percutaneous fasciotomy): this less-invasive procedure is performed by the hand doctor in the office using the tip of a needle to perforate the Dupuytren’s cord using local anesthesia. Once the Dupuytren’s cords are weakened, the finger can be manipulated and straightened. Recurrence is common with this technique, but it is the least expensive option and has minimal downtime. The technique can be repeated for recurrent contractures in the future. Not all patients are good candidates for this procedure.

Collagenase enzyme (Xiaflex): this medication is used to treat Dupuytren’s contracture and was FDA approved in the United States in 2010. Xiaflex is an enzyme which dissolves the collagen fibers in Dupuytren’s cords. The Xiaflex injection is performed by the hand doctor in the office, and later that week the patient returns for a manipulation procedure under local anesthesia. The surgeon then manually pops the cord once it has been weakened by the Xiaflex medication. Patients are instructed in home exercises and splinting by therapy, and there is minimal downtime required after the procedure. Recurrence is common with this technique, but it can be repeated for recurrent contractures. Not all patients are good candidates for this procedure

As with any medical procedure, there are possible complications from these treatments. Complications from Dupuytren’s surgery include infection, poor wound healing, bleeding, swelling, hand stiffness, and nerve/artery injury. Complications from needle aponeurotomy include skin tears, nerve injury, and infection. Complications from Xiaflex include flexor tendon rupture, allergic reactions, hand swelling, bruising, lymph node swelling, and skin tears.

Dupuytren’s surgery, Xiaflex injection, and needle aponeurotomy are available at Raleigh Hand Center. Call 919-872-3171 to schedule a consultation with a hand doctor. 

Dr Erickson and Edwards III

Dr. George Edwards III and Dr. John Erickson returned from their Nicaraguan mission trip. The physicians traveled with the not-for-profit organization COAN (Cooperacion Ortopedica Americano Nicaraguense) to deliver orthopedic care to patients in Leon, Nicaragua. They also provided lectures to orthopedic residents and medical students in several teaching conferences and taught surgical techniques to residents in the operating room. The surgical cases included a wide variety of problems including chronic contractures of the fingers and wrist, nonunion of a radius fracture, chronic nerve laceration in the forearm, acute fractures of the hand, wrist and forearm, trigger fingers, and tumors of the hand and wrist. For more information about COAN, please visit their website here: https://www.coanhealth.org

Operating Room in Nicaragua

Nicaragua

Carpal tunnel syndrome is the most common nerve problem in the hand. It results from increased pressure on the median nerve at the wrist, within the carpal tunnel. Symptoms such as numbness, tingling, weakness, and hand pain can result if the nerve is compressed or “pinched.”

The word “carpus” means “wrist.” The carpal tunnel is a passageway in the wrist through which the median nerve and tendons of the hand travel. The carpal tunnel is a narrow space: the floor of the tunnel is made up by the carpal bones of the wrist, and the roof is created by the transverse carpal ligament. The median nerve is at risk for being pinched within this tunnel. If there is abnormal swelling, altered wrist anatomy, or injury to this area, the function of the median nerve may be affected.

WHAT CAUSES CARPAL TUNNEL SYNDROME (CTS)?

In most cases, the cause of CTS is unknown. Thyroid disorders, rheumatoid arthritis, pregnancy, vitamin deficiencies, diabetes, fluid retention, and trauma can be associated with CTS. Women are more commonly affected than men. Repetitive, forceful gripping and heavy use of vibratory tools may increase the risk of CTS.

HOW DO I KNOW IF I HAVE CARPAL TUNNEL SYNDROME?

Patients with CTS commonly feel numbness and tingling in the fingers. Some patients feel that the fingertips are asleep or report poor circulation in the hands. Symptoms are often worse at night and people tend to shake their hands for relief. Some patients report increased symptoms while gripping a steering wheel. Dropping objects, clumsiness with the hands, or a weak grip are also common complaints. Some people also report pain in the forearm, wrist or fingers. In severe cases, the muscles at the base of the thumb (thenar muscles) can become weak and atrophy. See image below.

Often the diagnosis can be made based on your symptoms and physical examination. A nerve study can be ordered to confirm the diagnosis in some cases.

WHAT ARE THE TREATMENT OPTIONS?

Not everyone with carpal tunnel syndrome needs surgery. Many people with CTS improve with non-operative treatment. Wearing a wrist brace at night supports the wrist in good alignment and takes pressure off the nerve. Corticosteroid injections provide an anti-inflammatory effect and can be effective in many patients. 

If nerve compression is severe, or if conservative treatment does not help, carpal tunnel surgery may be recommended. A carpal tunnel release (CTR) is performed to decrease pressure on the median nerve. During this procedure, the “roof” of the carpal tunnel (the transverse carpal ligament) is divided. Cutting the transverse carpal ligament increases the size of the carpal tunnel and provides more room for the median nerve.

The type of surgical incision varies among surgeons; however, the common goal is to reduce pressure on the median nerve. Open CTR and endoscopic CTR are two surgical options. The recommended procedure will be discussed with you with your doctor. Raleigh Hand Center physicians are experts in carpal tunnel syndrome treatment.

Phalanx fractures are common hand injuries. These fractures are also called a “broken finger,” and they can occur from a variety of injuries such as a fall, a motor vehicle collision, or sports injury. There are fourteen phalanges in each hand — three in each finger and two in the thumb. The phalanges make up the bony architecture of the fingers and they are very important for normal hand function.

broken fingers

If you recently injured your finger and are wondering if it is broken, the best thing to do is get an x-ray to find out. 

In many cases, Raleigh Hand Center physicians can see patients the same day of an injury or the next day.

Call 919-872-3171 to contact Raleigh Hand Center. After regular office hours, if you call this phone number you will be connected to our hand surgeon on-call to discuss your injury to help guide your treatment.

Many breaks or fractures in the fingers can be misdiagnosed as “just a sprain” or a “jammed finger.” If a finger fracture is not treated appropriately, the long-term results may not be good. Many patients say: “I could still move it, so I didn’t think it was broken.” While in many cases, a fracture causes the finger to be stiff and difficult to move, however, this is not true in all cases. When in doubt, get it checked out.

What are the signs of a broken finger?

• pain

• swelling

• bruising

• stiffness

• numbness

• pain with range of motion

• deformity

• skin lacerations

What is a TFCC tear? 

The lower end of the radius and ulna, along with eight small carpal bones comprise the wrist.  Ligaments connect these bones and a few of these ligaments are prone to injury.  The triangular fibrocartilage complex (TFCC), which is made up of ligaments and a central trampoline-like fibrocartilage, is located on the side of the wrist below the small finger (ulnar side) and is approximately the size of a dime.  The ligaments and fibrocartilage of the TFCC stabilize the ends of the two forearm bones (radius and ulna) during gripping/lifting activities and forearm rotation.  It also helps cushion and suspend the carpal bones of the wrist.  Many patients diagnosed with a “wrist sprain” have injury to this ligament, which can cause ulnar-sided wrist pain.  

How is the TFCC ligament injured?

There are two types of injuries, acute or chronic.  An acute TFCC tear may occur after a fall on an outstretched hand or excessive rotation of the forearm.  Chronic tears are caused by a degenerative process that wears the ligament down over time.  In some patients, the ulna bone, due to excessive length, can pinch the TFCC ligament between the carpal bones, subsequently wearing a hole in the ligament.  Inflammatory disorders such as gout and rheumatoid arthritis can also lead to a chronic, degenerative tear.

What are the symptoms of a Triangular Fibrocartilage Complex tear?

Wrist pain (on the ulnar aspect) is the most common symptom of both acute and chronic tears.  The pain often increases during grip activities and forearm rotation.  Many patients complain of a popping or clicking sensation in the wrist with use.   Acute injury findings can range from mild wrist swelling and bruising to instability or dislocation of the distal radioulnar joint.

What treatment is necessary?

Most TFCC tears resolve with activity modification, splinting, and non-steroidal anti-inflammatory medications.  If symptoms persist, a corticosteroid injection in the ulnar wrist can be helpful.  Operative treatment may be required for persistent symptoms despite appropriate splinting and injection.  TFCC tears resulting in instability of the wrist or in association with wrist fractures may require immediate repair.

What is the surgical treatment for TFCC tears?

The type of surgery varies depending on the location of the tear in the ligament and the chronicity of the injury. Surgery can be performed either arthroscopically or using an open technique.  Chronic tears many times are related to excess length of the ulnar bone pinching the an ulnar shortening osteotomy. 

What kind of complications can occur with surgery?

Complications are rare, especially with arthroscopic treatment techniques.  Stiffness, sensory nerve injury, persistent wrist pain and infection have all been reported in the literature with surgical treatment of TFCC tears.  If an ulnar shortening osteotomy is required, non-union of the bone and pain in the location of the plate can occur.

How much rehabilitation is required after the surgery?

If the ligament is debrided, strength and motion typically return after surgery. The wrist is typically placed in a splint for two to six weeks after surgery and then the patient is allowed to start strengthening and stretching the wrist.  If ligament repair is performed, the ligament needs to be protected and the wrist immobilized for approximately six weeks to allow healing.  Incremental stretching and strengthening are then performed for the next six weeks.