There are many treatments available for carpal tunnel syndrome (CTS). If the hand numbness and tingling symptoms come and go, non-operative treatment is appropriate. People who have severe carpal tunnel syndrome should be evaluated by a hand surgeon. Constant numbness in the hand and loss of muscle tone at the base of the thumb are signs of nerve damage and severe CTS. Surgery is the best way to prevent the nerve from being damaged. If people wait too long before having surgery, some of the hand numbness and weakness can be permanent. The Raleigh Hand to Shoulder Center surgeons offer the best treatment for carpal tunnel syndrome. They are among the top doctors in the field of hand surgery. Read more to find out the best treatments for carpal tunnel syndrome.

Not all hand pain, numbness, and tingling are caused by CTS. If the symptoms are getting worse or not responding to treatment, a hand specialist should be consulted sooner rather than later.

The recommendations below are intended for Raleigh Hand to Shoulder patients with mild to moderate CTS symptoms. There are some things we can’t change about our health, such as our family history, age and hand anatomy. However, there are many things that we can modify to improve our health.

Best treatments for carpal tunnel syndrome:

— Wearing a wrist brace at night

— Hand and wrist stretching exercises

— Hand Therapy

— Smoking cessation

— Steroid injection

Treatments which are NOT helpful for carpal tunnel syndrome:

— Magnet therapy

— Laser therapy

— Long-term use of oral NSAIDs

— Expensive custom braces

— Most products on the internet claiming to be a cure for carpal tunnel syndrome

If these best treatments for carpal tunnel syndrome are not controlling the symptoms or if the nerve compression is severe, surgery should be considered. Raleigh Hand to Shoulder Center hand doctors are experts in the diagnosis and treatment of carpal tunnel syndrome. They are members of the premier hand society, American Society for Surgery of the Hand. Several surgeons have been named top doctors in the area.

Broken wrist treatment is important medical care. A distal radius fracture, sometimes called a “broken wrist,” is a common wrist injury. This type of fracture can occur from a variety of trauma, such as a fall at home or a motor vehicle collision. The distal radius is the portion of the radius bone just below the wrist joint. As we age, the bone of the distal radius loses bone mass and becomes more prone to fracture, particularly in post-menopausal women and people with osteoporosis. The distal radius may break (also called a fracture) as a result of a slip and fall in these cases. Younger patients with stronger bones may break the distal radius after high-energy trauma, such as a sports injury or car accident. Broken wrist treatment involves specialized orthopedic care, and proper healing is needed to obtain the best outcome.

Broken wrist treatment depends on the severity of the fracture on the x-rays and the patient’s health and activity level. The distal radius bone usually heals after a fracture; however, a goal of treatment is for the bone to heal in a good position for function. Many people have fractures which are in good alignment. These patients do not require surgery. Treatment in these cases is typically protection in a cast or brace for several weeks. Follow-up x-rays are obtained in clinic to see how the fracture is healing. Waterproof casts are available at the Raleigh Hand to Shoulder Center.

Broken Wrist Treatment with Surgery

Some patients have displaced fractures which can be re-aligned without surgery. This is called “closed reduction” and is performed either in the office or emergency room using an injection of a local anesthetic. After the broken bones are “set,” a plaster splint is molded to the wrist to maintain the alignment. After a few days, the patient can often be placed into a cast.

Some patients have fractures which are more severe. In these case the fracture alignment is not in good position for hand function. Surgery may be advised to improve the alignment of the bones. Open Reduction and Internal Fixation (ORIF) is a common procedure performed for this injury.

Raleigh Hand to Shoulder Center doctors are all hand specialists and they are members of the American Society for Surgery of the Hand. Broken wrist treatment is one of the many services provided by hand specialists. Raleigh Hand to Shoulder Center doctors are top doctors within their field of hand surgery. They are among the best hand surgeons in the area.

What is Mommy’s Thumb? This is another term for DeQuervain’s tendonitis or Mommy’s Wrist. This is a common condition involving the tendons on the thumb-side of the wrist. The syndrome is named after Fritz de Quervain, a Swiss physician who described the condition in the late 1800s. Symptoms arise when there is entrapment of the tendons of the thumb by their surrounding sheath at the wrist. Instead of gliding smoothly through the sheath, the tendons can meet resistance and cause friction. Over time, these tendons may become irritated and painful. Certain movements of the thumb and wrist can be excruciating. Some patients notice decreased thumb range of motion. Patients may feel a tender bump or notice swelling in the wrist where the tendons and/or sheath are thickened. Lifting objects, gripping, or pinching with the thumb often exacerbates symptoms.

The cause of DeQuervain’s is usually unknown, but symptoms can be aggravated by starting a new, repetitive activity. The condition is common in young females, especially pregnant and post-partum women. Lifting a young child can be very painful making it hard to care for the newborn. This is why it is often called mommy’s thumb.

Treatments for mommy’s thumb include thumb spica splinting, over the counter anti-inflammatory medications, topical medications, hand therapy, and cortisone injections. For most patients, these treatments will clear up the condition. In some cases, surgery is necessary to relieve the symptoms. Surgery is performed as an outpatient and most patients report excellent results. See the image below, which shows the tendons involved in DeQuervain’s tendonitis.

Raleigh Hand to Shoulder Center doctors are all members of the American Society for Surgery of the Hand and are experts in DeQuervains Tendonitis. Hand specialists can help diagnose and treat hand and wrist conditions and can help explain the answer to the question, What is Mommy’s Thumb?

Dr. James Post of the Raleigh Hand to Shoulder Center gave a talk on Scaphoid Fractures on August 30, 2021. Scaphoid Fractures are a common wrist injury. Treatments includes casts, surgery and hand therapy.

The Raleigh Hand to Shoulder Center (formerly Raleigh Hand Center) has treated patients in North Carolina for 30 years. While our name may be new, it better reflects what we have been doing for many years — caring for patients of all ages with hand, wrist, elbow, and shoulder problems. Dr. Edwards, Jr. co-founded the Raleigh Hand Center in 1991.

Dr. George Edwards III gives a talk at WakeMed UNC Orthopedic Resident conference on May 17, 2021. His talk is on Total Shoulder Arthroplasty, also called shoulder joint replacement. Dr Edwards III is a partner at Raleigh Hand to Shoulder Center.

Capital City Surgery Center (CCSC) was recently named the #1 Ambulatory Surgery Center in North Carolina! The Raleigh Hand to Shoulder Center physicians use CCSC for the majority of their outpatient surgeries and they are proud of the national and state recognition. The doctors have financial interest in the surgical facility.

Dr. John Erickson is the 2021 president of the North Carolina Society for Surgery of the Hand (NCSSH). The 2021 annual meeting will be in Pinehurst, NC in October. The NCSSH is a non-profit, professional organization of North Carolina hand surgeons.

A ganglion cyst is a very common bump in the hand and wrist. This type of cyst comes from a joint or tendon in the hand and wrist. The most common location is the back of the wrist (see image below). A ganglion cyst can occur in people of all ages. The cause of a ganglion cyst is unknown in most cases. One theory is that the cyst arises from joint fluid which has leaked from a small opening in the joint. The cyst is filled with a thick, jelly-like fluid and usually has a connection with a joint or tendon below.

What are the symptoms? Many people notice that the cyst fluctuates in size. In some cases the cyst can go away on its own. In many cases the cyst is not painful but in other cases, the cyst can cause pain and limited range of motion. Now you know what a ganglion cyst is. What is the best ganglion cyst treatment? Please read on.

Most ganglion cysts are diagnosed by history and physical exam by a trained physician. Since ganglion cysts are fluid-filled, a light shined directly on the mass will light up the cyst. X-ray, ultrasound, and MRI testing are not usually required to make the diagnosis in typical cases. Hand surgeons are experts in diagnosis of ganglion cysts in the hand and wrist.

What are the treatments available? There are three common ganglion cyst treatment options:

OBSERVATION:   Also known as watch and wait. Since ganglion cysts are benign (not cancer), surgery is not required to remove them. Cysts which are not painful and do not interfere with function can be left alone and monitored. Some cysts can go away on their own. If the cyst becomes larger, painful, or interferes with function, further options should be discussed.

ASPIRATION:   Also known as drainage with a needle. The cyst can be punctured and the thick fluid removed using a needle under sterile conditions. This is a quick procedure which is performed in the office. There is a high chance that the cyst comes back, however. There is a small risk of bleeding, pain, and infection from this procedure. Do NOT try this at home!

SURGICAL EXCISION: Finally, surgery is ganglion cyst treatment option. This surgery requires an incision and it is performed in the operating room. During surgery, the cyst is removed including the base which goes down to the joint. Removing the connection to the joint reduces the chance of cyst recurrence. Gardeners realize that the roots of the weed need to be removed, or else it will grow back.  

In the past, some physicians have recommended simply popping the cysts by hitting them with a heavy book or Bible. For this reason ganglion cysts have been called “Bible cysts.” This is not recommended since damage can be done to the surrounding area, and most cysts recur with this technique.

What is the recovery from ganglion cyst excision surgery? Ganglion cyst excision is performed on an outpatient basis. Most people can return to light duty work in a few days as the pain and swelling subside. Hand therapy is sometimes helpful after this procedure to improve range of motion and strength. Patients should avoid forceful use of the hand for approximately 4 weeks after surgery. Normal use of the hand is resumed as comfort allows. Complications from surgery include cyst recurrence (5-10%), wrist stiffness, scar tissue, and infection.

The ganglion cyst images are copyright Dr John Erickson and the cyst aspiration drawing is copyright AAOS OrthoInfo. The video is courtesy of American Society for Surgery of the Hand.

What is a boxers fracture? A boxers fracture is a very common hand injury. The typical cause is punching a wall with the fist. These injuries are most common in young adult males. They can also occur in a variety of ways such as a fall, sports injury, or car accident. A “boxer’s fracture” is defined as a fracture of the 5^th metacarpal neck. “Fracture” is simply the medical term for “broken bone.” See the picture below

There are five metacarpals — one for each finger and the thumb. The 5^th metacarpal is at the base of the pinkie. Bruising, swelling, pain, and finger stiffness are common symptoms at first. The knuckle may look abnormal or out of place as well.

The recommended treatment of this injury depends on the alignment of the fracture on the x-rays and the patient’s medical condition and activity level. Most patients have a boxer’s fracture with mild to moderate angulation. Therefore, they do not require surgery. Angulation is measured in degrees and this defines how “crooked” the bone is. A firm “bump” is often noticed at the fracture site during healing. This is composed of new bone formation, the body’s normal response to heal the fractured bone. This bump can be seen on x-ray and is called the “fracture callus.”

Mild to moderate angulation in a boxer’s fracture typically results in a good long-term hand function. Our hands can naturally compensate for this deformity and still function very well due to the motion at the base of the 5^th metacarpal. This is because the joint at the base of the 5^th metacarpal has a high degree of mobility. Treatment in these cases is typically rest and protection in a splint or cast for a few weeks. Ice, compression, elevation and oral NSAIDs are helpful to reduce hand swelling. Follow-up x-rays are obtained in clinic to evaluate how the fracture is healing. Hand therapy is often helpful to improve finger range of motion and hand strength.

If the fracture angulation is excessive, or the metacarpal alignment is poor, the bone can be re-aligned with manipulation. This procedure is called a “closed reduction” and is performed in the office with local anesthesia numbing medicine. These patients can be treated without surgery and achieve a good result.

Occasionally, surgery is recommended to fix the boxer’s fracture with metal implants such as pins, screws, or a plate. Surgery is most beneficial if there is significant angulation or if the finger is mal-rotated (twisted). Surgery has the potential complications of infection, stiffness, scar tissue formation, and need for removal of the metal implants.

Your doctor will explain the options to you and recommend individual treatment based on your specific type of hand injury. All Raleigh Hand to Shoulder Center doctors are members of the American Society for Surgery of the Hand.