Hand, Wrist & Elbow

Our orthopaedic physicians are trained in diagnosing and treating conditions and injuries affecting the hand and wrist. Using advanced diagnostic testing and applying minimally invasive surgical techniques, we can restore motion and function to relieve pain.

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Arthritis of the Thumb

The thumb joint is referred to as the basal joint or the carpal metacarpal (CMC) joint of the thumb. Arthritis in the thumb joint is known as basilar arthritis. As the cartilage that covers the bones of the thumb and wrist is damaged, arthritis related symptoms present.

Causes and Symptoms

Basilar arthritis can be caused by the following:

  • Rheumatoid arthritis. An immune system disease.
  • Osteoarthritis. Wear and tear that occurs with aging.
  • Post-traumatic arthritis. Arthritis following an injury (i.e. a fracture or break)

Pain, aching, or discomfort associated with pinching and gripping movements may be an indication of basilar arthritis. The following symptoms may also be indicators:

  • Swelling
  • Tenderness
  • Stiffness
  • A bony prominence over the joint
  • Weakness

Symptom severity ranges. Mild cases of basilar arthritis may produce little to no symptoms. A Severe Case of basilar arthritis may limit a patient’s ability to use their hand. The first step in treating the symptoms of basilar arthritis is making an appointment with an orthopaedic hand specialist.

Diagnosis

A detailed medical history, thorough physical examination, and x-rays used to evaluate the basilar joint and diagnose basilar arthritis.

Nonsurgical Treatment

Early stage basilar arthritis can be effectively treated using non-surgical treatment options such as the following:

  • Ice. Applying ice over the joint reduces pain and inflammation. Ice may be applied in 20-30-minute intervals throughout the day.
  • A brace or splint. Temporary immobilization gives inflammation a chance to subside.
  • Anti-inflammatory medications. Nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen are effective.
  • Rest. Slowing down or stopping activities that produce symptoms helps manage their severity and frequency.

When nonsurgical treatment does not improve symptoms, corticosteroids can be administered via injection into the joint. Often times, an injection provides fast acting pain relief. Because relief is only temporary, injections can be repeated in 3-month-intervals.

Surgical Treatment

Surgery may be required to treat severe basilar joint arthritis. The joint may be debrided, reconstructed, or fused to improve symptoms. Surgery is generally performed on an outpatient basis.

Wrist Arthritis

The wrist is a complex joint made up of eight small carpal bones. It is an important joint because it connects the hand and forearm and is responsible for many of the movements that people make to perform day-to-day activities. When the cartilage that allows the carpal bones to move smoothly over one another is damaged due to arthritis, patients can experience symptoms that can be limiting or debilitating. Several non-surgical and surgical treatment options are available to treat wrist arthritis. An important part of treatment is diagnosing and treating the disease before it progresses into advanced stages.

Causes and Symptoms

Wrist arthritis may be caused by the following:

  • Osteoarthritis. The wear and tear of cartilage with age
  • Rheumatoid arthritis. An immune system disorder where the body attacks its own cartilage
  • Post-traumatic arthritis. Arthritis that occurs following an injury.

Risk factors for wrist arthritis include smoking, overuse of the wrist, and a family history of wrist arthritis.

Symptoms

Symptoms of wrist arthritis include the following:

  • Pain
  • Stiffness
  • Decreased range of motion
  • Swelling

Because arthritis is a chronic condition, the goals of treatment are to manage symptoms and slow the progression of the disease.

Nonsurgical Treatment

Nonsurgical treatment options are effective when arthritis is detected in its early stages. Some of the most common nonsurgical treatment options include the following:

  • Activity modification. Altering or stopping movements that produce pain.
  • Immobilization. A brace or splint.
  • Nonsteroidal anti-inflammatory medications. Medications that decrease inflammation and pain.
  • Physical therapy. Stretching and strengthening exercises.

When these treatment options are not effective, an orthopaedic hand specialist may decide to inject the joint with corticosteroids—a strong anti-inflammatory medication. Pain relief following injection may occur quickly; however, it usually does not last. For this reason, injections may be repeated every three months.

Surgical Treatment

Severe wrist arthritis may require surgical intervention in the following forms:

A proximal row corpectomy. Wrist function is improved and pain is decreased by surgically removing three proximal (side closest to the forearm) carpal bones.

A wrist fusion. Arthritic bone is removed and a plate and screws are used to join adjacent bones. Gaps of bone are packed with bone graft. Following surgery, the bone heals to form a single, solid bone. Pain is reduced; however, the wrist is made stiff and can no longer move.

Patients who are experiencing wrist pain and are searching for a solution are encouraged to make an appointment with an orthopaedic hand specialist.

Dupuytren’s Contractures

Dupuytren’s Disease is characterized by the thickening of tissue in the hand. As the fascia found beneath the skin thickens and tightens, hard, visible knots form in the palm of the hand. These are known as Dupuytren’s contractures. While there is no known cause for the condition, it is most prevalent in men over 40-years-old and it is thought to be hereditary.

Signs and Symptoms

Dupuytren’s disease progresses gradually. Signs that commonly appear include the following:

  • Nodules. Small, tender lumps in the palm of the hand.
  • Cords. Nodules may develop into dense cords under the skin.
  • Contractures. When cords tighten, they pull the fingers inwards towards the palm.

Symptoms of Dupuytren’s include the following:

  • Pain
  • Inability to flatten the hand on a flat surface
  • Fingers that remain flexed, pulling towards the palm

Patients with Dupuytren’s contractures may have a difficult time grasping or holding objects and putting their hand in their pocket.

Diagnosis

A medical history and physical examination are used to diagnosis Dupuytren’s disease. When the disease is found in its early stages, an orthopaedic hand surgeon can monitor its progress and treat it accordingly. With proper treatment, the chances of cords and contractures developing decreases.

Treatment Options

Nonsurgical treatment options include the following:

  • Hand therapy. Stretching exercises help loosen tight bands of tissue.
  • Steroid injections. When injected into a nodule, steroids act to decrease pain and possibly decrease the likelihood of cord or contracture developing.

Dupuytren’s contractures that do not respond to non-surgical treatment options, may require surgical intervention. A fasciotomy is a surgical procedure in which the hand surgeon divides thickened tissue cords. A subtotal palmar fasciectomy is a procedure used to remove tissue and straighten the fingers. Generally, a subtotal palmar fasciectomy is more extensive, longer procedure than a fasciotomy.

Hand therapy is an important part of the recovery process. During hand therapy sessions the hand is stretched and strengthened and fingers regain mobility. Most patients have positive outcomes following surgery and subsequent hand therapy.

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome refers to a pinched nerve in the wrist. The median nerve travels under the transverse carpal ligament of the wrist on its way to innervate the thumb, index, middle, and part of the ring finger. Sometimes, pressure can build up in the space between the ligament and the nerve. When this happens, tingling, weakness, numbness, and pain can present in the hand and digits. Carpal tunnel syndrome (CTS) is the medical name used to describe this condition.

Causes and Diagnosis

CTS can be caused by several different factors. Often, it is caused by a combination of the following:

  • Tenosynovitis (tendon swelling)
  • Injuries (fractures and dislocations)
  • Arthritis
  • Fluid retention during pregnancy
  • Health conditions (diabetes, rheumatoid arthritis, thyroid gland imbalance)
  • Heredity factors

A medical history and physical examination are used to diagnose CTS. In some cases, x-rays are taken to make sure a fracture or arthritis is not what is causing symptoms. Nerve conduction tests are a type of diagnostic study that a hand specialist may use to confirm their diagnosis.

Treatment

Non-surgical options are always tried first and are generally effective. They typically include the following:

  • Activity modification. Managing symptoms by slowing down or stopping activities that produce them.
  • Bracing. Keeping the wrist straight takes pressure off the nerve.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs). Over the counter or prescription medications can help relieve pain and inflammation.
  • Corticosteroid injections. Anti-inflammatory medications can be administered via injection into the area where the nerve is pinched. Injections may quickly relieve symptoms; however, results are usually temporary. For this reason, injections may be repeated every three months.

Carpal tunnel that does not improve after being treated non-surgically may require surgical intervention in the form of a carpal tunnel release. During the procedure, the hand surgeon takes pressure off the nerve by cutting the transverse carpal ligament. Typical procedure time is 10-15-minutes. The procedure may be performed through an open incision or endoscopic surgical technique. Most patients are able to return to normal activities approximately one month after surgery.

Trigger Finger

Trigger Finger is a condition characterized by the inflammation and enlargement of the tendons that pull the fingers towards the palm of the hand. A locking, catching, or popping of the finger when trying to straighten it are key signs of trigger finger being present. Symptoms may include the following:

  • A lump in the palm
  • Tenderness
  • Catching
  • Popping
  • Pain
  • Swelling

Symptoms may increase in frequency and severity when the hand is overused.

Causes

Although there is no known cause of trigger finger, there are certain factors that put patients at an increased risk to develop the condition. They include the following:

  • Gender (female)
  • Age (middle aged)
  • Related medical conditions (diabetes and rheumatoid arthritis)

People who constantly use their hands while working (i.e. cashiers, clerks, writers) are also at an increased risk.

Diagnosis

A physical examination is the only thing needed to diagnosis trigger finger.

Treatments

Injections

A steroid injection is the most common treatment option. When steroids are injected into the tendon sheath of a trigger finger, they quickly improve the condition. As inflammation and swelling decrease, the finger is able to move without catching, locking, or popping. Symptoms decrease in frequency and severity. Because injections may only provide temporary relief, they may be repeated every three months.

Surgery

A severe trigger finger may require surgical intervention. A trigger finger release is a procedure commonly performed by orthopedic hand surgeons. During the procedure, the tunnel that the tendon passes through is widened so the tendon can move freely. The procedure may be performed under IV sedation or general anesthesia. Procedure time is approximately 30-45-minutes.

Outcomes

Some patients may see symptom improvement immediately after surgery. For others, it may take a bit longer. Generally, results are expected to be seen in 2-4-weeks. Patients should return to normal activities within that same time frame.