Carpal Tunnel Syndrome

The carpal tunnel is a passageway through the wrist carrying tendons and one of the hand’s major nerves. Pressure may build up within the tunnel because of disease (such as rheumatoid arthritis), injury, fluid retention during pregnancy, overuse, or repetitive motions. The resulting pressure on the nerve within the tunnel causes a tingling sensation in the hand, often accompanied by numbness, aching, and impaired hand function. This is known as carpal tunnel syndrome.

In some cases, splinting of the hand and anti-inflammatory medications will relieve the problem. If this doesn’t work, however, surgery may be required.

Dr. Green prefers to use a technique called the endoscopic carpal tunnel release to surgically treat carpal tunnel syndrome. In this operation, a small transverse incision is made in the wrist rather than on the palm, and a scope is passed into the carpal tunnel. A small blade is then deployed to release the roof of the carpal tunnel (the transverse carpal ligament) while watching on a video screen. This technique avoids cutting the sensitive tissues at the base of the palm and preserves the muscles at the base of the thumb. Instead of a splint and a bulky dressing, only a small bandage is applied to the wrist. Patients report that their overall recovery and return to work are approximately twice as fast using the endoscopic release as compared to the older style “open” carpal tunnel release.

Other Nerve Compressions

Other nerves may become compressed in the upper extremity causing numbness, weakness and pain. One example is cubital tunnel syndrome, compression of the ulnar nerve at the elbow. This can cause tingling of the little and ring fingers, loss of coordination and decrease in grip strength. Occasionally, the radial nerve, which supplies the muscles that lift the wrist and fingers, can be compressed by muscles in the forearm causing pain and weakness.

Hand therapy, splinting and anti-inflammatory medication will often significantly improve these conditions. Sometimes however, surgery will be required to relieve pressure on the nerves. This is only done when non-surgical management fails to significantly improve the condition.

Hand Injuries

Dr. Green will commonly operate to repair injured hands, including injuries to the tendons, nerves, blood vessels, and joints. He also treats fractured hand bones, burns, cuts, and injuries to the skin.

In many cases, surgery can restore a significant degree of feeling and function to injured hands. However, recovery may take months, and a period of hand therapy will most often be needed.

Rheumatoid Arthritis

Rheumatoid arthritis, an inflammation of the joints, is a disabling disease that can affect the appearance and the function of the hands and other parts of the body. It often deforms finger joints and forces the fingers into a bent position that hampers movement.

Disabilities caused by rheumatoid arthritis can often be managed without surgery by wearing special splints or using physical therapy to strengthen weakened areas. For some patients, however, surgery offers the best solution. Whether or not to have surgery is a decision you should make in consultation with your surgeon and your rheumatologist.

Surgeons can repair or reconstruct almost any area of the hand or wrist by removing tissue from inflamed joints, repositioning tendons, or implanting artificial joints. While your hand may not regain its full use, you can generally expect a significant improvement in function and appearance. Still, it’s important to remember that surgical repair doesn’t eliminate the underlying disease. Rheumatoid arthritis can continue to cause damage to your hand, sometimes requiring further surgery, and you’ll still need to see your rheumatologist for continuing care.

Dupuytren’s Contracture

Dupuytren’s contracture is a disorder of tissue called the palmar fascia underlying the skin on the palm side of the hand. Thick, scar-like tissue forms under the skin of the palm and may extend into the fingers, pulling them toward the palm and restricting motion. The condition usually develops in mid-life and has no known cause (though it has a tendency to run in families).

Surgery is the only treatment for Dupuytren’s contracture. The surgeon will cut and remove the bands of thickened palmar fascia, freeing the tendons and allowing better finger movement. The operation must be done very precisely, since the nerves that supply the hand and fingers are often tightly bound up in the abnormal tissue. Rarely, skin grafts are also needed to replace tightened and puckered skin.

The results of the surgery will depend on the severity of the condition. You can usually expect significant improvement in function, and hand therapy is sometimes required postoperatively. Only the diseased palmar fascia is removed and the remaining fascia in the hand may become involved at a later time.

Congenital Deformities

Congenital deformities of the hand-that is, deformities a child is born with-can interfere with proper hand growth and cause significant problems in the use of the hand. Fortunately, with modern surgical techniques most defects can be corrected at a very early age allowing normal development and functioning of the hand.

One of the most common congenital defects is syndactyly, in which two or more fingers are fused together. Surgical correction involves cutting the tissue that connects the fingers, then grafting skin from another part of the body. (The procedure is more complicated if bones are also fused.) Surgery can usually provide a full range of motion and a fairly normal appearance, although the color of the grafted skin may be slightly different from the rest of the hand.

Other common congenital defects include short, missing, or deformed fingers, immobile tendons, and abnormal nerves or blood vessels. In most cases, these defects can be treated surgically and significant improvement can be expected.

Additional Information