In this edition of our Orthopedic Anatomy Series: Exploring Your Body from the Inside Out, we look at the causes and treatments of common hand, wrist and elbow ailments that can cause this discomfort.
Our panel of five OrthoCarolina hand, wrist, & elbow specialists partnered with the education experts at Experience Anatomy to explore the ins and outs of hand/wrist/elbow pain, from when to consult an orthopedic specialist to pain injections to surgery recovery.
CASE STUDY – Carpal Tunnel & Trigger finger (Cadaver)
In this case study, Dr. Daniel Lewis, MD, shows us what to expect during a Carpal Tunnel Release & Trigger Finger surgery and what happens in the operating room.
**DISCLAIMER - GRAPHIC IMAGES**
CASE STUDY – common ailments of the hand, wrist & elbow
In this case study, Dr. Bryan Loeffler, MD, touches on what to do when you have hand, wrist, or elbow pain and what your next steps might be moving forward when consulting an orthopedic surgeon.
Our panel of hand, wrist, & elbow specialists addressed audience questions during an open Q&A.
Watch the complete Q&A discussion from 26:50 – 1:11:59. Q: When should you get surgery for your trigger finger?
Dr. Loeffler - When you’ve tried conservative treatments and those have failed and there is still pain and locking of the joints & catching in the finger. If it's affecting your daily life and waking you up at night, that’s when you should consider getting surgery. Fortunately, this is something that can be done in the offices under local anesthesia so it minimizes the inconvenience for the patient.
Q: After trigger finger surgery, how long does it take for the pain and stiffness to go away?
Dr. Loeffler - We all heal differently. Some people will recover quickly and have full motion right away & minimal pain. Other patients will have some pain and have stiffness of the palm, sometimes weeks & even, in some cases, months. Sometimes if a person comes in with a loss of motion or the trigger finger has been present for a long period of time, they are predisposed to a longer recovery for it. We take the stitches out between 8-10 days and check your range of motion, but it’s not uncommon at all to have soreness/pain in the area for weeks or even months.
Q: What is the difference between carpal tunnel and repetitive stress injury? Can the pain radiate as far up as your neck & shoulder?
Dr. Woodside - So, we often see carpal tunnel syndrome and compression of the nerve going on together. Part of what the spine doctors and hand doctors are trying to figure out what problem is causing the symptoms. It is typically much easier on the patient to deal with some of the symptoms lower down on the arm first; like carpal tunnel. It can be treated with bracing, injections & sometimes surgery. Often times we will see the pain of the CP go from the palm all the way up to the arm like to the bicep. Occasionally it will hurt all the way up to the shoulder. It can be all from the carpal tunnel but it could also be cervical compression in the neck that can go along with that as well.
Q: What causes a ganglion cyst? What happens if they go untreated? What non-surgical options are there for relief?
Dr. Gantt - Ganglion cyst is one of the most common things we see, are bumps in the hand, knots at the top of the wrist. These are benign and are not cancerous at all and are not to be very concerned about. Think of them like jelly. Just as you blow up a balloon the cyst begins either on a joint or tendon, it's basically filled with jelly fluid. Some patients it's simply come in and are reassured that it’s not cancer. We are not sure why people get them. Sometimes it could be related to stress or boot camp type exercise or repetitive use of the hands. Most people can't remember a concrete injury that caused the cyst. If they cause pain, there are a number of different treatment options. One includes draining the cyst, might add steroids. They are stubborn things that we treat that can come back. We often tell patients to not do anything about them if they are not causing pain. We generally are reassuring patients that they are not cancerous.
Q: If a nerve conduction test does not show you have carpal tunnel but you have all the symptoms, is it possible that it could still be a carpal tunnel?
Dr. Woodside - Typically we will have nocturnal symptoms, numbness or tingling, relieved by wearing a brace over time, but then it stopped working. When all the testing lines up & is showing that it’s carpal tunnel. When a patient comes back with a normal nerve conduction study, plus all of those signs, I would recommend a steroid injection. Typically this will show the result of surgery.
Dr. Briones - my treatment process is very similar. If someone comes in with classic symptoms but normal nerve study. I will many times offer the steroid injection.
Q: How long after surgery, for carpal tunnel syndrome, would I be able to use my hand?
Dr. Woodside - I typically do an endoscopic carpal tunnel. When I perform surgery, it brings the incision down to the wrist, where I typically use something that looks like a band-aid for that reason, I want my patients to use their hand to the fullest extent that they want to from day one. I typically allow them to go back to all activities as soon as they feel comfortable. It goes back to the patient's pain tolerance when this could be achievable.
Q: I am 76 years old and have noticed a couple of my fingers are starting to look curved. Is there anything to prevent this?
Dr. Woodside - There are a couple of things that could cause that and the first is simple, arthritis. If you think about two bones together and you start wearing out the one bone, it’s going to naturally start tilting in that direction. Preventing arthritis to happen is something we would all love to cure. However, if you have especially an index, middle & ring finger, it might be useful to tape them together to work on the alignment. I feel that a splint might be something that could impede the function of your finger and do not recommend it.
Q: Can you talk about Complex Regional Pain Syndrome (CRPS)?
Dr. Briones - CRPS often occurs after injury but can also occur after a common routine surgery. What happens is the sympathetic nervous system becomes overactive and oftentimes results in fairly significant pain in an extremity. To the point where even simple stimuli like touching your hand or a bed sheet rubbing against them can be extremely painful. The typical treatment for it is multifactorial and it takes a team to effectively treat this. It can take months up to a year for maximal improvement. We try to utilize pain meds, steroids, intensive therapy. We have a whole team when we are working on CRPS. It’s a very difficult problem to treat.
Q: What’s the determining factors or signs that your pain in your hands and arms could be coming from RA?
RA stands for Rheumatoid arthritis, which is a type of inflammatory arthritis, different than osteoarthritis. Osteoarthritis is where the body's cartilage deteriorates over time. RA is where the immune system attacks soft tissues & joints as well as bones. RA is an inflammatory phenomenon, it can occur in younger patients but also patients in their 50s, 60s. The joints will typically feel swollen and warm with a mild ache. The main difference is that inflammatory arthritis is painful around the clock even when you're not doing anything stressful. RA is also more symmetric in pain. Knuckles/hand and wrist are the most commonly affected.
Q: Can you describe Dupuytrens contracture and what causes it?
Dr. Woodside - Typically if you come into our office & you do get diagnosed, we do have a lot of booklets & handouts. This actually runs in your genetics and runs in your genes. Typically you're the first person to have it. The easiest way to think about it - you almost get scar tissues or thick collagen that forms in the hand that acts as a tether or rope that bends the fingers down. Sometimes you get nodules that are typically asymptomatic. When the form these ropes or cords, the fingers really get tethered. That tissue will keep you from being able to open your fingers up. We see it most commonly in the ring and index finger but it can be in the thumb, index, middle. It can be on both hands and soles of the feet as well.
Q: If I delay surgery for the trigger finger, can I cause permanent long term damage?
Dr. Woodside - The thing we see most commonly in the trigger finger is the contraction of the joint. Releasing the actual triggering of the finger would not affect it’s mostly the contracture of the inner phalangeal joint that would be.
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