Hand and Wrist Problems
The use of your hands is your livelihood. Being able to complete delicate tasks or balance the weight of a big project is important, and if your hands are holding you back thanks to pain, swelling or injury, it can stop you in your tracks. Reaching, holding and touching shouldn’t be held back by complications of your hands or wrists. Traditionally known for the delicacy of treating this area, South Florida Orthopaedics is proud to offer care by trained hand specialists who understand this area of the body and can offer you unique training and unsurpassed expertise.
Causes and Symptoms
Normally, everyday movements of the hand and wrist aren’t enough to cause problems. Over time, especially if you find yourself doing repetitive motions (like typing), overuse of the hand and wrist can trigger problems. Other causes of discomfort may be related to aging or injury—old or new. The most common causes of hand and wrist symptoms include tendonitis, arthritis, nerve complications or other medical conditions that affect the area.
Symptoms of hand and wrist problems can include numbness, tingling, weakness, swelling, soreness, stiffness, sensations of heat or cold, knots or bumps that appear or fingers that turn colors—like red, white or blue.
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Many conditions of the hand and wrist can be completed without surgical intervention. For swelling, treating with rest, ice, compression and elevation may help—especially when combined with anti- inflammatory drugs like ibuprofen or naproxen. If you know of a particular trigger for your symptoms, try to avoid those things. For example, extreme cold can cause sudden spasms of the blood vessels in the finger, resulting in pain, tingling or color changes. If necessary, wear gloves or protect your hands when handling cold items. Physical therapy may also be beneficial for strengthening, and proper body mechanics can help preserve function.
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Arthritis of the Hand
There are two forms of arthritis than can affect the hand: osteo and rheumatoid. Osteoarthritis often results from a breakdown of the tissues that are responsible for cushioning the joint. Most cases of osteoarthritis come from overuse and result in pain and stiffness of the hands with movement.
Rheumatoid arthritis is significantly different. This type of arthritis is degenerative—meaning it attacks the tissues and supporting structures surrounding the joints and breaks them down. As an autoimmune disorder, rheumatoid arthritis is the result of an attack on your body’s defenses that can cause deformities of the joint over time, as well as significant pain, stiffness and limited movement.
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Fractures, or breaks in the bones of the hand, are very common. Sports, accidents, falls and other traumatic events are usually the cause and will require medical evaluation and proper setting for a break to heal properly. Fractures can happen to any bone of the hand, wrist or fingers and your doctor will conduct x-rays or other tests, like a CT scan, to evaluate your case. It is essential that any fracture be treated by a trained hand surgeon who will understand the delicate structures inside the hand and be able to preserve and restore function to the area.
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Endoscopic Carpal Tunnel Release
Carpal tunnel syndrome is a common condition that affects the hand and wrist. It occurs when the median nerve in the wrist, which is responsible for sensation and muscle movement, is compressed. This syndrome has received much attention in the last few years because of suggestions that it may be linked to jobs that require repeated use of the hands. Individuals with carpal tunnel syndrome may feel numbness, pain and a “tingly” sensation in their fingers, wrists and arms. They may have difficulty grasping and gripping objects because of discomfort or weakness.
Endoscopic carpal tunnel release uses an endoscope placed in a small incision. An endoscope is a small device with a light and a lens that allows the surgeon to view the carpal tunnel without disturbing the nearby tissues. It may be used in conjunction with a camera or video system. The surgeon makes a small opening below the crease of the wrist and inserts the endoscope to view the carpal tunnel. Some surgeons make a second incision in the palm of the hand. Guided by the endoscope, the surgeon places a tube called a cannula along the side of the median nerve. A special surgical instrument is inserted through the cannula that makes an incision in the transverse carpal ligament. This surgery also opens the carpal tunnel and makes it larger to take pressure off the median nerve. Because endoscopic carpal tunnel release spares some of the tissue in the palm, individuals may heal faster and experience less discomfort.
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Basal Joint Arthroplasty
The joint at the base of the thumb that is responsible for the swiveling and pivoting motions of the thumb is known as the basal joint. Thanks to overuse, it’s common for the joint to become inflamed and swell, or become painful or weak during movements like pinching or gripping.
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Dupuytren’s Contracture (Aponeurotomy)
Dupuytren’s disease causes an abnormal thickening of the tissues located underneath the skin in the palm of the hand. As the tissue thickens it can form lumps and strong cords. The abnormal growth causes the fingers to bend in toward the palm of the hand. Severe symptoms can cause contractures and loss of hand function. Dupuytren’s contracture generally progresses slowly, but the speed at which it affects each person is different.
The cause of Dupuytren’s disease is unknown. Occurring more commonly in people of northern European descent and in women, the disease is rare among young people and more common in people over 40 years old. If it occurs in young people, the condition tends to be very severe and quickly progressing.
There is no way to stop the progression of Dupuytren’s contracture. Your doctor will monitor the progress of your disease and injections may help relieve the pain in some cases. Surgery is recommended if the fingers become flexed enough to interfere with the functional use of your hand. Needle aponeurotomy (NA) may also be used to treat symptoms. A minimally invasive procedure, NA uses a needle to divide the contracted palmar fascia to release the contracture. Considered a minimally invasive technique there are only tiny poke holes where the needle is inserted and virtually no scaring. NA can be done in the office. Our doctor will determine what surgical procedure will be best based on your personal situation.
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Finger Joint Replacement
Even the best non-surgical treatments for problems of the hand and fingers may not be enough. When this happens, your doctor may talk with you about finger joint replacement. Also called finger joint arthroplasty, the procedure takes about two hours to complete and can be done under general anesthesia (completely asleep) or local anesthesia.
By removing the irritated or damaged joints, your doctor will then replace them with a hinge-like synthetic joint that will function as your old one did—only better. Proper placement and fitting of an artificial joint is essential to prevent future complications like arthritis or stiffness and depends greatly on the skill of the physician placing it.
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Ganglion Cyst Care
Ganglion cysts are a common condition. They are not harmful or cancerous, although they may cause some people discomfort. Ganglion cysts usually appear as bumps on the back of the hand and at either side of the wrist. They are also called “Bible Cysts” because in the past, treatment included hitting them with a Bible or a large book. Today, of course, that practice is no longer accepted. Instead, individuals with ganglion cysts have several professional treatment options from which to choose.
Overall, ganglion cysts occur more often in women and the cause is unknown. One theory suggests that trauma or stress at the wrist joints may cause degeneration and the formation of cysts. This may occur in individuals who participate in activities that are strenuous to the hand, such as gymnastics or meat cutting. According to this theory, prior wrist injuries that are re-injured may be susceptible to ganglion cyst development. Another theory is that the ganglion cysts form because of structural flaws in the joint tissues. The cyst may develop when synovial fluid collects between the joints. As the fluid builds up, it may create a bulge where the tissues weaken.
Most cysts are painless and only cause cosmetic concerns for patients—sending them looking for a way to remove it permanently. Some ganglion cysts require no treatment and disappear on their own. Your doctor may recommend that you wear a wrist splint. This can help relieve pain caused by activity and promote healing.
To remove a cyst, a surgeon may use a needle to remove fluid from it, or you may need surgery to completely remove it if the cyst is painful or compressing other nerves. If surgery is chosen, your wrist will be splinted following the procedure to promote healing. Not long after the procedure, your doctor will prescribe exercises to mobilize the joints. Needle aspiration is a successful treatment, although some individuals may need to have it repeated a few times.
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Trigger Finger Release
Trigger finger is a common condition that occurs when the tendons in the thumb and fingers do not glide smoothly. Trigger finger causes the tendons to catch or be stuck when the fingers or thumb bend. This condition makes it difficult to straighten the fingers and thumb back out. It can also cause pain, discomfort and swelling. Trigger finger can occur in one or more fingers or the thumb at the same time, or it may occur in different fingers with or without thumb involvement at different times.
For people with mild symptoms, rest and pain relief may relieve symptoms. Your doctor may recommend that you wear a splint for support and to promote healing and may suggest over-the-counter pain medication to reduce discomfort and swelling. In some cases, physicians choose to inject an anti- inflammatory cortisone medication into the site.
Surgery is recommended when other treatments have failed or if the thumb or finger is stuck in a bent position. There are a couple of surgical options, and your doctor will help you decide which is best for you.
Our hand and wrist specialists serve patients along Florida’s Treasure Coast, including Fort Pierce, Port St. Lucie, Jensen Beach, Stuart, Palm City, Hobe Sound, and Jupiter, as well as Indiantown and Okeechobee. To schedule an appointment or physician referral, call South Florida Orthopaedics & Sports Medicine in Stuart, Florida at (772) 288-2400 or request an appointment online.
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