Hand & Wrist

Carpal tunnel syndrome (CTS) is a common condition that affects the hand and wrist. It is the most common nerve entrapment syndrome and affects up to 10 percent of the population. Carpal tunnel syndrome occurs when the median nerve in the wrist is compressed. The median nerve, which runs through a passageway called the carpal tunnel, carries signals for sensation and muscle movement to your hands and fingers; when it is compressed or entrapped, it cannot function properly.

Symptoms of carpal tunnel syndrome include numbness, pain, and a tingly sensation in your fingers, wrists, and arms. You may have difficulty performing grasping and gripping activities because of discomfort or weakness.

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Cubital Tunnel Syndrome is an injury to the ulnar nerve (or "funny bone") in the arm that can cause moderate to severe pain and numbness in both the elbow and fingers.

Dupuytren's contracture is a condition where tissue under the skin in the hand gradually starts to thicken. This thickening causes the ring and pinky fingers to pull in towards the palm, which can cause discomfort and difficulty performing everyday activities.

Cuts, pressure, stretching, or crush injuries can injure the nerves in the hand. These types of injuries result most frequently from falls, vehicle crashes, gunshot wounds, and other sources of physical trauma. Burns, freezing temperatures, electrical shock, radiation, and vibration can also cause hand nerve injuries.

There are three main nerves in the hand: radial, median, and ulnar. Each supplies sensation to and controls movement in different parts of the hand and fingers. An injured nerve cannot transmit nerve signals, causing a lack of sensation, movement, or both. Some types of nerve injuries may heal on their own while more severe nerve injuries require surgical repair.

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Wrist fractures most commonly result from a fall onto an outstretched hand. The scaphoid, a small bone located on the thumb side of your wrist, is the most commonly broken bone in the wrist. It spans the two rows of bones that make up your wrist. Because symptoms can be minimal, scaphoid fractures are frequently mistaken as sprained wrists.

Scaphoid fractures require casting or surgery. Treatment depends on the location of the fracture in the bone. Fractures located near the thumb heal well with casting because this area has a good blood supply. Fractures in areas of the scaphoid with a poor blood supply, as well as displaced fractures, generally require surgery.

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Another surgical option for carpal tunnel syndrome is endoscopic carpal tunnel release, which also takes pressure off the median nerve to relieve the symptoms of carpal tunnel syndrome. The procedure is performed using an endoscope placed in a small incision. An endoscope is small device with a light and a lens that allows the surgeon to view the carpal tunnel without disturbing nearby tissue.

Endoscopic carpal tunnel release is less invasive than an open release. Because the incision is smaller and some of the tissue in the palm is spared, you may heal faster and experience less discomfort.

There have been new advancements made in treating carpal tunnel. There is now what is known as “wide-awake local anesthesia” (surgery performed with only local anesthesia, avoiding the use of general anesthesia) for endoscopic carpal tunnel release in the office. Wide-awake local anesthesia endoscopic carpal tunnel releases can be performed at “surgicenters” or "surgery centers" which are standalone healthcare facilities that allow patients to have surgery without being admitted to a hospital.

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Endoscopic cubital tunnel release is a minimally invasive, surgical technique devised to decompress the ulnar nerve with the aid of a specific tool.

Nerve injuries classified as first- to third-degree injuries may heal on their own. Fourth- and fifth-degree injuries require surgery. There are many types of surgeries for nerve repair in the hand. The type of surgery that you receive depends on many factors, including the degree of injury and the size of the gap between separated nerve ends. Based on your injury, your doctor will determine when to perform your surgery and what type of repair to perform.

Nerves cut or severed by a sharp object can be operated on immediately. Nerve injuries from other causes, such as crush injuries, may require a short waiting period before surgery to allow the nerves and tissues to start the healing process.

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Enzymes are injected into the palm, which softens the thickened tissue allowing a hand specialist to manipulate the fingers back to where they belong.

The standard surgery for carpal tunnel syndrome is called an open release. Your hand surgeon will use a local or regional anesthetic to numb the area and make a 2- to 3-inch opening along the palm, which allows the surgeon access to the transverse carpal ligament, the roof of the carpal tunnel.

Your surgeon will make an incision in the transverse carpal ligament to open the tunnel and make it larger. By doing so, pressure is taken off of the median nerve. It only takes about 15 minutes to perform an open release surgery.

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