What Is It?
The carpal tunnel is a space in the wrist where a nerve and nine tendons pass from the forearm into the hand. Carpal tunnel syndrome occurs when swelling in the tunnel compresses the median nerve.

What Causes It?
The most common misconception is that carpal tunnel syndrome is limited to people who spent a great deal of time at computers. In reality, it affects anyone who grips something tightly or uses their wrists consistently, such as cashiers, cyclists, meat cutters and musicians. Occupations that involve prolonged use of vibrating equipment, such as a jackhammer, are also prone to carpal tunnel syndrome.

Symptoms:
Tingling, numbness and pain in the thumb, index and middle fingers are the most common symptoms of carpal tunnel syndrome. These symptoms are usually experienced at night, but also accompany prolonged gripping (steering wheel, newspaper, grocery or tote bags). Patients may also experience clumsiness when handling objects or a weaker grip.

Initial Evaluation:
The physician will examine your hand and arm and ask you about your medical history, any injuries you may have sustained to your hand or arm, the job that you perform, hobbies or sports you participate in, etc. An x-ray or other lab tests may be performed to rule out other causes of your symptoms. The Curtis National Hand Center has a test on-site that can determine if a person has carpal tunnel syndrome. Called the NeuroMetrix NC-stat system, the system measures neuromuscular signals that are useful in the diagnosis and evaluation of nerve entrapment affecting functions of the hand. The test is painless and results are available in about five minutes. Click here for a physician referral.

Treatment:
There are many non-surgical courses of treatment for carpal tunnel syndrome, such as splints or braces to immobilize and rest the wrist, adjustments to how you perform daily activities, oral anti-inflammatory medications and steroid injections. If non-surgical treatment is not successful or treatment is sought too late, surgery may be required. This surgery involves enlarging the carpal tunnel, which in turn will relieve the swelling and pressure on the nerve. This is an outpatient procedure done under local anesthesia. In severe cases, even surgery may not reverse the effects of carpal tunnel syndrome. Carpal tunnel surgery is followed by hand therapy which varies by case, but usually lasts 1-3 months.

DeQuervain's Disease is an irritation and swelling of the sheath or tunnel that surrounds the thumb tendons as they pass from the wrist to the thumb.

What Causes It?
DeQuervain's Disease may be caused by overuse and repetitive motion, and also has been associated with pregnancy and rheumatoid arthritis. New mothers may also be affected.

Symptoms
You may experience twinges of pain at the base of the thumb or the thumb side of the wrist. The pain may appear gradually or suddenly, and it is felt in the wrist and can travel up the forearm. The pain is usually worse with use of the hand and thumb, especially when forcefully grasping things or lifting items such as a gallon of milk.

Initial Evaluation
The physician will examine you to pinpoint the specific area of pain. He will ask you about your medical history, any injuries you may have sustained to your hand or wrist, the job that you perform, hobbies or sports you participate in, etc. The doctor will also perform a physical examination of your wrist and hand, most likely including a test called a finkelstein's test. In this test, you will be asked to make a fist with your thumb tucked in. This test will prove painful for patients with dequervain's disease.

Treatment
In almost all cases, non-surgical treatments are always explored first. Splints, oral anti-inflammatory medications or injections may help reduce the irritation and swelling. Temporary avoidance of activities that cause pain may also ward off symptoms. For those cases that do not respond to non-surgical treatments, surgery may be recommended. The procedure, which is done on an outpatient basis, enlarges the tendon compartment to make more room for the irritated tendon. Normal use of the hand can be resumed once comfort and strength return. Generally, hand therapy is recommended for 4 weeks following surgery.

Dupuytren's Disease is an abnormal thickening of the tissue between the skin and the tendons in the palm. This thickening may limit the use of one or more fingers or may eventually cause the fingers to be pulled in toward the palm.

What Causes It?
This condition is hereditary and the cause is not known, however it may be associated with smoking, vascular disease, epilepsy and diabetes. It is more common in men over the age of 50. The disease appears later in women.

Symptoms
The first sign is usually a small lump or nodule in the palm, occurring many times in the crease of the hand that is closest to the base of the ring and little fingers. Further indication is when the palm cannot be placed flat on a flat surface such as a table. As the disease progresses, the involved finger is drawn toward the palm.

Initial Evaluation
The physician will examine your hand and ask you about your medical history, any injuries you may have sustained to your hand or fingers, the job that you perform, hobbies or sports you participate in, etc. An x-ray or other lab tests may also be performed.

Treatment
Treatment is most effective when sought at the nodule (small lump) stage. There are no non-surgical options for this condition, and surgery will only temporarily restore use to the fingers. With time the condition will return. You doctor will discuss with you your individual case and whether surgery is a viable option for you. Hand therapy may be recommended with or without surgery.

Ganglion cysts (lumps) can occur all over the body, but are very common in the hand. They form when tissues surrounding certain joints become inflamed and swell up with lubricating fluid. They are generally found on the top of the wrist, on the palm, at the base of the finger and on the end joint of the finger. Although they may grow in size, they are not tumors or cancer.

What Causes Them?
There is no specific cause although they are sometimes associated with rheumatoid arthritis or excessive overuse of joints in the wrist and fingers.

Symptoms
You will see the lumps appear and they will most likely be very painful, although they may be painless. Pain will increase with extended use of the hand, and range of motion may be restricted. Ganglions often change in size and may disappear completely (spontaneously).

Initial Evaluation
The physician will examine your hand and ask you about your medical history, any injuries you may have sustained to your hand or fingers, the job that you perform, hobbies or sports you participate in, etc. An x-ray or other lab tests may also be performed.

Treatment
Treatment is indicated by the pain you are experiencing, the limits the cysts are placing on your daily activities, and/or your discomfort with the physical appearance of the cysts. Treatment can range from simply monitoring the cysts for changes to wearing a splint to immobilize the hand, fingers or wrist. Another non-surgical option is to remove fluid from the cyst with a needle. If non-surgical treatments are not successful, surgery to remove the cyst may be recommended by your hand surgeon.

What Is It?
Reflex sympathetic dystrophy (RSD) is a condition of chronic, burning pain, stiffness, swelling, sweating and discoloration of the hand or arm that may become disabling. It occurs from over-activity in the sympathetic (unconscious) nervous system that controls the blood flow and sweat glands. The sympathetic nervous system is that part of the nervous system that regulates involuntary, bodily functions such as increasing heart rate, constricting blood vessels, and increasing blood pressure. Excessive or abnormal responses of portions of the sympathetic nervous system are thought to be responsible for the pain associated with RSD. If not treated, RSD can cause stiffness and loss of use of the affected part of the arm.

What Causes It?
In some cases, the cause of RSD is unknown. RSD may follow a sprain, fracture, injury to nerves or blood vessels, or the symptoms may appear after a surgery. Other causes include pressure on a nerve, infection, cancer, neck disorders, stroke, or heart attack.

What Are The Symptoms?
The pain associated with RSD is often described as burning in nature. A patient with RSD who sustains an injury such as the ones listed above usually feels a greater amount of pain than a person without RSD who has sustained the same injury. Swelling can cause painful joints and stiffness. RSD has three stages:

Acute: May last up to three months. Symptoms include pain and swelling, increased warmth and redness in the affected part/limb and excessive sweating.

Dystrophic: Can last three to 12 months. Swelling is more constant, skin wrinkles disappear, skin temperature becomes cooler, and fingernails become brittle. Pain is more widespread, stiffness increases, and the affected area becomes sensitive to touch.

Atrophic: Lasts one year or more. The skin of the affected area is now pale, dry, tightly stretched and shiny. The area is stiff, pain may decrease, and the chance of getting motion back is decreased.

How Is It Diagnosed?
Diagnosis usually is made when at least three of the following symptoms are present: pain and tenderness, signs of changed blood flow (either increased or decreased), swelling with joint stiffness, or skin changes.

How is It Treated?
The pain of RSD may be severe, resulting in physical and psychological alterations. A coordinated multidisciplinary approach to treatment is best.

Treatment includes medication (oral and injections), physical or occupational therapy and/or surgery. Therapy is important to regain function and reduce discomfort caused by RSD. Successful treatment depends upon the patient's full and active effort in therapy. Occasionally surgery is performed in the later stages, but it is not always successful.

The physicians at The Hand Center of Excellence at Southview Hospital can advise you on the best treatment for your situation.

What Is a Flexor Tendon?
The muscles located in the hand and forearm that control the bending or flexing of the fingers are called flexor muscles. The flexor muscles are able to move the fingers by using cord-like extensions called tendons, which attach the muscle to bone. The tendons of the flexor muscles that lead to the fingers and the thumb begin just beyond the middle of the forearm.

What Causes Flexor Tendon Injuries?
Deep cuts on the palm side of the wrist, hand, or fingers can injure the flexor tendons, nerves or blood vessels. When a tendon is cut, the ends pull away from each other causing a rubber band effect.

What Are The Symptoms?
When a tendon has only been partially cut, fingers may still bend, but it will be painful and the tendon may eventually rupture. When both tendons are cut completely through, the finger joints cannot bend on their own at all.

What Is The Treatment?
It is more than likely that your doctor will recommend surgery to repair your cut tendon. Following surgery, and depending on the type of cut, the injured area will either be protected from movement or started on a very specific limited motion program for several weeks. If unprotected finger motion begins too soon, the tendon repair may rupture or pull apart. After four to six weeks, the fingers are allowed to move slowly and without resistance. Healing will take approximately three months after the repair.

Therapy is an important part of treatment. Although scarring of the repair is a normal part of the healing process, it can make bending and straightening of the finger very difficult. In most cases, full and normal movement of the injured area does not return after surgery. Therapy can help to loosen up the scar tissue and prevent it from interfering with the finger's movement. It is important to work closely with a hand therapist and your surgeon to understand your therapy and to follow set guidelines. In addition to regaining motion of the finger after a tendon injury, therapy can be helpful in softening scars and building grip strength. If therapy fails to improve motion, surgery to release scar tissue around the tendon may be required.

What Is Tennis Elbow?
Tennis elbow is the common term for lateral epicondylitis, an overuse injury that causes an inflammation of the tendon fibers that attach the forearm muscles to the outside of the elbow. This injury is not limited to those who play tennis.

What Causes Tennis Elbow?
Everyday use of the arm can stress the muscles in forearm and elbow. Causes range from housepainting or carrying a baby to using a computer and playing sports such as tennis or golf.

Symptoms
Pain near the bone on the outer side of the elbow. The area is usually tender to the touch and uncomfortable when gripping.

Trigger finger (stenosing tenosynovitis) occurs when the tendons in the hand that control the bending of your finger become swollen. Because the tendons are covered by a sheath, the swelling causes pressure to build up in the sheath and a knot or nodule is formed. The tendon is then prevented from gliding smoothly. This is what causes the pain, popping or catching feeling. This condition gets its name because in some cases the tendon catches and then is suddenly released as though a "trigger" were released.

What Causes Trigger Finger?
Causes can include, but are not limited to, rheumatoid arthritis, gout or diabetes. Occupations requiring repetitive bending of the finger (such as squeezing a spray bottle) or prolonged forceful grasping (such as power tools) may increase the risk of developing this problem.

Symptoms
Symptoms include soreness at the base of the finger, painful clicking or snapping when attempting to flex or extended the affected finger. In more severe cases, the affected finger will lock in a flexed or extended position.