Dr. Terry Messer from Raleigh Hand to Shoulder Center discussed the treatment of patients with TFCC injuries of the wrist. TFCC injuries are a common source of ulnar-sided wrist pain. Surgical and non-surgical options were described. He spoke at WakeMed Raleigh Hospital hand conference on 8/29/22.

Carpal tunnel syndrome (CTS) is a type of pinched nerve in the wrist. It is the most common compression neuropathy in the hand and arm. It results from increased pressure on the median nerve at the wrist, within the carpal tunnel. Symptoms such as numbness, tingling, weakness, and pain can result if the nerve is compressed or “pinched.”

The word “carpus” is derived from the Greek word karpos, which means “wrist.” The carpal tunnel is a passageway in the wrist which contain the median nerve and flexor tendons. The carpal tunnel is a narrow space made up by the bones of the wrist and the transverse carpal ligament. The median nerve is at risk for compression within this tunnel. If there is swelling, abnormal wrist anatomy, or injury to this area, the function of the median nerve may be affected.

WHAT CAUSES CARPAL TUNNEL SYNDROME?

In most cases, the cause of CTS is unknown. Thyroid disorders, rheumatoid arthritis, pregnancy, vitamin deficiencies, diabetes, fluid retention, and trauma can be associated with CTS. Women are more commonly affected than men. Repetitive, forceful gripping and heavy use of vibratory tools may increase a person’s risk of CTS.

HOW DO I KNOW IF I HAVE CARPAL TUNNEL SYNDROME?

Patients with CTS commonly report “numbness” or “tingling” symptoms in the fingers. Some patients feel that the fingertips are “asleep” or report “poor circulation” in the hands. Symptoms are often worse at night and people tend to shake their hands for relief to wake them up. Some patients report increased symptoms while gripping a steering wheel. Dropping objects, clumsiness with the hands, or a weak grip are also common complaints. Some people also report pain in the forearm, wrist or fingers. In severe cases, the muscles at the base of the thumb can become weak and atrophy, sometimes permanently. 

Often the diagnosis can be made on the basis of your symptoms, medical history, and physical examination. An electrodiagnostic study or nerve test can confirm the diagnosis in some cases. 

WHAT ARE THE TREATMENT OPTIONS FOR CARPAL TUNNEL SYNDROME?

Not everyone with carpal tunnel syndrome needs surgery. Many people with CTS improve without surgery. Wearing a wrist brace at night supports the wrist and takes pressure off the median nerve. Avoiding prolonged wrist flexion and forceful gripping may also help. Corticosteroid injections provide an anti-inflammatory effect and can be effective in many patients.

Treatment can include wrist brace, hand therapy, steroid injection and surgery if conservative treatment is not successful. Surgery is usually recommended if there are signs of severe carpal tunnel syndrome or nerve damage. Treatment for carpal tunnel syndrome can alleviate numbness and tingling in the hand at night and improve hand function during the day.

Should these measures fail to improve the condition, or if nerve compression is severe, surgery may be recommended. A carpal tunnel release surgery is performed to decrease pressure on the median nerve. During this procedure the transverse carpal ligament is divided to take pressure off the nerve. Cutting this ligament increases the size of the carpal tunnel and provides more room for the median nerve. The ligament grows back over time, but the tunnel size has been increased.

Raleigh Hand to Shoulder Center doctors are experts in treatment of CTS. They are members of the American Society for Surgery of the Hand. The doctors are board certified by the American Board of Orthopedic Surgery.

Dr. James Post of the Raleigh Hand to Shoulder Center discussed treatment options for patients with nerve injuries in the hand and arm. He gave conference at WakeMed hospital hand conference on Monday, August 15, 2022.

Dr. John Erickson of the Raleigh Hand to Shoulder Center discussed treatment of patients with rheumatoid arthritis affecting the hand. He gave hand conference at WakeMed hospital on Monday, August 8, 2022 discussing surgical and conservative treatment of patients with RA.

For over 30 years, North Carolinians have trusted the Raleigh Hand to Shoulder Center.  The doctors and therapists provide personalized and compassionate care to patients with conditions of the hand, wrist, elbow and shoulder. Each physician has completed training in orthopedic surgery and a fellowship in hand and upper extremity surgery. They are experts in treatment of carpal tunnel syndrome, wrist tendonitis, tennis elbow, Dupuytren’s contracture, hand and shoulder arthritis, rotator cuff tears, sport injuries, and fractures of the hand and arm. The practice has been recognized for high-value healthcare and patient satisfaction.

Non-surgical treatments are an important part of the practice, including splints, injections, and physical and occupational therapy. If surgery is necessary, the doctors operate primarily at Capital City Surgery Center, voted the #1 ambulatory surgery center in North Carolina for the past 2 years. 

Drs. James Post, Paul Schricker, Terry Messer, John Erickson, and George Edwards, III welcomed Dr. Timothy Luchetti to their practice this summer. After his hand and upper extremity surgery fellowship, Dr. Luchetti has practiced in Pennsylvania for two years and is now excited to call North Carolina home. Dr. George Edwards, Jr. recently retired after practicing for 38 years in Raleigh.

Dr. George Edwards, Jr. retired on May 1, 2022 after 38 years of hand and upper extremity surgery in Raleigh.  He thanks all the office, surgery center and hospital staff for their unwavering support in caring for our patients.  Drs. Post, Schricker, Messer, Erickson and Edwards, III will continue to offer care seamlessly for new and follow-up patients. Dr. Tim Luchetti joined RHSC in August, 2022

Many patients say: “my doctor said there is nothing we can do for arthritis.” It is true that doctors cannot cure arthritis, but treatment of hand arthritis is available.

What is arthritis? Arthritis is a common source of hand pain in patients older than 40 years of age. Osteoarthritis is the most common type of arthritis. This is also known as degenerative joint disease. Osteoarthritis is caused from normal “wear and tear” occurring gradually over time. The small joints in the fingers and the large joint at the base of the thumb are commonly affected areas in the hand. Rheumatoid arthritis, psoriatic arthritis, and gout arthritis are other specific types of arthritis, which are less common.

What are the signs of arthritis?

What are the signs of arthritis? Patients often describe a gradual onset of “dull ache” pain in the joints and morning stiffness in the fingers. In some patients, the stiffness in the fingers gets worse and the patient notices decreased range of motion in the hand. Some of the knuckles can develop prominent bumps, which are seen as bone spurs or “osteophytes” on x-rays. These bumps are called Heberden’s nodes. In more severe cases, the fingers can develop deformity and appear crooked. Not everyone with arthritis develops deformity or much pain, however.

What causes arthritis? There are many factors which contribute to osteoarthritis including family history, injuries, inflammation, and age. The joints in our bodies are made up of cartilage, which cushions and protects the end of the bones. The cartilage allows for full range of motion. Over time, this protective cartilage becomes thin and wears away. In some patients, the cartilage surface is worn out and there is “bone-on-bone” grinding at the joint, which can be painful. This “wear and tear” process can be increased after an injury.

Treatment of hand arthritis

What is a treatment of hand arthritis? Although there is no cure for arthritis, there are several treatments which can help reduce the symptoms. Simple things patients often try at home are warm water soaks in the morning, range of motion exercises with the fingers, and warm paraffin wax dips. There are many over-the-counter products which may help such as oral medications, dietary supplements, and topical ointments. Use of oral anti-inflammatory pills (Tylenol, Ibuprofen, Naproxen, etc.) can reduce pain temporarily. NSAIDs should be used sparingly due to side-effects.  Anti-inflammatory creams can be purchased over-the-counter and applied to the skin over a painful joint. Additionally, doctors can prescribe hand therapy and various types of braces or splints to help support arthritic joints. Corticosteroid injections (cortisone shots) can be used sparingly for a painful joint to reduce pain and swelling. Surgery is an option if non-surgical treatments are not satisfactory.

Is surgery needed for hand arthritis?

Is surgery needed for hand arthritis? Most people do not require surgery for hand arthritis. If patients have tried non-surgical treatment and still have severe pain, surgery might be recommended. Depending on the patient and the affected area, either joint replacement or joint fusion surgeries are options. The base of the thumb joint can be treated surgically with arthroplasty surgery, which can significantly decrease pain and improve hand function. Your hand surgeon can discuss these options with you.

Raleigh Hand to Shoulder Center doctors are experts in the diagnosis and treatment of hand conditions including osteoarthritis. They are members of the American Society for Surgery of the Hand and they are board certified by the ABOS. If you have hand arthritis, consider making an appointment with a hand and upper extremity specialist at Raleigh Hand to Shoulder Center.

There are many treatments available for carpal tunnel syndrome (CTS). If the hand numbness and tingling symptoms come and go, non-operative treatment is appropriate. People who have severe carpal tunnel syndrome should be evaluated by a hand surgeon. Constant numbness in the hand and loss of muscle tone at the base of the thumb are signs of nerve damage and severe CTS. Surgery is the best way to prevent the nerve from being damaged. If people wait too long before having surgery, some of the hand numbness and weakness can be permanent. The Raleigh Hand to Shoulder Center surgeons offer the best treatment for carpal tunnel syndrome. They are among the top doctors in the field of hand surgery. Read more to find out the best treatments for carpal tunnel syndrome.

Not all hand pain, numbness, and tingling are caused by CTS. If the symptoms are getting worse or not responding to treatment, a hand specialist should be consulted sooner rather than later.

The recommendations below are intended for Raleigh Hand to Shoulder patients with mild to moderate CTS symptoms. There are some things we can’t change about our health, such as our family history, age and hand anatomy. However, there are many things that we can modify to improve our health.

Best treatments for carpal tunnel syndrome:

— Wearing a wrist brace at night

— Hand and wrist stretching exercises

— Hand Therapy

— Smoking cessation

— Steroid injection

Treatments which are NOT helpful for carpal tunnel syndrome:

— Magnet therapy

— Laser therapy

— Long-term use of oral NSAIDs

— Expensive custom braces

— Most products on the internet claiming to be a cure for carpal tunnel syndrome

If these best treatments for carpal tunnel syndrome are not controlling the symptoms or if the nerve compression is severe, surgery should be considered. Raleigh Hand to Shoulder Center hand doctors are experts in the diagnosis and treatment of carpal tunnel syndrome. They are members of the premier hand society, American Society for Surgery of the Hand. Several surgeons have been named top doctors in the area.

Broken wrist treatment is important medical care. A distal radius fracture, sometimes called a “broken wrist,” is a common wrist injury. This type of fracture can occur from a variety of trauma, such as a fall at home or a motor vehicle collision. The distal radius is the portion of the radius bone just below the wrist joint. As we age, the bone of the distal radius loses bone mass and becomes more prone to fracture, particularly in post-menopausal women and people with osteoporosis. The distal radius may break (also called a fracture) as a result of a slip and fall in these cases. Younger patients with stronger bones may break the distal radius after high-energy trauma, such as a sports injury or car accident. Broken wrist treatment involves specialized orthopedic care, and proper healing is needed to obtain the best outcome.

Broken wrist treatment depends on the severity of the fracture on the x-rays and the patient’s health and activity level. The distal radius bone usually heals after a fracture; however, a goal of treatment is for the bone to heal in a good position for function. Many people have fractures which are in good alignment. These patients do not require surgery. Treatment in these cases is typically protection in a cast or brace for several weeks. Follow-up x-rays are obtained in clinic to see how the fracture is healing. Waterproof casts are available at the Raleigh Hand to Shoulder Center.

Broken Wrist Treatment with Surgery

Some patients have displaced fractures which can be re-aligned without surgery. This is called “closed reduction” and is performed either in the office or emergency room using an injection of a local anesthetic. After the broken bones are “set,” a plaster splint is molded to the wrist to maintain the alignment. After a few days, the patient can often be placed into a cast.

Some patients have fractures which are more severe. In these case the fracture alignment is not in good position for hand function. Surgery may be advised to improve the alignment of the bones. Open Reduction and Internal Fixation (ORIF) is a common procedure performed for this injury.

Raleigh Hand to Shoulder Center doctors are all hand specialists and they are members of the American Society for Surgery of the Hand. Broken wrist treatment is one of the many services provided by hand specialists. Raleigh Hand to Shoulder Center doctors are top doctors within their field of hand surgery. They are among the best hand surgeons in the area.

What is Mommy’s Thumb? This is another term for DeQuervain’s tendonitis or Mommy’s Wrist. This is a common condition involving the tendons on the thumb-side of the wrist. The syndrome is named after Fritz de Quervain, a Swiss physician who described the condition in the late 1800s. Symptoms arise when there is entrapment of the tendons of the thumb by their surrounding sheath at the wrist. Instead of gliding smoothly through the sheath, the tendons can meet resistance and cause friction. Over time, these tendons may become irritated and painful. Certain movements of the thumb and wrist can be excruciating. Some patients notice decreased thumb range of motion. Patients may feel a tender bump or notice swelling in the wrist where the tendons and/or sheath are thickened. Lifting objects, gripping, or pinching with the thumb often exacerbates symptoms.

The cause of DeQuervain’s is usually unknown, but symptoms can be aggravated by starting a new, repetitive activity. The condition is common in young females, especially pregnant and post-partum women. Lifting a young child can be very painful making it hard to care for the newborn. This is why it is often called mommy’s thumb.

Treatments for mommy’s thumb include thumb spica splinting, over the counter anti-inflammatory medications, topical medications, hand therapy, and cortisone injections. For most patients, these treatments will clear up the condition. In some cases, surgery is necessary to relieve the symptoms. Surgery is performed as an outpatient and most patients report excellent results. See the image below, which shows the tendons involved in DeQuervain’s tendonitis.

Raleigh Hand to Shoulder Center doctors are all members of the American Society for Surgery of the Hand and are experts in DeQuervains Tendonitis. Hand specialists can help diagnose and treat hand and wrist conditions and can help explain the answer to the question, What is Mommy’s Thumb?