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Hand & Wrist

Normal Hand Anatomy

The hand in the human body is made up of the wrist, palm, and fingers. The most flexible part of the human skeleton, the hand enables us to perform many of our daily activities. When our hand and wrist are not functioning properly, daily activities such as driving a car, bathing, and cooking can become impossible.

The hand’s complex anatomy consists of 27 bones, 27 joints, 34 muscles, over 100 ligaments and tendons, numerous blood vessels, nerves, and soft tissue.

It is important to understand the normal anatomy of the hand in order to learn about diseases and conditions that can affect our hands.

Skeletal Anatomy

The wrist is comprised of 8 bones called carpal bones. These wrist bones connect to 5 metacarpal bones that form the palm of the hand. Each metacarpal bone connects to one finger or a thumb at a joint called the metacarpophalangeal joint, or MCP joint. This joint is commonly referred to as the knuckle joint.

The bones in our fingers and thumb are called phalanges. Each finger has 3 phalanges separated by two joints. The first joint, closest to the knuckle joint, is the proximal interphalangeal joint or PIP joint. The second joint nearer the end of the finger is called the distal interphalangeal joint, or DIP joint. The thumb in the human body only has 2 phalanges and one interphalangeal joint.

Soft Tissue Anatomy

Our hand and wrist bones are held in place and supported by various soft tissues. These include

  • Cartilage: Shiny and smooth, cartilage allows smooth movement where two bones come in contact with each other.
  • Tendons: Tendons are soft tissue that connects muscles to bones to provide support. Extensor tendons enable each finger to straighten.
  • Ligaments: Ligaments are strong rope like tissue that connects bones to other bones and help hold tendons in place providing stability to the joints. The volar plate is the strongest ligament in the hand and prevents hyperextension of the PIP joint.
  • Muscles: Muscles are the fibrous tissues capable of contracting to cause body movement. Interestingly, the fingers contain no muscles. Small muscles originating from the carpal bones of the wrist are connected to the finger bones with tendons. These muscles are responsible for movement of the thumb and little finger enabling the hand to hold and grip items by allowing the thumb to move across the palm, a movement referred to as thumb opposition. The smallest muscles of the wrist and hand are responsible for fine motor movement of the fingers.
  • Nerves: Nerves are responsible for carrying signals back and forth from the brain to muscles in our body, enabling movement and sensation such as touch, pain, and hot or cold. The three main nerves responsible for hand and wrist movement all originate at the shoulder area and include the following

    Radial: The radial nerve runs down the thumb side of the forearm and provides sensation to the back of the hand from the thumb to the third finger.

    Median: The median nerve travels through the wrist tunnel, also called carpal tunnel, providing sensation to the thumb, index finger, long finger, and part of the ring finger.

    Ulnar: The ulnar nerve travels through a tunnel in the wrist called Guyon’s tunnel formed by two carpal bones and the ligament that connects them together. The ulnar nerve supplies feeling to the little finger and half of the ring finger.

  • Blood Vessels: The two main vessels of the hand and wrist are

    Radial Artery: The radial artery is the largest artery supplying the hand and wrist area. Traveling across the front of the wrist, nearest the thumb, it is this artery that is palpated when a pulse is counted at the wrist.

    Ulnar Artery: The ulnar artery travels next to the ulnar nerve through Guyon’s canal in the wrist. It supplies blood flow to the front of the hand, fingers and thumb.

  • Bursae: Bursae are small fluid filled sacs that decrease friction between tendons and bone or skin. Bursae contain special cells called synovial cells that secrete a lubricating fluid. When this fluid becomes infected, a common painful condition known as bursitis can develop.

Normal Movement

Biomechanics is a term to describe movement of the body. The fingers of the hand permit the following movements at the metacarpophalangeal joint (MCP) or knuckle joint.

Flexion: Moving the base of the finger towards the palm.

Extension: Moving the base of the fingers away from the palm.

Adduction: Moving the fingers toward the middle finger.

Abduction: Moving the fingers away from the middle finger.

Flexion: Moving the last two segments of the finger towards the base of the fingers.

Extension: Moving the last two segments of the finger away from the base of the fingers.

Biomechanics of the wrist include the following:

Flexion: Moving the palm of the hand towards the front of the forearm.

Extension: Moving the back of the hand towards the back of the forearm.

Adduction: Moving the pinky side of the hand toward the outer aspect of the forearm.

Abduction: Moving the thumb side of the hand toward the inner aspect of the forearm.

The thumb performs different movements at three separate joints. The carpometacarpal joint is where the wrist bones, carpals, meet the metacarpals, the bones in the palm of the hand. At this articulation, the following movements can be performed

Abduction: Moving the bone below the thumb towards the palm of the hand.

Extension: Moving the bone below the thumb away from the hand.

Adduction: Moving the bone below the thumb towards the back of the wrist.

Abduction: Moving the bone below the thumb towards the front of the wrist.

Opposition: Moving the thumb across the palm of the hand touching the other fingers.

The following movements occur at the metacarpophalangeal joint or MCP joint at the base of the thumb

Flexion: Moving the joint at the base of the thumb towards the heel of the hand.

Extension: Moving the joint at the base of the thumb away from the heel of the hand.

Adduction: Movement of the thumb base towards the back of the hand.

Abduction: Movement of the thumb base away from the back of the hand.

At the interphalangeal joint of the thumb or IP joint, the following movements can be performed:

Flexion: Bending the top of the thumb towards the base of the thumb.

Extension hyperextension: Moving the top of the thumb away from the base of the thumb.


Trigger Finger

Trigger Finger, also known as stenosing tenosynovitis or flexor tendonitis, is a condition where one of the fingers or thumb of the hand is caught in a bent position. The affected digit may straighten with a quick snap, similar to pulling and releasing the trigger on a gun, hence the name trigger finger.

Commonly reported symptoms associated with trigger finger include the following:

  • Bent finger suddenly pops out and straightens
  • Finger movement creates a “popping” or “clicking” sound or sensation
  • Finger feels stiff and sore
  • Finger becomes bent with inability to straighten
  • Symptoms are worse in morning

Causes

Trigger finger is caused by inflammation of the tenosynovium. The tenosynovium is the substance that lines the protective sheath around the tendon in the finger. This substance enables the tendon to glide smoothly within the sheath when the finger is bent or straightened. When inflammation is present, the tendon is unable to glide smoothly within its sheath causing “catching” of the finger in a bent position and then suddenly releasing the finger straight. Causes of trigger finger can include the following:

Repetitive Motion: Individuals who perform heavy, repetitive hand and wrist movements with prolonged gripping at work or play are believed to be at high risk for developing trigger finger.

Medical Conditions: Conditions associated with developing trigger finger include hypothyroidism, rheumatoid arthritis, diabetes, and certain infections such as TB.

Gender: Trigger finger is more common in females than males.

Diagnosis

Hand and wrist conditions should be evaluated by an orthopedic hand surgeon for proper diagnosis and treatment. Trigger finger is diagnosed based on the medical history and physical examination and without any special testing required.

Conservative Treatment Options

Your surgeon will recommend conservative treatment options to treat the trigger finger symptoms. Treatment options will vary depending on the severity of the condition.

Conservative treatment options may include the following:

  • Treating any underlying medical conditions that may be causing the problem, such as diabetes or arthritis
  • Immobilization: The finger is immobilized in an extended position with a splint for 4-6 weeks. This places the finger in a neutral position enabling the joint to rest.
  • Rest the hand for 2-4 weeks or more by avoiding repetitive gripping actions. Avoid activities that tend to bring on the symptoms.
  • Strengthening and stretching exercises with the affected finger may be suggested.
  • Occupational therapy may be recommended for massage, heat, ice and exercises to improve the finger.
  • Ice over the affected finger may help symptoms. Apply ice over a towel for
  • 5-15 min, 3-4 x daily.
  • Non-steroidal anti-inflammatory drugs (NSAID’s) may help to relieve pain and inflammation.
  • Steroid injections into the affected finger may help reduce the inflammation in the finger.

If conservative treatment options fail to resolve the condition and symptoms persist for 6 months or more and your quality of life is adversely affected, your surgeon may recommend you undergo a percutaneous trigger finger release surgical procedure to release the tendon. This surgery is usually performed in an operating room under local or regional anesthesia on an outpatient basis as day surgery. Your surgeon makes one small incision, about inch long, to the affected finger area. The surgeon then releases the tight portion of the flexor tendon sheath. The incision is then closed with a couple sutures and covered with a sterile dressing.

After surgery your surgeon will give you guidelines to follow. Common postoperative guidelines include:

  • Keep the surgical incision clean and dry. Cover the area with plastic wrap when bathing or showering.
  • Ice packs to the surgical area may be used to reduce pain and swelling.
  • The bandage is usually removed after a couple days.
  • Once the bandage is removed, full movement of the finger is encouraged.
  • Eating a healthy diet and not smoking will promote healing

Risks and Complications

As with any major surgery there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages. It is important that you are informed of these risks before the surgery takes place.

Complications can be medical (general) or specific to hand surgery. Medical complications include those of the anesthetic and your general wellbeing. Almost any medical condition can occur so this list is not complete.

  • Allergic reaction to medications
  • Blood loss requiring transfusion with its low risk of disease transmission
  • Heart attack, strokes, kidney failure, pneumonia, bladder infections
  • Complications from nerve blocks such as infection or nerve damage
  • Serious medical problems can lead to ongoing health concerns, prolonged hospitalization, or rarely death

The majority of patients suffer no complications following trigger finger surgery; however, complications can occur and include:

  • Infection
  • Nerve damage causing weakness, paralysis, or loss of feeling in the hand area
  • Stiffness to the finger
  • Trigger finger returns if sheath not adequately released

Risk factors that can negatively affect adequate healing after surgery include:

  • Poor nutrition
  • Smoking
  • Alcoholism
  • Chronic illness
  • Steroid use
  • Age (over 60)


Dupuytren’s Contracture

Dupuytren’s contracture is thickening of the fibrous tissue layer under the skin of palms, fingers, and hands which leads to curving of the finger. It is caused due to the excessive production of collagen which gets deposited under the skin. Hereditary factors, excessive alcohol consumption, diabetes, seizures, and increased age may increase the risk of developing the condition. It commonly occurs in the ring finger and little finger. Occasionally the middle finger is affected but the thumb and index finger are rarely affected. Dupuytren’s contracture is a condition that usually progresses slowly over many years and is not painful. However, some cases progress rapidly and may be painful to the patient.

The most commonly observed symptoms of Dupuytren’s contracture are lumps or nodules in the palm, difficulty in straightening the finger, and contracture of the nodules which forms tough bands under the skin.

The cause of Dupuytren’s contracture is unknown. However, there are certain risk factors that may increase your chance of developing the condition. These can include the following:

  • Age: It occurs more frequently around ages 40.
  • Social Habits: Smoking and drinking alcohol may increase your risk of developing the condition.
  • Medical Conditions: Patients with diabetes, alcoholism, cirrhosis of the liver, and seizure disorders appear to be at increased risk of developing the condition.
  • Gender: The condition is more common in males than females.
  • Heredity: The condition tends to run in families.
  • Ancestry: Most commonly affected are northern Europeans and people of Scandinavian descent.

Hand and wrist conditions should be evaluated by an orthopaedic hand surgeon for proper diagnosis and treatment. Your surgeon will collect medical history and perform physical examination. Dupuytren’s contracture is diagnosed based on the history and physical and without any special testing required.

Conservative Treatment Options

You may not need treatment for Dupuytren’s contracture if the condition is not affecting your ability to perform daily activities. However, if you are experiencing pain or if having difficulty using your hands for everyday activities, your surgeon will recommend conservative treatment options to treat your condition. Treatment options will vary depending on the severity of the condition. The conservative approaches include:

  • Heat: Applying heat to the palms of the hand prior to massage or exercise can help to loosen the tissues.
  • Massage: Gently massage the thickened tissues of the palm.
  • Exercises: Stretching exercises such as bending the fingers away from the palm may be useful.
  • Injections: Steroid injections in the palm may be done to relieve local inflammation.
  • Needle Aponeurotomy: This procedure involves inserting a small needle into the thickened palm tissue and manipulating it to loosen and break up the contracting tissue. Ultrasound may be used to guide the needle to avoid hitting nerves or tendons.
  • Collagenase Injection: An enzymatic drug that breaks down collagen can be injected into the corded tissue to soften and weaken the contracture. The physician then manipulates the tissue manually to break up the tissue.

Surgical Procedure

If conservative treatment options fail to resolve the condition and symptoms persist for 6 months or more and your quality of life is adversely affected, your surgeon may recommend you undergo a surgical procedure to open the tendon sheath and allow more room for tendon movement.

This surgery is usually performed in an operating room under local or regional anesthetic on an outpatient basis as day surgery. Your surgeon makes a small incision to the affected palm area. The surgeon then removes the thickened fibrous tissue causing the contracture. The incision is then closed with sutures and covered with a sterile dressing.

Complications can be medical (general) or specific to hand surgery. Medical complications include those of the anesthetic and your general wellbeing. Some of the complications associated with the surgery include:

  • Infection
  • Nerve damage causing weakness, paralysis, or loss of feeling in the hand area
  • Injury to the arteries of the fingers/hand
  • Recurrence
  • Allergic reactions to medications
  • Blood loss requiring blood transfusions
  • Heart conditions
  • Serious medical problems can lead to ongoing health concerns, prolonged hospitalization, or rarely death.
Hip Anatomy

De Quervain’s Tenosynovitis

De Quervain’s Tenosynovitis is a hand condition affecting a patients’ ability to move their thumb. It used to be referred to as washerwoman’s sprain or mother’s wrist but with the advent of technology, is now commonly referred to as “Blackberry thumb” from typing and texting on small handheld devices.

De Quervain’s Tenosynovitis is named after the Swiss surgeon who first identified the condition, Dr. Fritz de Quervain. Patients with this condition have difficulty gripping objects and performing their daily activities.

De Quervain’s Tenosynovitis is a hand condition affecting a patient’s ability to control movement of their thumb. There are two tendons which control thumb movements. These tendons are housed in a small tunnel or sheath which is lined with a soft, smooth tissue layer called synovium. Synovium enables the smooth gliding movements of the tendons within the sheath. Inflammation of the synovium lining affects the ability to move the thumb freely and is the cause of De Quervain’s tenosynovitis.

Signs and Symptoms

Commonly reported symptoms associated with De Quervain’s tenosynovitis include the following:

  • Pain and tenderness to the thumb base and wrist area near the thumb
  • Swelling to the wrist area near the thumb
  • Fluid filled cyst may occur at the thumb base
  • Pain may radiate up the arm
  • Pain may occur gradually or suddenly
  • Pain tends to increase with thumb movement
  • Difficulty or inability to grip objects
  • Impaired thumb function affecting daily activities

Causes and Risk Factors

The cause of De Quervain’s tenosynovitis is idiopathic or unknown. However, there are certain risk factors that may increase your chance of developing the condition. These can include the following:

  • Gender: The condition is more common in females than males.
  • Age: It occurs more frequently around ages 30-50.
  • Social Habits: The condition may be caused by overuse such as with frequent texting or typing on mobile devices with your thumbs.
  • Work Habits: Occupations that require repetitive hand and wrist movements such as with construction or playing music may increase your risk of developing the condition.
  • Medical Conditions: Patients with diabetes, alcoholism, cirrhosis of the liver, and seizure disorders appear to be at increased risk of developing the condition.

Diagnosis

Hand and wrist conditions should be evaluated by an orthopedic hand surgeon for proper diagnosis and treatment. Your surgeon will perform the following:

  • Medical History
  • Physical Examination

De Quervain’s tenosynovitis is diagnosed based on a simple test called the Finkelstein Test. Your doctor will ask you to make a fist with your fingers closed over the thumb and the wrist angled towards the pinky finger. This maneuver is usually painful over the tendons in the thumb side of the wrist in patients with this condition.

Conservative Treatment Options

Your surgeon will recommend conservative treatment options to treat your condition if you are experiencing pain and are having difficulty using your hands for everyday activities. Treatment options will vary depending on the severity of the condition. Conservative treatment options may include the following:

  • Immobilization: Splints may be applied to rest the affected wrist and thumb and prevent movement until the condition heals.
  • Ice: Applying ice to the affected area over a towel for 20 minutes 3-4xdaily may help with the pain and swelling.
  • Medications: Non-steroidal anti-inflammatory medications (NSAID’s) may be prescribed to decrease the swelling and discomfort.
  • Therapy: Physical therapy may be ordered to instruct you on exercises and ways to decrease stress to the area.
  • Injections: Corticosteroids injections to the affected tendon sheath may be done to relieve local inflammation and pain.

Surgical Procedure

If conservative treatment options fail to resolve the condition and symptoms persist for 6 months or more and your quality of life is adversely affected, your surgeon may recommend you undergo a surgical procedure to open the tendon sheath and allow more room for tendon movement.

This surgery is usually performed in an operating room under local or regional anesthesia on an outpatient basis as day surgery. Your surgeon makes a small incision over the affected tendons in the wrist area. The surgeon then cuts the sheath or tunnel that holds the tendons giving them more room to move. The incision is then closed with sutures and covered with a sterile dressing.

Post-Operative Care

After surgery your surgeon will give you guidelines to follow. Common post-operative guidelines include:

  • Keep the surgical incision clean and dry. Cover the area with plastic wrap when bathing or showering.
  • Ice packs to the surgical area may be used to reduce pain and swelling.
  • The bandage is usually removed after a couple days.
  • Your surgeon may recommend occupational therapy for strengthening exercises and measures to prevent recurrence.
  • Eating a healthy diet and not smoking will promote healing.

Risks and Complications

As with any major surgery there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages. It is important that you are informed of these risks before the surgery takes place.

Complications can be medical (general) or specific to hand surgery. Medical complications include those of the anesthetic and your general wellbeing. Almost any medical condition can occur so this list is not complete.

Complications Include:

  • Allergic reaction to medications
  • Blood loss requiring transfusion with its low risk of disease transmission
  • Heart attack, strokes, kidney failure, pneumonia, bladder infections
  • Complications from nerve blocks such as infection or nerve damage
  • Serious medical problems can lead to ongoing health concerns, prolonged hospitalization, or rarely death

Risks and complications of surgery

The majority of patients suffer no complications following tendon release surgery; however, complications can occur and include:

  • Complications from nerve blocks such as infection or nerve damage
  • Serious medical problems can lead to ongoing health concerns, prolonged hospitalization, or rarely death.
  • Infection
  • Nerve damage causing weakness, paralysis, or loss of feeling in the hand area
  • Injury to the arteries of the fingers/hand
  • Condition recurs

Risk factors that can negatively affect adequate healing after surgery include:

  • Poor nutrition
  • Smoking
  • Alcoholism
  • Chronic illness
  • Steroid use
  • Age (over 60)

A good knowledge of this procedure will make the stress of undertaking the procedure easier for you to bear. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages. It is important that you are informed of these risks before the surgery.


Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is a common, painful, progressive condition that is caused by compression of the median nerve at the wrist area. Common symptoms of carpal tunnel syndrome include numbness and tingling sensation in all the fingers except little finger; pain and burning sensation in hand and wrist that may radiate up the arm and elbow; and weakness in hand with diminished grip strength Exact causes of the condition are not known. However certain factors increase the risk of developing carpal tunnel syndrome and they include congenital abnormalities, repetitive motion of hand and wrists, fractures and sprains, hormonal imbalance, and other medical conditions such as hypothyroidism, rheumatoid arthritis, diabetes, obesity, gout, overactive pituitary gland, or the presence of a cyst or tumor in the canal.

Carpal tunnel syndrome may be treated using conservative approaches or surgery. The conservative treatments include:

  • Treating underlying medical conditions
  • Immobilization of the hand and wrist with a splint or wrist brace for 4-6 weeks
  • Rest the hand for 2 weeks or more
  • Ice packs to avoid swelling
  • Avoid activities that tend to worsen the symptoms
  • Medications such as nonsteroidal anti-inflammatory drugs, diuretics, and steroid injections.
  • Strengthening and stretching exercises once symptoms diminish

If conservative treatment options fail to resolve the condition your surgeon may recommend surgical procedure.

Carpal Tunnel Release Surgery

Carpal tunnel syndrome can be treated with carpal tunnel release surgery. Traditional surgery involves up to a 2- inch incision in the palm and wrist area, whereas endoscopic surgery involves one or two half-an-inch incisions and the use of an endoscope. During the surgery, the transverse carpal ligament will be dissected to release the pressure on the median nerve and enlarge the carpal tunnel. Your surgeon will decide which options are best for you based on your general and medical conditions.

Your surgeon may suggest you to practice certain post-operative procedures for better recovery and to avoid further complications.

  • Elevate the hand above heart level to reduce swelling
  • A splint may be worn
  • Ice packs to the surgical area to reduce swelling
  • Keep the surgical incision clean and dry. Cover the area with plastic wrap when bathing or showering
  • Physical therapy may be ordered to restore wrist strength
  • Eating a healthy diet and not smoking will promote healing

The majority of patients suffer no complications following carpal tunnel release surgery. However some patients may suffer from pain, infections, scarring, and nerve damage causing weakness, paralysis, or loss of sensation and stiffness in the hand and wrist area.


Arthroscopic Wrist Surgery

Wrist is also called as carpus, a complex joint comprised of bones and joints, ligaments and tendons, nerves, blood vessels, and muscles that hold the bones together. A fibrous cartilage present between the radius and ulna (forearm bones of the hand) separates the radioulnar joint from the rest of the wrist. Wrist connects the forearm to the hand and allows it to move. Carpal tunnel is an opening in the wrist through which the nerves and blood vessels pass.

Some of the common problems of the wrist which can be treated by arthroscopy include carpal tunnel syndrome (the nerves in the carpal tunnel are compressed), arthritis, bone fractures, dislocations, inflamed tendons and ligaments, ganglion cysts, chronic wrist pain

Arthroscopy is a minimally invasive procedure that allows your surgeon to look inside the wrist joint using small incisions (portals) and instruments. Wrist arthroscopy allows the surgeon to diagnose and treat the disorders of the wrist. Your surgeon makes several incisions near your wrist joint. Through one of the incision, an arthroscope, having a small camera fixed to the end of a narrow fiber-optic tube which is inserted. The camera magnifies and projects images of the wrist on a large screen monitor which helps in diagnosing the condition. Through the other incisions surgical instruments are inserted to treat the problem of the wrist. A sterile solution is injected into the wrist to expand the joint that allows clear view of the joint and provides extra room for the procedure. After the surgery the stitches are closed and dressing is applied.

After the surgery, your surgeon will place a cast or a splint that immobilizes that will prevent the movement of the wrist until it is healed completely. The operated wrist should be elevated to prevent excessive swelling and pain. Ice (wrapped over a cloth) can be applied over the operated area which helps to reduce swelling and medications are taken to reduce pain. Always remember to keep the operated area clean and dry to prevent infection and pus formation.

Some of the advantages of arthroscopy are smaller incisions, minimal soft tissue trauma, less pain, faster recovery time, low infection rate, less scarring, earlier mobilization, and allows patient to go home the same day.

Some of the risks observed after wrist arthroscopy include infection, damage to the nearby nerves or tissues during surgery, and stiffness which can be treated through post-operative rehabilitation. Exercises are performed to strengthen the wrist and rebuild your strength.

The human hand is an intricate instrument that is both tough and delicate. Its functions of sensations and motion allow us to experience and control the world around us.

One in three industrial or home accidents involves injury to the hand. The restoration of hand function after injury or disease is a gratifying experience for the hand surgeon.

Many routine hand conditions are treated in our practice. The following links provide a brief description of some of them. There are numerous other conditions that relate to the injury, disease and deformity of the wrist and hand. 

We are pleased to share with you our experience in the field of Hand Surgery and to provide state-of-the-art care in this area.

Trigger Finger

The tendons of the thumb and each of the fingers pass through a sheath on the palm side of the hand. Certain diseases and overuse activities can cause a thickening of this sheath. As the tendon passes through a thickened sheath, the tendon eventually becomes irritated and swells. Pain, catching and eventually locking of the finger will occur. Early treatment consists of anti-inflammatory medication or Cortisone injection. If these fail to provide relief, the sheath is opened surgically through a small incision at the base of the finger.

Dupuytren’s Contracture

This disorder is a thickening of a ligament in the palm, resulting in nodules on the ligament which, if severe enough, can cause an inability to fully straighten the fingers. The ring and small fingers are the fingers most commonly involved.

The cause of this disorder is unknown. It is seen more commonly in men and is usually found in individuals of northern European extraction.

If deformity is mild and there is no functional loss, no surgery is needed. If, however, there is significant contracture that interferes with full use of the hand, surgical removal of a portion of the ligament is the treatment of choice to improve function and to prevent further deformity.

De Quervain’s Tenosynovitis

Tendonitis on the thumb side of the wrist can be a very painful and disabling condition. Simple pinching and twisting activities can be almost impossible. The tendons to the thumb become inflamed as they pass under a ligament and the slightest motion of the wrist can cause pain.

Treatment consists of rest, medication and occasionally the use of a steroid injection. If these treatments do not provide relief over time, the tendons can be surgically released.

Carpal Tunnel Syndrome

Carpal tunnel syndrome is a common hand problem resulting from pressure on the median nerve at the wrist. Symptoms, which are often worse at night, consist of numbness and/or pain in the wrist and fingers. Eventually there is loss of strength, fine motor control and sensation.

Early treatment consists of splinting and anti-inflammatory medication. If symptoms do not improve, an outpatient surgical procedure to relieve the pressure on the nerve is suggested.

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