Common Hand and Wrist Conditions That May Require Surgery

It’s no secret that for most of us, our hands and wrists are some of the most used parts of our bodies. Our hands help us cook meals, perform jobs, and even make music and art. When our hands and wrists start to fail us, it can be debilitating. However, a specially trained surgeon can help you find relief. Below are some of the most common conditions that may require hand surgery explained: Carpal Tunnel Syndrome, Trigger Finger, Basal Joint Arthritis, Ganglion Cysts, and trauma to the hands and wrists.

Carpal Tunnel Syndrome

What is Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome occurs when the transverse carpal ligament (TCL) becomes narrowed or surrounding tissues place pressure on the median nerve which runs the length of the arm and into the hand. The condition is caused by compression of the TCL onto the section of the median nerve that connects from the base of the wrist into the hand. This pressure first presents itself through numbness and tingling in the thumb side of the hand but as time progresses, the compression becomes constant and causes loss of feeling and even weakness in the thumb muscle.

In the early stages of Carpal Tunnel Syndrome, a nighttime brace or oral steroid may be prescribed by a physician as treatment. Corticosteroid injections into the carpal tunnel may provide relief.  If pain and weakness continue, surgery is usually the next step. TPMG Orthopedic hand surgeon, Nicholas A. Smerlis, MD, FAAOS, CAQSH, explains the surgery to be a procedure involving an incision at the base of the palm to cut the transverse carpal ligament, which stretches across the wrist like a band, in turn relieving the median nerve from compression.  Overtime, the gap left in the transverse carpal ligament will fill with scar tissue. Following surgery, symptoms may go away quickly. However, if you can’t feel small things such as the back to an earring, it could take around six months to determine if the numbness will fully subside.

Who Is at Risk for Carpal Tunnel?

Researchers believe that genetics may play a role in this hand condition. However, early evaluation may prevent the condition from getting worse. Carpal Tunnel Syndrome is also more common in women and those of an older age. Those who work in fields with frequent vibrations and impact to their hands may have an increased risk.

How Can You Help Prevent Carpal Tunnel Syndrome?

If you believe you may have or are developing Carpal Tunnel Syndrome, here are some preventative tips to start using day to day.

  • Avoid sleeping in positions that may cause your wrists to bend and curl.
  • Improve your posture at work. Try using a wrist pad for your mouse and keyboard and adjusting your chair to a less strenuous height.
  • Take breaks from repetitive activities like lifting objects or typing.
  • Try to stretch your hand, wrist, and fingers once an hour. You can flex your palm and rotate your wrist in circles.
  • Ice your wrists if they feel sore.

Trigger Finger

What is Trigger Finger?

Flexor tendons run from the forearm muscles and into the palm of the hand to move your fingers.  In the palm, the tendon functions under a pulley system like a line on a fishing pole running through eyelets.  When the entry point to this system becomes irritated, it causes inflammation and thickening, causing the pulley to close in.  As the tunnel narrows, friction on the tendon results in a nodule (lump) which catches the tendon and prevents it from gliding. This causes the finger to lock in a bent position, otherwise known as trigger finger.

Surgery for this condition does not always have to be the first option. A hand specialist can discuss non-surgical options such as corticosteroid injections. “This condition may be treated with up to three injections.  If injections fail, surgery is usually the next option to provide relief,” said Dr. Smerlis. “Surgery releases the constrictive band to open the tunnel.”

Who is at risk for Trigger Finger?

  • Trigger Finger is more common in women than men.
  • Those who have diabetes or rheumatoid arthritis are at a higher risk.
  • Repeated or prolonged gripping may increase your risk of Trigger Finger. This can be true for those who lift heavy objects or play instruments.
How Can You Help Prevent Trigger Finger?

To help prevent Trigger Finger, practice hand stretches throughout the day. This will give your hands a much-needed break.  Some stretches to try are:

  • Finger Spread: Pinch the tips of your fingers and thumbs together. Place an elastic band around your fingers and practice spreading your fingers open. Repeat 10 times.
  • Object Pickups: Place various small objects on a table such as coins, tweezers, or buttons. Pick up one object at a time by grasping with your affected finger and thumb. Repeat the exercise twice a day.

Basal Joint Arthritis

What is Basal Joint Arthritis?

Arthritis can come in different forms but the most common is osteoarthritis which is caused by the normal wear and tear people can experience through their life. This condition occurs when the cartilage lining the joints between bones deteriorates, causing bone-on-bone friction. This deterioration causes irritation, inflammation, pain, loss of motion, weakness, swelling, and stiffness.  In the hand, the base of the thumb commonly develops degenerative changes known as Basal Joint Arthritis.

Initial treatment for this condition often includes over-the-counter medications, supplements, topical medications, injections, splints, compression, and immobilization. Speak with your primary care provider before taking any medications or supplements.  A hand surgeon may administer a corticosteroid injection to calm inflammation and provide relief.

If initial treatment options fail, the most common surgery for Basal Joint Arthritis is a ligament reconstruction tendon interposition (LRTI).  This surgery removes the bone at the base of the thumb to eliminate the grinding and subsequent pain generation to support the thumb in space, allowing for pain free use.  After surgery, the thumb may need up to six weeks before beginning use again and further recovery with a certified hand therapist.  “For many hand conditions and surgeries, hand therapy is a crucial part of recovery,” said Dr. Smerlis.

Hand Exercises to Help Avoid Arthritis
  • Gently create a fist with your thumb on the outside. Stretch out your fingers and return to the fist position. Repeat this several times throughout the day.
  • Bend your fingers, one at a time, down towards your palm and then straighten out again.
  • Curve your fingers to create an “o.” Hold and release.
  • Lay your hand flat on a surface. One finger at a time, lift them up and hold for a few seconds before returning to the start position.
  • Stretch your wrist up and down, applying slight pressure to the wrist as needed.

Ganglion Cysts

What are Ganglion Cysts?

Ganglion Cysts are common lumps on the hand and wrist. These cysts occur randomly and are not linked to any age, gender, or lifestyle. They are small sacs filled with fluid or a clear, jellylike substance. Most commonly, ganglion cysts are benign and pain-free. In some cases, the location of a ganglion cyst can interfere with movement of the hand and wrist.  In other cases, the cyst causes pain and discomfort.

Ganglion Cysts can be treated a variety of ways.  The cysts can be watched if they are not causing any symptoms. Other times, immobilization can remove the pain.  Alternatively, a cyst can be aspirated or drained using a needle by a hand surgeon.  If the cyst is persistent and becomes symptomatic, surgery can be performed to remove it.

Hand and Wrist Trauma

Different Types of Trauma to the Hand or Wrist

Trauma commonly occurs to the hand and wrist. Bones can be broken or fractured from physical activity (falls, sports, etc.), car accidents, and more.  These breaks or fractures can be non-displaced (bone in position) or displaced (bone out of position).  Sometimes breaks can be managed in an office visit with simple splint or casting.  At other times, the bones can be realigned in office by manipulation or resetting the bones.  If the bones are too out of place, surgery is required to reset the bones and hold them in place with pins, plates, or screws.

Another common form of trauma is a crush injury which involves smashing your fingers or hand between two objects. When this happens, you run the risk of having nail bed lacerations or soft tissue injuries. So, what should you do if you crush your finger in a door, for instance? There could be an underlying broken bone or fracture beneath the nail bed.  Seeing your primary care provider or a hand specialist is an important first step.  Untreated injuries may cause prolonged pain and dysfunction. Nails have more purpose than just cosmetic.  Nails improve dexterity, the ability to use the hand and fingers to manipulate objects, by providing tactile feedback and sensitivity in the hand. Possible negative long-term effects of not treating a crush injury may include nail deformity, loss of feeling, hypersensitivity, and possible cold intolerance.

Recovery for Hand and Wrist Fractures

If you have fractured your hand or wrist, it can take up to a year to fully heal. While healing, the hand and wrist may become stiff and weak.  Hand therapy by a certified hand therapist is essential to a full and successful recovery.  Normal activity can be resumed at a moderate pace usually within three to four months following trauma.

While dealing with any of these hand and wrist conditions, it’s important to know that you have not hit the end of the road. If pain continues, impacts your daily life, or has been bothering you for some time, a hand specialist can step in to help you find relief.

Nicholas Smerlis, MD

About Nicholas A. Smerlis, MD, FAAOS, CAQSH

Board certified Orthopedic hand surgeon, Nicholas A. Smerlis, MD, FAAOS, CAQSH has over a decade of experience specializing in the surgical and non-surgical treatment of the hand, wrist, and elbow. Although he specializes in surgery of the hand, not all problems need surgery. Dr. Smerlis often uses non-operative treatments such as medications, splints, injections, and hand therapy to restore function to the hand and wrist. Dr. Smerlis joined TPMG Orthopedics in June 2019 and sees patients in the Newport News and Williamsburg offices.

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