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Carpal Tunnel Syndrome

Carpal Tunnel Syndrome (CTS) is a common hand condition that happens when pressure is increased on the median nerve, inside the wrist. The median nerve passes through a tunnel in the wrist, hence the name Carpal Tunnel Syndrome. The median nerve provides sensation to the thumb, index and middle finger. 

 

Common symptoms of CTS include: 

·       Numbness 

·       Tingling in the fingers 

·       Pain across the fingers/wrist/arm 

·       Weakness in the thumb and hand 

·        

These symptoms affect the ability to grip and use the hand normally. They are often worse at night and can interfere with sleep, which can become more constant as the condition worsens.  

 

There are many treatments used to treat Carpal Tunnel Syndrome, both non-surgical and surgical. Non-surgical treatments include wearing splints at night, taking nonsteroidal anti-inflammatory drugs such as ibuprofen, or getting cortisone injections. If non-surgical treatments are ineffective then surgery is recommended. Surgery will involve cutting the ligament enclosing the Carpal tunnel at the base of the palm to increase the size of the Carpal Tunnel. In turn, relieving pressure on the nerves and tendons passing through the space. The surgery is quick, is done using local anaesthetic and can takes six weeks to fully recover and resume normal activity.

Ganglion Cyst

Ganglion cysts are small fluid-filled lumps, just below the skin, which usually form near joints such as the finger and wrist. Ganglia are one of the most common non-cancerous masses that form in the body’s tissues. These cysts often occur spontaneously but may be connected to injury or developing arthritis.

Ganglion cysts are most common in mid-adulthood (aged 20-50) and are 3 times more likely in women. These cysts appear to look like a bubble has been blown near a joint. They can have a translucent appearance, are often firm and can move under the skin. Many Ganglion cysts carry no symptoms apart from a visible bump under the skin. They can vary in size and shape and may grow bigger over time. Sometimes a cyst may cause muscle pain or a tingling sensation where the cyst causes pressure and inflammation to the joint.

Most ganglia do not need treatment and they go away on their own however, sometimes treatment is required. The use of anti-inflammatory drugs and a splint can help to relieve discomfort and swelling. If necessary, a needle can be used to remove fluid from the cyst.

If these treatments do not help or a cyst returns, surgery is recommended to remove the whole cyst. This surgery is called a ganglionectomy and recovery from this can last between 2-6 weeks. By having a ganglionectomy, the risks of a cyst returning is significantly reduced and will most likely resolve the symptoms.

Dupuytren's Disease

Dupuytren’s disease (also called Dupuytren’s contracture) is a common genetic hand disorder which affects the fingers. Dupuytren’s disease occurs when the tissue under the skin on the palm of the hand and fingers tightens. Small bumps or nodules grow on the tissue in the hand, which can eventually form thick cords under the skin. This causes the fingers to bend to the point that they cannot straighten. 

Dupuytren’s disease is most common in males and people of European descent. However, conditions such as diabetes, epilepsy and HIV or AIDS can increase the likelihood of Dupuytren’s disease developing. Symptoms can take months or years to present.

Symptoms of Dupuytren’s disease include:

  • Inflammation

  • Tenderness or pain and itching (most commonly on the ring and pinkie finger

  • Inability to straighten fingers

There are several treatment options for Dupuytren’s, and these vary depending on the severity of symptoms. Early on, treatments may include physical therapy exercises, bracing and splinting, ultrasonic or heat treatments and sometimes corticosteroid injections. Other helpful treatments are radiation (to soften nodules), needle aponeurotomy (to release tension in fingers) and collagenase injections (to break down nodules).

If the symptoms affect quality of life, surgery is recommended. The surgery is an outpatient procedure where local anaesthetic is used. The surgeon will remove some or all of the affected tissue. 

Trigger Finger

Trigger Finger is a common hand condition that causes the fingers or thumb to be hard to move and straighten. Fingers can freeze in a bent position due to the tendons in the hand becoming swollen. This makes straightening of the digits (fingers/thumb) difficult, most commonly the ring finger.

Trigger Finger is most common in people of age 40-60 and conditions such as arthritis and diabetes can increase the risk of experiencing Trigger Finger. 

Symptoms of Trigger Finger include:

  • A snapping sensation when the fingers are moved

  • Pain and stiffness

  • Soreness at the base of the fingers

  • Swelling in the palm

  • Digits locking in flexed position

These symptoms are usually at their worst in the morning as digits are not in use whilst asleep. However, there are several treatments to ease symptoms and prevent then from worsening. 

The treatment depends on the severity of the Trigger Finger. If the condition is mild treatment may include rest, splints to stretch the digit, exercises or anti-inflammatory drugs (e.g., Ibuprofen).

Surgery may be required for severe cases and is known as a Trigger Finger release procedure. A small cut will be made in the tunnel of tissue surrounding the tendons giving the tendons more space to move. The surgery is an outpatient procedure and recovery can be a few weeks until the thumbs/fingers can be used normally.

DeQuervain's

De Quervain's tenosynovitis (also known as De Quervain's tendinosis or De Quervain's tendinitis) is a common hand condition where the tendon around the thumb becomes inflamed and painful. The tendons link muscles to bones allowing the bones to move. There are two tendons which join the thumb to the wrist. Normally tendons move easily through a tunnel of tissue called the sheath. However, with De Quervain's, the sheath around the thumb tendons will swell up and thicken causing extra friction when moving the affected thumb or wrist. This makes certain movements in the thumb or wrist painful and difficult. 

Symptoms of De Quervain's include:

  • Pain in the wrist or forearm on the thumb side which worsens when using the wrist

  • Swelling

  • Snapping/popping sensation in the wrist

  • Stiffness

  • Numbness

De Quervain's can be caused by overusing the wrist, arthritis, impact to the thumb or wrist, sports, lifting young children and using tools. This is more common in women and people over the age of 40. 

Treatments may include wearing a splint, using ice, rest, anti-inflammatory drugs, corticosteroids, and exercises. In the most severe cases where other treatments do not relieve symptoms surgery may be needed.

The surgery is an outpatient procedure where the surgeon makes a small cut into the sheath around the thumbs tendons to allow more space to move.

Arthritis

Arthritis is a common disease which impacts the joints. Most commonly, it includes inflammation and breakdown of the joints which is known to cause pain when the joint is in use.

Arthritis is common in the hands and feet however it is a broad term used for several joint conditions including osteoarthritis, gout, and rheumatoid arthritis which can all affect the hand.

Arthritis can develop as a result of occupational or sporting activities that put stress on joints. It can also develop due to some autoimmune diseases or infections. The risk of arthritis increases with age and is more common in women than men. 

Symptoms of Arthritis include:

  • Pain

  • Redness

  • Stiffness

  • Swelling

  • Tenderness

Arthritis has no cure however treatments can be used to manage the condition and the treatments used will depend on the severity of the arthritis. For most cases of arthritis non-surgical treatments can be used such as: anti-inflammatory medications, physical therapy, or therapeutic injections to relieve pain and inflammation.

Surgery is only recommended for severe cases of arthritis. The two main options are either fusion or joint replacement. Fusion is when two bones on the affected joint are permanently fused together to reduce pain caused by movement. Joint replacement is where the arthritic joint gets replaced with a new artificial one to preserve movement and joint function.

Cubital Tunnel

Cubital Tunnel Syndrome is also known as Ulnar Nerve Entrapment. It is a frequent condition, which occurs when the ulnar nerve is compressed in the elbow. The ulnar nerve runs from the neck to the hand. It provides control and sensation to the fingers, forearm, and hand. The ulnar nerve travels through a tissue tunnel called the cubital tunnel which is over the medial epicondyle, the bony bump on the elbow, otherwise known as the ‘funny bone’. Cubital Tunnel affects the pinkie and ring finger, caused by swelling in the elbow joint and may be connected to arthritis or past elbow injuries.

Common symptoms of Cubital Tunnel include:

  • Intermittent numbness or tingling in the fingers and hand

  • Weakness in the hand

  • Elbow pain.

 

These symptoms may be worse when the elbow is bent during activities such as driving or sleeping.

There are several treatments for Cubital Tunnel Syndrome. Non-surgical treatments include wearing a splint, exercises, hand therapy and the use of nonsteroidal ant-inflammatory drugs such as ibuprofen. However, if these are not successful, surgery may be suggested. There are three surgical options:

1. Cubital Tunnel release - splitting the ligament that encloses the cubital tunnel to release pressure.

2. Ulnar nerve anterior transposition – moving the ulnar nerve to the front of the elbow.

3. Medial epicondylectomy – removing part of the medial epicondyle to release the nerve.

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