What medical problem does a carpenter, typist, truck driver, jackhammer operator, violinist, pianist and court stenographer have in common? Carpal tunnel syndrome! Over the past 10-15 years, carpal tunnel syndrome has moved to the forefront in medicine and has become water cooler conversation. So what is carpal tunnel syndrome and how is it treated?
Carpal tunnel syndrome (CTS) is a nerve disorder caused by compression of the median nerve at the wrist. The median nerve is one of three main nerves that provide sensation to the hand. This nerve specifically supplies sensation to the thumb, index, middle, and half of the ring finger. In CTS, compression on the median nerve occurs as it travels through a narrow passage in the wrist called the carpal tunnel. The carpal tunnel is formed by eight bones in the wrist (the floor of the tunnel) and the transverse carpal ligament, a strong ligament traveling across the roof of the tunnel. Within the tunnel there are nine tendons, which are a bit smaller than a pencil. These tendons share this space with the median nerve. In the case where there is swelling on the structures in the carpal tunnel, a person can experience pins and needles, numbness, and aching in the hand.
To be properly diagnosed, a physician will discuss your symptoms and medical history, and examine strength and sensation. A nerve conduction study, electromyography (EMG), and x-ray may be ordered to provide information regarding sensation in the median nerve distribution and confirm compression at the carpal tunnel.
Treatment focuses on the causes. Therefore treatment suggestions may include activity modification and postural changes during activities. Other suggestions may include frequent rest periods, elevation, and exercises or stretching. Wrist splints are effective in relieving compression at the carpal tunnel and are typically recommended for night wear. Appropriate fit of the splint is vital. Occupational and physical therapists or certified hand therapists can check the fit of pre-fabricated splints or can fabricate a custom splint. The above mentioned treatments all focus on decreasing inflammation and compression on the median nerve.
Your physician may order pain relievers or anti-inflammatory medication. A cortisone injection into the carpal tunnel may also be recommended to assist with decreasing inflammation near the carpal tunnel.
A referral to an occupational or physical therapist or certified hand therapist may be made. A therapist can provide information regarding the diagnosis, appropriate treatment, and symptom reduction. They can make recommendations to introduce into daily activities to allow appropriate positioning of the upper extremities. A therapist will also instruct individuals on helpful stretching exercises or fabricate a wrist splint. Other treatments include ultrasound, iontophoresis, and massage. The focus of therapy is to introduce changes and interventions that reduce inflammation at the carpal tunnel to assist with symptom relief.
Surgery, referred to as a carpal tunnel release, may be indicated if symptoms are significant and impair functional activity performance.
To reduce your chances of getting CTS:
Guest Contributor: Nancy Naughton, OTD, CHT, is a doctor of occupational therapy and certified hand therapist, specializing in the rehabilitation of the hand and upper extremity at Hand Surgery Associates, Olyphant, PA.
NEXT WEEK! Read Dr. Mackarey’s "Health & Exercise Forum" – every Monday
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM. For of Dr. Paul's article, check out our exercise forum!
Dupuytren’s Disease is a condition of the hand that was initially described in the 1600’s and named after a Swiss surgeon in the 1800’s. This condition reaches beyond quarterback greats and has affected a pope, prime minister, and a U.S. president.
Last week’s column (part one), presented the cause, incidence, progression and prevention of the disease. Part two will focus on treatment options.
Dupuytren’s disease is a benign condition that affects a normal structure in the hand called fascia. It often causes lumps on your palm and cords on the palm or fingers. These cords can begin to thicken and shorten and pull on the skin which causes a puckering or dimpling and eventually begin to cause the finger to bend into the palm. Typically, the lumps are not painful, although sometimes, in the early stages they can be tender. This can be concerning because of appearance and loss of hand function. The fingers most affected are the ring and little finger, but all fingers including the thumb can be affected.
Several available treatment options exist. Following an assessment of your hand, you, along with your surgeon, will determine which option is best for you. The goal with all treatment options is to reduce the deformity of the finger and improve hand function. The treatment options include the following:
Hand therapy following each of the procedures is beneficial. You may receive a referral for hand therapy a few days following any of the above procedures. You will begin range of motion of the fingers. Early motion is important to regain hand function and decrease the tendency for your fingers to return to a contracted position. Your surgeon may also suggest for a custom orthosis (splint) to assist in keeping your fingers straight which you will only wear at night for sleep. You can also use your hand for light activities. Your stitches will be removed in approximately 2 weeks.
Hand therapy will initially focus on managing swelling that may occur following any of the procedures. Wound care and bandage changes will be performed if you have had surgery. Scar management and exercises will include those that focus on restoring motion for straightening the fingers, however closing or flexing the fingers is also important to maximize hand function. You will also be shown exercises to perform at home to optimize your recovery. As you continue to progress your therapy routine will be upgraded to include hand strengthening and functional tasks to allow you to return to your daily activities at home and work.
A team approach which includes you, the surgeon and therapist is important to ensure that an optimal recovery and a return to your everyday functional tasks are achieved.
GUEST AUTHOR: Nancy Naughton, OTD, CHT, is a doctor of occupational therapy and certified hand therapist, specializing in the rehabilitation of the hand and upper extremity at Hand Surgery Associates, Olyphant, PA.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
For all of Dr. Mackarey's articles visit: https://mackareyphysicaltherapy.com/forum/
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.
John Elway has an impressive resume, hall of fame quarterback, president of football operations for the Denver Broncos and more recently for something less glamorous, but still intriguing. He has a hand condition called Dupuytren’s contracture or Dupuytren’s disease. His recent appearance in a television commercial has brought to light this condition of the hand that was initially described in the 1600’s and named after a Swiss surgeon in the 1800’s. This condition reaches beyond quarterback greats and has affected a pope, prime minister, and a U.S. president.
Dupuytren’s disease is a benign condition that affects a normal structure in the hand called fascia. It often causes lumps on your palm and cords on the palm or fingers. These cords can begin to thicken and shorten and pull on the skin which causes a puckering or dimpling and eventually begin to cause the finger to bend into the palm. Typically, the lumps are not painful, although sometimes in the early stages they can be tender. This can be concerning because of appearance and loss of hand function. The fingers most affected are the ring and little finger, but all fingers including the thumb can be affected.
There is a genetic component to the disease and largely affects people of Northern European descent and is more common in men although does affect women. Dupuytren’s contracture can begin in your 40’s, but is more common in your 50’s and 60’s. According to the American Society for Surgery of the Hand, there is no known connection between Dupuytren’s disease and a specific occupation. The progression of the disease is difficult to predict and varies between each person. Some individuals remain with nodules and thickened cords in the hand while others progress to severely bent fingers. The condition may progress in months but generally takes years.
As the condition progresses, the fingers begin to bend in toward the palm and there is an inability to straighten the fingers. Dupuytren’s cannot spread to other fingers, but often there is more than on finger involved. As the deformity progressive it may affect your hand function. The activities that become most difficult are often; shaking hands, putting your hand in your pocket, putting on gloves, pushing up from a table, washing your face and clapping, as some examples.
There is no “cure” for Dupuytren’s and no specific treatment that will prevent someone from getting Dupuytren’s, however it is very treatable, and the intervention generally depends on whether the position of the fingers is affecting your daily activities.
Therapy is a conservative and safe option, however since the thickened cords in your hand are not elastic the likelihood of straightening the fingers is low. However, instruction for some basic exercises and education on how to monitor your symptoms may be temporarily helpful for some people. Hand therapy will be a more appropriate and helpful following surgery or another procedure. It is never too early to be evaluated by a hand surgeon and seeing a hand surgeon does not mean you need to have surgery. One sign suggested by the American Society for Surgery of the Hand is once you are not able to place your hand flat on a table surface may be a good time to be evaluated.
A team approach which includes you, the surgeon and therapist is important to ensure that an optimal recovery and a return to your everyday functional tasks are achieved.
GUEST AUTHOR: Nancy Naughton, OTD, CHT, is a doctor of occupational therapy and certified hand therapist, specializing in the rehabilitation of the hand and upper extremity at Hand Surgery Associates, Olyphant, PA
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” Next week read Dupuytren’s Part 2 of 2.
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Read all of Dr. Mackarey's articles at: https://mackareyphysicaltherapy.com/forum/
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.
