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Carpal tunnel syndrome is compression of the median nerve at the level of the wrist. It commonly occurs when tissue around the wrist swell and cause compression of the nerve at the level of the wrist. Symptoms progress over months to years and it’s the most commonly diagnosed neuropathy in the upper extremity. So about 3 to 6 percent of people are diagnosed with carpal tunnel throughout their lifetime. Slightly more common in women and the median age is about 55 when you’re diagnosed with carpal tunnel. Symptoms of a carpal tunnel include numbness and tingling of the thumb, index long and part of the ring finger. Patients also get pain in their wrists that sometimes radiates up their forearm. Patients also usually complain of nighttime symptoms that wake them up several times through the night. Extremes of wrist motion cause an increase in symptoms with activities such as driving. These symptoms usually progress over months to years. With end stage disease process, patients can actually get weakness in the thumb with advanced disease.

Carpal tunnel is a clinical diagnosis that we diagnose through a patients history and physical exam. We do often order electrical diagnostic studies that do help, help us diagnose carpal tunnel. The most important this is they also help grade the severity of carpal tunnel syndrome.

Patients are at a higher risk to develop carpal tunnel with certain co morbidities which include diabetes, hypothyroidism, auto immune disease, advanced age and obesity. There’s also a genetic predisposition in certain families for carpal tunnel syndrome, also during pregnancy patients are also a higher risk of developing carpal tunnel syndrome.

The treatment of carpal tunnel syndrome is a combination of non operative and operative measures. A lot of it depends on the patients severity of carpal tunnel and what they’ve tried before they see us. Mild carpal tunnel or early on carpal tunnel, we often treat conservatively. That includes modalities such as physical therapy, splinting and anti inflammatories and activity modification. When you get more advanced disease process or disease process that’s not responsive to conservative measures usually we try either steroid injections or surgery.

Some people with mild carpal tunnel, can be managed for the rest of their life with conservative stuff like, splinting, anti inflammatories, activity modification and hand therapy. There is a large proportion that it does progress on to, need an surgical intervention.

Arthritis in the hand and wrist often feels like a dull, deep, aching kind of pain. But when certain activities, certain kinds of aggravating activities, such as opening a jar or really powerful grip type of activities, it can actually feel like more of a sharp, stabbing type pain.

Arthritis in the hand and wrist is caused like arthritis pretty much throughout the body by breakdown of the cartilage on the joint surfaces. As that wears away, you get bones rubbing against each other that aren't as smooth as cartilage, so that's what causes the pain. It's a little bit different in the wrist compared to the rest of the hand because the wrist actually can come from a previous injury. A fractured bone or a ligament tear can actually lead to a certain pattern of arthritis.

There aren't really any specific aggravating activities or jobs. There are injuries, like I said, in wrist arthritis that can start the ball rolling toward arthritis. A small bone can get fractured in the wrist. If it doesn't go on to heal, it can lead to early arthritis. A certain ligament in the wrist that's pretty commonly torn, people think it's just a wrist sprain that changes how the wrist moves, it changes the biomechanics of the wrist. That can create some wear on the cartilage surfaces that leads to arthritis.

Nonsurgical treatment may not work for some patients just because of how severe their arthritis is. Once that cartilage is gone, you can't really regrow it. Once the bones are rubbing against each other, it really is a pain generator. Some people are able to benefit quite a bit from nonsurgical steroid injections or bracing different kinds of treatments, but some people, those treatments don't prove effective, and surgery is really the best option.

Steroid injections are like a high dose anti-inflammatory directly to a certain area of the body. Like anti-inflammatories that you take orally, ibuprofen or naproxen, they deliver an anti-inflammatory effect. Those things you take orally go throughout your whole body and affect your kidney, your stomach, everywhere. Whereas corticosteroid or steroid injections are like a high dose, targeted therapy just to one joint of the body. When you give an injection in the knee for knee arthritis, you're getting a targeted therapy just there. Similarly, in the hand, if you give an injection for base of thumb arthritis, you give a small dose of steroid directly where you need it.

Determining the best surgical treatment for a patient with wrist arthritis can depend on what they want to do with their wrist. Some heavy duty laborer type patients need the stability and strength in their wrist, and they don't mind losing some motion. In that situation, we would probably lean more toward what we call a fusion procedure where we make the bones stable and actually act as one long bone. Whereas if someone isn't as heavy lifting type daily activities, they can save their motion and do alternative procedures where we take out the arthritic bone, but we don't fuse the two bones together.

A ring avulsion injury is when any kind of ring that's on your hand gets stuck on a fast moving object, such as machinery or falling from a ladder, and your ring gets stuck on something and is forcefully pulled off your finger. It can be a devastating injury because it involves stripping away often all of the soft tissue around the bone of your finger.

Ring avulsion injuries are very difficult injuries to treat. Often they involve an injury to the blood vessels, tendons, and even the bones of a finger, so pretty much every level of the finger's anatomy is injured. Often times an attempt is made to reconnect all of those different structures. The tendons are repaired, the blood vessels are repaired, the skin is repaired, and the bones are fixed, if possible. Unfortunately, often times, these injuries have to result in a surgical amputation even further back from where the injury started, so that the skin can be closed and you have a functioning hand.

Because ring avulsion injuries are so devastating the most important thing to take away from any kind of education about them is to try and prevent them from happening in the first place. That means taking off your ring whenever working with fast moving equipment or if you have a job that involves working with machinery, always take off your wedding band before starting work. If your wedding band gets caught on anything fast moving, it can result in a ring avulsion injury and lead to permanent damage. It's very quick and easy to prevent it from happening. Take off the ring.

The people that are higher risk for ring avulsion injuries, as you might expect, are the people that work with fast-moving parts and machinery. People at industrial, manufacturing-type jobs that have high powered, high-speed moving parts that a ring could get caught on. Anybody that is working at a height on a ladder or a roof that could potentially fall and get their ring caught on something is potentially at risk for a ring avulsion injury, but the highest risks are those that work with machines.