Wrist
De Quervain’s Syndrome Carpal Tunnel Syndrome Guyon Canal Syndrome
Description: This is a condition that causes pain on the inside of the wrist and forearm just above the thumb. It is a common problem affecting the wrist and is usually easy to diagnose. De Quervain's tenosynovitis affects two thumb tendons. These tendons are called the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB). Tendons connect muscle to bone. Muscles pull on tendons for movement. The muscles connected to the APL and EPB tendons are on the back of the forearm. The muscles angle toward the thumb.On their way to the thumb, the APL and EPB tendons travel side by side along the inside edge of the wrist. They pass through a tunnel near the end of the radius bone of the forearm. The tunnel helps hold the tendons in place, like the guide on a fishing pole.This tunnel is lined with a slippery coating called tenosynovium. The tenosynovium is a slippery covering that allows the two tendons to glide easily back and forth as they move the thumb. Inflammation of the tenosynovium and tendon is called tenosynovitis. In de Quervain's tenosynovitis, the inflammation constricts the movement of the tendons within the tunnel.Repeatedly performing hand and thumb motions such as grasping, pinching, squeezing, or wringing may lead to the inflammation of tenosynovitis. This inflammation can lead to swelling, which hampers the smooth gliding action of the tendons within the tunnel. Arthritic diseases that affect the whole body, such as rheumatoid arthritis, can also cause tenosynovitis in the thumb. In other cases, scar tissue from an injury can make it difficult for the tendons to slide easily through the tunnel.
Symptoms: At first, the only sign of trouble may be soreness on the thumb side of the forearm, near the wrist. If the problem isn't treated, pain may spread up the forearm or further down into the wrist and thumb. As the friction increases, the two tendons may actually begin to squeak as they move through the constricted tunnel. This noise is called crepitus. If the condition is especially bad, there may be swelling along the tunnel near the edge of the wrist. Grasping objects with the thumb and hand may become increasingly painful.
Treatment: If at all possible, you must change or stop all activities that cause your symptoms. Take frequent breaks when doing repeated hand and thumb actions. Avoid repetitive hand motions, such as heavy grasping, wringing, or turning and twisting movements of the wrist. Keep the wrist in a neutral alignment. In other words, keep it in a straight line with your arm, without bending it forward or backward. Your doctor may want you to wear a special forearm and thumb splint called a thumb-spica splint. This splint keeps the wrist and lower joints of the thumb from moving. The splint allows the APL and EPB tendons to rest, giving them a chance to begin to heal. Anti-inflammatory medications may also help control the swelling of the tenosynovium and ease symptoms. These medications include common over-the-counter medications such as ibuprofen and aspirin. If these simple measures fail to control your symptoms, your doctor may suggest an injection of cortisone into the irritated tunnel. Cortisone reduces the swelling of the tenosynovium and may temporarily relieve your symptoms. Cortisone injections will usually control the inflammation in the early stages of the problem. Your doctor may have you work with an occupational therapist. The main focus of therapy is to reduce or eliminate the cause of irritation of the thumb tendons. Modalities such as heat or ice, ultrasound, and iontophoresis (anti-inflammatory medication delivered via an electrode) can help alleviate localized pain and inflammation. Finding positions and movements which alleviate symptoms is also an important component of treatment. Stretching and strengthening exercises to improve muscle balance in the hand and wrist can help improve overall mobility and may significantly alleviate symptoms. Your therapist may check your workstation and the way you do your work tasks. Suggestions may be given about the use of healthy body alignment and wrist positions, helpful exercises, and tips on how to prevent future problems.
Description: The carpal tunnel is an opening through the wrist to the hand that is formed by the bones of the wrist on the bottom and the transverse carpal ligament on the top. (Ligaments connect bones together.) This opening forms the carpal tunnel. The median nerve passes through the carpal tunnel into the hand. It gives sensation to the thumb, index finger, long finger, and half of the ring finger. The median nerve also sends a nerve branch to control the thenar muscles of the thumb. The thenar muscles help move the thumb and let you touch the pad of the thumb to the tips each of each finger on the same hand, a motion called opposition. The median nerve and flexor tendons pass through the carpal tunnel. The median nerve rests on top of the tendons, just below the transverse carpal ligament.The flexor tendons are important because they allow movement of the fingers and hand, such as when grasping. The tendons are covered by a material called tenosynovium. The tenosynovium is a slippery covering that allows the tendons to glide next to each other as they are worked. Any condition that makes the area inside the carpal tunnel smaller or increases the size of the tissues within the tunnel can lead to symptoms of carpal tunnel syndrome (CTS). For example, a traumatic wrist injury may cause swelling and extra pressure within the carpal tunnel. The area inside the tunnel can also be reduced after a wrist fracture or dislocation if the bone pushes into the tunnel.Other conditions in the body can produce symptoms of CTS. Pregnancy can cause fluid to be retained, leading to extra pressure in the carpal tunnel. Diabetics may report symptoms of CTS, which may be from a problem in the nerve (called a neuropathy) or from actual pressure on the median nerve. People with low thyroid function, called hypothyroidism, are more prone to problems of CTS.
Symptoms: One of the first symptoms of CTS is gradual numbness in the areas supplied by the median nerve. This is quickly followed by pain where the nerve gives sensation in the hand. The hand may begin to feel like it's "asleep," especially in the early morning hours after a night's rest. Pain may spread up the arm to the shoulder and even to the side of the neck. If the condition progresses, the thenar muscles of the thumb can weaken and atrophy, causing the hand to be clumsy when picking up a glass or cup. If the pressure keeps building in the carpal tunnel, the thenar muscles may begin to shrink (atrophy). Touching the pad of the thumb to the tips of the other fingers becomes difficult, making it hard to grasp items such as a steering wheel, newspaper, or telephone.
Treatment: Conservative Treatment
Activities that are causing your symptoms need to be changed or stopped if at all possible. Avoid repetitive hand motions, heavy grasping, holding onto vibrating tools, and positioning or working with your wrist bent down and out. If you smoke, talk to your doctor about ways to help you quit. Lose weight if you are overweight. Reduce your caffeine intake. A wrist brace will sometimes decrease the symptoms in the early stages of CTS. A brace keeps the wrist in a resting position (not bent back nor bent down too far). When the wrist is in this position, the carpal tunnel is as big as it can be--so the nerve has as much room as possible inside the carpal tunnel. A brace can be especially helpful for easing the numbness and pain felt at night and can keep your hand from curling under as you sleep. The wrist brace can also be worn during the day to calm symptoms and rest the tissues in the carpal tunnel. Anti-inflammatory medications may also help control the swelling and reduce symptoms of CTS. These include common over-the-counter medications such as ibuprofen and aspirin. In some studies, high doses of vitamin B-6 have been shown to help in decreasing CTS symptoms. Some types of exercises have also shown to help prevent or at least control the symptoms of CTS. If these simple measures fail to control your symptoms an injection of cortisone into the carpal tunnel may be suggested. This medication is used to reduce the swelling in the tunnel and may give temporary relief of symptoms. Cortisone can help ease symptoms and also aids your doctor in making a diagnosis. If you don't get even temporary relief from the injection, it could indicate that some other problem is causing your symptoms. When your symptoms do go away after the injection, it's likely they are coming from within the carpal tunnel. Some doctors feel this is a signal that a surgical release of the transverse carpal ligament would have a positive result.
Your doctor may suggest that you work with an occupational therapist. The main focus of treatment is to reduce or eliminate the cause of pressure in the carpal tunnel. Modalities such as heat or ice, ultrasound, and iontophoresis (anti-inflammatory medication delivered via an electrode) can help alleviate localized pain and muscle tightness. Manual (hands-on) therapy interventions are commonly used by therapists, and include stretching, joint mobilizations, and other techniques aimed at improving movement and decreasing pain. Finding positions and movements which alleviate symptoms is also an important component of treatment. Stretching and strengthening exercises to improve muscle balance in the hand and wrist can help improve overall mobility and may significantly alleviate symptoms. Your therapist may check your workstation and the way you do your work tasks. Suggestions may be given about the use of healthy body alignment and wrist positions, helpful exercises, and tips on how to prevent future problems .If all attempts to control your symptoms fail, surgery may be suggested to reduce the pressure on the median nerve. Several different surgical procedures have been designed to relieve pressure on the median nerve. By releasing the pressure on the nerve, the blood supply to the nerve improves, and most people get relief of their symptoms. However, if the nerve pressure has been going on a long time, the nerve may have thickened and scarred to the point that recovery after surgery is much slower. The most common procedure is an open-incision technique, but some surgeons are using a newer procedure called endoscopic carpal tunnel release. Using a smaller incision and a fiber-optic TV camera, the doctor is able to see inside the carpal tunnel and release the transverse carpal ligament.
Description: Guyon's canal syndrome is a common nerve compression affecting the ulnar nerve as it passes through a tunnel in the wrist called Guyon's canal. This problem is similar to carpal tunnel syndrome but involves a completely different nerve. Sometimes both conditions can cause a problem in the same hand. Guyon's canal syndrome has several causes. Overuse of the wrist from heavy gripping, twisting, and repeated wrist and hand motions can cause symptoms. Working with the hand bent down and outward can squeeze the nerve inside Guyon's canal. Constant pressure on the palm of the hand can produce symptoms. This is common in cyclists and weight lifters from the pressure of gripping. It can also happen after running a jackhammer or when using crutches. Pressure or irritation of the ulnar nerve can cause symptoms of Guyon's canal syndrome. A traumatic wrist injury may cause swelling and extra pressure on the ulnar nerve within the canal. Arthritis in the wrist bones and joints may eventually irritate and compress the ulnar nerve. In rare cases, the ulnar artery that travels right beside the nerve may be damaged and form a blood clot. The symptoms caused by the clot mimic Guyon's canal syndrome. The lack of blood supply to the ulnar nerve is believed to cause the symptoms.A fractured hamate bone in the wrist can pinch the nerve inside Guyon's canal. The hamate bone forms one side of Guyon's canal. This bone has a small hook-shaped spur that sticks out to provide an attachment for several wrist ligaments. Known as the hook of hamate, this small bone can break off and press against the ulnar nerve within Guyon's canal. This bone is sometimes fractured when golfers club the ground instead of the golf ball and when baseball players are batting.
Symptoms: Symptoms usually begin with a feeling of pins and needles in the ring and little fingers. This is often noticed in the early morning when first awakening. This may progress to a burning pain in the wrist and hand followed by decreased sensation in the ring and little fingers. The hand may become clumsy when the muscles controlled by the ulnar nerve become weak. Weakness can affect the small muscles in the palm of the hand and the muscle that pulls the thumb into the palm. Gradual weakness in these muscles makes it hard to spread your fingers and pinch with your thumb.
Treatment: Nonsurgical Treatment: Activities that might be causing your symptoms need to be changed or stopped if at all possible. Avoid repetitive hand motions, heavy grasping, resting your palm against hard surfaces, and positioning or working with your wrist bent down and out. A wrist brace will sometimes decrease the symptoms in the early stages of Guyon's canal syndrome. A brace keeps the wrist in a resting position (neither bent back nor bent down too far). It can be especially helpful for easing the numbness and pain felt at night and can keep your hand from curling under as you sleep. The wrist brace can also be worn during the day to calm symptoms and rest the tissues within the canal. Anti-inflammatory medications may also help control the symptoms of Guyon's canal syndrome. These medications include common over-the-counter medications such as ibuprofen and aspirin. You may work with a physical or occupational therapist. The main focus of treatment is to reduce or eliminate the cause of pressure on the ulnar nerve. Your therapist may check your workstation and the way you do your work tasks. Suggestions may be given about the use of healthy body alignment and wrist positions, helpful exercises, and tips on how to prevent future problems.
Surgery: If all attempts to control your symptoms fail, surgery may be suggested to reduce the pressure on the ulnar nerve.